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外科监护室退药现象分析及对策

目的　通过对外科监护室退药现象的分析，从而寻求控制退药的途径与方法。 方法　收集外科监护室2011年1月－6月发生的退药信息，并对各退药原因进行统计分析。 结果　引起退药的原因依次是患者转出占49.4%、医生调整医嘱25.9%、出院死亡8.6%、医生错开5.1%、医院信息系统不完善3.6%、操作电脑失误2.5%、其他占4.9%。 结论　降低外科监护室退药比例应从控制转出患者退药、医生更改医嘱等方面入手，同时尽量降低因医生错开、电脑系统操作失误和信息系统不完善导致的退药。

中药糖衣片的变色原因及其对策

【摘要】在中药糖衣片生产、贮藏过程中,因糖衣层受潮引起颜色改变或发霉变质是较为常见的质量问题。应调整提取工艺、合理选用赋形剂、正确处理辅料中的糖及色素、严格执行工艺标准、改进包装、改善贮藏环境等解决措施,使中药糖衣片不易产生变色现象,保证药品质量。

Clinical Evidence of Unexplained Infertility

影响剖宫产术后母乳喂养的因素分析及干预措施

目的　讨论提高剖宫产妇母乳喂养率的方法及途径。 方法　2010年2月－2011年2月，将300例拟择期行剖宫产术的单胎初产妇，按随机抽取法分为观察组和对照组，对其进行母乳喂养宣教及干预，并就术后两组母乳喂养状况进行观察对比。 结果　观察组母乳初动时间早于对照组，两组差异有统计学意义（Z=?6.771，P=0.000）；观察组母乳量充足时间早于对照组，两组差异有统计学意义（Z=?4.748，P=0.000）。 结论　术前对产妇进行母乳喂养宣教，术后对产妇母乳喂养给予相关协助与指导是提高母乳喂养的关键。

Causes and solutions of dissatisfied complaints about frame glasses wearing after medical optometry

Objective To explore the causes and solutions of dissatisfied complaints about frame glasses wearing after medical optometry to improve service quality. Methods Patients with dissatisfied complaints about frame glasses wearing after medical optometry in West China Medical Center of Optometry Glasses between January 2013 and December 2014 were selected. Targeted re-examination and corresponding treatment was performed on them. The causes of their complaints were clustered and analyzed. Result There were 105 cases of complaints out of the 58 278 patients with frame glasses wearing after medical optometry, including complaints about wearing glasses uncomfortable in 58 cases (55.2%), mainly related to abnormal binocular vision, high myopia and progressive glasses lens fitting; quality of glasses in 23 cases (21.9%), in whom 16 were dissatisfied with the frame; quality of service in 10 cases (9.5%); glasses assembly / calibration in 7 cases (6.7%); and other dissatisfaction in 7 cases (6.7%). Conclusions In medical optometry, optometrists and sales staff should establish a good communication with patients according to individual differences, attach importance to the selection of right frame and lens in patients with high myopia or progressive piece of glasses, introduce the right wearing method of progressive piece of glasses, and enhance the follow-up service. For patients with obvious eye fatigue, it is needed to check the binocular visual function, if the visual fatigue is closely related to abnormal binocular visual function, special glasses fitting and functional training should be instructed to the patients.

The causes of Latarjet surgery failure and the revision surgeries

ObjectiveTo review the causes of Latarjet surgery failure and various revision surgeries, in order to provide the reference for the revision of treatment options for Latarjet surgery failure.MethodsLiterature on the causes of Latarjet surgery failure and revision surgeries was extensively reviewed and analyzed. ResultsLatarjet surgery is widely used in clinical practice for recurrent anterior dislocation of shoulder with glenoid defects, especially for the defects of more than 25%. The main reasons for its failure are ununion, bone resorption, graft dislocation, trauma, and graft fracture, etc. The revision surgeries are diverse, the standard treatment has not yet been formed. The revision surgeries include open iliac bone grafting, microscopic Eden-Hybinette surgery, soft tissue reconstruction, open or arthroscopic bone grafting, etc. The differences among the revisions are mainly reflected in grafts, complications, and their costs.ConclusionLatarjet surgery is difficult to operate and requires high technical requirements for the surgeons. It is necessary to continuously improve the surgical technology to reduce the complications related to Latarjet surgery and its revision surgery.

