目的:信息系统的改进应用是为确保急诊科预检分诊处将来能使医院对自然灾害事件的伤员救治时以最便捷、最快速的方式录入自然灾害事件伤员的信息资料和快速评估伤情，优先准确的将伤员按病情和就诊区域分类，以便畅通及时救治伤员；在治疗中和日后便于识别、查找、统计灾害事件伤员。方法:LIS（检验系统）+ RIS（影像系统）+ HIS（无纸化办公系统）三合一系统和增加自然灾害伤员的“录入信息资料”眉栏。结果:进一步改进信息网络应用系统后，能满足一般患者信息资料录入和自然灾害事件应急状况下的患者资料录入，实现电子病历和电子处方等信息网络系统，达到院内、科内资源共享。
分析国内急诊护理教育现状与发展情况，介绍自身急诊护理发展情况及教育成效。提出急诊护理教育必须注重急诊理论教育与专科操作技能的结合，综合运用课堂教学、读书报告、业务查房、论文撰写等多样的形式组织学习，并定期考核。通过急诊护理教育的拓新，必将保证急诊临床护理质量，促进专科发展。
目前，国内尚未制定出较为完整的康复医学专业常见骨关节疾病的康复临床路径，为适应现代康复医学发展的需要，四川大学华西医院康复医学科根据卫生部《临床路径管理指导原则》要求，结合康复医学科住院患者的疾病、康复评定、康复治疗、康复护理、康复教育等，于2011年制定了康复医学科常见疾病的康复临床路径，希望通过临床试用，对路径的临床实用性、可行性进行探讨，并逐渐完善。
目前，国内尚未制定出较为完整的康复医学专业常见骨关节疾病的康复临床路径，为适应现代康复医学发展的需要，四川大学华西医院康复医学科根据卫生部《临床路径管理指导原则》要求，结合康复医学科住院患者的疾病、康复评定、康复治疗、康复护理、康复教育等，于2011年制定了康复医学科常见疾病的康复临床路径，希望通过临床试用，对路径的临床实用性、可行性进行探讨，并逐渐完善。
卫生部下发《临床路径管理指导原则(试行)》(卫医管发〔2009〕99号)的通知, 希望建立一套既能贯彻医院质量管理标准, 又能节约资源的医疗标准化模式。为适应现代医学和康复医学发展的需要, 采用康复临床路径对康复治疗进行规范, 是非常重要的。四川大学华西医院康复医学科根据临床路径要求, 于2011年制定了康复医学科膝骨关节病康复临床路径, 希望通过临床试用, 对路径的临床实用性、可行性进行探讨, 并逐渐完善。
【摘要】 目的 〖JP2〗研究质子泵抑制剂（PPI）是否为危重患者发生医院获得性肺炎的危险因素。 方法 收集2002年6月-2009年6月收治的198例重症患者资料，分为使用PPI组（96例）和未使用PPI组（102例）。采用logistic回归分析PPI使用情况和医院获得性肺炎的关系。 结果 使用PPI组肺炎的发生率较高（26.9%），尤其是PPI使用时间超过7 d者（37.5%）。在不同的多变量logistic回归模型中，分别用APACHE Ⅱ评分和入住重症监护室原因校正后，使用PPI以及使用天数均是医院获得性肺炎发生的危险因素（P=0.031，OR＝2.230，95%CI：1.957~2.947；P=0.002，OR＝1.824，95%CI：1.457~2.242）。 结论 长时间应用PPI可能是增加ICU患者发生医院获得性肺炎的一种风险因素。【Abstract】 Objective To identify whether proton pump inhibitors (PPI) is a risk factor of hospital-acquired pneumonia (HAP) in critical patients. Methods The clinical data of the critical patients admitted to ICU from June 2002 to June 2009 were retrospectively analyzed. A total of 198 patients were divided into two groups: 96 in PPI group and 102 in non-PPI group. The relationship between PPI and HAP was analyzed by logistic regression. Results The patients in PPI group had a higher risk of HAP (26.9%), especially who were treated with PPI more than 7 days (37.5%). Adjusted by APACHE Ⅱ score and reason for admission to ICU, PPI therapy and the using duration of PPI were both the risk factors of HAP in different multiple logistic models (P=0.031, OR=2.230, 95%CI: 1.957-2.947; P=0.002, OR=1.824, 95%CI: 1.457-2.242). Conclusion Long-term use of PPI is a risk factor of HAP.
