ObjectiveTo summarize and explore the clinical management and practical effect of ambulatory hysteroscopic surgery.MethodsThe annual operation volume, disease types, three- and four-grade operation proportion, complications, hospitalization expenses, patient satisfaction and average length of hospital stay of patients undergoing ambulatory hysteroscopic surgery in the First Affiliated Hospital of Chongqing Medical University between September 2014 and August 2019 were retrospectively analyzed.ResultsA total of 5 446 patients underwent hysteroscopic surgery during the five-year period, of whom 569 cases underwent the operation in conventional hospitalization mode in the first year and 4 877 cases did in ambulatory mode in the following four years. The quantity of hysteroscopy operations increased by stages (P<0.001) and the structure of disease types was optimized. The proportion of three- and four-grade complex operations increased from 48.15% to 79.15% stage by stage in ambulatory mode (P<0.05); ambulatory hysteroscopic surgery was proved to be safe and controllable with a low incidence of complications [0.43% (21/4 877)]; the average hospitalization cost of the patients was significantly lower than that of the conventional hospitalization mode (P<0.05); the score of patient satisfaction increased from 92.90±1.77 to 94.57±2.11 compared with the conventional hospitalization mode, and increased further with the construction of the specialized platform to 96.19±2.24 (P<0.05); the average length of hospital stay in ambulatory mode was significantly shortened than that in conventional hospitalization mode (P<0.05).ConclusionHysteroscopic surgery in ambulatory mode can improve the efficiency of medical services, ensure patient safety, improve patient satisfaction, reduce the average length of hospital stay, and reduce the economic burden of patients, so it could be widely promoted and standardized in clinical practice.
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
Epilepsy is an important or common clinical manifestation of numerous rare diseases, frequently emerging as an initial or core symptom in children and adolescents. Due to the low prevalence and heterogeneous clinical presentations of rare diseases, as well as generally insufficient awareness and limited research among both patients and healthcare providers, epilepsy-related rare diseases are often subject to diagnostic delays, misdiagnosis, and suboptimal management in routine clinical practice. To address these challenges, the development of a systematic, clear, and clinically applicable classification catalogue for epilepsy-related rare diseases is critical for enhancing disease recognition, standardizing diagnostic and therapeutic methods, developing expert consensus, and optimizing healthcare resources allocation. Focusing on the prominent challenges of epilepsy in rare diseases, this article systematically outlines the background, classification principles, and overall framework for epilepsy-related rare diseases. Furthermore, we further highlight the pivotal role of this classification system in improving clinical management, promoting multidisciplinary collaboration, and guiding health policy formulation. The proposed framework is intended to serve as a foundational reference for the standardized and holistic management of epilepsy-related rare diseases.
A study on clinical management methods and process of off-label drug use (OLDU) is carried out at managerial level in the Guangdong General Hospital to develop management regulations, processes and strategies of OLDU, so as to regulate OLDU behaviour in clinic. The hospital officially initiated the application-recording-approval process of OLDU in February, 2013, receiving 22 OLDU applications from 5 clinical departments in the first batch. The pharmacy management and pharmacotherapeutics committee approved eight applications and rejected one application according to regulation procedures. In this way, the Guangdong General Hospital well regulate the OLDU behaviour of physicians, which is significant to the further studies in OLDU in this hospital.