In recent years, day surgery has developed rapidly in China. It is very important to ensure the medical quality and safety of day surgery patients post-discharge. However, there are no regulations, guidelines or policy on the quality and safety of medical care post-discharge in China yet. As one of the medical institutions which are the earliest to carry out day surgery in a standardized way in China, West China Hospital of Sichuan University has summarized the nearly 10 years’ experiences in day surgery, and formulated management norms after discharge of day surgery, including discharge evaluation, discharge guidance, follow-up after discharge, and emergency plan. This paper introduces the management norms for day surgery post-discharge from West China Hospital ofSichuan University, in order to provide reference for the management of the day surgery patients post-discharge medical care in China.
Severe trauma is a challenging medical problem. Uncontrolled post-traumatic hemorrhage and traumatic coagulation dysfunction are closely related to the prognosis of these patients. In May 2019, the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma published the fifth edition of the European guideline on management of major bleeding and coagulopathy following trauma. To assist Chinese in better understanding of the latest developments, this paper translated the main treatment recommendations in the guideline and interpreted the updated content from the fourth edition.
ObjectiveTo describe the status of quality of life (QOL) and self-management behavior in patients following mechanical heart valve replacement, and explore the relationship between QOL and self-management behavior. MethodsConvenient sampling was used to recruit 352 patients following mechanical heart valve replacement in a high-level hospital in Chengdu between January 2011 and June 2012. General information questionnaire, MOS SF-36 scales, and self-management behavior questionnaire were used to collect data. T-test was used to analyze the difference between patients and normal people. And correlation analysis was used to see the correlation between QOL and self-management. ResultsFor MOS SF-36 scale results in patients within one year after surgery, physical functioning (PF) score was 73.44±15.11, role-physical (RP) was 49.52±39.17, body pain (BP) was 63.13±17.93, general health (GH) was 58.85±14.88, vitality (VT) was 63.54±18.10, social functioning (SF) was 76.67±17.40, role-emotional (RE) was 64.96±41.37, and mental health (MH) was 72.76±17.40. All these scores of the patients were significantly lower than the norm of Sichuan Province (P<0.05) except the dimension of mental health. For patients one year or more after surgery, PF score was 76.53±14.41, RP 58.44±39.21, BP 68.16±18.26, GH 61.39±13.57, VT 68.47±16.37, SF 79.79±19.34, RE 72.94±37.29, and MH 75.87±14.70, among which PF, RE, BP and GH scores were lower than the norm (P<0.05). The average total score of self-management behavior was 143.21±20.63. QOL and self-management behavior were positively correlated. ConclusionThere is still a gap between patients following mechanical heart valve replacement and normal people in terms of quality of life. Patients' self-management behavior is positively correlated with the quality of life. Good self-management behavior contributes to the improvement of QOL.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
Gout is the most common inflammatory arthritis, which is characterized by elevated urate and monosodium urate (MSU) crystal deposition in tissues, leading to arthritis, soft-tissue masses (tophi), nephrolithiasis, and urate nephropathy. It has a major impact on health-related quality of life. The American College of Rheumatology (ACR) published ACR guidelines for the management of gout in June 2020, in which 42 recommendations (including 16 strong recommendations) were generated. The guideline described indications for urate-lowering therapy (ULT), approaches to initiating, ongoing management, gout flares, and lifestyle and other medication strategies in patients with gout and in individuals with asymptomatic hyperuricemia. This paper interprets it to provide references for clinical practice.
ObjectiveTo determine the effects of the management mode participated by doctors, nurses and patients on the safety of medical tubes for restlessness patients in the Neurosurgery Intensive Care Unit (NICU). MethodsA total of 133 restlessness patients treated between May 17 and November 22, 2013 were included in the study as control group, who were admitted to the NICU before application of the management mode participated by doctors, nurses and patients; another 119 restlessness patients treated between May 17 and November 22, 2014 were included in the study as research group, who were admitted to the NICU after application of the management mode participated by doctors, nurses and patients. Then we compared the accidental extubation situation between the two groups. ResultsThe accidental extubation rate of all kinds of medical tubes in the research group was lower than that in the control group, among which the extubation rate of urethral catheter (0.67% vs. 4.32%), gastric tube (2.26% vs. 10.14%), trachea cannula (1.08% vs. 7.84%), and arterial cannulation pipeline (1.12% vs. 6.93%) was significantly different between the two groups (P<0.05). ConclusionThe management mode participated by doctors, nurses and patients can effectively reduce the accidental extubation rate of medical tubes for restlessness patients, prevent the occurrence of adverse events and ensure the treatment and nursing safety in the NICU.
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
目前哮喘的治疗已经取得了显著的进步, 大多数哮喘按全球哮喘防治创议( GINA) 推荐的治疗方案进行规范治疗都可以获得良好的临床控制, 但仍有部分中重度患者难以获得良好的临床控制, 所以仍有必要探索针对这一部分哮喘人群的更好的干预措施。
ObjectiveTo provide a reference for the implementation of risk management in other medical institutions by introducing the practical experience of building a medical risk management system in West China Hospital of Sichuan University.MethodsBased on Donabedian’s SPO model, the practical experience in the construction of West China Hospital of Sichuan University was summarized from the aspects of structure, process, and results.ResultsThe establishment of medical risk management system made the hospital adverse event management effect good, and the risk management indicators were good. The average number of medical disputes in hospitals from 2016 to 2018 was 103.33, the average number of medical disputes per 100 medical practitioners was 7.01, the average number of medical disputes per 10 000 surgical cases was 6.55, and the average number of medical disputes per 10 000 cases was 0.18.ConclusionThe construction of medical risk management system is conducive to enhancing the awareness of medical risk prevention among medical institutions, continuously improving the quality of medical care and medical safety of hospitals, ensuring patient safety, promoting harmony between doctors and patients, and promoting the realization of healthy China.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).