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Objective:To explore the application of understanding teaching mode combined with hierarchical training in the standardized training of nurses in gastrointestinal surgery department.Methods:Sixty-three nurses who had standardized training in gastrointestinal surgery department in West China Hospital, Sichuan University from January 2018 to January 2022 were selected as the study objects, among which, 32 nurses from January 2018 to July 2020 were set as the control group, taking regular training method, and 31 nurses from August 2020 to January 2022 were set as the observation group, taking the understanding teaching mode combined with hierarchical training method. The core competence scores of the two groups after training were compared, the scores of basic theory and practical skills of the two groups were compared, and the satisfaction degree of nurses during training was compared between the two groups. SPSS 22.0 was used to perform t-test. Results:After the training, the scores of core competence in the observation group were higher than that in the control group, and the difference was statistically significant ( P < 0.05). The scores of theoretical assessment (96.59±3.22) and practical skills (97.09±2.88) in the observation group were significantly higher than those in the control group (91.52±2.45)(91.14±2.85) ( P < 0.05). The total satisfaction scores of the observation group (93.48 ± 2.52) was higher than that of the control group (86.80 ± 2.22), and the difference was statistically significant ( P < 0.05). Conclusion:It is suggested that understanding teaching mode and joint hierarchical training can improve the core ability and assessment score of nurses in gastrointestinal surgery department, and improve the satisfaction of nurses.
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Objective@#To investigate the clinical application of repairing the large-area skin defect of legs with medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap.@*Methods@#16 cases with a large area of soft tissue defects caused by severe trauma were included in this study. The vascular pedicles of free thoracic umbilical flap were anastomosed with the opposite posterior tibial artery and vein, and the pedicle skin tubes were made and amputated 4 weeks after surgery.Observation of postoperative flap include survival situation, shape, color, elastic, scar contracture, and dysfunction.@*Results@#16 cases of postoperative all flaps survived.In 1 case pain occurred 10 hours after the operation and led to arterial crisis, which was relieved with analgesia.There were no vascular crisis in other 15 eases. Followed up for 2-24 months, all the flaps survived with good color, elasticity and sensory recovery. There was no apparent stiffness in double knee and ankle joint.@*Conclusions@#For the injured limbs impossible to be repaired with local vascular pedicle, routine local transfer of skin flap or cross leg skin flap, the bridge cross anastomosis of free flap graft may be an ideal surgical treatment.
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Objective To investigate the clinical significance of the reconstruction surgery using the toes to repair thumb and fingers defect with the help of the digital technology. Methods Between June, 2012 and May, 2017, 17 partial thumb and finger defects in 12 cases received 3D-CTA assisted finger reconstruction surgeries in us-ing the toe. Preoperative ipsilateral foot 3D-CTA were conducted and the 3D digital models were analyzed. It helped to know the parameters of the move direction and classification of the arteries and veins, etc.It was helpful for design-ing personalized surgical scheme that could match with the length of each finger defect and the defect area and shape in the recipient site of the specific case. Results All 17 toe-to-hand transplants in 12 cases survived. With 6-12 month's followed-up, the appearance of the reconstructed fingers was very closed to the normal fingers. The two-point discrimination was 6-10 mm. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 9 digits, good in 6 digits, fair in 1 digit and poor in l digit. Conclusion The digital technology can help to formulate the operation scheme of personalized and accurate reconstruction of thumb and fingers before the operation.It was helpful to reduce the opera-tion risk and improve the survival rate of fingers reconstruction.It has very good practical and clinical significance.
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Objective To investigate the clinical outcome of the feasible method of the free string type dor salis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm.Methods From May,2011 to January,2017,the anterior combined ankle flap of the ankle were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases survived.Follow-up were done from 2 months to 2 years after operation.Bone healing was achieved in all cases.Two-point discrimination recovered to 6-8mm.Total active range of motion of the fingers reached 75 ％ of the normal side.Both appearance and texture of the flaps were good.Both the appearances of the repaired palms and the functional recovery were satisfactory.The function assessment of the hand was excellent in 8 cases,good in 5 cases,fine in 2 cases and poor in 1 case.The eligible rate was 81.25 ％.Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant,which facilitate the dissection of the flaps during operation.The repairement of skin defects at two sides,both the palm and the back of hand,can be achieved via one operation.Therefore,the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.
