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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:To explore the application effect of micro-lecture based on virtual reality technology on the standardized residency training in the department of orthopedics.Methods:A total of 40 trainees who received standardized residency training in department of orthopedics from December 2019 to August 2020 were selected and randomly divided into control group and experimental group, with 20 cases in each group. For the same orthopedic teaching content, the control group received the conventional training, and the experimental group received micro-lecture teaching based on digital virtual reality technology. And the teaching effect of the two groups and the feedback of the trainees on the teaching were compared. SPSS 22.0 was used for t test. Results:Compared with the students in the control group, the trainees in the experimental group had better performance in theoretical knowledge, comprehension of surgery, and clinical skills, and the difference was statistically significant ( P<0.05). Compared with the control group, the trainees in the experimental group scored higher in satisfaction with class interest [(9.69±0.28) vs. (9.24±0.42)] and participation [(4.38±0.43) vs. (4.03±0.62)], with statistically significant differences ( P<0.05). Conclusion:For the standardized residency training in the department of orthopedics, micro-lecture teaching based on virtual reality technology is more conducive to improving students' academic performance and clinical skills compared with traditional teaching, and increasing the interest and participation of students in the process of standardized residency training.
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Objective To explore the clinical characteristics of multidrug-resistant organisms (MDROS) and analyze the risk factors for MDROS recurrent infections in orthopedic in-patients.Methods A retrospective study was conducted of the clinical data of 296 in-patients with MDROS infection from June 2011 to August 2017.They were 216 males and 80 females with an average age of 49.9 years.Their average hospital stay was 37.2 days.Univariate analysis was conducted for items like age,hospital stay,bedridden time,concomitant internal disease (chronic obstructive pulmonary disease,chronic cardiovascular disease and diabetes),open or closed fracture,uninary catheter,use of hormone,stay in ICU,implantation material,incision grade,albumin level,hemoglobin level,reoperation,type of antibiotics and duration of antibiotics use.Multivariate logistic regression analysis was performed using SPSS 20.0 for items with significant differences.Results A total of 352 strains of pathogens were isolated,including methicillin-resistant staphylococcus aureus (26.7％),extended-spectrum β-lactamase-producing Escherichia coli (24.4％) and multidrug-resistant acinetobacter baumannii (24.1％).The pathogens were observed mostly at surgical sites (34.1％) and open wounds (23.0％).Forty-two patients reinfected the same strain after treatment.The multivariate logistic regression analysis revealed the following as the independent risk factors for MDROS recurrent infections in the orthopedic in-patients:hospital stay [OR =4.918,95％ CI (1.642,14.731),P =0.004],long bedridden time [OR=3.583,95％ CI (1.081,11.876),P=0.037],open injury [OR=2.375,95％CI (1.291,4.368),P=0.005],diabetes [OR=6.360,95％ CI (2.112,19.149),P=0.001],and chronic obstructive pulmonary disease [OR=4.170,95％ CI (1.419,12.251),P=0.009].Conclusions To prevent recurrent MDROS infections in orthopedic patients,surgeons should shorten unnecessary hospital stay,encourage ambulation as early as possible,effectively control blood sugar and actively treat concomitant internal diseases in addition to regular use of antibiotics.
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Objective To explore the effect of psychological intervention combined with drug multimodal treatment on analgesic effect and stress reaction in Department of orthopedics.Methods80 cases of Department of orthopedics patients in Ruian City People's Hospital from March 2016 to March 2017 were selected and randomly divided into control group and observation group, 40 cases in each group.The control group was treated with drugs only, and the observation group was treated with psychological intervention combined with multi multimodal.The analgesic effect and stress response of the 2 groups were observed.ResultsThe satisfaction rate in observation group were significantly higher than the control group.There was no significant difference in heart rate, diastolic blood pressure and systolic blood pressure between two groups before intervention, after group intervention, the changs in observation group were relatively small, and the difference was statistically significant(P<0.05).Visual acupuncture scores were observed at different time points,the pain in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05).ConclusionMultimodal therapy for analgesia in the Department of orthopedics and found psychological intervention combined with stress reaction the drug, compared with simple drug intervention, can play a good analgesic effect, at the same time to reduce the patient's stress response, so it is worthy of reference.
