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Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
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Objective:To document any effect of clinical rehabilitation pathway management on intubation time, dysfunction and medical expenditure associated with tracheotomy after a stroke.Methods:A total of 154 stroke survivors undergoing tracheotomy were randomly divided into an observation group and a control group, each of 77. Both groups were given routine rehabilitation, while the observation group was additionally provided with clinical rehabilitation pathway management during the rehabilitation intervention. Kaplan-Meier analysis was performed before the experiment and after 2, 4 and 6 weeks of treatment. Clinical pulmonary infection scores (CPISs), scores on the Chelsea Physical Function Assessment Scale (CPAx) and hospitalization cost were compared between the two groups.Results:The median extubation time of the observation group (2d) was significantly shorter than that of the control group (10d). After 2, 4 and 6 weeks of treatment, the average CPIS scores of the observation group were in each case significantly lower than those before treatment and the control group′s averages at the same time points, even though after 4 and 6 weeks of treatment the control group′s average CPIS scores had improved significantly. After 2, 4 and 6 weeks of treatment, the average CPAx scores of the observation group were significantly higher than those before treatment and better than the control group′s averages, even though the control group too had improved significantly compared with before the treatment. Hospitalization days, total hospitalization cost, antibiotic cost and laboratory examination cost of the observation group were, on average, significantly lower than those of the control group.Conclusion:Rehabilitation path management can shorten the period of intubation, prevent pulmonary infections, relieve dysfunction, and reduce medical expenses for stroke survivors after a tracheotomy. It is worthy of clinical promotion.
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Objective:Combined with the development and application of the hospital's current scientific research fund management information system, this paper explores how to further improve the informatization of scientific research fund management.Methods:Through the analysis of the service condition of four information systems, this paper identifies and illustrates problems existed in the process of informatization of scientific research funds.Results:There are some problems in the information system of scientific research funds, such as the failure to realize the " full life cycle" informatization of scientific research funds management, the uneven quality of information system, and lack of top-level design of management team. Route-cause analysis is conducted.Conclusions:It is suggested that the top-level design of information management at the national level, the reform of internal control system in hospitals, the cultivation of inter-disciplinary talent, and the increase of publicity should be taken to improve the informatization management of scientific research funds and improve the efficiency of funds utilization.
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Objective:By demonstrating the performance, experience and practical value of the original " science and technology evaluation" of Fuwai Hospital, it is expected to build the brand of " Fuwai innovative service for science and technology evaluation" and provide a wider social service.Methods:The four-in-one " science and technology evaluation and service system" , which is composed of " standardized local data-base" , " Fuwai Spider Net Map and Spider Track Map evaluation method" , " hierarchy three-level index system" , and " intellectual science and technology evaluation and service system" , is established for efficient evaluation of science and technology.Results:The " science and technology evaluation and service system" has run with benefit in Fuwai Hospital for years.With the multi-factor evaluating feature, it solves the drawbacks of traditional evaluating system, thus improving accuracy of evaluation and helping implementation of national policies.If the system is extended to other hospitals, it would advocate the feature and strength of Fuwai science and technology evaluation system as well as provide pluralistic reference and advice for decision-making departments.Conclusions:Science and technology evaluation is such a systemic work, with all issues of different levels along the whole evaluating process to be considered.Drawbacks exist in the traditional method which depends on a single final score.By the practice of Fuwai Hospital, the innovative " four in one" evaluation system has been validated to be more scientific.
