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Enhanced recovery after surgery(ERAS)is not only an evidence-based set of perioperative interventions, but also a highly innovative multidisciplinary collaboration model and organizational system. The authors reviewed the research status of the organizational structure and service process of ERAS at home and abroad, elaborated the establishment mode and management operation system of ERAS-multidisciplinary team(ERAS-MDT), discussed the communication mechanism between the teams to strengthen the communication and cooperation of ERAS-MDT, and emphasized the reasonable allocation of human resources of ERAS-MDT to reduce the workload of members. At the same time, the authors reviewed the standardized clinical pathway to facilitate the connection of all aspects during the perioperative period, and through the quality control and quality improvement measures of ERAS mode, the authors hope to further standardize the ERAS service process and escort the efficient operation of ERAS.
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Objective To explore the appropriate scientific research award mechanism to promote the transformation of scientific and technological achievements.Methods Literature review was adopted to conduct comprehensive analysis of the incentive mechanisms of foreign patent transformation as well as related policies in China.Results Aimed to providing sufficient opportunities and motivation for the patent transformation platform,increasing the proportion of incentives for R&D personnel and setting up performance rewards for scientific research administration,a policy named Provisions on the proportion of rewards for R&D personnel after the transformation of intellectual property rights in Zhongshan Hospital was developed,which effectively facilitated the medical patents to market transformation.Conclusions It is alerted that improve the enthusiasm of relevant personnel for patent transformation plays important role in increasing the transformation of medical patents.
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OBJECTIVE@#To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy.@*METHODS@#This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, =50) or postoperative analgesia with dizosin (control group, =48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups.@*RESULTS@#At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores ( < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% 66.67%, < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group ( < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% 54.17%, < 0.05) as well as a lower incidence of nausea and vomiting ( < 0.05), an earlier time of first ambulation and first flatus passage after the operation ( < 0.05), and a shorter postoperative hospital stay ( < 0.05).@*CONCLUSIONS@#In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
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Humans , Analgesia, Patient-Controlled , Analgesics, Opioid , Anesthetics, Local , China , Double-Blind Method , Isoxazoles , Pain Management , Pain Measurement , Pain, Postoperative , Pancreaticoduodenectomy , RopivacaineABSTRACT
Objective As one of the important parts of medical scientific research outcomes,the significance of nursing patents is becoming more and more prominent during recent years.However,the nursing department is the blind spot of intellectual property in most hospitals.This article tried to explore strategies to eliminate harriers to the implementation of nursing intellectual property rights in order to promote nursing patents.Methods This paper conducted systematic analysis of the problems and obstacles in the implementation and transformation of nursing patents,and proposed tailored administrative plan.Results Identified obstacle factors include personal reasons of the nursing staff,heavy daily clinical work,as well as the immature patent system and patent market in China.Accordingly,our hospital adopted several corrective measurements,for instance,improving the support for the implementation of nursing patents,strengthening the cultivation and incubation of the intellectual property of nursing staff and standardizing the patent management.Conclusions These measures have effectively im proved the awareness and enthusiasm of nurses' patent knowledge.And we have obtained the ice breaking of the transformation of nursing patents in our hospital.
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Objective To compare delivery accuracy and precision of nutrients as well as physicochemical property between self-made homogenate diet an d commercial dairy based enteral nutrition product and investigate the clinical significances.Methods GB methods were used to examine and analyze the nutrients in self-made homogenate diet and commercial dairy based protein product.Results Self-made homogenate diet exhibited high viscosity (20,000±2121.32) cps because of high water content.The actual values for macronutrients and energy were all lower than 10％ of designed values.The actual values for lipid soluble vitamins A and E were only 49.32％ and 56.47％ of designed values,while the actual values for water soluble vitamins B1,B6 and C were all very low that were close to or lower than detection levels.All minerals,except for potassium were lower than the designed values,wherein iron was only 25.16％ of designed value.For commercial enteral nutrition product,the actual contents of energy,macro-and micro-nutrients including vitamins and minerals were all higher than the designed values and the difference between the contents of minerals and its designed values were controlled within deviation range (5％ ～ 10％).Conclusion For vitamins and minerals in self-made homogenate diet,non-linear correlation was identified between the testing value and designed value.Commercial enteral nutrition product can provide more accurate nutrient level to reach the designed value,and has better flexibility on individual nutrient fortification.
