目的 探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。 方法 回顾性分析四川大学华西医院消化内镜中心2010年1月－2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。 结果 38例患者，男18例，女20例，年龄8～80岁；病变下缘距肛门齿状线1～4.0 cm24例，侵及齿状线14例。病变大小（按病变最大径分类）：1.5～3.0 cm 12例，3.1～4.0 cm 8例，4.1～5.0 cm4例，5.1～7.0 cm 10例，10 cm 4例。病变直径在5.0 cm以下的24例患者，经首次手术治疗肿瘤完整切除，术后2例灶性癌变，追加外科手术；其余22例2个月复查，病变无残留，6个月复查，2例复发，经再次手术病变完整切除。随访1年，全部未见复发，治愈率为100%，无残留。病变直径5.1～7.0 cm的10例患者，经首次手术治疗肿瘤分次切除，2个月复查，6例病变完整切除无残留，6个月复查，其中2例复发，经再次内镜下手术切完病变，随访1年，无复发；另4例有残留，经再次内镜下手术切完病变，6个月复查无复发，随访1年，4例均未见复发。病变直径10 cm 的4例患者，经多次手术后复查均有病变残留，无法完全切除，患者拒绝外科手术。5.1 cm以上病变治愈率71.43%，残留率高达57.14%。本组术后出血16例，感染1例，直肠狭窄1例，肛门坠胀3例，无穿孔发生。 结论 内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效，对5.0 cm以下病变能一次完整切除，5.1 cm以上病变残留率高，需再次内镜下手术，10 cm以上病变切除不完全。应慎重选择病例，术后密切随访。
摘要:医院有效事前监测、管控医疗不良事件，是保障患者安全、提高医疗质量的管理措施之一。超大型医院对医疗不良事件管理的实战中，建立、实施医疗安全隐患事件关键监测指标、医疗安全隐患事件筛查程序指标，积极开展医疗不良事件后台监管工作，切断医疗安全隐患事件向医疗风险事件演变、医疗风险事件向医疗纠纷事件演变的环节，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.
Microsurgery has always been the main treatment for large vestibular schwannomas. With the progress of microsurgical technique and neuroimaging, the application of the intraoperative physiological monitoring technology, as well as the popularization of the concept of minimally invasive neurosurgery, the current development trend of surgery for vestibular schwannomas is to realize both the maximal tumoral resection and the maximal preservation of facial nerve function, which puts more emphasis on the improvement of quality of life. It is still a challenge for neurosurgeons to resect the tumor to the maximum extent and preserve the nerve function as well. In view of this background, the strategy of " near-total resection” and " subtotal resection” combined with stereotactic radiotherapy has been more and more accepted in the past years. However, as a neurosurgeon, the ultimate goal should be " gross-total resection of tumor” and preservation of the nerve function as well. For those tumors severely adherent to neurovascular structure, " near total resection” might be a rational choice. Meanwhile, long-term follow-up should be conducted to clarify the biological behavior of tumor residues, as well as the necessity and long-term effect of stereotactic radiotherapy.
Objective To explore the differences between large and small studies in rare events meta-analysis. Methods Empirical data were collected from The Cochrane Systematic Review Database from January 2003 to May 2018. Meta-analyses with rare events, binary outcomes involving at least 5 studies, and at least 1 large study were screened. Peto and classical ORs were used to compare the magnitude, direction and P-value. Results A total of 214 meta-analyses were included. Among 214 pairs of ORs of large and small studies, 66 pairs (30.84%) were inconsistent in the direction of ORs based on Peto OR (Kappa =0.33), and 69 pairs (32.24%) were inconsistent in the direction of ORs based on classical OR. The Peto ORs resulted in smaller P-values compared to classic ORs in a substantial (83.18%) number of cases. Conclusion There are considerable differences between large and small studies in the results of meta-analysis of rare events.
Efficient disciplinary management in hospitals plays an important role in improving the level of medical services, promoting talent development, elevating research levels, and enhancing the overall strength of hospitals. At present, large comprehensive hospitals are facing increasingly complex challenges and problems in disciplinary construction and management. Bibliometrics, as a tool for literature analysis and evaluation, can assist hospitals in carrying out disciplinary management. This article explores the application and value of bibliometrics in hospital disciplinary management from the perspectives of disciplinary planning, optimizing resource allocation, evaluating disciplinary level, and exploring hot topics and development trends in disciplinary fields, and hopes to provide reference and ideas for peers.
Based on the scientific research management experience for many years and the characteristics and advantages of the hospital, West China Hospital of Sichuan University develops an innovative scientific research management model relying on deepening the top-level design of scientific research management, strengthening the information management means, establishing the assessment and evaluation system of full-time scientific research personnel, and creating the benchmark of scientific research technician training industry. The “West China Model” of innovative scientific research management has achieved remarkable results. The comprehensive strength of scientific research has been strong, the management strength of scientific research has been greatly improved, and the scientific and technological research on the epidemic situation has been accurately deployed. The “West China Model” of innovative scientific research management not only provides a working path for research hospitals, but also lays a theoretical foundation for the exploration and establishment of the “scientific research management-scientific research team-scientific research project” trinity innovative hospital scientific research management system, which plays a positive role in effectively stimulating the vitality of scientific research and improving the core medical technology.
Objective To investigate and analyze the 3-year physical examination results of the employees of a large financial enterprise in Chengdu, explore the key factors of health management and provide scientific basis for implementing reasonable health management. Methods The physical examination results of the employees of a large financial enterprise in Chengdu from 2012 to 2014 were analyzed, and the common abnormal results in the physical examination were summarized. Results The proportion of the employees whose physical examination results were completely normal in 2012, 2013, and 2014 was 4.97%, 2.01%, and 1.48%, respectively, showing a decreasing trend. Overweight, fatty liver and elevated triglycerides were always the top three of the abnormal examination results; the detection rates of which in the male staff were much higher than those in the female staff (P<0.05). In the female staff, the detection rate of overweight was always in the first place; the detection rate of columnar ectopy was always in the top three; the detection rate of liver cyst was in third place in 2013; and the detection rate of Nabothian cyst was in the second place in 2014. Conclusion The health management program of employees of this large financial enterprise is poor, thus health management should be paid enough attention to improve the employees’ physical quality.