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Objective To investigate the clinical effect of compound lidocaine cream in the supine position of the department of orthopedics under general anesthesia of laryngeal mask airway. Methods 100 cases of laryngeal mask intubation under general anesthesia for department of orthopedics supine internal fixation surgery patients as the research object, are in our hospital from February 2016 to February 2017 were randomly divided into liquid, paraffin oil lubrication for anesthesia (control group, n = 50) with compound lidocaine anesthesia for emulsion lubrication (observation group, n = 50) contrast effect. Results Compared with the control group, the 0-3 stage agitation rate, language instruction satisfaction, laryngeal mask extraction time and complications were better in the observation group (P<0.05). Conclusion The laryngeal mask anesthesia department of orthopedics fixation removal patients, application of compound lidocaine cream hood to daub lubricating anesthesia on agitation for effective control, to improve the language instruction with satisfaction, shorten the extraction time of laryngeal mask, lower complication rate.
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Objective To investigate the clinical effect of compound lidocaine cream in the supine position of the department of orthopedics under general anesthesia of laryngeal mask airway. Methods 100 cases of laryngeal mask intubation under general anesthesia for department of orthopedics supine internal fixation surgery patients as the research object, are in our hospital from February 2016 to February 2017 were randomly divided into liquid, paraffin oil lubrication for anesthesia (control group, n = 50) with compound lidocaine anesthesia for emulsion lubrication (observation group, n = 50) contrast effect. Results Compared with the control group, the 0-3 stage agitation rate, language instruction satisfaction, laryngeal mask extraction time and complications were better in the observation group (P<0.05). Conclusion The laryngeal mask anesthesia department of orthopedics fixation removal patients, application of compound lidocaine cream hood to daub lubricating anesthesia on agitation for effective control, to improve the language instruction with satisfaction, shorten the extraction time of laryngeal mask, lower complication rate.
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Objective To research the clinical application effect of thrombela-stogram(TEG) for anticoagulant therapy to prevent deep venous thrombosis(DVT) in perioperative period of Orthopedics Department.Methods Sixty-eight cases of fracture patients treated with surgery in the Orthopedicsin Department of Jiangning Hospital of Nanjing were selected as the research subjects,and 42 healthy volunteers for a physical examination at the same period were selected as the control group.All fracture patients were treated with anticoagulant therapy after surgery,according to the different anticoagulants,the fracture patients were divided into the low molecular weight heparin(LWMH) group and the rivaroxaban group.On the day of the investigation,the control group was detected by TEG,and the TEG test was performed on all the patients during the perioperative period.Results There was no significant difference on the TEG test results between fracture patients and the control group(P>0.05),the TEG test results of fracture patients were normal,and the blood was not in the high coagulation state.On the 7th d of anticoagulant therapy and the end of anticoagulant therapy,the R value in the LWMH group and in the rivaroxaban group were the highest positive rate,were all more than 50%.At the end of the anticoagulant therapy,the abnormal detection rate of α angle,maximum thrombus(MA) and integrated coagulation index(CI) in the rivaroxaban group were 35.29%,32.35%,41.76%,respectively,were significantly higher than those in the LWMH group(8.82%,17.65%,11.76%),the differences were statistically significant(χ2=6.9283,5.7566,7.5556,P<0.05).After the end of the anticoagulant therapy for Doppler ultrasound,9 cases were diagnosed as DVT,and the incidence rate was 14.06%.Compared and founded,at the end of the anti coagulation therapy,the great value of the diagnostic indicators were α angle,MA and CI,the sensitivity was 64.71%,76.47%,73.53% respectively,and the specificity was 79.41%,73.53%,82.35% respectively.Conclusion After fracture surgery,the coagulation function of the patients are changed,using TEG dynamic detection can accurately understand the change of blood state in real time,and it has important reference value for the evaluation of blood coagulation function.With MA was equal to 68.35 mm as a clinical diagnosis of critical point.
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Objective To explore the effect of special management intervention on improving the rational use of antibacterials before operation in Department of orthopedics.Methods A total of 129 patients who did not carry out the special management of nursing integration were enrolled in this study, and 130 cases of special care for medical integration were administered to 2 patients.The rational use of Antibacterials in the two groups was observed.Results The qualified rate of antibacterial drugs before intervention was 106 (82.2%).The qualified rate of using antibiotics was 125 (96.2%) before intervention, and the difference was statistically significant (P< 0.05) before intervention.Conclusion The special management of medical integration is significant to improve the rational use of antibiotics in Department of orthopedics, and is worthy of clinical and nursing work.
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This paper expounded the development situation of doctor -patient communication software , from two aspects of the server and the client introduces the main functions of the 3D orthopaedic doctor -patient commu-nication software , discussed emphatically the main role , including: improving the efficiency of doctor -patient communication;improving the quality of medical services;improving the patients′satisfaction degree .
