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The treatment concept and standardization of primary surgery for patients with differentiated thyroid cancer vary among different regions and different treatment centers in the same region, resulting in different reoperation rates for patients. Intraoperative experience, preoperative evaluation, surgical approach, and procedure may all influence the success rate of reoperation. In order to reduce the risk of surgery and complications, reoperation should be treated standardized, while combining the current diagnosis and treatment techniques to provide individualized treatment options for reoperation patients, under the premise of ensuring efficacy, to broaden the indications of surgery, make large incisions into small incisions, and change traditional open surgery into minimally invasive surgery, improve the quality of life of patients and confidence in coping with social stress. This paper will summarize the main content of preoperative assessment at the time of reoperation in patients with differentiated thyroid cancer, analyze the notes and rationally developing a surgical plan for patients, in the hope of attracting the same emphasis and normalizing the reoperation treatment, so as to achieve reoperation of the tumor R0 resection.
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OBJECTIVE：To establish the eva luation criteria for the rationality of tumor nutritional standardized treatment ，and to provide reference for nutritional standardized treatment in tumer patients . METHODS ：Based on domestic and foreign guidelines or expert consensus ，the rationality evaluation standard of tumor nutritional standardized treatmentwas formulated in our hospital （Bozhou Municipal People ’s Hospital ）. 50 nutritional treatment medical records in our hospital from Jan. to Jun. 2019 were evaluated by weighted TOPSIS ；according to the evaluation results ，nutritional intervention was carried out ，and 50 nutritional treatment medical records （group B ）from Aug. to Dec. 2019 were re-evaluated by the same method after intervention. RESULTS ： The established evaluation criteria for the rationality of tumor nutritional standardized treatment in our hospital included 18 indicators，such as malnutrition diagnosis ，description of the nature of malnutrition ，nutrition screening and evaluation ，etc. After analysis ，the rational rate of nutritional treatment was only 18％ in group A （Ci of ideal solution with 9 medical records≥0.6），and 78％ in group B （Ci of ideal solution with59 medical records ≥0.6）. There was statistical significance in the rationality of nutritional treatment before and after nutritional intervention （Ci≥0.6）（P＜0.05）. CONCLUSIONS ：The established rational evaluation method of tumor nutritional standardized treatment is feasible ，and the evaluation results are intuitive and reasonable. Nutrition intervention is helpful to reduce the irrational rate of nutritional treatment.
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Traumatic brain injury ( TBI) is one of the major causes of mortality and disability among young and middle-aged people. High mortality and disability rates impose a heavy economic burden on society. After TBI, rapid and standardized emergency treatment should be carried out to prevent or correct secondary injury factors leading to deterioration of nerve function, protect patients' nerve function, save lives and improve prognosis. Base on the latest research progress and literature review, the author summarizes several important aspects of TBI, especially the early treatment of severe TBI, and elaborates on several controversial issues in the treatment of severe TBI, providing reference for more standardized treatment.
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Acute pancreatitis is one of the common diseases of digestive system. It is characterized by acute onset and can be severe within a short time if not promptly treated. The mortality of severe acute pancreatitis is still high. Therefore, early management of acute pancreatitis within the first 72 hours is particularly important. In this article, the diagnostic criteria, severity grading, prognostic factors, as well as etiological therapy, fluid resuscitation, nutritional support, antibiotic use, protection against organ failure and other early management measures of acute pancreatitis were described for helping the establishing of guidelines for the early management of acute pancreatitis.
