【摘要】 目的 探讨125I粒子植入治疗中晚期胰腺癌的临床并发症及相关护理措施。 方法 回顾分析2006年10月-2010年4月121例行125I粒子植入治疗的胰腺癌患者的临床治疗及护理，采取积极有效的护理措施，预防及处理并发症，促进患者康复。 结果 121例患者接受放射性125I粒子植入治疗后，7例出现胰瘘，13例出现胃肠道反应，经对症处理和精心护理后均治愈。 结论 125I粒子组织间植入近距离治疗中晚期胰腺癌近期疗效好、安全、副反应少，良好的护理对改善中晚期胰腺癌患者预后具有重要意义。【Abstract】 Objective To observe the complications in patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation, and the investigate the proper nursing methods. Methods The clinical data including the therapy and nursing methods for the complications in 121 patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation from October 2006 to October 2010 were retrospectively analyzed. The treatment and care for complication were analyzed. Results In the 121 patients who had been treated by 125I particle, pancreatic fistula occurred in seven, and severe gastrointestinal upset was found in 13. The patients with the complications recovered after postoperative treatment and nursing. Conclusion 125I particle implantation for patients with middle and advanced pancreatic carcinoma is effective and safe with a few side reactions; proper nursing is important to improve the prognosis.
Objective To optimize the environment of outpatient clinics in large hospitals, facilitate the patients’ visits and improve the comprehensive management level. Methods From September to November 2015, 2 hospitals in each part of a provincial city (middle, east, west, north and south), a total of 10 hospitals were chosed by convenient sampling method. The forms, types and distribution of outpatient navigation service system were investigated and analyzed by using a self-designed questionnaire. Results There were a total of 14 forms of counseling-guide services in the 10 hospitals. Just 1 hospital provided all the 14 forms of counseling-guide services, and 2 hospitals provided 13 forms of counseling-guide services, which were relatively complete. While the other 7 large hospitals provided only 4 to 6 forms of counseling-guide services, which were relatively simple. Conclusion Qualified outpatient navigation service system can help patients to receive more effective treatment, optimize the environment, highlighting the modern hospital humanistic service and the concept of intelligent service and scientific management.
ObjectivesBased on the historical data of inpatients, a logistic regression model was established. It aimed to identify the influencing factors of patient's admission scheduling decisions and compare them with the actual scheduling rules, so as to discover the differences and deficiencies.MethodsWe extracted data of outpatients and inpatients in Department of Respiration in West China Hospital of Sichuan University from January 1st, 2016 to December 31st, 2016, and standardized the original dataset. We established the binary multivariate logistic regression model through R software and ‘glm’ package.ResultsThe analysis of multi-factor logistic regression showed that the effect of the five variables (type of medical insurance, time of registration, waiting time, type of disease and admission priority) on patient schedule was statistically significant.ConclusionsThe logistic regression model constructed in this study has a good effect on patient planning, which is helpful to provide decision support for admission schedule through identification factors.
ObjectiveTo explore the model of sharing appointments between medical inspection resources in medical alliance hospitals in the medical profession, in order to improve the utilization efficiency of medical inspection resources and patient satisfaction, and to promote the effective implementation of intelligent services in medical alliance hospitals. MethodsBy analyzing the medical process of medical inspection appointments, and organizing the inspection appointment resources of each hospital according to the actual business characteristics of each hospital of the medical alliance by the unified medical inspection appointment platform. Through the unified big data platform, the business collaboration between the medical alliance hospitals and the sharing and scheduling of medical inspection resources among the hospitals of the medical alliance are realized. ResultsThe construction and use of the medical alliance unified inspection platform has realized the sharing and utilization of inspection resources between hospitals in the medical alliance, which is convenient for patients to choose their own inspection resources across hospitals when making an appointment for inspection, and further improves patient satisfaction. ConclusionThe unified medical appointment platform unifies the management of the medical alliance's appointment examination resources, which can not only effectively improve the utilization efficiency of medical inspection appointment resources, but also expand the effective scope of patients' choice of medical inspection appointments, and at the same time improve patient satisfaction and promote the construction of hospital intelligent services.
Patient priority evaluation has been studied and applied abroad for a long time, which is a mature theory and widely used in practice now. This article uses the priority, patients, waiting list and criteria as keywords to search Wiley Inter Science, Web of Science, Scopus Pub Med, The Cochrane Library, Science Direct, Springer, and Jstor database (searching time is up to December 2017), to collect relevant indicators for patient admission priority evaluation. In addition, relevant citations and grey literature were searched, and experts from relevant fields in China were consulted to obtain more comprehensive research literature. On this basis, this article describes the concept of patient admission priority evaluation, and describes the meanings of the indicators and the countries of application from the three dimensions of clinical indicators, expected results, and social factors. It is considered that the research and implementation of the evaluation of the priority of patient admission has been relatively many. However, there are only a few related researches in the country and without unity. There is no systematic patient-related priority evaluation. It is necessary to use foreign mature theory research to establish a hospital admission priority evaluation system suitable for China’s national conditions.
