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OBJECTIVE:To reduce the incidence of irrational medical orders for parenteral nutrition,and promote the rational use of parenteral nutrition. METHODS:The medical orders for parenteral nutrition of the first quarter of 2016 in general surgery de-partment of our hospital were collected,and the number and types of its irrational medical orders were summed up. Then FO-CUS-PDCA(Find-organize-clarify-understand-select-plan-do-check-act)cycle management was adopted to analyze and improve the existing problems in issuing medical orders for parenteral nutrition. The improved(the third quarter of 2016)medical orders for par-enteral nutrition were collected,the number and types of its irrational medical orders were summed up,and management effect was evaluated. RESULTS:Establishing nutrition support group,strengthening the training and communication of medical staff,adding prescription evaluation module for parenteral nutrition in hospital information system and a number of measures had made the inci-dence of irrational medical orders for parenteral nutrition in general surgery department declined from 48.25%(1433/2970)before improvement to 5.67%(120/2118)after improvement. The incidences of cation excess,inappropriate selection of drugs and inap-propriate compatibility in irrational types were 0. CONCLUSIONS:FOCUS-PDCA cycle management can reduce the irrational rate of medical orders for parenteral nutrition and promote the rational use of parenteral nutrition in hospital.
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Objective To study and evaluate mini-titanum-plates the effects applied to four limbs bone and joint fracture.Methods 132 patients in our hospital suffered from four limbs fractures treated with open reduction internal fixation of Medicon mini-plate from February 2004 to June 2013 were studied retrospectively,including 60 cases of metacarpal and phalanx fracture(93 lesions),37 cases of metatarsal and phalanx fracture(62 lesions),15 cases of radial head fracture,9 cases of scaphoid fracture,4 cases of coronoid process of ulna fracture,4 cases of patella frature,3 cases of condyles of femur.Results Clinical outcomes:hands and feet group:follow-up postoperative 8-12 months,evaluation results showed that excellent was 78cases,good was 66cases,poor was 11cases,good rate was 92.9％.group of radius head fracture:Fractures got osteal union after 6 months to 1 year.good rate was 93.3％.group of scaphoid bone fracture:Fractures got osteal healing.all cases adopt improved Mayo Evaluation Wrist Function to evaluate,good rate was 88.9％.Including 4 cases of Coronoid process of ulna fracture,4 cases of patella fracture,3 cases of femoral condylar fracture,the excellent good rates was 100％.Conclusions Metacarpal and metatarsals phalanx fracture treated with mini-plate can get reduction anatomically,control rotation,prevent malformation and keep compression,they are the ideal internal fixation material;free fragments for intra-articular fracture fixed by mini-titanum-plate and screws can get reduction precisely,be fixed satisfactory,also can choose the appropriate application.
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[Abstrct] Objective The deformity of severe varus knee (varus angulation > 15°) can be treated by many ways in primary total knee arthroplasty , but the efficacy and cost are different. The topic of this study provides a new surgery: autograft (wedge grafts) implant and substitute medial tibial bone defects. Methods From Jan. 2006 to Jan. 2014 , a retrospective study was conducted in the First Affiliated Hospital of BaoTou Mendical College. Out of 687 patients, 721 primary knees were operated. Bone defects in proximal tibia (varus angulation >15° ) were encounted in 16 patients in 21 knees in the pattern of non-inclusive slope bone defects in the mean varus degree of 27°. Their IBM was 31 kg/m2. The average age of patients was (63 ± 5) years. The score of clinical knee society score (KSS) before operation was 18 on average. Among of them, the pain score were 12 points, the average range of motion (ROM) were 12 points. the average funtional score were 20 points. During operation,the slope bone defect of the medial tibial plateau was tailored into wedge-shaped ladder bone defect by osteotomy,and then the defect was filled with the resected tibial plateau autograft in which the thickness and shape were matched completely. The high-intensity cortical part of the autograft was placed in the rim to sustain the tibial prosthesis. Three months after operation ,patients started to walk without the help of crutch. Results The average followup period was 5.3 y , We observed that an average postoperative scores of clinical KSS from 42 points to 88 points with the score of functional KSS from 57 points to 92 points. Fusion was observed by trabeculae crossing from the graft to the tibial metaphysis on plain films at least 6 mouths without collapse, stress fracture, untight and bone ununion. Confirmation of vascularization of the graft was observed in bone scans of nuclide. showing increased uptake in the operated area. Inflammatory makers were normal. Conclusion Autograft (wedge grafts) reconstruction of medial tibial bone defects, is of high rate of healing in implant bones, good restoration of the function and low cost.