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Objective To analyze the effect on clinical outcome of sepsis patients treated by early positive and standardized treatment in primary hospitals. Methods The clinical data of sepsis patients admitted to intensive care unit (ICU) of Dushanzi People's Hospital from January 1, 2015 to December 31, 2018 were retrospectively analyzed. The sepsis patients were further divided into a control group (from January to December, 2015) who received non-standardized treatment of sepsis, only according to doctors' experience, using routine antibiotics, fluid resuscitation, detection of lactic acid, etc. and a study group; from 2016, the patients with sepsis (the study group) received standardized diagnosis and treatment according to the Guidelines of Sepsis 3.0 and the actual conditions of our hospitals, and they were further subdivided into three periods: 2016 (from January to December, 2016), 2017 (from January to December, 2017), and 2018 (from January to December, 2018) periods. The main clinical outcome indicator of these patients in 4 time periods, 28-day mortality, the secondary clinical outcome indicators such as the length of stay in ICU and medical expenses in ICU were observed. Results Sixty-six patients with sepsis were finally enrolled, including 17 cases in 2015, 18 cases in 2016, 17 cases in 2017 and 14 cases in 2018. Compared with 2015, the length of ICU stay in 2016, 2017 and 2018 were significantly shorter (days: 17.45±9.09, 12.95±5.93, 12.14±4.92 vs. 20.85±13.45, all P <0.05), and the medical cost of ICU stay were significantly lower (ten thousand yuan: 9.93±5.35, 7.22±3.86, 5.15±2.88 vs. 13.37±14.14, all P < 0.05); the 28-day mortality was significantly decreased [16.67% (3/18), 11.76% (2/17), and 14.29% (2/14) vs. 35.3% (6/17), all P < 0.05]. Conclusion Early standardized treatment for patients with sepsis can significantly reduce the length of stay in ICU and medical expenses in ICU.
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Endoscopic resection is becoming the preferred primary treatment for early gastric cancer with a low incidence of lymph node metastasis. There have been published guidelines and consensus on the standardized endoscopic diagnosis and treatment in recent years. As part of the standardized endoscopic process, risk stratification regarding gastric cancer should be performed prior to gastroscopy. This is followed by a systematic gastroscopic mapping. The pre-malignant mucosal changes should be noted during screening. Chromoendoscopy and Image-Enhanced Endoscopy are recommended to assist the preoperative diagnosis for any suspicious lesion. Indication for endoscopic resection is according to the pathologic findings post biopsy. There are two main goals of a successful endoscopic resection: en bloc resection and negative margins. The final pathological diagnosis should be comprehensive and systematic. Follow-up surveillance or additional surgery should be based on the eCure system.
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Objective To observe the effect of out-hospital standardized treatment on the recurrence of the first onset of acute unprovoked pulmonary thromboembolism (PE) after discontinued anticoagulant therapy or during anticoagulation therapy in PE patients after treatment and discharged from hospital.Methods A prospective study of patients with acute PE admitted into emergency ICU for training in out-hospital standardized anticoagulation treatment was carried out from January 2015 to December 2016 (observation group).Another cohort of EP patients without training in out-hospital standardized anticoagulation treatment admitted from January 2010 to December 2014 was enrolled for retrospective analysis(control group).The out-hospital standardized anticoagulation treatment strategy included the guidance of anticoagulation therapy,record all of the patients' symptoms related with recurrent EP both during and discontinuous anticoagulant treatment,V/O scan at 3 months,6 months and 12 months follow-up,respectively.The patients with ceased anticoagulant therapy would be followed up for at least one year.Patients with signs of recurrence would have a definite diagnosis at once.The anticoagulation status and outcome of the patients in control group found in out-patient department were recorded.Results ① There were 129 patients with acute unprovoked PE in observation group and 246 in control grouThere were no significance difference both in mean age and gender between two groups (P ＜0.05).② Recurrence rate was 11.63％ in observation group and 22.36％ in control group (P ＜0.01);③ There was significance difference in mortality rate between observation group (3.1％) and control group (10.85％) (P ＜0.05).There was also significant difference in rate of missing follow-up between observation group (10.85％) and control group (21.54％) (P＜0.001),and.there was significant difference in rate of discontinuous anticoagulation therapy between observation group (1.55％) and control group (8.5％) (P ＜0.01).④ There was no significance difference seen in the rate of patients exposed to multiple risk factors of arteriosclerosis between observation group (82.25％) and control group (77.64％) (P＜0.05).But the target rate of controlling various risk factors of arteriosclerosis was 79.31％ in observation group and 54.97％ in control group respectively (P＜0.05).Conclusions Standardized treatment can effectively reduce the recurrent rate of the venous episodes of the patients with first episode of acute unprovoked pulmonary thromboembolism;Recurrent venous episodes of the PE patients who exposed to the multiple risk factors of arteriosclerosis require more attentions.