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Objective:To investigate the related factors of length of stay in type 2 diabetes mellitus (T2DM) with urinary tract infection, and provide reference for clinical nursing.Methods:A retrospective analysis was used to collect patients ′ general demographic data, disease history, HbA1c, and other laboratory indicators, and etc. A total of 228 hospitalized patients with confirmed T2DM with urinary tract infection in Shanxi People ′s Hospital from January 2019 to September 2020 were selected as the study subjects. The patients were divided into observation group ( n=79) and control group ( n = 149) according to their length of stay. The electronic medical history and related laboratory examination indexes of the two groups during hospitalization in the Department of Endocrinology were analyzed retrospectively. The general demographic data, disease history, glycosylated hemoglobin and other laboratory indexes of the two groups were statistically analyzed. Results:The results of single factor analysis on the influence of length of stay showed that there were statistically significant differences in age, gender, medicare payment method, Charlson Complication Index (CCI), treatment, glycosylated hemoglobin, procalcitonin (PCT) ( χ2 values were from 5.107 to 20.134, t value was 3.946, Z value was -2.914, P<0.05). Logistic regression analysis showed that female ( OR=0.405, 95% CI 0.172-0.951), age≥70 years old( OR=0.528, 95% CI 0.263-0.922), insulin treatment ( OR=0.479, 95% CI 0.269-0.854), CCI≥3 points ( OR=2.555, 95% CI 1.346-4.851), payment method of new rural cooperative medical insurance ( OR=0.273, 95% CI 0.120-0.620), resident medical insurance ( OR=0.184, 95% CI 0.083-0.405), others ( OR=0.367, 95% CI 0.157-0.862), PCT( OR= 0.252, 95% CI 0.290-0.877), and HbA1c ( OR= 0.81, 95% CI 0.705-0.930) were the influencing factors for the length of stay in patients of T2DM with urinary tract infection. Conclusion:Patients have a longer hospital stay in women, age ≥70 years old, and insulin treatment, CCI≥3 points, HbA1c and PCT. Compared with the employee medical insurance, patients have a shorter hospital stay with new rural cooperative medical insurance, resident medical insurance and other payment methods. Therefore, clinical testing ability should be further improved to effectively reduce the pain and economic burden of patients.
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Objective:To establish a method for simultaneously determinating the content of 10 constituents including chlorogenic acid, puerarin, forsythoside A, liquiritin, matrine, saikosaponin A, saikosaponin D, forsythin, ammonium glycyrrhizate, indirubin in Xiao’er-Jinqiao granules by UPLC. Methods:ACQUITY UPLCTMC18 chromatographic column (100 mm × 2.1 mm, 1.7 μm) was used. The mobile phase was acetonitrile-0.05% phosphoric acid solution with gradient elution at the flow rate of 0.2 ml/min. The detection wavelength was 250 nm. The column temperature was 30 ℃. The injection volume was 2 μl.Results:The linear ranges of chlorogenic acid, puerarin, forsythoside A, liquiritin, matrine, saikosaponin A, saikosaponin D, forsythin, ammonium glycyrrhizate, indirubin were 0.789 5-15.793 4 μg ( r=0.999 6), 0.571 8-11.445 6 μg ( r=0.999 4), 0.110 7-2.214 7 μg ( r=0.999 3), 0.047 5-0.950 5 μg ( r=0.999 2), 0.269 8-5.395 8 μg ( r=0.999 7), 0.085 1-1.703 9 μg ( r= 0.999 5), 0.105 7-2.113 0 μg ( r=0.999 4), 0.065 6-1.312 1 μg ( r=0.999 3), 0.080 5-1.611 2 μg ( r=0.999 5), 0.057 7-1.153 3 μg ( r=0.999 4). The limits of quantitation were 8.322, 9.023, 9.857, 4.583, 6.872, 7.844, 8.643, 5.895, 7.568, 5.251 μg/ml. The average recovery rates were 99.11%, 98.87%, 97.83%, 98.10%, 98.17%, 98.30%, 98.10%, 98.14%, 97.99% and 98.02%, and RSDs were all below 2.0%, respectively. RSDs of precision, reproducibility and stability tests were lower than 2.0%. Conclusions:The established method of multi-component content determination is fast, accurate and reproducible. It can be used for the quality control of Xiao’er-Jinqiao granules.
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OBJECTIVE：To provide reference for the c onstruction of subject diagnosis and treatment scheme in drug clinical trials. METHODS ：The subject diagnosis and treatment module was developed and implemented in our hospital on the basis of CTMS，and its effects were evaluated. RESULTS ：A subject diagnosis and treatment module was established in CTMS of our hospital. Within one year from the launch of the module in the middle of October ，2019，the overall number of subjects in the group showed an increasing trend ，and the overall mean dropout rate of subjects was 0.16％. The data interface of CTMS system ， hospital information system （HIS），laboratory information management system ，medical imaging information system had been established，so as to realize the synchronization of subject information （displaying subject identification in HIS system ）and the interaction of diagnosis and treatment information and billing data （patients and subjects were charged separately ）. Since the launch of the module ，the amount of data generated by the interface had been increasing ，and the number of departments producing the subject diagnosis and treatment business had been increasing month by month. Compared with subject diagnosis and treatment project based on HIS system ，the number of subject diagnosis and treatment business based on CTMS system was increased significantly（P＜0.05）. CONCLUSIONS ：The subject diagnosis and treatment module based on CTMS improves the efficiency of subject diagnosis and treatment project implementation and financial settlement ，and realizes the efficient implementation of drug clinical trial projects in large general hospitals.