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Objective To explore the establishment and implementation of nursing quality evaluation system in department of orthopedics. Methods Randomly 527 patients hospitalized in the department of orthopedics from December 2011 to December 2012 were selected and assigned into the control group, where a traditional evaluation system was used. Another 528 patients hospitalized from April 2013 to June 2014 as the observation group, where orthopedics specialist evaluation system was used. The two groups were compared in terms of hospital evaluation accuracy, observation accuracy, accuracy rate of specialist intervention complications, the qualified rate of nursing records and patient satisfaction. Result The hospital evaluation accuracy, observation accuracy, the accuracy rate of specialist intervention complications, the qualified rate of nursing records and patients satisfaction of the observation group were significantly higher than those of the control group (P<0.01) and there was no incidence in two groups. Conclusion The establishment of orthopaedic nurse quality evaluation system can make up the shortage of traditional evaluation system and improve the quality of the orthopaedic nursing management.
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Objective To investigate the bacterial distribution and resistance in orthopedic patients with wound infections in the hospital in 2014 .Methods The bacteria identification and the antimicrobial susceptibility test were conducted by VITEK‐2 compact automatic system .Results A total of 864 pathogenic strains were collected ,with Gram‐positive bacteria 451 strains (52 .2% ) , Gram‐negative bacteria 398 strains(46 .1% ) .The first major pathogens of Gram‐positive bacteria were Staphylococcus aureus(n=233 ,27% );The top three pathogens of Gram‐negative bacteria were Pseudomonas aeruginosa(n=94 ,10 .9% ) ,Enterobacter cloacae (n=63 ,7 .3% ) ,Acinetobacter baumannii(n=58 ,6 .7% ) .All the Staphylococcus aureus isolates were susceptible to vancomycin , tigecycline ,nitrofuratoin ,quinupristin/dalfopristin ,linezolid .The resistant rates of Acinetobacter baumannii were higher than 50%to multiple antibiotics .Conclusion Staphylococcus aureus were predominant pathogens in orthopedic patients with wound infec‐tions in our hospital .Meantime ,Pseudomonas aeruginosa and Enterobacter cloacae were the prime pathogens in the Gram‐negative bacteria .The drug‐resistance situation is still severe ,and more effective measures should be taken to control the dissemination and growth of resistant strains .
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Objective To summarize the experience of clinical pharmacist ’ s work and explore the working method of pharma-ceutical care in the department of orthopedics .Methods With the characteristics of the orthopedics department , clinical pharmacists should provide pharmaceutical care in steps .At present, we focus on pharmaceutical inquisition , management of antibiotics use of peri-operative patients , and assisting doctors on the treatment of infectious patients and choosing proper analgesics .Results The work was gradually been accepted by doctors and nurses , and their requirement for clinical pharmacist was increased , which enhanced the basis of depth and breadth of pharmaceutical care in the future .Conclusion Clinical pharmacists should grasp the feature of orthopedics de-partment and improve their working capability gradually , thus to supply pharmaceutical care for the clinic with better quality .
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Objective To analyse the distribution of pathogenic isolates and their durg resistance from inpatient in department of orthopedics from Jan.2008 to Dec.2012 and promote rational use of antibiotics.Methods All the clinical isolates were analyzed ret-rospectivily.Results of 1044 isolates,Gram-negative bacteria accounted for 54.12% (151/279 ),the most common pathogens of which were Escherichia coli,Enterobacter cloacae,and Pseudomonas aeruginosa.Gram-postive bacteria accounted for 41.58%(116/279),Staphylococcus aureus were the most common type.Fungi isolates accounted for 3.94%.The drug sensitive test showed that the resistance of different bacteria to the same antibiotic was different.The same kind of bacteria showed different drug resistance to different antibiotics.The most effective drugs for Enterobactericaeae infection treatment was Imipenem.Pseudomonas aeruginosa was sensitive to all the antibiotics exept for ciprofloxacin,to which the drug resistance was was 80%.The drug-resistance rate of Staphylococcus aureus to erythromycin,SMZ-TMP and clindanmycin were all higher than 50%,while to the rest antibiotic was low.Conclusion The bacteria that caused the infection in patients were widely distributed in the department of orthopedics,antibi-otics should be properly chosen according to the results of microbial culture and antimicrobial susceptibility test.
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Objectives To explore the effect of evidence-based nursing on the recovery of severe trauma patients complicated with stress ulcer in department of orthopedics.Method Seven severe trauma patients with stress ulcer hospitalized in the department of orthopedics were treated with evidence-based nursing intervention and the effects were observed.Results The effect of nursing intervention of stress ulcers in 7 patients were obvious and moderate in 5 and 2 cases,respectively.All of them were discharged after being cured.Conclusion The evidence-based nursing can effectively improve the quality of nursing staff,effectively improve the cure rate by way of early intervention and treatment.