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Objective To explore the effect of pattern-specific physical therapy based on functional impair-ment on chronic neck pain ( CNP ) . Methods Ninety-three CNP patients treated in the outpatient department of our hospital between March 2016 and November 2017 were randomly divided into a study group ( n=46) and a control group ( n=47) . The control group received routine physical treatment, while the study group was treated with pattern-specific physical therapy involving local pain management, traction, soft tissue relaxation, mobilization, strength training, posture control training and active exercise as well as health education. Each was based on a physical exami-nation and pattern classification by doctors and therapists. The subjects in both groups were required to complete 3 to 6 ninety-minute sessions of outpatient treatment and 6 thirty-minute sessions of self-training at home over 2 weeks. Pain intensity and cervical dysfunction were rated using a visual analogue scale ( VAS) and a neck disability index ( NDI) before and after the two-week intervention and one month later. Before the intervention and during the follow-up, postural analyses for the head and neck in a standing position were performed. The cranial vertebral angle ( CVA) , protracted shoulder angle ( PSA) and sagittal head elevation were measured. Results Eighty-seven par-ticipants completed the treatments and follow-up. After the 2-week intervention, the average VAS rating at the end of cervical anteflection in the study group was significantly lower than that in the control group ( P≤0.05) . Significantly greater improvement in the NDI scores was observed in the study group than the control group ( P≤0.05) . During the follow-up, it was found that the average CVA score had improved more significantly in the study group than with the control group ( P≤0.01) , but there were no significant differences in the other measurements between the two groups.Conclusion This pattern-specific physical therapy process is more effective for relieving the end pain during cervical anteflection quickly. It can improve functioning and ability in daily activities to some degree, as well as correct head and neck posture in the long term. It may be helpful in regulating physical therapy for neck pain and for developing a standardized treatment protocol for CNP .
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Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are relat?ed to many special departments,such as gastroenterology,general surgery,neurology,endocrinology,radiology,traditional Chinese medicine,blood purification,endoscopy,intervention,and ICU. It is necessary to apply a multidisciplinary treatment (MDT)mode. However,the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team,formulate the formal working procedures,and standard?ize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.
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Objective To explore the effect of setting up standardized treatment demonstration ward for cancer pain on the management of narcotic drugs. Methods The study group (from 2015 to 2016 to create the standardized treatment of cancer pain ward) and control group (from 2013 to 2014 to create a standardized pain treatment demonstration unit ) all kinds of narcotic drugs dosage and medication frequency (DDDs), a monthly 30 prescriptions from tumor anesthesia, analysis of prescription writing quality qualified the rate and the rate of unreasonable use. Results The study group of patients with cancer pain drug usage and DDDs, oxycodone dosage rises fast, DDDs way ahead, dosage of morphine increased gradually, morphine dosage gradually decreased, transdermal fentanyl DDDs decreased, pethidine dosage remains low. The research group for the passing rate of prescription writing quality 99.3％, the control group of prescription writing quality qualified rate is 81.1％, the research group of narcotic drug use rate was only 4％, reasonable utilization rate is as high as 96％ is not reasonable, unreasonable use of narcotic drugs control group was as high as 18.5％, reasonable utilization rate is only 81.5％ (P<0.05). Conclusion The creation of standardized pain treatment demonstration unit narcotic drugs more reasonable structure, can improve the quality of narcotic drugs prescription writing qualified rate, reduce the rate of unreasonable use, reasonable use of pain medicine has positive significance to ensure patient safety and efficacy of.
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The purpose of medicine is to cure patients' illness.As an ancient disease which has not been conquered,cancer has always been accompanying with the development of medicine in human history.Separation and progress of medical subspecialties have promoted human's understanding of cancer and propelled the standardization of cancer treatment.Along with the deepening cognition of pathology,early diagnosis,establishment of surgical and adjuvant therapeutic schedules,the standardized treatment of gastric cancer has stepped forward gradually.The coming big data era will further refine the classification of gastric cancer and provide new opportunities for treatment updating.
