Day surgery mode is a challenge for surgeons, anesthesiologists, nurses, and managers. Standardized management should be implemented in each management model, no matter centralized management or decentralized management model, by utilizing the theory of enhanced recovery after surgery and information management to establish a system to ensure patient’s safety and medical quality. Only in this way the development of day surgery will be healthy and sustainable.
Under the background of promoting day surgery nationwide and ensure the medical quality, fine management is crucial and in trend. As one of the earliest central health organizations that started day surgery service in China, West China Hospital of Sichuan University has conducted approximate 140 000 day surgery cases in the past nearly 10 years. Based on the experience of practice, West China Hospital of Sichuan University has summarized 26 clinical indicators from 5 aspects to evaluate and monitor the economic efficacy and medical quality and safety of day surgery, including the input and output, the efficiency, the patient experience, the medical quality and safety, and the difficulty evaluation of surgery. The aim is to explore and establish an appraisal and monitoring system for day surgery, promote the stable development of day surgery, improve the work efficiency, and take the government plan of implementation day surgery to improve medical services into action.
After nearly 30 years of localized development of day surgery in China, in order to enable more patients to enjoy high-quality and affordable day surgery medical services, some medical institutions have begun to try same-day surgery, which means the patient can be operated and discharged within the same workday. With the help of the national three-level diagnosis and treatment service model, it provides continuous medical services and guarantees for day surgery patients through the integration of “hospital-community”. This article first introduces the development history of day surgery, summarizes the definitions and requirements of day surgery in different countries or academic associations, and finally focuses on same-day surgery in China, aims to provide some ideas for the future development of day surgery in China.
Under the background of promoting the high-quality development of public hospitals, day surgery in China has also entered a stage of refined and high-quality continuous development. The high-quality connotation of day surgery includes high quality of medical treatment, high quality of nursing, high quality of management and high quality of service, which is also a difficulty and challenge faced by current medical management. Among them, medical treatment is the core, nursing and service are the key, and management is the essence of day surgery.
【摘要】 目的 研究肥大细胞膜稳定剂色甘酸二钠（disordium cromoglycate，DC）对葡聚糖硫酸钠（dextran sulfate sodium，DSS）诱导的大鼠急性结肠炎的影响。 方法 出生80~100 d的雄性SD清洁级大鼠30只，体重180~250 g。30只大鼠随机分为3组:正常对照组（A组）、溃疡性结肠炎组（B组）和DC组（C组），每组各10只。B组和C组自由饮用40 g/L DSS溶液（4%） 7 d诱发急性结肠炎，同时C组每天按100 mg/kg腹腔注射DC 1次，A组和B组每天腹腔注射等量的生理盐水。7 d后，处死各组大鼠。对各组大鼠行疾病活动指数评分，结肠组织行大体评分、组织学评分，检测门静脉血一氧化氮浓度，结肠组织髓过氧化物酶活性。 结果 疾病活动指数评分、大体评分、组织学评分、一氧化氮浓度及髓过氧化物酶活性均表现为B组gt;C组gt;A组（Plt;0.05）。 结论 肥大细胞膜稳定剂DC对DSS诱导的大鼠急性结肠炎有一定的保护作用。【Abstract】 Objective To observe the influence of the mast cell memebrane stabilizer, disordium cromoglycate (DC), on dextran sulfate sodium (DSS)-induced colitis in rats. Methods Thirty male Sprague-Dawley (SD) rats aged 80 to 100 days with their weight ranged from 180 to 250 g were randomly divided into 3 groups: normal control group (group A), dextran sulfate sodium group (group B) and disordium cromoglycate group (group C), with 10 rats in each. Rats in group B and C drank 40 g/L DSS solution (4%) for 7 days to induce acute colitis. At the same time, intraperitoneal administration of DC (100 mg/kg) to rats in group C was carried out once a day, while the other two groups of rats were given the same amount of normal saline solution. Disease activity index (DAI), gross and histological evaluation were analyzed. NO concentration of blood from portal vein was measured. Myeloperoxidase (MPO) activity of colonic tissue was detected. Results The experimental data of group C, including DAI, gross evaluation, histological assessment, NO concentration and MPO activity, were all significantly higher than those of group A (Plt;0.05), but lower than those of group B (Plt;0.05). Conclusion Disordium cromoglycate can protect the colon of rats with DSS-induced acute colitis.
