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Abstract Introduction Fishbone foreign body retention is one of the most common problem with various clinical manifestations from asymptomatic, abscess formation, and perforation to mediastinitis with subsequence morbidity and mortality. Accurately identifying the location of the fishbone leads to precise removal, which, in turn, prevents serious consequences. Digital radiographs have been widely used for diagnosis, but many studies show poor sensitivity. Object The present study was designed to compare the diagnostic performances of digital radiograph and low-dose computed tomography (CT) for fishbone retention and to demonstrate the radiation dose of the two modalities. Methods We collected 2 pieces of fishbone from each of the 15 species commonly eaten in Southeast Asia. We embedded each fishbone in a fresh pig's neck, then subjected the pig's neck to lateral soft tissue neck digital radiograph. The locations to embed included tonsil, base of tongue, and upper esophagus. Then, we subjected the same specimen to a CT scan. Two experienced radiologists interpreted each image. Results Visibility in the digital radiograph group was 13%, and in CT images group, it was 87% regardless of the locations. The average radiation dose from digital radiographs was 0.4 mGy (radiation dose field), while from CT images it was 8.6 mGy (CT dose index). Conclusion Most of the common fishbones in Southeast Asia could not be visualized by digital radiograph when embedded in the neck. Computed tomography scans demonstrated better diagnostic performance of fishbone retention compared to digital radiographs, regardless of the embedded location.
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Introduction : Quality control of the laboratory has gained increased importance in the present years. 70 % of the errors in the clinical laboratory occur in the pre-analytical phase. With various guidelines to gauge the quality of the laboratory, Six Sigma Metrics remains by far the most difficult benchmark that a laboratory can achieve. We aimed to quantify the performance of the quality indicators of the routine clinical Biochemistry laboratory in the pre-analytical phase in the form of sigma metrics and devise measures and identify steps to decrease the percentage of errors by defining the DMAIC approach. Materials and Methods : One year retrospective data was collected from January, 2020 to December, 2020 from the data entry register and pre-analytical variables were quantified. Defects Per Million and sigma metric were calculated for each pre-analytical indicator. DMAIC approach was applied and post intervention sigma scores for the month of Jananuary, 2021, February, 2021 and March, 2021 were calculated. Results : Postinterventional analysis was done on a month-to-month basis to monitor the trend and also to ensure corrective action can be taken without delay. Out of 5 quality indicators which were quantified, the pre versus post sigma scores (March’21) are as follows: missing location of the patient (Sigma 4 versus 3.6), missing registration number (Sigma 3.7 versus 4.3) and both registration number and location missing (Sigma 3.6 versus 4.0), Homolysed sample (4.2 versus 4.6), insufficient sample volume (sigma 3.9 versus 4.7). Encouraging results in the form of improved Sigma scores were seen in four of the quality indicators except for the fact that the patient location were still missing in the forms and hence warrants continuous monitoring.
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Objective:To explore the effect of fishbone diagram combined with PDCA(plan, do, check, action) closed-loop management in the teaching of orthopedic interns in operating room.Methods:The 60 interns received by the Department of Orthopedics in our hospital from January 2019 to August 2020 were randomly divided into the conventional group and the observation group in average. The conventional group used traditional methods, and the observation group introduced fishbone diagram combined with PDCA closed-loop management. The theoretical and practical assessment scores and the evaluation of satisfaction with the teaching were compared between the two groups before and after the teaching in the operating room. SPSS 22.0 was used for t-test and Chi-square test. Results:The scores of each theoretical assessment, the total scores of theoretical assessments, and the scores of practical assessments, in the observation group were higher than those of the conventional group ( P<0.05). The satisfaction rates of interest, effectiveness, rationality, and popularization with teaching in the observation group were 100.00%, 100.00%, 96.67%, and 100.00% respectively, which were higher than those (80.00%, 83.33%, 80.00%, and 83.33% respectively) in the conventional group. Conclusion:The application of fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching can improve the performance of interns in the assessment, and can also achieve better teaching satisfaction.
