RESUMO
Control of the qualifications and behaviors of medical practitioners in branches of a hospital group has become imperative to guarantee medical quality and safety.We have explored a development program of the information platform to meet the needs of unified authorization and closed-loop management of hospital groups,constructed a medical qualifications authorization management and control platform based on private clouds,established a specialized medical qualifications and authorization model,standardized the approval process,and reduced the approval time.At the same time,we work with a human resources management platform,to develop qualifications assessment tools for supervision,for the purposes of dynamic renewal and withdrawal of medical qualifications.We have set up a centralized medical behavior authority database and an authority verification interface,selected key business steps,and readapted the business system for authority verification.These measures can effectively control practitioners' medical behavior and ensure medical safety.
RESUMO
Objective We sought to evaluate the efficacy of bipolar radiofrequency ablation of atrial fibrillation (AF) in patients undergoing cardiac surgery,and to determine independent factors affecting the recurrence.Methods From June 2007 through February 2010,81 patients with atrial fibrillation underwent a modified Cox-Maze Ⅳ procedure using a biopolar radiofrequency device( Medtronic in 32 cases,Atricure in 49 cases).There were 45 males and 36 females,aged (48.2 ± 11.0)years,including 26 cases of permanent AF,44 cases of persistent AF and 11 cases of paroxysmal AF.The mean duration time of AF was (7.56 ± 7.47 ) years.The left atrial diameter were 36 ～ 72 mm.In conjunction with cardiac surgery including:mitral valve replacement (MVR) (or add tricuspid valve plasty (TVP) in 33 cases,mitral and aortic valve replacement (DVR)( or add TVP) in 18 cases,off-pump coronary artery bypass surgery (OPCAB) in 16 cases,aortic valve replacement (AVR) in 4 cases,MVR and coronary artery bypass grafting (CABG) in 1 case,mitral valve plasty (MVP) in 1 case,and others in 8 cases.Among them,22 patients were undergoing electrophysiological mapping by high-frequency bipolar stimulation from June 2009 to February 2010.A follow-up of 12 to 44 months was completed.Recurrences were evaluated by 12-lead ECG or 24 hour Holter recording every clinic visit-1,3,6,9,and 12 months after the procedure and yearly thereafter,or if symptoms developed.Multivariate regression analysis was performed to determine independent factors affecting the recurrence.Results Hospital mortality was 1.23％.The successful ablation of AF were 100％,82.5％,and 84.8％ immediately after operation,at discharge,and at 2(6.1 ± 13.6) months after operation respectively.Multinomial regression analysis showed small left atrium ( ＜ 60 mm),and electrophysiological mapping might contribute better sinus rhythm restoration ( P ＜ 0.05 ).Conclusion Bipolar radiofrequency ablation of atrial fibrillation in patients undergoing cardiac surgery is safe and effective.Small left atrium ( ＜ 60mm) and electrophysiological mapping should be considered to improve results in selected patients.