目的：探讨国产自膨式镍钛记忆合金食管支架在食管、贲门良恶性狭窄及食管瘘中的临床应用并观察疗效。方法:收集我院2005年11月～2008年8月采用胃镜辅助置入镍钛记忆合金食管支架的患者108例，其中男90例，女18例，年龄37~88岁；包括食管癌性狭窄41例，贲门癌性狭窄5例，放疗后狭窄1例，肺癌压迫致食管狭窄1例，食管、贲门癌术后吻合口顽固性狭窄21例，食管癌术后复发致狭窄6例，食管瘘33例。结果：108例患者共置入食管支架116枚，一次性置入成功率100%，置入后患者吞咽梗阻的症状有不同程度的改善，呛咳的症状基本消失。结论：食管支架置入操作简单、安全，成功率高，是治疗食管良恶性狭窄及封堵瘘口的有效方法。
Objective To discuss the running effect of the modified hospital-community integrated two-way-referral service mode in day surgery. Methods The hospital-community integrated two-way-referral service mode in day surgery was built in May 2014 by our center, and applied in the communities’ health service network in Chenghua District, Wuhou District, and Jinjiang District. From March 2017 some improvements of the mode were made, such as assigning specific person for the management of two-way-referral, conducting lectures in communities to train the community medical staff, and carrying out gratuitous treatment. The community acceptance rate and patients satisfaction were retrospectively analyzed between March of 2016 and March of 2017, and the number of upward referral (from community to hospital) was retrospectively analyzed between March to June of 2016 and March to June of 2017. Results The community acceptance rate was elevated from 81.3% to 99.1% and the patients satisfaction was improved from 95.4% to 100.0%, and the differences between the two periods were statistically significant (P<0.05). The number of upward referral increased from 0 to 23. Conclusions The modified hospital-community integrated service mode could optimize the course of surgery appointment, and make it convenient for patients. Furthermore, it also adjusts the reasonable allocation of medical resource effectively and promotes the implementation of national hierarchical medical system.
By learning the nearly ten years’ experience and summaries in day surgery, West China Hospital of Sichuan University drafts a series of standards for day surgery management. This article mainly introduces the pre-administration management standards of West China Hospital of Sichuan University, involving: standards for the management of surgeons, nurses, patients, and the type of operation; standards for pre-administration work procedure; standards for pre-administration health education; standards for appointment, scheduling, and coordination for day surgery; and standards for surgery notification. This paper aims to share experience with peer professionals, and provide theoretical basis and practical guidance for the standardization and development of day surgery, as well as the establishment of a safe day surgery management system.
As an advanced mode of diagnosis and treatment, day surgery is widely carried out in foreign countries. Although it started late in China, it has been gradually valued and vigorously promoted in medical and health field in recent years. The effective implementation of day surgery in hospital cannot be separated from the strong support of performance management system. Through introducing the performance management experiences in promoting day surgery mode in West China Hospital of Sichuan University, this article discusses how to construct an effective whole-course performance management system for day surgery combined with operation management through three mechanisms: the management committee mechanism, the operation management mechanism and the performance assessment mechanism, which are based on the structure-process-outcome dimensions of quality management system, at the three levels of hospital, department and position, so as to provide a reference for developing day surgery in China.
Coronary heart disease with gastrointestinal bleeding is common in clinical practice. The disease is dangerous and has a high mortality rate. This article will review the risk factors for coronary heart disease with gastrointestinal bleeding (including Helicobacter pylori infection, long-term use of antiplatelet drugs and combined anticoagulation drugs), blood transfusion strategies (including hemoglobin transfusion thresholds and platelet transfusion strategies), and the management of antithrombotic drugs after bleeding (including the management of antiplatelet drugs and the management of anticoagulation combined with antiplatelet drugs). The purpose is to provide a theoretical basis for the diagnosis and treatment of coronary heart disease with gastrointestinal bleeding.