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Objective:Combined with the hospital's optimization of expenditure management measures, this paper discusses how to enable scientific research personnel with appropriate discretion right to use scientific research funds and further improve the efficiency of the use of scientific research funds under the background of the reform of Release, manage and service.Methods:Through the implementation of information management system, policy revision, reconstruction of the approval process of expenditure, integration of multi department management resources and other ways, the efficiency of expenditure has been improved.Results:After optimizing the management of expenditure, the management efficiency and the efficiency of scientific research personnel is improved, the burden of scientific research personnel is reduced, and the expected effect of expenditure management is achieved.Conclusions:The optimization of expenditure management can improve the efficiency of expenditure to some extent, but more reform is still needed to promote the development of scientific research.
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Objective@#To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX).@*Methods@#The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX.@*Results@#A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 (P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism(P<0.05).@*Conclusion@#The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.
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Objective@#To evaluate the effect of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on the expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) in condyloma acuminatum (CA) tissues.@*Methods@#A total of 56 patients with CA were enrolled from Department of Dermatology, The First Affiliated Hospital of Zhengzhou University from October 2016 to September 2017, and skin lesions were obtained before and 1 week after the first ALA-PDT treatment. Immunohistochemical SP method was used to determine the expression of VEGF and PCNA in keratinocytes in the CA tissues. Chi-square test and rank sum test were carried out to analyze differences between pre- and post-treatment expression rate and intensity of VEGF and PCNA, and Spearman correlation analysis was conducted to analyze the correlations between the protein expression of VEGF and PCNA.@*Results@#The expression rates of VEGF and PCNA in keratinocytes in the CA tissues were 71.43% (40/56) and 73.21% (41/56) respectively before ALA-PDT, and 44.64% (25/56) and 41.07% (23/46) respectively after ALA-PDT. There were significant differences between pre- and post-treatment expression rate and intensity of VEGF and PCNA (expression rate: χ2 = 8.25, 11.81 respectively, both P < 0.05; expression intensity: H = 11.29, 12.22 respectively, both P < 0.05) . The expression of VEGF was positively correlated with the expression of PCNA in the CA tissues before and after the ALA-PDT treatment (rs = 0.202, 0.273, respectively, both P < 0.05) .@*Conclusion@#The expression of VEGF and PCNA decreased in CA tissues after ALA-PDT treatment, which may be one of the mechanisms underlying the treatment of CA with ALA-PDT.
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Objective:To evaluate the volume status of hemodialysis patients with hypertension by bioelectrical impedance vector analysis, and investigate the effect of high volume status on the prognosis of patients with hypertension.Methods:The study subjects came from the patients with pre-dialysis systolic blood pressure>160 mmHg (mean systolic blood pressure of 6 times of treatment) in the Affiliated BenQ Hospital of Nanjing Medical University. According to the volume status assessed by bioelectrical impedance vector analysis, patients were divided into two groups: fluid overload group and non-overload group (including normal fluid status and fluid decline). The clinical data, laboratory test results, ratio of intracellular and extracellular water (ICW and ECW), body cell mass, lean body mass and the percentage of total body weight, fat percentage of body weight, resistance/height, reactance/height, phase angle and illmarker were compared between two groups. Kaplan-Meier survival curve was used to compare the difference of survival rate between the two groups.Results:A total of 51 hemodialysis patients with hypertension were enrolled in this study, including 19 patients in fluid overload group and 32 patients in non-overload group (27 patients with normal volume status and 5 patients with decreased volume). The levels of albumin, prealbumin, hemoglobin, hematocrit and serum phosphorus in patients with fluid overload decreased significantly compared with non-overload patients (all P<0.05), and the proportion of lymphocytes increased in fluid-overload patients ( P<0.05). The ratio of extracellular water and illmarker index in fluid overload group were significantly higher than those in the other group (both P<0.01). However, phase angle, resistance/height, reactance/height were lower than those in patients with non-overload (all P<0.01). After 20 months of clinical observation, the control rate of blood pressure (pre-dialysis systolic blood pressure<160 mmHg) in fluid overload group was lower than that in the non-overload group (26.3% vs 43.8%), but not statistically significant ( P=0.218). The all-cause mortality rate of patients in the fluid overload group was higher than non-overload group (26.3% vs 15.6%). Kaplan-Meier survival curve analysis suggested that the difference in survival rate between the two groups was not statistically significant. Conclusions:The extracellular fluid of hemodialysis patients with hypertension and fluid overload increases significantly, and the nutritional status evaluation index decreases compared with that of patients without increased volume. Increased proportion of lymphocytes may be related to the micro-inflammatory status. Blood pressure is more difficult to control in hypertensive patients with fluid overload and the clinical prognosis can be worse in patients without increased volume.
