摘要:目的:了解甘精胰岛素联合二甲双胍治疗对口服降糖药血糖控制不理想的2型糖尿病患者的疗效和安全性。方法:对30例口服降糖药血糖控制不理想的2型糖尿病患者给与甘精胰岛素联合二甲双胍治疗,共12周。治疗前后测身高、体重、空腹血糖(FPG)、餐后2小时血糖(PPG)以及糖化血红蛋白(HbA1c)水平。了解治疗期间低血糖发生情况。结果:治疗后的FPG、PPG以及HbA1c水平明显下降,分别下降了303mmol/L、510mmol/L和198%,差异有统计学意义(Plt;005)。治疗后5330%的患者HbA1c水平lt;70%。治疗前HbA1c水平≥70%lt;90%的患者,治疗后706%的患者HbA1c水平lt;70%,治疗前HbA1c水平≥90%的患者,治疗后307%的患者HbA1c水平lt;70%,两者的HbA1c达标率有明显差异(Plt;005)。治疗前后体重及BMI无明显差异(Pgt;005)。30例患者中仅发生两次轻微低血糖。结论:甘精胰岛素联合二甲双胍治疗对口服降糖药治疗血糖控制不理想的2型糖尿病患者是安全有效的,尤其是对HbA1c水平lt;90%的患者,血糖控制更好,达标率更高。
Objective To compare the postoperative outcomes of elderly and non-elderly patients undergoing inguinal hernia repair in same-day surgery mode, and explore the utility and safety of same-day surgery mode in inguinal hernia repair. Methods Patients who underwent inguinal hernia repair in Day Surgery Center, West China Hospital of Sichuan University between January 1st 2021 and October 31st 2021 were prospectively included. The patients were divided into elderly group (≥60 years old) and non-elderly group (18-59 years old). The preoperative conditions, postoperative outcomes, discharge readiness and social support of the two groups were analyzed. Results A total of 451 patients were enrolled, including 111 elderly patients and 340 non-elderly patients. The male proportion, prevalence rates of preoperative comorbidities, and bilateral inguinal hernia proportion in the elderly group were significantly higher than those in the non-elderly group (P<0.05), and the body mass index in the elderly group were significantly lower than that in the non-elderly group (P<0.05). There was no significant difference in anesthesia method, analgesic method, bleeding volume, or surgery time between the two groups (P>0.05). The postoperative pain score of the non-elderly group was higher than that in the elderly group (Z=–2.226, P=0.026), but there was no statistically significant difference in the rate of postoperative unplanned analgesia, rate of discharge delay, pain score on the third day after discharge, re-consultation within one month after discharge, complications within one month after discharge, or post-discharge satisfaction (P>0.05). The total score of social support was higher in the elderly group than that in the non-elderly group (31.77±3.04 vs. 29.75±4.78; t=4.182, P<0.001). Conclusion The same-day surgery mode for inguinal hernia repair is feasible and safe in elderly patients and worthy of implementation.
Objective To systematically review the abroad studies on patients for patient safety, and compare them with the current status of domestic studies, so as to provide suggestions for evidence-based strategic decision about how to conduct the education of patients for patient safety and improve the medical quality. Methods The databases of MEDLINE, EMbase and Chinese Biomedical Literature Database (CBM) were searched to identify the relevant studies and their references. Literatures were screened with data extraction in accordance with the predefined inclusive and exclusive criteria. The quality of literatures was assessed with the standard of Cochrane Handbook 5.0 and Critical Appraisal Skills Programme, and the data were comprehensively analyzed with qualitative research methods.Results Among 28 included studies, 5 were Chinese literatures, 1 was RCT, and the others were cross-sectional studies. The results showed that: a) Generally, the patients at home and abroad were poor in the awareness of patient safety, but they were eager to participate in the patient safety; b) Factors affecting patients’ participation were their characteristics, disease-related, and emotional feelings; c) Three studies reported the methods of involving patients in patient safety from the aspects of infection, malpractice, and medication; d) Some studies showed that patients’ participation could effectively promote the standardized operation of medical staffs, prevent unsafe events, and reduce damages; and e) The research contents of the included Chinese literatures were just related to the patients’ awareness of patient safety, attitude to participation, and influencing factors. Conclusion The limited studies relevant to patients for patient safety are short of high-quality RCTs for proving the effectiveness of patient participation methods, so it indicates that the stress should be laid on evaluating the effectiveness of patients for patient safety in future research.
During the medical rescue after the earthquake, the Security Department of West China Hospital understood those factors affecting the hospital safety in the earthquake disaster, established emergent communication platform and information release channel, and opened up special areas and passages for the wounded, so as to ensure smooth passages for the rescue work, security of disaster-relief materials as well as an orderly, safe and stable medical environment.
摘要:目的: 探讨临床护理安全规范化管理的有效方法和效果。 方法 :成立病房护理安全管理小组;完善护理安全管理制度,培养质量管理意识;改善重点环节工作流程,强化质量监控;构建护理安全文化氛围。 结果 : 患者满意度明显提高,用药错误、管道脱落、压疮、投诉等发生率明显降低(〖WTBX〗P lt;0005)。 结论 : 规范化的护理安全管理提高了护理质量,保障了患者的安全,有效降低了护理风险的发生。Abstract: Objective: To discuss a effective way and effect of standardardized management of clinical nursing safety.Methods :Setted up nursing safety management team; Improved the nursing safety management system and trained awareness of quality management; Improved workflow of key links,and strengthened the quality control; Built a nursing safety culture. Results : Patients satisfaction improved obviously, and the medication errors、 pipe off、pressure sores、the incidence of complaints such as decreased obviously(P lt;0005).Conclusion : Standardized management of nursing safety improved the nursing quality, protected patients safety, and effectively reduced the risk of the occurrence of nursing.
Objective To determine the extent of off-label drug use in pediatric outpatients of West China Second University Hospital in 2010, and to analyze its possible risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China and developing policy of off-label drug use. Methods The stratified random sampling was conducted to select prescriptions of children aged 0 to 18 years in pediatric outpatients of the West China Second University Hospital in 2010. According to drug instructions, off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs. In addition, an analysis was conducted to check the relationship between off-label use and following possible risk factors: age, sex, essential medicines and over-the-counter drugs. Results A total of 2 640 prescriptions with 8 588 medical advices involving 329 drugs were extracted and analyzed, with incidence rates of off-label drug use accounting for 76.59%, 40.88% and 83.89%, respectively. The main categories of off-label drug use were no pediatric information (35.57%), indication (25.44%), and dosage (25.31%). The top 2 age groups with highest incidence rate of off-label drug were neonates (54.35%) and adolescents (49.64%). The top 4 drugs with highest incidence rate of off-label drug were respiratory system medicines (48.12%), Chinese patent medicines (48.12%), digestive and metabolic system medicines (33.36%), and systemic anti-infectives (16.27%). The off-label use risks in all age groups in the hospital were indifferent, and the essential medicines and prescription medicines were likely to present higher risks of drug off-label. Conclusion Off-label drug use in pediatric outpatients is common with growth trend in pediatric outpatients of the West China Second University Hospital. On the one hand, drug instructions lack pediatric information, and on the other hand, it’s badly in need of developing relevant legislation, regulations or guidelines to regulate off-label drug use, providing more evidence by conducting clinical trials on pediatric drugs, encouraging the development and production of the applicable drugs and dosage forms for children, and establishing the children essential medicine list, so as to avoid doctor’s professional risk and ensure the safety of pediatric drug use.
ObjectiveTo investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus.MethodsFrom November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29# J-valveTM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.ResultsA total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good.ConclusionTAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.