ABSTRACT
Objective:To evaluate the clinical effect of high-intensity focused ultrasound(HIFU)and drug con-servative treatment on the treatment of type Ⅰ and type Ⅱ cesarean scar pregnancy(CSP).Methods:A retrospec-tive analysis was performed on 191 patients diagnosed with type Ⅰ and type Ⅱ CSP by ultrasonography and trea-ted in Mianyang Central Hospital from January 2018 to December 2021,and they were divided into drug group(n=67)and HIFU group(n=124)according to different treatment methods before curettage surgery.After receiv-ing conservative drug treatment or HIFU treatment,preformnegative pressure suction curettage under ultrasound monitoring to evaluate the effectiveness and safety of the two pretreatment methods.Results:There were no sig-nificant differences in age,number of cesarean sections,gestational age,the maximum diameter of the gestational sac,number of incision pregnancies,the β-hCG level before pretreatment,the heart tube pulse in the gestational sac,size of fetal bud,and fertility requirements between the medication group and HIFU group(P＞0.05).The proportion of type Ⅱ incision in HIFU group was higher than that in drug group(P＜Q.05).There were no signifi-cant differences between the two groups in intraoperative bleeding,treatment outcome effective rate after pretreat-ment,postoperative vaginal bleeding duration,postoperative uterine cavity residual,rate of reoperation and rate of repregnancy(P＞0.05).There were statistical differences between the two groups in the operation time of curet-tage surgery,whether the operation method was changed after pre-treatment,total hospital stay,β-hCG recovery time and hospitalization cost(P＜0.05).Following up to November 2022,there were 12 cases re-pregnancies in the drug group and 16 cases re-pregnancies in the HIFU group.Conclusions:For type Ⅰ and type Ⅱ CSP,HIFU pretreatment before negative pressure suction curettage under ultrasound monitoring is a safe and effective treat-ment,which improves the treatment effect and reduces the hospitalization time of patients.It may be an effective clinical therapy for type Ⅰ and type Ⅱ CSP treatment.
ABSTRACT
Transformation and quality improvement of clinical pharmacy is key to assuring quality of care for public hospital reform.The clinical pharmacist working model has been established after years of exploration in China,which plays a positive role in promoting such quality and optimizing the allocation of medical resources.However,with the advance of the health care reform,the original working model and methods of clinical pharmacists need to be further improved to meet emerging demands.This paper puts forward a new model of clinical pharmacist development based on the concept of hospital total quality management,which involves the clinical pharmacists′ duty,the work model from the “Pay a visit to bedside”to “Stay by bedside”in clinic,professional development training and performance evaluation.The reform provides a feasible way for the transformation and development of clinical pharmacists in public hospitals.
ABSTRACT
Objective To investigate the diagnosis and treatment value of laparoscopic surgery in tubal obstruction infertility patients with endometriosis.Methods Retrospective analysis was done in 381 cases underwent laparoscopic treatment for tubal obstruction from May 2005 to May 2010,,of which 119 cases were combined with endometriosis.The treatment results were analyzed,including the decomposition of the umbrella side tubal obstruction adhesions,lesions of endometriosis electrocoagulation,endometriosis cystectomy and pregnancy and so on.Results Hysterosalpingography(HSG)showed tubal occlusion in both side or one side in the distal end in 381 cases,and these patients were treated with laparoscopic surgery.There were 262 cases showed distal tubal occlusion not companied with endometriosis,of which 82 cases clinically pregnanced,accounting for 31.3％.Surgical treatment of endometriosis found in 119 cases,accounting for 31.2％ ; and 29 cases pregnaced,which accounted 24.4％.We found 42 cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,16 cases of clinical pregnancy,accounting for 38.1％ ;Twenty-six cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,7 cases of clinical pregnancy,accounting for 26.9％ ;Twenty-eitht cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅰ-Ⅱ,4 cases of clinical pregnancy,accounting for 14.3％ ;Twenty-three cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅲ-Ⅳ,2 cases of clinical pregnancy,accounting for 8.7％.The clinical pregnancy rate in the first group was significantly higher than the other groups,chnical pregnancy rate of the last group was the lowest.Conclusion Laparoscopic surgery is an effective treatment of tubal obstruction infertility combined with endometriosis.After laparoscopic surgery,the clinical pregnancy rate is significantly higher in Tubal obstruction without endometriosis than patients with endometriosis.After surgery,the clinical pregnancy rate in patients with the light stage tubal adhesions and endometriosis is better than those severely.