三甲医院高层次卫技人才队伍建设发展现状及对策研究

通过对某三甲医院高层次卫技人才的规模、构成、引培和流失进行统计分析,了解医院高层次卫技人才队伍建设现状和流动变化规律,为制定和完善医院高层次卫技人才队伍建设策略提供证据参考。结果显示,该院高层次卫技人才规模、构成均得到有效改善,高层次卫技人才流失情况在可控范围内,但也面临着高层次卫技人才总量相对不足、流失人才中辞职占比较大等问题。未来要继续推动"人才强院"战略,创新人才引培考核机制,完善人才培养体系和计划,建立科学的测评体系以及健全绩效评价机制和薪酬分配制度。     

Management of midgut volvulus with extensive necrosis by “patch,drain, and wait” in early infancy and childhood

Midgut volvulus with extensive intestinal necrosis in the newborn period and in early infancy and childhood presents a difficult therapeutic dilemma of how to control sepsis and preserve a maximum and life-sustaining amount of large and small intestine. This problem is similar to that faced in cases of necrotizing enterocolitis with extensive intestinal ischemia and necrosis. The successful use of the patch, drain, and wait approach in necrotizing enterocolitis suggested its potential usefulness in midgut volvulus with similarly extensive necrosis in early life [7]. The basic principles of this approach involve maximum bowel salvage by avoidance of both resection and enterostomy; extensive bilateral Penrose drainage of the peritoneal cavity to provide an exit for sepsis and debris for peritonitis control; and de facto enterostomies for potential enteric fistula capture, gastrostomy for upper gastrointestinal tract venting and decompression, and Broviac catheter placement for long-term hyperalimentation. Three cases involving the successful use of this approach are reported.     

经皮心包穿刺置管引流大量心包积液21例

目的:探讨经皮心包穿刺置管引流大量心包积液的可行性、安全性.方法:分析1999年3月～2004年3月收治的21例大量心包积液临床资料.结果:21例患者均一次引流成功,病因分析;心包转移瘤(8例)、结核性心包炎(5例)、甲状腺功能减退症(2例)、系统性红斑狼疮(1例)、尿毒症(2例)、不明原因(3例).结论:经皮心包穿刺置管引流大量心包积液的可行、安全.     

The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction

Abstract

In recent years the acellular dermal matrix (ADM) has gained popularity in prosthetic breast reconstruction. These procedures involve placement of a closed suction drain in the reconstructed breast. Although it is now widely accepted that ADM has an overall positive effect on the outcome of breast reconstruction, data regarding its effect on postoperative drain secretions is lacking. This study was designed to quantitatively evaluate the influence of ADM on postoperative drain secretions in the setting of immediate prosthetic breast reconstruction (IPBR). This is a prospective, comparative controlled study. Two groups of 16 patients each underwent skin sparing mastectomies (SSM) and IPBR with or without ADM. Closed suction drains were left in all the reconstructed breasts and daily secretion volumes were recorded and compared. Postoperative complications were also noted. Patients in the ADM group showed higher daily and overall secretion volumes compared with patients in the control group (p = 0.014) and the time for removal of the drains was higher by an average of 5 days (13 compared with 8 days, respectively; p = 0.004). There was no correlation between ADM and infection. This study provides the first objective evidence that ADM contributes to elevated and prolonged drain secretions when used for IPBR. This might affect possible prosthesis-related complications (e.g., rotation and malposition, capsular contraction, seroma formation, and infection). This study also noted erythema of the post-mastectomy skin flaps in selected patients, which may be attributable to a local inflammatory reaction to the ADM rather than infection.     

Intranodal Lymphangiography with Thoracic Duct Embolization for Treatment of Chyle Leak after Thoracic Outlet Decompression Surgery

From 2015 to 2019, 9 patients underwent ultrasound-guided intranodal lymphangiography for the treatment of a chyle leak following thoracic outlet decompression surgery. Chyle leaks were identified by Lipiodol (Guerbet, Roissy, France) extravasation near the left supraclavicular surgical bed in all patients. The technical success rate of thoracic duct embolization was 67% (6 of 9), including fluoroscopic transabdominal antegrade access (n = 4) and ultrasound-guided retrograde access in the left neck (n = 2). Clinical success was achieved in 89% of patients (8 of 9). The mean interval from lymphangiography to drain removal was 6.6 days (range, 4–18 d). No patients had a chyle leak recurrence during clinical follow-up (mean, 304 d).     

To drain or not to drain,that is the question

Spontaneous pneumothorax is an uncommon problem in childhood. However, it is frequent enough that most paediatricians will encounter this at some point in their careers. Traditional management for children and young people with a moderate to large pneumothorax has involved either needle thoracocentesis, chest drain insertion or both. However, recent clinical trials have suggested that a conservative approach may be possible and in some circumstances preferable to immediate intervention. This short article offers a suggested framework for management of spontaneous pneumothorax in children and young people.     

Unexpected Severe Cerebral Edema after Cranioplasty : Case Report and Literature Review

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.