Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
目的 探讨提高临床护理质量的管理方法。 方法 利用归因理论，对2009年12月－2010年11月护理部3级综合质量检查、午夜间及节假日2级护理质量检查、科室1级护理质量自查存在的128项问题进行回顾性归因分析。 结果 危重患者护理、病房规范化管理、5年内护士、午间时段为扣分项目多发点。 结论 护理人力资源合理配置、质控归因分析会、低年资护士培训、抓重点时间段、注重人性化管理等有望改变现状。
Medical quality and patient safety will be impacted by infection prevention and control directly. There will be many challenges on infection prevention and control, especially in large general hospitals. In the practice of infection prevention and control, the quality control work for infection prevention and control needs to establish a service concept, pay attention to the scientificity and precision of management. Multi-disciplinary team work and evidence-based medical study will also play an important role in infection prevention and control. Overall, quality management of infection prevention and control should be developed scientifically and normatively. Based on the practical experience of infection prevention and control, this article summarizes the experience of infection prevention and control management quality control in the First Affiliated Hospital of Zhengzhou University, in order to provide a reference for the research and management practice of infection prevention and control management quality control strategies.
ObjectiveTo investigate the current situation of orthopedic quality control and management in county-level regional general hospitals in Guangdong, and to provide a scientific basis for further standardizing the procedures of orthopedic quality control and management in county-level regional general hospitals and continuously improving the work of provincial orthopedic quality control center.MethodsFrom June 2019 to July 2020, online and offline questionnaire survey and field survey were used to investigate the quality control and management of orthopedic departments in 22 county-level regional general hospitals in Guangdong.ResultsAmong the overall scores of the surveyed hospitals, the highest score was 96.5, the lowest score was 72.0. There were 6 hospitals with a total score of “excellent” (accounting for 27.3%). The “facilities and equipment” and “medical quality” of the surveyed hospitals were relatively valued. Taking Guangzhou, the capital of Guangdong as the center, the districts and counties were divided into the east, the south, the west and the north regions, and the difference in overall scores of orthopedics among the four regions was statistically significant (F=6.299, P=0.004). The unqualified rates of department setting, key technology development, average hospitalization days of representative diseases, equipment allocation, personnel allocation, department management and building layout were relatively high, which were 77.3%, 63.6%, 45.5%, 40.9%, 40.9%, 36.4% and 36.4%, respectively. Most hospitals had set up special debridement rooms in orthopedic department (95.5%), and the management and monitoring of the use of antibacterial drugs was mostly reasonable (90.9%). In terms of the level of orthopedic medical treatment, only 3 hospitals with sufficient key technologies reached the standard, accounting for 13.6%, and only 7 hospitals reached the standard of scientific research capacity, accounting for 31.8%. In terms of quality control, the numbers of hospitals with qualified medical record sampling (72.7%), perfect management and supervision mechanism (86.4%) and quality management team in departments (77.3%) were the least. In addition, among the investigated hospitals, beds were in short supply in orthopedic departments, with 12 hospitals accounting for 54.5% being deducted; 16 hospitals (72.7%) were deducted for unqualified doctor-patient ratio and 11 hospitals (50.0%) were deducted for unqualified nurse-patient ratio.ConclusionsThe overall level of orthopedics construction and management in the surveyed hospitals is uneven. The medical professional and technical level is insufficient. It is difficult to meet the practical needs, and there is an imbalance in the ratio of medical personnel. In the future, it is necessary to strengthen the quality control of orthopedic medical care, strengthen the medical technology training of county-level regional general hospitals and increase the medical and health resources and capital investment, so as to improve the quality control of county-level regional general hospitals.
With nearly four decades of progress in healthcare-associated infection prevention and control in China, the national quality control efforts in this field have been ongoing for the past ten years, advancing rapidly with significant achievements. Over the last decade, the team of infection control professionals involved in quality management and control in China has consistently expanded, accompanied by an enhancement of their skills. Management capabilities have steadily grown, and operational mechanisms have been continuously refined. As public hospitals transition into a new phase of high-quality development, emphasizing refined management models and intrinsic development of medical quality, it becomes crucial to further fortify the foundation and foster innovation in infection control work to ensure quality. This article provides an overview of the establishment and implementation of the National Center for Quality Control of Infection Prevention and Control, examines the current shortcomings and challenges in the field, and collectively explores the positioning and direction of the development of quality control efforts for infection prevention and control in China.
目的 依托四川大学华西医院的临床资源，建立了一个规范化、标准化的肿瘤组织标本库，对临床医学研究提供了珍贵的资源。 方法 于2009年6月创建四川大学华西医院肿瘤组织标本库、进行质量控制、规范化管理及总结实践经验。 结果 从创建肿瘤组织标本库至2012年2月，共收集各类肿瘤（胃、食管、肝、肺、肠、乳腺、胰腺、甲状腺、纵隔、肾脏、喉、脑）组织标本44 609例，包括肿瘤组织、肿瘤旁组织（距离肿瘤组织2 cm的组织）和切缘远端非肿瘤组织（距离肿瘤组织＞5 cm的组织）。对肿瘤组织标本进行有效和科学的管理，为科研提供了便利和高质量的资源。 结论 建立了一个国际标准化、规范化、信息完善的肿瘤组织标本库，可为肿瘤的发生、发展、转移及生物标志物的研究提供高质量的标本。
ObjectiveTo explore the application effect of standardized management on video-electroencephalogram (VEEG) monitoring.MethodsIn January 2018, a multidisciplinary standardized management team composed with doctors, technicians, and nurses was established. The standardized management plan for VEEG monitoring from outpatient, pre-hospital appointment, hospitalization and post-discharge follow-up was developed; the special quilt for epilepsy patients was designed and customized, braided for the patient instead of shaving head, standardized the work flow of the staff, standardized the health education of the patients and their families, and standardized the quality control of the implementation process. The standardized managemen effect carried out from January to December 2018 (after standardized managemen) was compared with the management effect from January to December 2017 (before standardized managemen).ResultsAfter standardized management, the average waiting time of patients decreased from (2.08±1.13) hours to (0.53±0.21) hours, and the average hospitalization days decreased from (6.63±2.54) days to (6.14±2.17) days. The pass rate of patient preparation increased from 63.14% to 90.09%. The capture rate of seizure onset increased from 73.37% to 97.08%. The accuracy of the record increased from 33.12% to 94.10%, the doctor’s satisfaction increased from 76.34±29.53 to 97.99±9.27, and the patient’s satisfaction increased from 90.04±18.97 to 99.03±6.51. The difference was statistically significant (P<0.05).ConclusionStandardization management is conducive to ensuring the homogeneity of clinical medical care, reducing the average waiting time and the average hospitalization days, improving the capture rate and accuracy of seizures, ensuring the quality of medical care and improving patient’s satisfaction.