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Objective To evaluate the effect of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on the expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) in condyloma acuminatum (CA) tissues.Methods A total of 56 patients with CA were enrolled from Department of Dermatology,The First Affiliated Hospital of Zhengzhou University from October 2016 to September 2017,and skin lesions were obtained before and 1 week after the first ALA-PDT treatment.Immunohistochemical SP method was used to determine the expression of VEGF and PCNA in keratinocytes in the CA tissues.Chi-square test and rank sum test were carried out to analyze differences between pre-and post-treatment expression rate and intensity of VEGF and PCNA,and Spearman correlation analysis was conducted to analyze the correlations between the protein expression of VEGF and PCNA.Results The expression rates of VEGF and PCNA in keratinocytes in the CA tissues were 71.43％ (40/56) and 73.21％ (41/56) respectively before ALA-PDT,and 44.64％ (25/56) and 41.07％ (23/46)respectively after ALA-PDT.There were significant differences between pre-and post-treatment expression rate and intensity of VEGF and PCNA (expression rate:x2 =8.25,11.81 respectively,both P ＜ 0.05;expression intensity:H =11.29,12.22 respectively,both P ＜ 0.05).The expression of VEGF was positively correlated with the expression of PCNA in the CA tissues before and after the ALA-PDT treatment (rs =0.202,0.273,respectively,both P ＜ 0.05).Conclusion The expression of VEGF and PCNA decreased in CA tissues after ALA-PDT treatment,which may be one of the mechanisms underlying the treatment of CA with ALA-PDT.
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Objective:To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX).Methods:The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX.Results:A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 ( P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism( P<0.05). Conclusion:The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.
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Objective By using the approach of "hierarchy three-level index system",this study aims at achieving precise scientific research performance evaluation,improving the proportion of high-tech products,and complementing the accumulative effect of conventional evaluation system.Methods This study transforms the conventional "plat three-level index system" into ‘hierarchy three-level index system',which consists of three levels of indexes,namely the national level,provincial level and local level.Candidates are categorized into three echelons according to the criteria for inclusion.Candidates of each echelon are evaluated and ranked by three-level indexes.Fuwai hospital's scientific advanced departments and individuals were evaluated by these two methods mentioned above,and the results were compared.Results These two index system are basically the same regarding to the overall evaluation pattern.Hierarchy three-level index system better displays the‘ quality strategy',allowing units with greater proportion of high-tech products to stand out as well as reducing the accumulative effect of massive production of medium-and-low-end products.Conclusions "Hierarchy three-level index system" is the remedy for the deficiencies of the conventional "plat three-level index system",it improves the reliability and validity of technology evaluation.Therefore,the system will contribute to the selection of scientific brains and the establishment of technology innovation system.