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Objective To investigate the actual cost and benefit of stoma nursing at present as a reference for the improvement of stoma care cost management program. Methods A cross sectional study was carried out in gastrointestinal surgery of a tertiary- level hospital in southwestern China from April 2014 to December 2014. The consumption of intestinal stoma care work, the average monthly income/average monthly working hours ratio and other indicators of stoma care nurse specialist were measured by the step cost allocation method, to investigate the actually cost of a single stoma care service which colostomy patients had received and analyze the gap between actually costs and charge standard of Sichuan Province. Results The directly human cost of stoma care expenses were (22.33 ± 3.66) yuan; working fee expenses were (4.18 ± 0.68) yuan;administrative expenses were (1.87 ± 1.32 ) yuan; research and education expenses were (1.87 ± 1.32 ) yuan; the total cost of investment was (29.14 ± 4.76) yuan, which was much higher than the current charge standard of Chengdu Bureau of Commodity Prices (t=119.50, P <0.05). Conclusions There is a difference between the actual cost and charge standard of stoma care. The situation of low pay to labor is not in line with economic laws, and not conducive to the future development of stoma care speciality.
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Objective To observe the clinical efficacy and adverse reactions of docetaxel and carboplatin 21 day regimen (TC)as second -or third -line in treatment of patients with advanced triple -negative breast cancer (ATNBC).Methods 37 ATNBC patients with anthracyclines resistance were given docetaxel 70mg/m2 ,the first day of intravenous drip,carboplatin AUC =5,through intravenous drip on the first day,21 days for a course of treatment, until disease progression or not tolerated or most received six cycles of chemotherapy.Results 147 cycles of chemo-therapy were completed in 37 patients,and the median chemotherapy cycle was 4 cycles.The efficacy and adverse reactions could be evaluated in all patients.Among them,complete remission (CR)in 0 patient,partial remission (PR)in 12 patients (32.43%),stable (SD)in 11 patients (29.73%),and progression (PD)in 14 patients (41.18%).The effective rate(CR +PR)was 32.43%.The disease control rate (CR +PR +SD)was 62.15%,median TTP was 3.9 months (95%CI:4 -8months),and median OS was 10 months.Until the end of follow -up,there were 3 patients with no progress.The main adverse reactions were hematological toxicity (51.53%)and gastrointestinal reaction (56.76%).Conclusion TC regimen is effective and safe in the treatment of patients with ATNBC.
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Objective To study the interactive debridement methods in treatment and nursing of the wound in patients with abdominal surgical incision infection.Methods In May 2010 to December 2013 in West China hospital of Sichuan University,54 patients with postoperative incision infection accompanied with tissue necrosis after gastrointestinal surgery were divided into two groups,23 cases who accepted interactive debridement treatment were set as the observation group,31 cases with traditional dressing hypertonic saline gauze debridement were named as the control group.The wound debridement completion time,wound healing velocity,wound healing time,dressing change frequency and cost were compared between two groups of patients.Results Compared with those of the control group,in the observation group,the wound debridement completion time was shorter,wound healing velocity was faster,dressing change frequency was longer.Although single dressing change cost was higher in the observation group,but the total dressing change cost was lower compared with the control group.Conclusions The interactive debridement methods used in treatment and nursing of patients with abdominal surgical incision infection showed good effect and safety,which is worthy of wide clinical application.
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AIM: To study the optimum technological parameters for extraction of Astragalus polysaccharides by ultra-high pressure extraction. METHODS: Measured concentration of total astragalus polysacharides served as the marker,the design of uniform distribution was applied to evaluating the ultra-high pressure extration efficiency in comparison with reflux and ultrasonic extraction efficiency. RESULTS: The optimal parameters of ultra-high pressure extraction was as follows: 350 MPa pressure,60 mL/g ratio of solvent to solid material,5 h soaking time,2 min extraction time.Under the conditions,the high yield was up to 24.2 %. CONCLUSION: Ultra-high pressure extraction has a series of advantages,such as higher yield,less impurity,easier separation-purification,shorter extraction time and lower energy input.