This article discusses the concret implementation of day surgery in Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University during the coronavirus disease 2019 epidemic and under the regular prevention and control, so as to provide a basis for ensuring the safety and effectiveness of clinical work in the special period. According to the requirements of health administration departments and the hospital for the prevention and control of epidemic, combining with the characteristics of concret work, the Ophthalmology Center carried out and accurately implemented a series of prevention and control management measures, and obtained good results in the clinical work on the basis of comprehensive security protection. From February to October, 2020, there were a total of 16 507 cases who underwent the day surgery in the Ophthalmology Center, with no surgical infection or suspected case of coronavirus disease 2019. The safety and quality management of epidemic prevention and control has played an active and effective role in the active development of day surgery in this center. The safe and optimized diagnosis and treatment process has reassured the patients and their families, and the strict implementation of protective measures by medical staff has ensured the safety of surgery and the work being proceed with smooth progress and high efficacy.
As a methodological tool, evidence-based management can assess the technological advantages and economical value of medical consumables scientifically, and select the most cost-effective products into the hospital access directory with guarantees of the development of clinical disciplines. Now this method has been widely used for consumable access management in our hospital. Policies and processes have been established to normalize the assess, allocation, and usage, and the management mode is transformed from experience-based management into evidence-based management. With clinical nominalism being changed, the method of evidence-based management can be used for every link of comsumble management, to reduce the costs and ensure the safety and quality of medical consumables at the same time, so as to promote the rational cost of medical consumables.
ObjectiveTo construct the terminology standard of hospital quality and safety. MethodsThe draft terminology standard was constructed through group discussions, and the final draft terminology standard was formed after one round of Delphi expert consultation and two rounds of expert consensus meetings. ResultsThe recovery rate of the questionnaire was 100%, and the authority coefficient of experts was 0.87. A total of 15 experts were invited to two rounds of expert consensus meetings. The terminology standard for hospital quality and safety (TCHAS 10-1-1-4—2022) was finally released, including 4 first-level categories, 20 second-level categories, and 370 terms in total. ConclusionThe terminology standard of hospital quality and safety developed in this study is scientific and reliable, which can be used as a tool to assist medical institutions in carrying out standardized management.
Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
Objective To explore the generalizability and implementation effectiveness of standardized clinical pathways of food for special medical purpose (FSMP). Methods From November 10, 2023 to November 30, 2023, a pilot study for the standardized clinical pathway of FSMP in medical institutions was conducted at Nanjing Drum Tower Hospital (the Affiliated Hospital of Nanjing University Medical School), Chenzhou First People’s Hospital, and the Second People’s Hospital of Yibin. The hospitalized patients using FSMP in these three hospitals were continuously included to analyze the feasibility and effectiveness of the pathway. Results A total of 99 patients were included. The overall effect evaluation of the pathway showed that the proportion of convenient medical order (96.9%), timely delivery (100.0%), and easy storage (96.9%) were relatively high. The proportion of patients with good compliance was 88.9%, the proportion of patients who achieved treatment goals was 51.5%, and the proportion of patients who suspended the use of FSMP in advance was 19.2%. The incidence of gastrointestinal complications, metabolic complications, and infectious complications in patients were relatively low (<30%), and the median (lower quartile, upper quartile) satisfaction scores for patients, family members, and nurses were all 9.0 (8.0, 10.0) points. There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different prescribing personnel (P>0.05). There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different nutritional support methods (P>0.05). Conclusions The FSMP clinical pathway pilot has performed well in terms of convenience, compliance, satisfaction, with a low incidence of complications. The pathway is effective and safe, and can be widely applied.
ObjectiveTo describe the status of quality of life (QOL) and self-management behavior in patients following mechanical heart valve replacement, and explore the relationship between QOL and self-management behavior. MethodsConvenient sampling was used to recruit 352 patients following mechanical heart valve replacement in a high-level hospital in Chengdu between January 2011 and June 2012. General information questionnaire, MOS SF-36 scales, and self-management behavior questionnaire were used to collect data. T-test was used to analyze the difference between patients and normal people. And correlation analysis was used to see the correlation between QOL and self-management. ResultsFor MOS SF-36 scale results in patients within one year after surgery, physical functioning (PF) score was 73.44±15.11, role-physical (RP) was 49.52±39.17, body pain (BP) was 63.13±17.93, general health (GH) was 58.85±14.88, vitality (VT) was 63.54±18.10, social functioning (SF) was 76.67±17.40, role-emotional (RE) was 64.96±41.37, and mental health (MH) was 72.76±17.40. All these scores of the patients were significantly lower than the norm of Sichuan Province (P<0.05) except the dimension of mental health. For patients one year or more after surgery, PF score was 76.53±14.41, RP 58.44±39.21, BP 68.16±18.26, GH 61.39±13.57, VT 68.47±16.37, SF 79.79±19.34, RE 72.94±37.29, and MH 75.87±14.70, among which PF, RE, BP and GH scores were lower than the norm (P<0.05). The average total score of self-management behavior was 143.21±20.63. QOL and self-management behavior were positively correlated. ConclusionThere is still a gap between patients following mechanical heart valve replacement and normal people in terms of quality of life. Patients' self-management behavior is positively correlated with the quality of life. Good self-management behavior contributes to the improvement of QOL.