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Objective:To explore whether CD5 + CD19 + B cells has the function of secreteing interleukin-10 (IL-10) in vitro, and to further investigate its possible effects and mechanisms on CD8 + cells in the process of hepatitis B virus (HBV) infection. Methods:From July 2017 to June 2018, at Wuxi Second People′s Hospital Affiliated to Nanjing Medical University, 23 patients with chronic hepatitis B (chronic hepatitis B group), 18 patients with liver cirrhosis (liver cirrhosis group) and 19 healthy individuals in the same period as healthy controls (healthy control group) were enrolled. Peripheral blood mononuclear cell (PBMC) were isolated and cultured. CD5 + CD19 + B cells were isolated. The cells were analyzed by flow cytometry. The ratio of high CD5 + CD19 + B cells content (>6 % of lymphocytes), the secretion of IL-10 by CD5 + CD19 + B and the ratio of high IL-10 + cells content (>4 % of lymphocytes) of three groups were compared. The effects and possible mechanisms of CD5 + CD19 + B cells on the secreting of interferon-γ (IFN-γ) by CD8 + cells were analyzed. Liver biopsy and immunohistochemistry examination were conducted in 18 patients (13 patients with chronic hepatitis B and 5 patients with liver cirrhosis) and the expression of CD5 + CD19 + B cells in human liver tissues was analyzed. Chi square test and Fisher exact probability test were used for statistical analysis. Results:The ratio of high CD5 + CD19 + B cells content of liver cirrhosis group was higher than that of healthy control group (8/18 vs. 2/19) and the difference was statistically significant (Fisher exact probability test, P=0.029). The precentage of CD5 + CD19 + B cells in healthy control group ( n=10), chronic hepatitis B group ( n=23) and liver cirrhosis group ( n=18) accounted for 81.6%, 82.3% and 70.1%of IL-10 + cells, respectively, and the number of patients with high IL-10 + cells precentage was 2, 7 and 2, respectively. There were no statistically significant differences among three groups (all P>0.05). After stimulated with lipopolysaccharide and cultured for 48 hours, the precentage of CD8 + IFN-γ + cells in lymphocytes of healthy control group ( n=10), chronic hepatitis B group ( n=10) and liver cirrhosis group ( n=10) were compared, and the differences were not statistically significant (all P>0.05). After CD5 + CD19 + B cells were eliminated, the precentage of CD8 + IFN-γ + cells in lymphocytes increased in 5, 4 and 4 patients of healthy control group ( n=10), chronic hepatitis B group ( n=10) and liver cirrhosis group ( n=10). After adding IL-10 receptor blocker, the precentage of CD8 + IFN-γ + cells in lymphocytes in PBMC increased compared with that before the addition of IL-10 receptor blocker (7.23% vs. 6.87%). The results of immunohistochemistry examination of liver biopsy indicated that CD4 + and CD8 + cells were strong expressed in portal area of liver tissue of patients, while CD5 + and CD19 + were less expressed. Conclusions:CD5 + CD19 + B cells do not show obvious quantitative and functional differences in the process of chronic HBV infection, however the ability of CD8 + cells to secrete IFN-γ, which may be achieved by secreting IL-10 rather than by direct contact between cells.
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Objective:To investigate the indication of pre-cut-endoscopic mucosal resection (pre-cut-EMR) on the treatment of colorectal laterally spreading tumors (LSTs).Methods:A retrospective study was performed on data of colorectal LSTs patients, who underwent pre-cut-EMR in Wuxi Second People’s Hospital and Zhongshan Hospital from January 2014 to June 2019. The relationships between the clinical characteristics of the lesions and the success rate and complications of pre-cut-EMR were analyzed.Results:Data of 132 colorectal LSTs cases were included in the study. Morphology of 29 (22.0%) LSTs were homogeneous granular type, 43 (32.6%) LSTs were mixed non-granular type, 58 (43.9%) LSTs were flat elevated type, and 2 (1.5%) LSTs were pseudo-depressed type. The diameter of lesions was 2.3±1.5 cm (ranged from 2.0 cm to 5.0 cm). Among the 132 LSTs, 36 (27.3%) tumors were located in rectum, 15 (11.4%) in sigmoid colon, 10 (7.6%) in descending colon, 17 (12.9%) in splenic flexure of colon, 21 (15.9%) in transverse colon, 24 (18.2%) in hepatic flexure of colon, 6 (4.5%) in ascending colon, and 3 (2.3%) in cecum. The histopathological diagnoses of the 132 LSTs included low grade intraepithelial neoplasia in 58 cases (43.9%), high grade intraepithelial neoplasia in 69 cases (52.3%), intramucosal carcinoma in 2 cases (1.5%), and canceration in 3 cases (2.3%). Pre-cut-EMR was achieved in all 132 patients, and the operation time was 25.3±13.6 min (ranged 20-65 min). The rate of en bloc resection and complete resection were 95.5% (126/132) and 100.0% (132/132), respectively. Two cases (1.5%) had intraoperative perforation, and were both located in the sigmoid colon with the diameter of 4.0 cm and 4.5 cm, respectively. Twelve cases (9.0%) had immediate bleeding during operation, and 2 cases (1.5%) had delayed bleeding after operation. Patients had been followed up for 6-24 months, the wound healed well after operation, and no local recurrence was found.Conclusion:Pre-cut-EMR is an effective and safe therapy for colorectal LSTs with diameter less than 4.0 cm.
