ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis. MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life. ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) . ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma. Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method: a right anterolateral minithoracotomy group including 15 patients, with 7 males and 8 females, aged 45.1±15.4 years; a median sternotomy group including 26 patients, with 10 males and 16 females, aged 49.4±11.9 years. The clinical data of the two groups were compared. Results There was no significant difference in preoperative clinical data between the two groups. All patients completed the operation without perioperative death. There was no significant difference in the operation time, cardiopulmonary bypass time, aortic clamp time or the incidence of postoperative complications between the two groups. However, compared with the median sternotomy group, the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation, ICU stay and postoperative hospital stay, and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05). After 3–106 months follow-up, no recurrence was observed in both groups. Conclusion Compared with traditional median sternotomy for left atrial myxoma resection, right anterolateral minithoracotomy is safe, effective and less traumatic. It can be used as a routine treatment for left atrial myxoma.
目的:总结分析25例地震伤致气性坏疽伤员的救治经验，探讨救治方案，为临床工作提高参考。方法:回顾性研究25例地震伤致气性坏疽伤员的早期临床表现，诊断方法，隔离措施、临床管理及其预后。结果:共收治25例气性坏疽伤员，无一例死亡。院外诊断7例，院内诊断18例。截肢18例，开放性截肢12例，非开放性截肢6例；扩创7例。发生急性肾功能衰竭2例，行血液透析治疗后肾功能恢复；无院内交叉感染的发生。结论:早期诊断、治疗、早期隔离及全面、系统护理可以提高临床救治水平，改善患者的预后，避免院内交叉感染的发生。
This investigation analyzes the management of medical schools merged with comprehensive universities through internet search and research review in order to reveal management model and effect of the merger. The conclusion is safely reached that governance models are divided into two different patterns: centralized management and decentralized management. Eight universities, representing the two models, were selected and evaluated comprehensively. Among them, the universities that carried out decentralized management have greater development after the merger based on a quality comparison concerning freshmen, faculty, teaching and research between the two patterns. In China, decentralized management in comprehensive universities is more beneficial to the development of medical schools
ObjectiveTo evaluate the role and value of multidisciplinary team (MDT) in the decision-making for the treatment of elderly patients with large hepatocellular carcinoma (HCC) with multiple organ dysfunction. MethodThe clinicopathologic data of an elderly patient with large HCC with multiple organ dysfunction admitted to Dongguan Hospital of Southern Medical University were analyzed retrospectively. ResultsThe patient was an 82 years old male patient with asthmatic bronchitis, long-term hormone use, severe pulmonary ventilation dysfunction, moderate pericardial effusion, hypertension, and poor liver function compensation. After MDT discussion including 10 departments and full communication with the patient and his families, the open hepatectomy for hepatic S5 and S4b and cholecystectomy were proposed to perform. The operation process was smooth, and the patient was discharged on the 15th day after the operation without any complications. After discharge, lenvatinib was taken and thymosin alpha for injection was injected. At present, the patient’s quality of life was better, and there was no tumor recurrence or metastasis. ConclusionsFor the elderly patients with large HCC with severe cardiopulmonary dysfunction, the risk of treatment is higher. By MDT mode, the optimum treatment scheme for patient could be formulated to ensure efficient and accurate diagnosis and ensure high-quality treatment process, so as to maximally benefit patient.
ObjectiveTo systematically review the efficacy and safety of early abdominal paracentesis drainage (APD) in patients with severe acute pancreatitis (SAP). MethodsThe PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials and cohort studies on the management of SAP via early APD from inception to December 10, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software and Stata 17.0 software. ResultsEighteen studies were included, with a total sample size of 2 685 patients. The meta-analysis showed that early APD could decrease mortality (OR=0.49, 95%CI 0.35 to 0.69, P<0.01) and the incidences of multiple organ failure (OR=0.56, 95%CI 0.45 to 0.71, P<0.01), ARDS (OR=0.54, 95%CI 0.41 to 0.71, P<0.01), and infectious complications (OR=0.72, 95%CI 0.57 to 0.92, P<0.01) and also reduce the need for further interventions and the total cost incurred during hospitalization, reduce the length of hospital stay, and reduce the number of days spent in the intensive care unit. However, there were no significant differences in the incidence of pneumonia, bacteremia, and sepsis between the two groups. ConclusionThe treatment of SAP via early APD, which has high clinical value, could decrease the incidence of multiple organ failure, improve the prognosis of patients, and reduce the associated mortality rate. Moreover, APD does not increase the risk of infection-related complications. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To explore the effects of the centralized management of bed use in a large-scale integrated hospital. Methods We selected the staff with good quality for centre work after setting up the bed use centralized management centre in the West China Hospital. Then, we formulated unified an admission principle and incorporated it into the systematic management and control, made a short instructional video for rolling show in the centre so as to let the patient know basic conditions of this hospital before admission; and regulated the admission process for patients’ convenience. Results After more than one year, the centre simplified the in-patient admission procedures, regulated the process, saved nursing manpower (24 persons), and increased patients’ satisfaction (from 89.30% to 93.25%). Meanwhile, the bed use rate was increased and the average length of stay was shortened the to some extent, which improved the order in wards. Conclusion Unified bed use management centre established in large-scale integrated hospitals, can save nursing manpower, simplify the admission process of patients, and meet the need for the development of hospitals, which is worthy of promoting application.
Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.
Objective To evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.