Objective To explore the effect of applying evidence-based medicine theory to quality management in long-term-system clinical medicine teaching. Methods We introduced the concept of evidence-based quality management system of clinical medicine to the delivery of teaching with Internet-based teaching quality real time supervision system as the core. A special quality scale was used to assess the teaching quality of teachers and the results were analyzed by SPSS 10.0 using u test. Results The system stored 853 280 pieces of data from the years 2001 to 2003. Up to 96.4% (275/285) of the evaluated topics scored over 85 points. Whether the teachers had overseas experience or not and whether their ages were over 45 or not had no significant influence on the teaching quality (P ＞0.05), but their degrees had influence on the teaching quality (P ＜0.05). Conclusion In long-term-system clinical medicine teaching quality management, we should apply the concept and approach of EBM to our practice so that we can ensure that the teaching quality of long-term-system clinical medicine will improve steadily.
ObjectiveTo summarize the treatment results of double aortic arch (DAA) by minimally invasive surgical technique. MethodsWe retrospectively analyzed the clinical data of DAA patients who underwent minimally invasive surgeries in our center between October 2016 and August 2021. ResultsThere were 11 males and 4 females with a mean age of 3-61 (20.00±18.80) years. There were 8 patients of DAA and 7 patients of DAA complicated with distal left-sided aortic arch atresia and ligamentum connection. All patients received operations through minimal subaxillary incision, 13 patients were through left side and 2 patients were through right side. One patient with ventricular septal defect was performed operations concurrently under the cardiopulmonary bypass through right minimal subaxillary incision. All patients had symptom improvement without surgery related complications or death in postoperative period. The duration of operation was 30-192 (61.93±40.19) min and mechanical ventilation time was 2-9 (5.33±2.53) h. The length of ICU stay was 18-124 (51.00±38.07) h and hospital stay time was 8-21 (12.67±3.42) d. All patients had symptomatic relief with good growth and exercise tolerance during the follow-up of 6 (3, 9) months. ConclusionMinimally invasive surgical technique is a safe, effective and cosmetic approach with good results for DAA treatment.
ObjectiveTo analyze the surgical results of patients with supracardiac total anomalous pulmonary venous connection (TAPVC) in a single pediatric cardiac center.MethodsA retrospective study was conducted on 98 pediatric patients with supracardiac TAPVC receiving surgical repair from 2014 to 2019 in our center. There were 64 males and 34 females with a median surgical age of 3.0 (1.5, 7.0) months and a median weight of 5.0 (4.0, 6.0) kg. Twenty-three (23.5%) patients had preoperative pulmonary vein obstruction. Ninety-two (93.9%) patients received conventional surgical repair, while six (6.1%) patients were treated with the sutureless technique. The Cox regression model was used to analyze the data.ResultsThe median follow-up time was 26.50 (5.75, 44.25) months. There were 9 (9.2%) deaths. Lower weight at the time of repair (P=0.013) and prolonged cardiopulmonary bypass time (P=0.007) were associated with mortality. Postoperative pulmonary vein obstruction was observed in 8 (8.2%) patients. Associated risk factors for postoperative pulmonary vein obstruction included lower weight at the time of repair (P=0.042) and prolonged cardiopulmonary bypass time (P=0.002).ConclusionSurgical repair of supracardiac TAPVC has achieved satisfactory results in our center. Risk factors such as lower weight at the time of repair and prolonged cardiopulmonary bypass time are associated with a poor prognosis.
ObjectiveTo introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection (TAPVC).MethodsClinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed, including 4 males and 7 females. The median surgical age was 1.4 (0.3, 27.0) months. The median weight was 4.3 (3.5, 8.5) kg.Six (54.5%) patients were of supracardiac subtype, and five (45.5%) patients were of infracardiac subtype. Five (45.5%) patients had preoperative severe pulmonary hypertension, and three (27.3%) patients had preoperative pulmonary vein obstruction. The surgical results were compared with those of 10 patients treated with conventional surgical technique.ResultsThe median follow-up was 12 (range, 1-65) months. During the follow-up, no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group. The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group, but the difference was not statistically significant (P>0.05). The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group (P=0.049).ConclusionThe modified sutureless technique which includes partial suture and then incising, and eversion of pulmonary vein incision, is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
Clinical practice guidelines are decision-making tools for bridging the gap between current best evidence and clinical practice. Studies have shown poor clinical applicability of existing guidelines, which may not be solved by improving the quality of guidelines alone. National medical management service guidance center is developing clinical practice guidelines of clinical evaluation system of construction projects, based on evidence-based method formulated by the target users of clinical guidelines evaluators’ applicability evaluation system of clinical practice guidelines. It aims to identify guidelines with high clinical applicability and provide the evaluation results of clinical applicability to developers and revisers of clinical guidelines, and then optimize the development and update, eventually improving the clinical applicability of guides and promote Chinese clinical guidelines in clinical application.
ObjectiveTo study the method of rapid and accurate measurement of body temperature in dense population during the coronavirus disease 2019 pandemic.MethodsFrom January 27th to February 8th, 2020, subjects were respectively measured with two kinds of non-contact infrared thermometers (blue thermometer and red one) to measure the temperature of forehead, neck, and inner side of forearm under the conditions of 4–6℃ (n=152), 7–10℃ (n=103), and 11–25℃ (n=209), while the temperature of axillary was measured with mercury thermometer under the same conditions. Taking the mercury thermometer temperature as the gold standard, the measurement results with non-contact infrared thermometers were compared.ResultsAt 7–10℃, there was no statistical difference among the forehead temperatures measured by the two non-contact infrared thermometers and the axillary temperature (P>0.05); there was no difference among the temperature measured by blue thermometer on forehead, neck, and inner side of forearm (P>0.05); no difference was found between the temperature measured by the red thermometer on forehead and inner side of forearm (P>0.05), while there was statistical difference between the temperatures measured by the red thermometer on forehead and neck (P<0.05). Under the environment of 11−25℃, there was no statistical difference among the forehead temperatures measured by the two infrared thermometers and the axillary temperature (P>0.05); the difference between the temperatures of forehead and inner side of forearm measured by the blue thermometer was statistically significant (P<0.05), while no difference appeared between the forehead and neck temperatures measured by the blue thermometer (P>0.05); there was no statistical difference among the temperatures of three body regions mentioned above measured by the red thermometer (P>0.05). According to the manual, the allowable fluctuation range of the blue thermometer was 0.3℃, and that of the red one was 0.2℃. The mean differences in measured values between different measured sites of the two products were within the allowable fluctuation range. Therefore, the differences had no clinical significance in the environment of 7–25℃. Under the environment of 4–6℃, the detection rate of blue thermometer was 2.2% and that of the red one was 19.1%.ConclusionsThere is no clinical difference between the temperature measured by mercury thermometer and the temperature measured by temperature guns at 7–10 or 11–25℃, so temperature guns can be widely used. In order to maintain the maximum distance between the measuring and the measured persons and reduce the infection risk, it is recommended to choose the inner forearm for temperature measurement. Under the environment of ambient temperature 4–6℃, the detection rate of non-contact electronic temperature gun is low, requiring taking thermal measures for the instrument.