Evidence-Based Treatment for a Patient with Obscure Gastrointestinal Bleeding

Objective　 To discuss the common clinical problems and make the individualized treatment for a patient with obscure gastrointestinal bleeding by means of evidence-based medicine, so as to ultimately control the symptoms and reduce the mortality. Methods　 After the clinical problems were put forward, the systematic reviews and randomized controlled trials (RCTs) were collected in The Cochrane Library (online), MEDLINE, EMBase, SCIE and CNKI databases, from the date of their establishment to 2010. The treatment protocol was made by combining the assessment of evidence with the willingness of both patient and relatives. Results　 A total of 30 RCTs and 5 systematic reviews were identified. A rational diagnostic and therapeutic plan was made upon a serious evaluation of the data and willingness of patients. The Mickel’s diverticulum was found through capsule endoscopy, which was then locally excised under laparoscopy. After a 6-month follow-up, the plan proved to be optimal. Conclusion　 The treatment efficacy in diagnosed obscure gastrointestinal bleeding has been improved by adopting an individualized treatment plan according to evidence-based methods.

The Analysis of the Cause for Prehospital “120”Emergency Medical Services Cases Death

摘要:目的: 探讨基层医院急诊“120”院前救治水平的影响。 方法 :分析301例死因,年龄及百分比。 结果 :急诊致死原因疾病病谱前9位分别是交通事故,猝死,溺水,意外伤害,自杀,电击伤,刀伤,一氧化碳中毒及呼吸道梗塞,“无名氏”群体86例占285%,这部分给临床和社会带来了新问题,这仍有待今后继续探讨。 结论 :完善基层医院“120”体系,提高救治水平。Abstract: Objective: To explore the factors relate to prehospital“120”Emergency Medical Services cases death. Methods : Analysis the cause for death, ages and percentage of the age in 301 cases. Results : Traffic accident, sudden death, drowns, accident, suicide, electric burn, knife trauma, anthracemia and respiratory tract obstruction were the leading cases in the diseases spectrum of the cause for death in emergency cases. 86 cases were anonym, which brought new problems to clinic treatment and provoked social issue, accounting for 285% in total cases. These remain us to study henceforth. Conclusion : Consummate the “120” Emergency MedicalServices system in grassroots hospital and enhance the level of cure.

小儿烧伤惊厥的原因分析及干预措施

目的　探讨小儿烧伤并发惊厥的原因及护理措施。 方法　回顾性分析2010年3月－2012年2月收治的35例患儿烧伤并发惊厥的临床病历资料。 结果　小儿烧伤惊厥的原因有休克、高热、电解质紊乱、烧伤毒血症、脑缺氧脑水肿，各种原因之间相互影响。本组35例患儿中，惊厥持续时间30 s～5 min不等，34例治愈，1例因多器官功能衰竭死亡，所有患儿随病情而好转。 结论　小儿烧伤后并发惊厥的原因较多，在治疗和护理过程中应随时把握病情变化，正确处理患儿高热、电解质紊乱等，一旦发生惊厥应采取及时有效的救护措施，防止意外发生。

Analysis on 55 Cases of Orthopedic Medical Disputes

目的　分析骨科医疗纠纷的原因及特点，为医疗纠纷的防范提供参考。 方法　收集2010年1月－2011年12月四川华西法医学鉴定中心涉及四川省各级医疗机构的骨科医疗纠纷鉴定案例55例，进行回顾性分析。 结果　55例骨科医疗纠纷中2010年25例，2011年30例；医源性医疗纠纷41例（74.5%），非医源性医疗纠纷14例（25.5%）。医源性医疗纠纷中医疗机构存在的问题主要以手术操作不当及失误为主（15例，占27.3%），其次为医患沟通不到位（8例，占14.5%）。 结论　骨科医疗纠纷防范的关键在于医务人员认真履行其诊疗义务。