ObjectiveTo understand the current research status of conservative mastectomy with breast reconstruction for breast cancer, so as to provide a reference for surgeons and patients with breast cancer to choose surgical method. MethodThe recently domestic and foreign literature on the research of conservative mastectomy with breast reconstruction for breast cancer was reviewed and summarized. ResultsAt present, conservative mastectomy mainly included nipple sparing mastectomy, skin sparing mastectomy, and skin reduction mastectomy. All three surgical methods were safe and effective in the treatment of breast cancer, and the complications could be controlled. When combined with breast reconstruction, the better cosmetic effect could be obtained, and the postoperative satisfaction and quality of life of patients were markedly improved. ConclusionsAfter comprehensively preoperative evaluation for patients with breast cancer, conservative mastectomy provides a treatment choice for them. After conservative mastectomy, individualized reconstruction scheme is formulated according to size and sagging degree of breast, as well as individual expectations of patients, which can obtain a higher quality of life while treating diseases for patients with breast cancer.
Objective To optimize the environment of outpatient clinics in large hospitals, facilitate the patients’ visits and improve the comprehensive management level. Methods From September to November 2015, 2 hospitals in each part of a provincial city (middle, east, west, north and south), a total of 10 hospitals were chosed by convenient sampling method. The forms, types and distribution of outpatient navigation service system were investigated and analyzed by using a self-designed questionnaire. Results There were a total of 14 forms of counseling-guide services in the 10 hospitals. Just 1 hospital provided all the 14 forms of counseling-guide services, and 2 hospitals provided 13 forms of counseling-guide services, which were relatively complete. While the other 7 large hospitals provided only 4 to 6 forms of counseling-guide services, which were relatively simple. Conclusion Qualified outpatient navigation service system can help patients to receive more effective treatment, optimize the environment, highlighting the modern hospital humanistic service and the concept of intelligent service and scientific management.
目的 调查在院前急救中医患双方对留置针使用的满意度，并就留置针在急救中应用的合理性进行研究。 方法 将我院急诊科2011年6月－8月院前急救的患者，按出诊顺序分为两组，观察组患者使用留置针穿刺建立静脉通道，对照组则采用一次性静脉输液针，并调查患者或亲属、穿刺操作护士就两种穿刺方法的满意度。 结果 观察组留置针一次穿刺成功者达198例（94.29%），对照组一次穿刺成功者为206例（88.79%），两组比较差异有统计学意义（P＜0.05）；护士对留置针使用满意度明显高于一次性静脉输液针；患者及家属对留置针在保持静脉通道通畅、输液肢体舒适的满意度较一次性静脉输液针高。 结论 静脉留置针在院前急救中能提高医患双方的满意度，值得推广使用。
ObjectiveTo carry out health education to day surgery patients, assist the smoothness of their operation, promote early recovery of patients and improve the quality of nursing and patients' degree of satisfaction. MethodsA total of 1 888 operations from January to May, 2013 were chosen to be the control group; and 2 136 operations from January to May, 2014 were regarded as the trail group. Patients in the control group accepted routine nursing and health education, while patients in the trail group accepted health education before and after surgery, and through telephone during the follow-up period. ResultsThe rate of failure to keep the appointment, the readmission rates, and the satisfaction rate to the nursing work were 0.28%, 0.94% and 94.71% respectively in the trial group, while were 3.50%, 3.07%, and 90.20%, respectively in the control group. the differeces between the two groups were significant (P<0.05). ConclusionPersonalized health education can ensure the smooth operation of day surgery, advance wound healing of the patients, and improve the day surgery ward care quality and patient satisfaction.
Patient satisfaction is regarded as a key component of measuring and reporting quality of medical services. It is also an important indicator in performance appraisal for public hospitals in China. Based on the literature review on the theories and practices of patient satisfaction assessment in China and other countries and areas, this paper performed an in-depth analysis on the theoretical frameworks and instruments for patient satisfaction assessment, as well as their applications in management practices. Further research and improvements are needed.
目的:了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。方法:采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取2.4‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata 3.0 进行数据录入、SPSS13.0进行统计分析。结果:共发放问卷240份,收回有效问卷229份(有效回收率95.4%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为45.4%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为33.6%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P值分别是0.033,0.001)。结论:震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。
ObjectiveTo explore the influence factors on inpatients' satisfaction, in order to identify influence factors for improving inpatients' satisfaction. MethodsA sampling survey was conducted in hospitals at different levels in Sichuan province. The satisfaction of inpatients in these hospitals was investigated by self-designed questionnaire. Then, a structural equation model on influence factors of satisfaction was constructed. ResultsA total of 1 237 inpatients from 12 hospitals were surveyed. The total satisfaction of these patients was 82.14%. The patients' satisfaction of grade A tertiary hospital in Chengdu city was obviously lower than that of the prefecture- and county-level hospitals (all P values <0.05). The fitting degree of structural equation model was good; Inpatients' satisfaction was mainly influenced by 5 factors including hospital values (HV), service quality of doctors and nurses (SQ), service process (SP), convenience of resources (CR) and comfort of facilities (CF). Of the 5 factors, the HV and SQ respectively ranked the 1st and 2nd to the influence degree on satisfaction. ConclusionThis study identifies the key influence factors on inpatients' satisfaction. Specific measures should be taken by hospital administrators to improve the quality of medical services and the satisfaction of inpatients.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.