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Intravitreal drug injection is a treatment for common chronic fundus diseases such as age-related macular degeneration and diabetic retinopathy. The "14th Five-Year" National Eye Health Plan (2021-2025) recommends focusing on fundus diseases and improve the management mode of patients with chronic eye diseases. Therefore, it is imperative to explore how to further optimize the service process of intravitreal injection under the premise of guaranteeing patients' medical safety, to promote medical service efficiency and standardized management level and improve the medical experience of patients. Based on the quality control standard of vitreous cavity injection for retinopathy in China, Chinese fundus disease and related field experts developed the present expert consensus on the establishment of a one-stop intravitreal injection model and the management of its organization after a serious, comprehensive, and complete discussion, focusing on a standardized operation process, quality control, and safety management, providing more references for establishing a suitable intravitreal injection management model for ophthalmology and promoting the development of diagnostic and treatment models for fundus disease in China.
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Objective@#To summarize the measures and experience of treatment in mass extremely severe burn patients.@*Methods@#The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment.@*Results@#Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients.@*Conclusions@#Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.
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Objective To investigate the current situation of healthcare-associated infection(HAI)organization management systems in primary medical institutions.Methods 95 primary medical institutions in 5 provinces (au-tonomous regions,municipalities)in China were investigated.Results Of 95 primary medical institutions,82 (86.32%)established HAI management groups,65 (68.42%)set up antimicrobial management departments,87 (91.58%)assigned professionals for antimicrobial management.Before 2010,only 26 antimicrobial management departments were set up,which increased to 65(68.42%)in 2015.Hospitals established rules and regulations on medical waste management (n=93,97.89%),disinfection and sterilization(n = 87,91.58%),disposable sterile medical device (n=87,91.58%),HAI prevention and control measures (n=79,83.16%),occupational health and safety protection for health care workers(n=76,80.00%),outbreak reporting system (n=73,76.84%),hand hygiene (n=69,72.63%),and monitoring on HAI (n=56,58.95%).Conclusion Current situation of HAI or-ganization management systems in primary medical institutions needs to be improved,health administrative depart-ments should strengthen supervision to improve the level of HAI prevention and control.
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Entre las orientaciones del Ministerio de Salud Pública de Cuba está desarrollar estrategias aceleradas para la formación de doctores en ciencias en el sector, fundamentalmente, a nivel local. Por ello, consecuentemente con esta orientación la provincia de Holguín se propuso impulsar el proceso de formación de doctores, en este caso en Ciencias de la Salud, para elevar el nivel de excelencia académica de la Universidad de Ciencias Médicas, como parte de su inserción en el campo internacional y además, como respuesta a la solicitud de los profesionales de la provincia que deseaban obtener este grado científico. Se muestra la estrategia elaborada y su diseño sustentada en un proceso formativo flexible y ajustado a las normas vigentes por la Comisión Nacional de Grados Científicos de Cuba para la obtención del grado de doctor en una especialidad determinada, procedimiento conocido y utilizado por otros sectores, pero prácticamente desconocido en el sector de la salud. Este proceso de formación doctoral es un modelo de transformación académica que agiliza la formación de doctores en ciencias de la salud en Holguín y prevé disponer a corto plazo de un grupo importante de profesores científicamente fortalecidos. A un año de ejecución de la estrategia se observan resultados estimulantes y se han trazado las proyecciones para su sostenibilidad
One of the instructions of the Ministry of Public Health is the development of strategies for the intensive formation of Ph.D. in health sciences, mainly at local level. To this end, Holguín province intended to give a boost to the process of Ph.D. formation in the health sciences field, in order to increase the level of academic excellence at the provincial medical science university, as part of its insertion in the international arena, and additionally, as a response to the request of the health professionals in that province. The strategy and its design, based on a flexible formation process adapted to the present standards of the National Commission of Scientific Degrees in Cuba for obtaining Ph.D. in a given specialty, was presented. This procedure is known and used in other sectors, but it is practically unknown in the healthcare sector. This process of Ph.D. formation is a model of academic transformation that speeds up the formation Doctors of health sciences in Holguin, and anticipates short-term availability of a significant group of scientifically sounded professors. After one year of the implementation of this strategy, stimulating results were observed and new projections towards its sustainability have been set
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Efficiency, Organizational , Education, Graduate/trends , Health SciencesABSTRACT
OBJECTIVE To explore the management method to improve the control quality of hospital infection.METHODS Three-rating organization management of hospital infection was adopted,to make a management net for hospital infection control which contains leaders,doctors and nurses.RESULTS Three-rating organization management not only raised the understanding level of medical staff to hospital infection,but also good for implementing the regulations and rules to control hospital infection.CONCLUSIONS Three-rating organization management is a practicable method to control hospital infection.