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Objective To explore the application of cancer pain standardized treatment in patients with lung cancer pain and clinical results.Methods 120 cases of lung cancer pain patients as the research object in Our hospital from April 2015 to June 2016,The patients were randomly divided into study group and control group,60 cases in each group,the patients in the control group were treated with routine therapy and nursing,and the patients in the study group were treated with normalized treatment and care of cancer pain,and then compared the two groups after treatment Pain status changes and adverse events and patient satisfaction statistics.Results There was no significant difference in pain status and VAS score between the two groups before treatment,but the pain status was relieved after treatment.The pain status of patients in the study group after standardized treatment of cancer pain changed significantly,the VAS score was lower than the control,the difference between the two groups was statistically significant(P<0.05).After treatment,the adverse events of the study group including non-on-time medication,syncope pressure sores and the incidence of self-mutilation or suicide were statistically significant And the difference was statistically significant(P<0.05).The satisfaction of the patients in the two groups showed that the satisfaction of the patients in the study group was significantly higher than that of the control group,The difference between groups was statistically significant(P<0.05).Conclusion The standardized treatment of cancer pain is effective in the treatment of patients with lung cancer pain.It can effectively relieve the pain and improve the quality of life and satisfaction of patients with lung cancer pain.It has broad clinical application and popularization value.
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Objective To investigate the treatment of chronic heart failure in two communities in Pudong and find the deficiency of standardized treatment in community hospital.Methods A retrospective study of all the inpatient,family bed and outpatient with heart failure who visit Hudong and Lujiazui community health Service center was conducted from March 2012 to March 2015 retrospectively.General situation(gender,age,smoking history,drinking history,daily salt intake,concomitant disease),etiology and if have the acute heart failure onset in half a year and what are the incentives,drug treatment and treatment of concomitant hypertension and diabetes mellitus were analyzed by face to face follow up.Results The study included 300 patients,average age was (58 ± 10) years.Daily salt intake of 55.0％ (165/300)patients was more than 9 g.Coronary heart disease (45.7 ％,137/300),hypertension (30.7％,92/300)and cardiomyopathy (9.0％,27/300)were the chief heart failure etiology.59.3％ (178/300) patients had acute heart failure in half a year.Acute blood pressure(20.8％,37/178),transfusion too fast or too much and infection(14.6％,26/178) were the chief incentives leading to acute heart failure.83.3％ (250/300)patients used ACEI/ARB,but only 32.0％ (80/250) of them applied the target dose.53.7％ (161/300)patients used beta blockers and 98.1％ (158/161) of them could not reach the target dose.Tartaric acid metoprolol (51.6％,83/161),peso parlour (18.6％,30/161) and carvedilol (14.9％,24/161) were commonly used drug in clinic.76.6％ (230/300)patients had hypertension and blood pressure was controlled in 82.2％ (189/230) of them successfully.44.0％ (132/300) patients had diabetes mellitus and glycosylated hemoglobin (HbA1c) was controlled from 7 ％ to 8 ％ in 23.5 ％ (31/132) of them.Conclusion In the community treatment of heart failure,the drugs recommended by guidelines were low usage and achieved the target dose rarely.Treatment of concomitant diseases was not good.The knowledge of new progress was not enough.
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At present surgical treatment is a main method for gastric cancer,while multidisciplinary comprehensive treatment for gastric cancer has gradually become the mainstream direction of treatment,which is based on regarding patients as the core part of treatment,aiming at specific disease,building multidisciplinary team and making individualized,standardized,scientific and continuous comprehensive treatment plan.Meanwhile,it can provide the best treatment option and efficacy for particular patients,and raise the diagnostic and treatment skills and academic level.There are obvious promotions in the integration between medical education and health management and the progresses of medicine and science.