ObjectiveTo explore the practical effect of standardized management path for inpatients with chronic and difficult-to-heal wounds.MethodsThe inpatients with chronic and difficult-to-heal wounds in People’s Hospital of Deyang City from July 2015 to June 2019 were collected. According to the random number table, the patients were divided into control group and intervention group. The control group were given routine management and the intervention group were given standardized management. Skin symptoms, Visual Analogue Scale (VAS), wound healing time, length of hospital stay, efficacy, complications, satisfaction and scar hyperplasia were recorded and compared.ResultsA total of 605 patients were included. There were 314 cases in the control group and 291 cases in the intervention group. Before treatment, there was no significant difference in skin symptom score or VAS score between the two groups (P>0.05); after treatment, the skin symptom scores and VAS scores of the two groups decreased (P<0.05), and the scores in the intervention group were lower than those in the control group (P<0.05). The wound healing time [(24.21±1.42) vs. (18.59±1.63) d; t=45.301, P<0.001] and length of hospital stay [(26.97±1.54) vs. (20.03±1.42) d; t=57.492, P<0.001] in the intervention group were shorter than those in the control group. All patients were followed up. The total effective rate (χ2=3.911, P=0.048) and satisfaction (χ2=4.340, P=0.037) of the intervention group were higher than those of the control group. The degree of scar hyperplasia (Z=4.913, P<0.001) and the incidence of complications (P=0.039) of the intervention group were also lower than those of the control group.ConclusionsThe standardized management of hospitalized patients can significantly shorten the chronic and difficult-to-heal wounds healing time, reduce the occurrence of complications, improve the patient’s satisfaction and prognosis. It is worthy of clinical application.
ObjectiveTo evaluate the effect of airway management drugs on the respiratory function and postoperative recovery of patients who had moderate or severe chronic obstructive pulmonary diseases(COPD) undergoing an open chest surgery. MethodThere were a total of 22 patients suffering from both lung cancer, esophageal cancer or gastroesophageal junction carcinoma and moderate to severe COPD(of which there were 16 males and 6 females; accepting traditional operation 5 cases and minimally-invasive operation 17 cases; lung cancer 16 cases, esophageal cancer 4 cases and gastroesophageal junction carcinoma 2 cases as the observation group). To statistic the respiratory function and arterial blood gas analysis before and after treating with airway management drugs. And compare the postoperative pulmonary complications(PPCs) and hospital-stay with 50 patients who have no COPD(of which there were 34 males and 16 females; accepting traditional operation 17 cases and minimally-invasive operation 33 cases; lung cancer 35 cases, esophageal cancer 11 cases and gastroesophageal junction carcinoma 4 cases as the control group). ResultThere was a statistical difference of forced expiratory volume in one second(FEV1), forced vital capacity(FVC) and maximal voluntary ventilation(MVV) after the above treatment by 7 to 10 days and comparing with prior treatment(P<0.05). Partial pressure of oxygen(PaO2) increased with no statistical difference(P>0.05) while PaCO2 decreased with a statistical difference(P<0.05）. Comparing with patients without COPD, the incidences of PPCs and postoperative hospital stay were of no statistical difference(P>0.05). ConclusionPatients with moderate or severe COPD with airway management drugs(antibiotics,glucocorticoids, bronchodilators and phlegm dissolving agent) in perioperative period could improve the respiratory function and operation tolerance effectively, reduce the incidence of PPCs and shorten postoperative hospital stay.
Objective To provide scientific evidence for the establishment of medical specialist system in China by investigating the history, current situation, problems and countermeasures of medical specialties training at home and aboard. Method The principle and theroy of evidence-based medicine were adopted. The information before Dec. 31, 2003 of Pubmed, CBM, official website, some journals, most frequently used search engines and medical monograph were systematically reviewed. Included literatures were assessed and graded according to the pre-defined criterias. Results A total of 1 319 studies (1 298 in English, 21 in Chinese) were included, among which only 6 were related to the classification of medical specialties. Based on the information from official website of USA, Canada, UK, Singapore, Australia and China (including HK and Taiwan), it showed that China has the largest number of medical specialties, followed by that of USA. In China, the number of medical specialties has more than that of the disciplines in clinical field, which was followed by resident training programs. Some specialties were duplicate, or not international standardized. Conclusions The classification of medical specialties should be developed consecutively, which comprehensively considered the international trend, characteristics of doctor training and the current situation. Specialties whose training program are well-established and developed should initiate firstly. Others will be put into practice gradually after being fully exprienced.