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1—3N0 gastric cancer. Methods One hundred and twenty patients with stage pT1—3N0 gastric tumors were included, and 2 106 lymph nodes were harvested and examined in all the specimens. There were 9－28 lymph nodes with average 18 lymph nodes from each patient. All the lymph nodes were negative by HE staining. The CK20 expression of lymph nodes was tested by immunohistochemistry. The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed. Results The positive expression rate of CK20 was 9.07% (191/2 106) in lymph nodes and 26.67% (32/120) in patients with pT1—3N0 gastric cancer by immunohistochemistry. Eleven cases were with micriometastasis, 21 cases were isolated tumor cells (ITC). The average postoperative follow-up was 66.35 (range 24—121) months. Five-year disease free survival rates were 87.4%, 78.3%, and 40.9% for the lymph node negative, ITC, and micrometastasis groups, respectively. Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group (P=0.000) and ITC group (P=0.046). However, there was no significant difference between the lymph node negative group and ITC group （P=0.253）. Multivariate analysis identified tumor diameter (P=0.011), depth of tumor invasion (P=0.043), and lymphatic vessel invasion (P=0.002) were related with CK20 positive expression. There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates. Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi), the restage rate was 9.17%. While the lymph node negative (88 patients) and ITC (21 patients) were recorded pN0(i-) and pN0(i+), respectively, and were not recommended restage (stage pN0). Conclusion Patients with stage pT1—3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate, for whom adjuvant therapies may be justified and effective.
Objective To explore the referral patterns for rehabilitation of patients with spinal cord injury (SCI) in community hospitals and establish green channel for SCI rehabilitation between community hospitals and large comprehensive hospitals. Methods Thirty SCI patients who were referred from the Center of Rehabilitation Medicine, West China Hospital to community hospitals between February 2013 and June 2014 were selected for this study. All the patients were assessed with American Spinal Injury Association (ASIA 2011), activities of daily living (ADL), and instrumental activities of daily living (IADL). Based on the assessment results, rehabilitation plan was made and the patients underwent community rehabilitation treatment. Results After rehabilitation treatment in community hospitals, the scores of ASIA, ADL and IADL in all the SCI patients were significantly higher than those at the time of referral (P<0.001). Conclusions SCI patients can accept rehabilitation treatment in community hospitals with good conditions. This practice can provide a new type of seamless referral pattern between large comprehensive hospitals and community hospitals for rehabilitation of SCI patients.
Objective To summarize the progress of biological indexes which could predict the efficiency of neoadjuvant chemotherapy for breast cancer. Methods Various related researches were collected to make a review. Results Many indexes linked to the efficiency of neoadjuvant chemotherapy for breast cancer according to several studies. According to many studies, indexes such as human epidermal growth factor receptor-2 (HER-2) gene, estrogen receptor (ER), progesterone receptor (PR), Ki-67, P53 gene, neutrophil to lymphocyte ratio (NLR), platelet level, and mean platelet volume (MPV) may have association with the outcome of neoadjuvant chemotherapy in treatment of breast cancer, and these factors maybe individual biomarkers to predict the efficiency of the treatment, but no coincident conclusion has been reached for these indexes. Conclusion The value of these indexes that predict the efficiency of neoadjuvant chemotherapy is not sure, further study need to be done to solve this topic.
Objective To summarize types of post-mastectomy breast reconstruction and present situation. Method The relevant literatures about post-mastectomy breast reconstruction in recent years were reviewed. Results With the increasing incidence of the breast cancer and the progressing of the treatment methods, it has become a trend for the post-mastectomy breast reconstruction. If the patient’s condition is allowed, the post-mastectomy breast reconstruction can be performed. At present, the post-mastectomy breast reconstruction mainly include the implant based reconstruction, autologous tissue reconstruction, autologous fat transplantation, etc.. There are different options for the breast reconstruction according the indicators and it had the corresponding complications. So the selection of reconstruction technique depend on the individual requirements, determining by the patient choice, advice of the reconstructive surgeon, and anticipated post-mastectomy therapy, particularly the needs for the radiotherapy and chemotherapy, etc.. Conclusions Post-mastectomy breast reconstruction is common abroad, corresponding research has been carried out in our country, experiences in learning are shairing. With deepening of domestic and foreign exchanges and progressing of technology, it is believed that post-mastectomy breast reconstruction might become one of conventional reconstruction options in future.