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Objective ToinvestigatethevalueofMSCTandpost-processingtechniquesforthepresentationoffishboneinesophagus, andtoexploretherelatedfactorsofcomplicationsafterfishboneincarceration.Methods TheclinicaldataandMSCTdataof81cases ofesophagealfishforeignbodiestreatedbyendoscopyorsurgerywereanalyzed,including46 malesand35females;moreoverttest andχ2testwereusedforintergrouptesting.Results (1)Therewerenosignificantdifferencesinthemaleandfemalepatients’age, distributionoffishboneincarceration,theperiodofbetweenmedicaltreatmentandfishbonepuncturingintotheesophagus,thelength ofthepuncturedfishbone,theincarcerationmethod,andtheperforationcomplications(P＞0.05).Thedistancebetweenthefishbone andtheincisorinthemalepatientswasfarlongerthanthatinthefemalepatients,andthedifferencewasstatisticallysignificant(P＝0.011).Therewere54cases(66.7%)inthehorizontalincarcerationand27cases(33.3%)inthelongitudinalincarceration.(2)9patients (11.1%)hadesophagealperforation.Theoccurrenceofesophagealperforationcomplicationwasnotrelatedtotheageofthepatient, thedistancefromthetopofthefishbonetotheincisor,andthelengthofthefishbone(P＞0.05);theincarcerationtimewaspositively correlatedtotheperforationcomplications(r＝0.258,P＝0.02).Horizontalincarcerationoffishbonewasmoreeasilyperforatedthan longitudinalincarceration (P＝0.000).(3)Alltheforeignbodiesoffishbonesshowedbone-likehighdensityonCT.Theforeign bodiesoffishbonesweremostlyembeddedintheupperesophagus.Thedistancebetweenthetopofthefishboneandtheincisorwas about(19.38±4.08)cm.Allcaseshadswellingandthickeningoftheesophagealwall.Conclusion Thefishbonehorizontalincarceration, andlongertimestayintheesophagusaremorelikelyhappentoperforationcomplications.MSCTandpost-processingtechniquesprovidea basisforthequalitativediagnosisoffishbones,displayingthelocation,incarceration,andperforationcomplicationsofthefishbones intheesophagus.
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Objective To analyze the regularity and characteristics of 2621 cases of adverse drug reaction (ADR) occur-ring in our hospital during 2013-2016 ,and to explore the factors and causes of ADRs ,so as to provide evidence for the contin-uous improvement of rational use of drugs .Methods 2621 cases of ADR reports were retrospectively analyzed by monitoring software to extract ADR report source ,patient age and sex ,related pharmaceutical dosage forms ,routes of administration , clinical characterization ,organ involvement and other information .The Pareto method was used to identify the main drugs that caused ADR and ADR factorial analysis was performed with Fishbone diagram .Results ADR mainly reported by physicians (2573 cases ,98 .17％ ) and pharmacists reported at least (3 cases ,0 .11％ );population aged >70 years accounted for the lar-gest proportion (570 cases ,21 .74％ );ADR mainly caused by intravenous infusion (1680 cases ,64 .10％ ) .The clinical mani-festations were gastrointestinal system lesions (717 cases ,24 .17％ ) .Pareto analysis showed that the main drug factors in-volved anti-infective drugs ,anti-neoplastic drugs ,Chinese medicine injections and parenteral nutrition drugs .Fishbone analysis showed that elderly patients ,intravenous administration ,incomplete monitoring and related drugs were the determining factors associated with ARDs .Conclusion The close attention should be paid to monitoring and guidance of special populations ,espe-cially the elderly ;reducing intravenous forms ,monitoring the main factors of medicines ,carrying out the individualized medica-tion monitoring ,strengthening clinical pharmacy ,in order to promote clinical rational use drug and reduce the occurrence of drug-induced diseases .
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Objective To analyze retrospectively the quality control data to enhance the infant incubator risk management. Methods The factors influencing the qualified rate of the infant incubator were analyzed by fishbone analysis method,and then the data statistics method was used to analyze the quality control data from 2013 to 2015 to find out the causes of the factors that affected the qualified rate. Some practical improvement measures were put forward. Results The improvement measures enhanced the qualified rate of the infant incubator quality control greatly. Conclusion The retrospective quality control data analysis contributes to bettering the infant incubator quality control and its clinical safety.