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In consideration of the population aging and growing demands for elderly health care, medical institutions in China are faced with severe challenges. Medical knowledge, given its potential to guide clinical practice, cannot apply to clinical practice directly, and a synergy research network should be built among diversified organizations instead. Authors of this paper described the roadblocks against building a medical synergy network, and presented the experiences of Huashan Hospital, Fudan University in its exploration and development of National Clinical Research Center for Aging and Medicine. In view of major setbacks such as the absence of the following factors, namely the trust towards medical evidences produced in other facilities, a trans-organizational information sharing system, a referral procedure, clear requirements at hospital management level, and a well-functioning reimbursement mechanism. Hence the hospital is required to enhance its functionality of clinical research and play a more active role in the clinical research eco-system.
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Objective To investigate the application effect of selective cyclooxygenase-2 (COX-2) inhibitor in perioperative preemptive on-demand analgesia of the patients with laparoscopic cholecystectomy under enhanced recovery after surgery(ERAS).Methods The clinical data in 206 cases of gallstones undergoing selective COX-2 inhibitor for preemptive analgesia (new type analgesic group) from June to December 2015 and 198 cases of gallstones undergoing tramadol postoperative analgesia (traditional analgesia group) in the biliary surgery department of West China Hospital of Sichuan University were retrospectively analyzed.The intraoperative anesthesia schemes in the two groups were consistent.The same pain resolution scheme was adopted after operation.Then the VAS pain score,pain relief drug use rate,adverse reactions,analgesic satisfaction and hospitalization time were compared between the two groups.Results The VAS scores at postoperative 2,6,12,24 h in the new type analgesia group were lower than those in the traditional analgesia group,the difference was statistically significant (P＜0.05);the analgesic drug use rate in the new type analgesia group was lower than that in the traditional analgesia group (14.56％ vs.44.95％,P＜0.05),and the use rate of tramadol hydrochloride and pethidine hydrochloride was lower than that in the traditional analgesia group (P＜0.05).The incidence rate of adverse reactions in the new type analgesia group was lower (2.43％ vs.36.36％,P＜0.05).The incidence rate of nausea and vomiting in the new type analgesia group was lower than that in the traditional analgesia group (P＜0.05),and the incidence rate of other complications had no statistically signifiwas higher than that in the traditional analgesia group (P＜0.05);the average hospital stay and postoperative hospital stay had no statistical difference between the two groups (P＞0.05).Conclusion COX-2 inhibitors can effectively reduce perioperative pain degree in the patients with laparoscopic cholecystectomy,reduces the use frequency of analgesic drugs,shortens the hospital stay time and increases the patient satisfaction.cant difference (P＞0.05).The perioperative patient analgesia satisfaction the in the new type analgesia group
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Objective To investigate the treatment and prognosis of spinal giant cell tumors recurrence after total spondylectomy.Methods Between February 2001 and February 2016,five female patients suffered from spinal giant cell tumors recurrence after total spondylectomy were retrospectively analyzed.They underwent total spondylectomy with an age ranging from 17 to 63 years old (average 32.6 years).Four cases were primary cases and 1 was recurrent case at the first time of visit.Tumors were located in the thoracic vertebrae in 3 cases,including 1 case in T10 and 2 cases in T11.Tumors were involved in lumbar vertebrae in 2 cases,which were L2 and L5,respectively.According to Tomita spinal tumor classification,all cases were type 5.The Frankel classification for spinal cord injury was grade A in 1 case,grade C in 1 case,grade D in 1 case and grade E in 2 cases.Reoperation was introduced to treat the recurrent tumors after total spondylectomy with adjuvant radiotherapy and drug.The effect of tumor therapy,postoperative complications,nerve function and so on were observed in follow-up.Results One patient was treated with total en bloc spondylectomy (TES) and 4 patients was treated with piecemeal total spondylectomy.The operative approach was onestage posterior approach in 4 patients and combined antero-posterior approach in 1 patient.One patient received radiotherapy and 1 patient was treated with bisphosphonate post operation.The spinal cord function recovered to grade D in 1 patient and grade E in 4 patients.The