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Clinical decision support system (CDSS) and multidisciplinary team (MDT) are important measures to improve the efficiency and quality of healthcare service. This article reviews and analyzes the current status of the development of CDSS and MDT in China and foreign countries and summarizes their features and shortcomings, and with the background of the new era of “medical big data resources” and “big data technology”, this article looks into the future of developing an intelligentized diagnostic and therapeutic mode (a combination of CDSS and MDT) for hepatobiliary tumors suitable for the national conditions of China.
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Objective@#To identify the impeding and promoting factors of role definition in nursing handoff, in order to increase the quality of nursing handoff.@*Methods@#Two nursing managers, 22 head nurses and four nurses were recruited by purpose sampling. Data were collected by using focus group study, and analyzed using content analysis.@*Results@#According to the framework of role transition theory, the factors could be classified as individual factors (37 items, 23.72%), organizational factors (105 items, 67.31%), effectiveness of role definition (11 items, 7.05%), and problems of role definition (3 items, 1.92%).@*Conclusions@#Role definition in nursing handoff helping the coming nurse check the performance of the last shift and transfer the nursing responsibility, contributes to the improvement of nursing quality, but there are still many factors affecting the role definition in nursing handoff.
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Objective@#To explore the advantages and disadvantages of a new management model of eye community based nurse-led clinics.@*Methods@#From March 2016 to March 2018, a community clinic of a tertiary eye hospital, Qingdao Eye Hospital was analyzed. The situation of staff and equipment allocation and adjustment in the Clinic during the two years was also reviewed.@*Results@#A total of 17042 patients were admitted to the community clinic of a tertiary eye hospital in the past two years, among whom 44.9% were over 65 years old. Ocular surface diseases (34.4%, 5862), cataracts (31.6%, 5382), and refractive errors (17.2%, 2928) were the top three causes of patient visits. The waiting time for NLC patients was 1~114 (8.5±8.5) min, and the waiting time for outpatients in the main hospital area was 32.0~61.0 (42.4±7.1) min. The difference was statistically significant (Z=-135.172, P<0.01). The per capita cost of NLC patients was ¥ 4.0~153.2 (64.9±22.0), and the per capita cost of outpatients in the main hospital area was ¥ 110.0~586.9 (291.0±160.0), the difference was statistically significant (Z=-136.531, P<0.01). NLC scored higher than the main hospital area in consultation, timeliness and convenience of the disease(Z=-7.278, -7.462, -12.677, P<0.01), and was lower than the main hospital in the disease-solving project (Z=-3.188, P<0.01).@*Conclusion@#The NLC model is a new management model that can meet the needs of community clinics and also is a new challenge for nursing staff under the health care reform.
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Objective To explore the clinical significance of protection "Choke vessel area" in the application of perforator flap to repair large defect of trunk after tumor resection.Methods A total of 62 patients (38 males and 24 females,aged from 19 to 79 years) from the Department of Plastic Surgery,Second Affiliated Hospital of Suzhou University underwent reconstructive surgery for large area defects of the trunk from March 2012 to January 2016.The perforator flap was designed according to the perforator location detected by Doppler before surgery.The flaps were harvested on the pedicle of perforators and dissected on the deep layer of deep fascia (including part of the myolemma).The areas of flap ranged from 5.0 cm × 10.0 cm to 19.0 cm × 22.0 cm.The donor site was sutured directly or local flap was transferred to repair.Results Flaps survived well in 59 of the 62 cases.The tip of flap was necrotic and healed after dressing change in 1 diabetic patient.The distal part of flap was necrotic on cuticular layer and healed after dressing change in another patient with scrotal defect.One patient had flap necrosis 10 days after operation and was repaired twice.The results were satisfied after following-up from 3 months to 2 years for 17 cases and from 6 months to 2 years for 25 cases.Fibrosarcoma protuberant and squamous cell carcinoma recurred in 1 case each,but the function and appearance were satisfactory after primary repair.Conclusions The procedure of preserving Choke vessel area can improve the blood supply of perforator flap and obtain larger survival area and survival quality.It is worthy of clinical application.