الملخص
Objective To integrate the best available evidence of preoperative care for ophthalmic patients undergoing day surgery into clinical practice,so as to improve the quality of nursing.Methods This project was performed in an ophthalmic day surgery ward,guided by the Joanna Briggs Institute(JBI)Practice Application of Clinical Evidence System (PACES) program which includes 3 procedures:baseline audit,evidence implementation,and re-audit.Eight audit criteria were made based on evidences from JBI.Twelve nurses and 267 patients were enrolled in baseline audit,and 12 nurses and 234 patients were recruited for re-audit after evidence implementation.Results Six of the audit criteria that nurses showed poor compliance in the baseline audit(0％～28.5％),such as providing preoperative telephone screening and reducing preoperative waiting time through better preparation and planning,were significantly improved in the re-audit(71.43％～100％).The preoperative waiting time was shortened from 109.70±18.34 minutes to 88.22±9.91 minutes;the correct rates of operation-related knowledge in patients increased from 63.0％ to 85.09％;the patients' satisfaction scored 84.23±17.01 in baseline audit and 95.02±7.32 in the re-audit(P＜0.001).Conclusion Application of evidence-based preoperative care of ophthalmic patients undergoing day surgery can improve nurse's behavior and compliance with the implementation of evidence into clinical practice,and increase patient satisfaction.Continuous audits are needed to continuously improve clinical nursing quality.
الملخص
Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand.Methods From March,2014 to September,2016,there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand.The donor and recipient areas were scanned by 64 row spiral CT before operation.Three dimensional images were obtained by CTA 3D reconstruction technology.Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system.Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeal bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound.The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm × 5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm ×17.0 cm to 12.0 cm × 25.5 cm,respectively.Postoperative followed-up was performed to evaluate the effect of the operation.Results All 9 thumbs and flaps survived after the operation.Postoperative followed-up time ranged from 8 to 16 months.The appearance of reconstructed thumb was close to normal,and the two-point discrimination was from 8.0 to 11.0 mm.According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences,7 cases were excellent and 2 cases were good.The survival flaps had soft texture,good blood circulation and satisfactory appearance at the repaired site.Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results.