average interval of recurrence after total spondylectomy was 12-57 months (average 29.6 months).At the second visit,the Frankel classification was grade C in 1 patient.Grade D and grade E were in 2 patients,respectively.Three patients were treated with reoperation to resect the tumors.One patient received radiotherapy and another one was untreated.All 5 patients were followed up with 47-196 months (average 108 months).Four patients survived without tumor and 1 patient without treatment for recurrence survived with tumor.Two patients occurred internal fixation fractures were treated with revision surgery.One of the patients had postoperative spinal canal infection and was cured after internal fixation removal,irrigating and drainage,and antibiotic treatment.The loosening screw in 1 patient was fixed again.Two patients suffered from obvious titanium mesh subsidence (＞ 5 mm).In the last follow-up,there were 1 patients with Frankel grade A,1 with grade D and 3 with grade E.Conclusion Active reoperation combined with radiotherapy and drugs therapy can significantly improve the prognosis of patients with recurrent spinal giant cell tumors after total spondylecmy.
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Objective The demand for medical intellectual property transformation has been increasing.However,the current patent transformation system in our country is not yet perfect.The specialization and complexity of patent value evaluation hampered the transformation.In this article,we argued and analyzed the method of value evaluation before the transformation of medical patent in order to promote the transformation of medical patent.Methods Through the analysis and comparison of classic patent valuation models,the advantages and disadvantages of the three types of cost method,market method and income method are summarized,also introduced the methods and experience of Zhongshan Hospital affiliated to Fudan University.Results The three methods including comprehensive cost accounting,market value valuation and negotiation between the two parties to carry out the pre-transformation value evaluation,can help to obtain the transaction valuation value of the medical patent that meets the current actual situation.Conclusions The scientific and operable value evaluation method of medical patents before transformation,organized approval process and clear revenue management are vital strategies for the transformation of medical patents.
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Objective To know about knowledge about prevention and treatment of venous thromboembolism (VTE) in nurses from tertiary hospitals in China,and to analyze influencing factors to provide guidance for nursing of VTE. Methods A questionnaire survey was conducted among 5279 nurses from 80 tertiary hospitals in 29 provinces (municipalities,and autonomous regions). Results The average score of knowledge about VTE prevention and treatment in nurses was 61.26%. The knowledge was obviously unbalanced. Nurses had poor knowledge of elastic stockings and injection of prefilling anticoagulant drugs. The scores were high for nurses who were over 30 years old, had worked for more than 10 years, and had higher titles. Conclusion Currently knowledge about pre-vention and treatment of VTE in nurses in our country is not ideal,and there is imbalance in knowledge. Training is still an effective approach. There should be standardized training according to level of knowledge of nurses.
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In this paper, current status of doctor-nurse integration mode was reviewed, including the definition, history of development, way of working and main problems exist currently. We also analyzed the future trends of doctor-nurse integration mode by taking the latest research progress abroad into consideration. The future research should focus on developing indigenous scales to measure the behaviors and degree of cooperation in Chinese cultural background and medical environment. The role responsibilities need to be clarified, further more, a standardized and institutionalized organizational structure should be constructed on the basis of theories of modern hospital management.
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In this paper, current status of doctor-nurse integration mode was reviewed, including the definition, history of development, way of working and main problems exist currently. We also analyzed the future trends of doctor-nurse integration mode by taking the latest research progress abroad into consideration. The future research should focus on developing indigenous scales to measure the behaviors and degree of cooperation in Chinese cultural background and medical environment. The role responsibilities need to be clarified, further more, a standardized and institutionalized organizational structure should be constructed on the basis of theories of modern hospital management.
