目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
Objective To improve the satisfaction of standardized remote consultation of epilepsy center in patients with refractory epilepsy, and initially establish a standardized remote consultation model of three-level comprehensive epilepsy center. Methods Based on the characteristics of our epilepsy center, we designed a set of standardized remote consultation process of epilepsy center in tertiary hospitals, including sorting out patient data before consultation, improving examination, application of multi-modal technology during consultation, notification of results after consultation, and decision of operation time and method. A total of 209 patients who received remote consultation in our epilepsy center from January 2022 to June 2023 were selected as the observation group, and 150 patients who received offline consultation in our epilepsy center during the same period were randomly selected as the control group. The satisfaction of patients in the two groups on the service of doctors and nurses in consultation and the consultation results were compared. Results Through the application of the new multi-modal remote consultation mode, the number of consultations gradually increased, Compared with the offline consultation mode, there was no significant difference in patients' satisfaction with the service of doctors and nurses in remote consultation mode (P<0.05). Conclusion The establishment of standardized remote consultation mode in epilepsy center has effectively reduced the economic burden of patients, simplified the medical treatment process and improved the service quality, but the consultation quality has not been affected.
According to a guideline on promoting the high-quality development of public hospitals issued by the General Office of the State Council and a guideline on accelerating the development of medical rehabilitation, a high-quality and efficient rehabilitation system should be established, and efforts should be made to promote the high-quality development of rehabilitation services in public hospitals. We propose an action guideline for promoting the high-quality development of rehabilitation services in public hospitals, which is based on a Delphi method questionnaire on the opinions of front-line clinical rehabilitation experts, and integrated with relevant literature and evidences. This guideline introduces 31 specific action plans from 7 dimensions, including standardization of basic rehabilitation settings, standardization of clinical rehabilitation techniques, improvement of the tertiary rehabilitation system, standardization of emergency rehabilitation, standardization of rehabilitation education, standardization of rehabilitation management, and promotion of scientific and technological innovation in rehabilitation medicine.
We summarize the primary structure, objective and achievements of the resident standard training program in West China Hospital of Sichuan University during the past decade. We also give some advices on how to develop and accomplish future goals of resident standard training.
Research on the Chinese medicine standardized calendar is not only required for the development of evidence-based pharmacy, but it is also needed in order to adapt to, and promote, clinical rational use of Chinese medicine. The experience of the clinical calendar is summarized in this article. This may provide some significant clues and basis for the design and conduct of research when constructing a Chinese medicine standardized calendar.
ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.
Primary bronchopulmonary carcinoma occurs in the bronchial mucosa epithelium, also called lung cancer (LC), and has currently become the first cause of death of malignant tumors in China. With constant efforts of Chinese physicians, the diagnosis and management of LC has made certain progress, but standardized surgery for LC still varies to a great extent due to difference regions, nature of medical centers, and technical levels. Complete and standardized surgical resection can provide good long-term survival for patients with stageⅠ, Ⅱand partly ⅢA LC, and cannot be a substitute for other treatment, which shows the importance of standardized surgery. As the most solid member, surgery plays a decisive role in comprehensive multidisciplinary treatment of LC. Today's medical development requires thoracic surgeons to provide most standardized and individualized treatment with principles of evidence-based medicine. This review focuses on progress of standardized surgery for stage Ⅰto ⅢA LC.
Objectives To investigate the personnel allocation and workloads of the medical residents across the subspecialties of the Department of Internal Medicine at a tertiary hospital. Methods A cross-sectional survey was performed to investigate personnel allocation and workload. The resulting data were compared with the ministerial standard that regulates the training of medical residents. Results Aside from the subspecialty of Rheumatology, medical residents accounted for 40% to 70% of the total staff physicians. The faculty physicians accounted for only 20% to 50% of the total. When the non-faculty residents were not taken into account, each individual faculty physician took charge of between 5.3 to 15.5 beds across all the subspecialties. When only the non-faculty residents were accounted for, each individual resident took charge of 1.7 to 9.4 beds, 1.3 to 5.7 bed-days per day, and 5.8 to 17.3 patients per month. When both were accounted for, each physician was responsible for 1.3 to 5.9 beds, 1 to 3.6 bed-days per day, and 4.2 to 10.7 patients per month. In comparison with the ministerial standards, medical residents have managed more patients per month in the subspecialties of Nephrology, Respiratory Diseases, Digestive Diseases, Neurology and Infection.Fewer patients were managed in the subspecialty of Endocrinology. Conclusion The medical resident allocation is balanced across the subspecialties of the Department of Internal Medicine, although it is less stable. The total number of physicians is smaller than required, and physicians generally bear an overload of work. The number of patients managed by each individual resident is more than the requirement set by the ministerial standards, and has significant variations across subspecialties. Medical residents need to be allocated in accordance with the corresponding workloads.