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Abstract Introduction Some patients with a fishbone as a foreign body of difficult diagnosis may require further investigations. Generally, radiography is used as the first choice for finding the fishbone. Objective The objective of this study is to determine the accuracy of digital radiography for diagnosis of fishbone foreign body in the throat Methods This descriptive experimental study design has three phases. In the first phase, we assessed subject contrast and visibility of fishbone on a homogeneous background; as for the second phase, we evaluated the embedded fishbone in the fresh cadaver's throat. In the last phase, we studied the accuracy of radiography in diagnosing the fishbone foreign body at any site of the cadaver's throat. Results The subject contrast of 15 fishbones ranged from 0.94 to 0.99. All types of fishbone were obvious in the first phase, whereas, in the second phase, visibility of fishbone was varied. The subject contrast and diameter of fishbone did not show statistically significant correlation with visibility (p = 0.09 and p = 0.24, respectively). In the third phase, embedded fishbone in the base of tongue was detected with the highest accuracy (sensitivity of 1.00 (95%CI: 0.44-1.00) and specificity of 0.92 (95%CI: 0.65-0.99)); whereas, the tonsil was of difficult interpretation with poorest diagnostic value (sensitivity of 0.00 (95%CI: 0.00-0.56) and specificity of 1.00 (95%CI: 0.76-1.00)). Conclusion The digital radiography provides the highest accuracy and benefit to the diagnosis of a fishbone foreign body at the base of the tongue; whereas, the tonsil was of difficult interpretation.
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OBJECTIVE:To improve high-alert medication management in our hospital. METHODS:According to assessment criteria of JCI,referring to the problems of high-alert medication management in our hospital,PDCA(plan,do,check,action)cy-cle method,reverse fishbone diagram and other methods were adopted to formulate and implement relevant countermeasures. Com-pliance rate of 29 departments was evaluated within 12 months after the implementation of countermeasures. RESULTS:Relevant emergency measures were formulated for 2 negative factors by reverse fishbone diagram;whole-course and orderly quality control of high-alert medication was conducted through establishing high-alert medication management institutions,formulating high-alert medication management system and quality measurement criteria,strengthening staff training and education,improving hospital in-formation system,etc. The compliance rate of departments increased from 53% in Jan. to 100% in Jun.(P<0.05),and kept sta-ble until Dec. CONCLUSIONS:PDCA cycle improves the systemization and standardization of high-alert medication management and multiple department cooperation,and contributes to the safety of drug use.
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Foreign body management is an important aspect in the practice of a general practitioner1. In Singapore, the most common foreign body we encounter would be fishbone. This is not surprising as steamed fish is a common dish in our Asian diet. In spite of the rapid advances in medical technology, a good history taking and physical examination remain the most important step in helping us clinch a diagnosis. In this article, we will focus on the common foreign bodies seen in the Ear, Nose and Throat area as a general practitioner, and the tips and pearls in the examination and management. In each section, there will also be some tips on the red flags to look out for and when a tertiary referral should be made.
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This paper analyzes the explore the factors influencing the TCM clinical pathway using the fishbone dragram. We found that the main impacting factors of TCM clinical pathway were government policy factors, hospital management factors and personal factors. It was suggested to promote Chinese medicine clinical pathway pilot job, not only need to cooperate with the administrative departments of health and medical institutions, also need to strengthen the change of the idea of both doctors and patients.
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Objective To investigate the influence of fishbone diagram in the incidence of blood residual after sealing tube indwelling needle in cardiovascular disease patients.Methods Two hundred and ninety-three patients(1,035 times)with sealing tube intravenous indwelling needle were assigned into control group and another 272 ones(1,276 times)with the needle into experiment group according to admission sequence. In the former group the method of conventionally sealing the tube for intravenous indwelling needle was applied and in the latter,fishbone diagram was applied to analyze the key factors for blood residuals and regulate pertinent measures for effective sealing of tube.The two groups were compared in terms of incidence of blood residuals.Result The incidence of blood residuals in the experiment group was significantly lower than that in the control group(P<0.05).Conclusion The fishbone diagram is effective in reducing the incidence of blood residuals after sealing the tube for intravenous indwelling needle by way of taking effective interventional measures after screening out the key influential factors for blood residuals.
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The main impacting factors on implementing clinical pathway were analyzed by applying fishbone diagram.The factors include policy factors,organizational factors and personal factors.It was suggested to improve the trial work of implementing clinical pathway management by reforming the medical care payment system,putting the clinical pathway management into the evaluation system,building up medical information system,putting more efforts on promotion and enhancing cooperation among related departments.