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Objective To explore the role of National Natural Science Foundation (NSFC) funding on improving medical research of China,based on the SCIE paper output of a teaching hospital in East China,in order to provide evidence-based decision-making basis for hospital management of scientific research and discipline construction.Methods SCIE output of a teaching hospital in East China during 2009-2015 was retrieved based on the web of science (WOS) platform.The papers funded by the NSFC were further analyzed.Results From 2009 to 2015,the output of SCIE of the hospital showed a steady upward trend,with an annual growth rate of 26.10％.Among them,the NSFC funded project output 835 papers SCIE,accounting for 46.62％oo of the total paper;and the absolute value of the output of the paper showed an upward trend year by year,an increase of 49.52％.The main subjects of the NSFC funded by the hospital focus on oncology,liver disease and digestive system diseases and cardiovascular and cardiovascular diseases,and the hospital's clinical status basically.The quality of the journals published by the NSFC SCIE project funded by the hospital was significantly improved.Conclusions NSFC funding plays an important role in improving the output and quality of SCIE papers in clinical medicine,which should be paid attention to in scientific research management and decision-making.
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<p><b>OBJECTIVE</b>To compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients.</p><p><b>METHODS</b>Patients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed.</p><p><b>RESULTS</b>Multimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000).</p><p><b>CONCLUSIONS</b>Multimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.</p>
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Humans , Acetaminophen , Therapeutic Uses , Amides , Therapeutic Uses , Analgesia, Patient-Controlled , China , Comparative Effectiveness Research , Defecation , Drug Combinations , Eating , Flatulence , Gastrectomy , Rehabilitation , Isoxazoles , Therapeutic Uses , Length of Stay , Oxycodone , Therapeutic Uses , Pain Management , Methods , Pain, Postoperative , Drug Therapy , Postoperative Complications , Prospective Studies , Recovery of Function , Stomach Neoplasms , General Surgery , Surgical Wound , Rehabilitation , Therapeutics , Suture Techniques , Treatment Outcome , WalkingABSTRACT
<p><b>OBJECTIVE</b>To compared the early outcomes of patients undergoing elective surgeries for colon cancer with and without preoperative mechanical bowel preparation.</p><p><b>METHODS</b>Between July, 2014 and February, 2016, patients undergoing elective surgery for colon cancer with primary anastomosis were randomly assigned into control group with mechanical bowel preparation 12 h before surgery and treatment group without mechanical bowel preparation. Baseline data collection was completed within 12 h after the operation. The levels of hemoglobin, total protein, albumin, prealbumin and albumin<globulin ratio of the patients were recorded at 1 day before surgery and 1 day and 5 days after the surgery. The patients were followed up till 30 days after the surgeries and the complications were recorded.</p><p><b>RESULTS</b>Seventy-six patients were assigned in the treatment group and 72 in the control group. Significant differences were found in the incidence of wound infection and intra-abdominal infection (P<0.05) but not in that of anastomotic leakage or early postoperative bowel obstruction (P>0.05) between the two 2 groups. The first flatus time (P=0.03) and prealbumin level on the first postoperative day (P=0.03) differed significantly between the two groups, but the operation time was similar between them (P=0.06).</p><p><b>CONCLUSION</b>In patients undergoing elective surgeries for colon cancer, preoperative mechanical bowel preparation is associated with increased postoperative complications, delayed recovery of intestinal motility and poorer nutrition status early after the operation.</p>
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Objective To investigate the cause of an outbreak that with fever,chest tightness,cough as the main symptoms in a production enterprise of solar cells,and to provide suggestrons for the on -site disposal and preventing of re -issued. Methods Clinical features and epidemiological characteristics of the cases were analyzed.The workplaces and treatment of industrial wastes were investigated.Legionella in the throat swab sample and residual water during the processes were detected.Simulation test for poisonous gas from waste incineration was performed using a portable GC -MS detector. Results 52 cases were found and the attack rate was 42.76%.The case distribution was consistent with the characteristics of the outbreak of a homologous exposure.Legionella test result was negative.Clinical symptoms of patients were similar to those of fume fever.In the 1 2 jobs,the higher the amount of compressed air used in the job,the higher the incidence rate was,and there were statistical correlation between the two (P <0.01 ).A large number of fluorine -containing solid waste was burned in the evening before the onset of the disease.The compressed air station was downwind from the location of waste incineration,and the simulation test showed that the concentrations of fluobenzene and two -fluobenzene were 435 and 51 3 mg/m3 ,respectively.Conclusion The toxic smoke produced by illegal incineration of fluorine -containing solid waste,from the compressed air station into the workshop,causing the workers exposed to organic fluoride poisoning,and then the fluoropolymer fume fever outbreak.Fortunately,we disposed it timely and effectively,and all cases quickly recovered and no secondary occurred.
