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Objective:To explore the evaluation dimensions and indicators of research hospital, provide empirical evidence for the construction of research hospital.Methods:Non-probability sampling was adopted, physicians from 9 hospitals in Shanghai that have a National Clinical Medical Research Center or Shanghai Clinical Medical Research Center were invited as survey participants. The physician participants were divided into senior and junior groups. For senior group, a questionnaire including 5 dimensions and 21 indicators was provided. The survey participants were consulted to determine whether the indicators can be used to measure this dimension, and also invited to propose additional dimensions and indicators for improvement.For junior group, two open questions were proposed to explore their needs of support in both clinical service and research.Results:Based on suggestions from the research participants, the research team, and other expert consultant, this article tried to propose 5 dimensions and 21 indicators for evaluating research hospitals. Among them, 11 were indicators compiled by the research team based on the literature review and agreed by more than 2/3 of senior physicians surveyed, while others were proposed based on the survey results. The research team planned to use the entropy method to determine the weights of different indicators, thus, the participants were not required to make judgments on the weights of dimensions and indicators.Conclusions:The evaluation of research hospitals has not yet formed a systematic consensus. Through the exploration and establishment of evaluation dimensions and indicators, identify hospitals that are closer to the development goals of research hospitals can provide a basis for future next-step practices.
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Objective To compare the efficacy of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax.Method From January 2013 to December 2015, we retrospectively collected clinical data of 53 patients with spontaneous pneumothorax who were treated with uniportal VATS, as study group; compared with control group: 53 patients received single utility port VATS in the same period. The clinical data was compared between the two groups, including the operation time, intraoperative blood loss, drainage time, postoperative extubation time, postoperative pain score, postoperative hospitalization and recurrence.Results All patients were successfully completed the operation, no death and serious complications occurred. There were no significant differences in intraoperative blood lose, duration of chest drainage, duration of hospital stay and incidence of serious postoperative complications between two groups (P > 0.05). Mean Visual Analogic Scale (VAS) score for 24 h post-operative pain was: (2.60 ± 0.71) for uniportal VATS and (3.38 ± 0.84) for single utility port VATS (P > 0.05), 72 h post-operative pain was: (1.30 ± 0.51) for uniportal VATS and (1.58 ± 0.62) for single utility port VATS (P > 0.05). Follow up 5 ~ 36 months, median follow up was 19 months. No recurrence occurred during follow up.Conclusions The study suggested that both surgical approaches to spontaneous pneumothorax are safe and effective. Significant differences were found for early post-operative pain between the two approaches, the uniportal way is better. It is worthy of clinical promoting.
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Objective To investigate curative effects and prognostic factors of video-assisted thoracoscopic extended thymectomy ( VATET ) for nonthymomatous myasthenia gravis ( NTMG ) . Methods Clinical records of 43 patients with an established diagnosis of NTMG who underwent VATET from December 2009 to September 2014 were reviewed. Three-port thoracoscopic right thymectomy with resection of fat tissue in anterior mediastinum was conducted.The curative effects and prognostic factors were evaluated and analyzed with the Monden standard. Results The VATET was successfully completed in all the 43 patients.The operation time was 75-240 min (mean, 115.4 min).The intraoperative blood loss was 10-200 ml (mean, 42.2 ml). No peri-operative death occurred.Follow-ups for 4 -60 months ( mean, 36.2 months) showed 12 cases of remission, 18 cases of improvement, 10 cases of unchanged disease, and 3 cases of deterioration.The effective rate was 69.8% (30/43).Multivariate logistic regression analysis showed that pathological type of thymic hyperplasia was the independent risk factor for NTMG postoperative outcomes (β=0.921,95%CI:1.866-2.811, P=0.000). Conclusion Video-assisted thoracoscopic extended thymectomy is effective in most myasthenia gravis patients.
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OBJECTIVE To study the clinical application and its advantage of cervical tongue-shaped flap in tracheal stoma after total laryngectomy.METHODS A tongue-shaped flap was retained underneath the U-shape incision in front of the neck.When tracheal stoma was made,the tongue-shaped flap was sutured with the mucous membrane of tracheal posterior wall.A little bit tissue of tracheal anterior wall in the broken end could be cut off and sutured with the skin under the tracheal stoma.RESULTS The diameter of the tracheal stoma was or not less than 3.0 cm?2.5 cm after operation.All the cases were followed up for 1 to 4.5 years after surgery.The tracheal stoma of all the cases grown downwards to 2.0～1.8 cm after a half to one year and then maintained invariably.The tongue-shaped flap and the skin around the tracheal stoma maintained smooth.It was not necessary for the patients to wear the trachea cannulas.CONCLUSION This method has lots of advantages such as less pain,lower medical cost and the increased recovery rate.