ObjectiveTo explore a method for establishing a priority-scoring model for thyroid carcinoma patient admission. MethodsA questionnaire survey was conducted among specialists and outpatients in the thyroid surgery department of the hospital. The weight coefficient of the index factors was calculated to establish the priority-scoring mode by the analytic hierarchy process. The differences in results between specialists and patients were compared. The logical rationality of the model index was tested. ResultsA priority-scoring model for thyroid carcinoma surgery admission was established, including 10 first-level indicators, such as sex, age, cancer type and TNM stage. The weight coefficients of the indicators from high to low were cancer type (0.137), TNM stage (0.134), tumor size (0.127), tumor invasion degree (0.126), tumor invasion site (0.124), relationship between tumor and capsule (0.111), age (0.093), sex (0.061), place of residence (0.05) and medical insurance type (0.035). After the total ratio test, the model CR value was 0.0073, and the model index was highly rational. ConclusionThis study successfully establish a priority-scoring model for thyroid carcinoma surgery admission, which can provide references and a basis for tiered medical services and relevant researches in the future.
Objective To explor the influence of the hospital-community-family mental rehabilitation mode on the quality of life of patients with schizophrenia. Methods We selected 101 patients diagnosed as schizophrenia according to ICD-10, who were hospitalized in mental health center of the West China Hospital and took part in rehabilitation voluntarily after discharge. Those patients were randomly assigned to two groups. Hospital-community-family mental rehabilitation mode intervention was applied to the patients based on inpatient rehabilitation in the trial group (n=52), while inpatient rehabilitation alone was applied in the control group (n=49). The total score of quality of life, psycho-social dimension, motivation and energy dimension, score of mental disability and social function, and family social care index were recorded. Then, statistical analysis was performed using SPSS 17.0 software. Results After 3 months and 6 months, the trial group had lower scores of the total score of quality of life, psycho-social domain, and motive and energy dimension than those of the control group (Plt;0.05). After 6 months, the trial group had lower scores of mental disability and social function (Plt;0.05) but a higher score of family social care index (Plt;0.05). The scores of WHO-DSA II and SQLS were positively correlated, while the scores of APGAR and SQLS were negatively correlated. Conclusion The integral mode of hospital-community-family mental rehabilitation effectively improves the quality of life of patients with schizophrenia, which also positively improves patients’ rehabilitation.
Objective To evaluate the clinical effectiveness and safety of escitalopram in the treatment of major depression. Methods A randomized double-blind active-drug controlled trial was used to observe 56 patients with major depression. They were randomly divided into the treatment group (escitalopram, 28 patients) and the control group (citalopram, 28 patients). We used HAMD,CGI-I, and HAMA to evaluate clinical effectiveness and symptom-recording to evaluate safety. All outcomes were measured before treatment and at 14 days, 28 days and 42 days after treatment. Results According to an intention-to-treat (ITT) analysis in the Full Analysis Set with last observation carried forward (LOCF), the HAMD score decreased from baseline by 15.1±7.8 in the treatment group, and 12.1±7.7 in the control group. There was no significant difference between the two groups(t=1.42,P=0.1613). The rate of effectiveness, based on the percentage decrease of HAMD is 78.6% in the treatment group, and 67.9% in the control group(χ2 = 0.8195,P=0.3653). The HAMA score decreased from 15.1±3.7 to 3.3±4.5 in the treatment group, and from 14.0±4.1 to 5.0±3.7 in the control group(t=1.5756, P=0.1223). From the point of CGI, there was no significant difference between these two groups at any follow-up. At the end of the trial, the proportion of patients assessed to have a great improvement or more was 90.0% in the treatment group, and 87.8% in the control group (CMH=1.5013,P=0.2205). Side effects were recorded for 32.5% of the treatment group and 30.8% of the control group(χ2 =0.0770, P=0.7814). The most frequent side effects were nausea(11.7%), dry mouth(9.2%), dizziness(5.8%), insomnia(3.3%), hypodynamia(2.5%), transaminase elevation(1.7%), palpitation(1.7%), and constipation(1.7%). Conclusion The therapeutic action of escitalopram for the treatment of major depression is confirmed with less side effects than the well-proven antidepressant- citalopram.