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Objective To explore effects of doctor-nurse integrated care management model on fast track (FT) perioperative management of colorectal cancer patients.Methods Between January 2014 and September 2014,112 colorectal cancer patients (innovation group) underwent doctor-nurse integrated care and FT management in West China Hospital were analyzed retrospectively;who were compared with 96 patients (control group) underwent FT management from the same period of 2011.Early postoperative rehabilitation indicators,length of hospital stay,30d readmission rates,total hospitalization costs and patients satisfaction were compared.Results Innovation group of patients for the first time of post-operative flatus,defecation,oral feeding,ambulation,gastric and drainage tubes removal time were all earlier than those in control group,P ＜0.05,while the difference of urinary catheter tube removal time between the two groups was not statistically significant,P ＞ 0.05;the length of hospital stay in innovation group(6.05±2.05) d was significantly shorter than that in control group (7.85±3.22) d,P ＜ 0.05;preoperative hospital stay in innovation group was (1.35±0.45) d,shorter than that in control group (2.56±0.63)d,P ＜ 0.05;the patients satisfaction points in innovation group was (94.t2±3.12) points,which was higher than that in control group (86.36±5.51) points,t=2.589,P ＜0.05.Conclusion Doctor-nurse integrated care management model can improve postoperative rehabilitation effects,can reduce average hospital stay,total hospitalization costs and improve patients satisfaction.
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Objective To investigate the relationship between cancer-related fatigue (CRF) and quality of life (QOL) of the colorectal cancer patients.Methods In this study,patients diagnosed definitely as colorectal cancer were enrolled from November 2010 to January 2011 in this hospital.Piper Fatigue Scale was used to assess the CRF and QLQ-C30 was used to assess the QOL.Results 74 patients were enrolled in this study,and among them 28 patients had CRF(37.84％).Patients with CRF was significantly worse in QOL than patients without CRF.Physical function,role function,emotional function,social function and the general health subscale had a negative correlation with CRF,while pain,fatigue and loss of appetite had a positive correlation with it.Conclusions CRF had an impact on QOL,and this study will provide some reference information when the nurses take measures to intervene CRF and improve QOL of the colorectal cancer patients.
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Objective To explore the effect of situational clinical probation fourth-step method in Nursing Managementteaching in clinic.Methods We introduced innovative teaching method in clinicsituational clinical probation fourth-step method in Nursing Management.Firstly,it took students to learn the construction of the management structure in clinic (observation),then interview management persons (interview),and playing roles in management activities (role-play),at last interactive discussion (seminar).Results Through the SCP fourth-step learning,the nursing students' learning ability was strengthened,the students' ability to innovate and the learning interest in nursing management were inspired.Conclusions Application of situational clinical probation fourth-step method in Nursing Managementteaching in clinic shows better effect,which should be widely applied in clinic practice.
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Objective To explore the establishment of the coherent health service system for patients undergoing surgery in this region to optimize health care resources.Methods Using the Quantitative-qualitative research to investigate the conditions and needs of the regional network of health service between the third-grade class-A hospital and its collaborative hospitals,and it is about two-way referral,the follow ups after discharge,remote consultation,the conditions and needs of the remote training and the knowledge to the obstacles of carrying out the regional network service.Results The doctors and nurses in the research said,it was difficult to achieve the up referral in two-way referral,and there was financing obstacles for remote consultation and training,furthermore,the effects of the remote training was uncertain.Conclusions The regional network of health service between the third-grade class-A hospital and its collaborative hospitals is still weak,and we need to intensify the development of the regional network service.