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With the constant development of imaging-guided percutaneous tumor ablation technology, its safety and efficacy have been recognized by clinical physicians as well as by patients. It has played a more and more important role in the modern minimally- invasive treatment for liver tumors. However, great differences in technique level of operation, the experience of physician, the function of the equipment, and patient’s condition exist between different medical units. The therapeutic efficacy, recurrence rate and complication rate are also quite different from one hospital to another. In order to resolve the problems mentioned above and to further improve the clinical efficacy and safety of ablation therapy , the establishment of an agreement on ablation indication, treatment strategy of standardization and individualization, and standardized operation procedure and technique in China is mandatory at present. Besides, to formulate the license policy, to improve knowledge compensation from multiple clinical disciplines and to pay great attention to treatment standardization, etc. all are important means in order to improve the overall efficacy of liver tumor ablation in our country.
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The incidence of colorectal cancer increased yearly,and more than 50％ patients had liver metastases.As continuous development of recognition and treatment of colorectal liver metastases,it now has been reckoned as a potentially curable disease,and its prognosis has been improved significantly.However,how to choose the reasonable treatment is a problem for us.The standardized treatment of colorectal liver metastases should include imaging examination,surgical treatment and multi-disciplinary treatment,and individualized treatment should be considered.In this article,the selection of proper imaging examination,comparison of different treatment methods,surgical treatment of liver metastases and multi-disciplinary treatment are discussed.
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Background: In 2006, the burn unit of an emergency public hospital in Chile standardized its medical and surgical treatment protocols. Aim: To analyze the evolution of mortality among patients admitted to the unit after the standardization process. Material and Methods: Patients admitted to the unit between March 2005 and March 2006, were analyzed. An early surgical debridement was performed, according to the guide-lines, after a standardized reanimation with Lactate Ringer using Parkland formula (4 ml/kg/ percent burn surface area). All patients were monitored. An algorithm was used to decide the indication of vasoactive drugs or invasive monitorization. Results: Eighty eight patients aged 43 +/- 19 years (65 percent males) were admitted. The estimated percentage body burned was 30 +/- 21 percent, deep in 12.5 +/- 17 percent. A mean of 9.122 +/- 6.930 mi of fluid were administered in the first 24 hours. The first surgical debridement was performed at 48 hours (range 1 to 15 days). The first escharotomy was performed at 4.2 days (range 3 hours -15 days), the first covering at 3.8 days (range 3 hours-19 days) the first auto graft at 18 days (range 4-26 days). Operative times in the first three surgical procedures were less than 87 min. Global mortality was 37 percent. Conclusions: The standardized treatment of burns resulted in an absolute reduction of mortality.
Introducción: En el 2005 el Servicio de Quemados del HUAP inició un proceso de modernización. Durante el primer año se intervino en el protocolo terapéutico médico y quirúrgico. Se analizarán la mortalidad observada en este período. Materiales y Métodos: Se analizaron los pacientes admitidos en Cuidados Intermedios e Intensivos de nuestra unidad desde el Iº de marzo de 2005 a Iº de marzo de 2006. Se realizó aseo quirúrgico precoz, según protocolo, previa reanimación estandarizada con Ringer Lactato usando la fórmula de Parkland, 4 cc/kg/ por ciento SCT (superficie corporal total). Todos los casos fueron monitorizados, guiados por diuresis y con algoritmo para decidir inicio de drogas vasoactivas o monitorización invasiva. Resultados: Ingresan 88 pacientes, 58 por ciento trasladados de otros centros. Edad promedio 43 +/- 18,9 años; hombres 65 por ciento, mujeres 35 por ciento; superficie corporal quemada 30 +/- 21 por ciento, profunda 12,5 +/- 17 por ciento. Se administró en promedio 9.122 +/- 6.930 ce durante las primeras 24 hrs. Primer aseo se realizó a las 48 hrs (1 hr -15 días), Ia escarectomía a los 4,2 días (3 hrs - 15 días), Ia cobertura a los 3,8 días (3 hrs - 19 días), 1er autoinjerto a los 18 días (4 - 26 días). Tiempos operatorios promedio en las 3 primeras cirugías inferiores a 87 min. Mortalidad absoluta disminuyó a 19 por ciento. Mortalidad global 37 por ciento. Conclusiones: Luego del primer año del proceso de modernización, con reanimación estandarizada, equipos quirúrgicos proporcionales a la SCT quemada con disminución de los tiempos quirúrgicos, asociado a un manejo multidisciplinario, se logró una disminución de la mortalidad global.