目的 探讨围手术期患者静脉血栓预防的分级护理方法，为静脉血栓的预防提供实证依据。 方法 2009年5月－2012年1月，以某市级乙等综合性医院各科室手术患者为对象，引入量化工具评估患者围手术期静脉血栓发生的危险，并根据评估结果采取分级护理方法进行防治，并在患者出院时用彩色多普勒超声判断是否存在静脉血栓，以验证分级护理防治效果。 结果 纳入的318患者经评估均存在发生静脉血栓的风险，其中低度危险患者65例，中度182例，高度危险71例。经分级护理治疗，出院时均未发生静脉血栓症状、肺栓塞。 结论 分级护理方法安全、简便，可操作性强，便于围手术期患者静脉血栓的早期、普遍预防，值得推广。
Abstract: Objective To evaluate the prediction validation of European system for cardiac operative risk evaluation （EuroSCORE） in prolonged intensive care unit (ICU) stay, mortality, and major postoperative complications for Chinese patients operated for acquired heart valve disease. Methods Between January 2004 and January 2006, 2 218 consecutive patients treated for acquired heart valve diseases were enrolled in Fu Wai Hospital. All these patients accepted valvular surgery. Both logistic model and additive model were applied to EuroSCORE to evaluate its ability in predicting mortality, prolonged ICU stay and major postoperative complications of patients who had undergone heart valve surgery. An receiver operating characteristic curve（ ROC) area was used to test the discrimination of the models. Calibration was assessed by HosmerLemeshow goodnessoffit statistic. Results Discriminating abilities of logistic and additive EuroSCORE algorithm were 0.710 and 0.690 respectively for mortality, 0.670 and 0.660 for prolonged ICU stay, 0.650 and 0.640 for heart failure, 0.720 and 0.710 for respiratory failure, 0.700 and 0.740 for renal failure, and 0.540 and 0.550 for reexploration for bleeding. There was significant difference between logistic and additive algorithm in predicting renal failure and heart failure (Plt;0.05). Calibration of logistic and additive algorithm in predicting mortality, prolonged ICU stay and major postoperative complications were not satisfactory. However, logistic algorithm could be used to predict postoperative respiratory failure (P=0.120). Conclusion EuroSCORE is not an accurate predictor in predicting mortality, prolonged ICU stay and major postoperative complications, but the logistic model can be used to predict postoperative respiratory failure in Chinese patients operated for acquired heart valve diseases.
Objective To analyze the early clinical outcome of high-operative-risk coronary artery bypass grafting （CABG） classified according European System for Cardiac Operative Risk Evaluation （EuroSCORE）. Methods Classified eighty-four patients accepted CABG from Feb. 2004 to Sep. 2004 in our ward to high-operativerisk group （≥6, n=40） and low-medium-operative-risk group （0-5, n=44） according EuroSCORE. Record the operative schemes, complications after operation and evaluate the severe state with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment（SOFA） for all patients. Compare the early clinical outcome between the two groups. Results The operative mortality, ratio of long ICU-staying time, incidence of complications and severe degree of high-operative-risk group were higher than those in the low-mediumoperative-risk group. Standard EuroSCORE had significant positive correlation with either of A0, A1, Amax or S1, Smax counted in total patients （P〈0. 01）, and the same as logistic EuroSCORE （P〈 0. 05）. But when compared the relationships in certain risk ranks, only in high-operative-risk group the positive correlation was found between standard EuroSCORE and A1, Amax, S1 and Smax （P〈 0. 05）, between logistic EuroSCORE and Amax （P〈 0. 05）. Conclusion EuroSCORE could evaluate overall operative risk perfectly in our patients, and maybe more sensitively in the high-operative-risk patients. Many factors could improve the prognosis of high-operative-risk patients： accurate evaluation of the operative risk before surgery; perfect myocardial protection, effective myocardial revascularization and thorough correction of malformation in operation, and proper postoperative management in time.
Improving the quality of infection management in outpatient and emergency departments is crucial for ensuring medical safety and advancing infection control practices. To enhance the level of infection management in outpatient and emergency departments, Tengzhou Central People’s Hospital developed a two round risk assessment system for outpatient and emergency departments hospital infection management using risk matrix and failure mode and effects analysis methods, including hospital-outpatient and emergency departments, very high risk outpatient and emergency departments-high risk point. Based on the enterprise risk management integration framework, the risk management system has been optimized to provide decision support for the prevention and control of outpatient and emergency departments hospital infection. This article will introduce the practical exploration experience of optimizing management in outpatient and emergency departments hospital infection based on risk assessment.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Breast cancer, the most common malignancy in the world, also causes the most death cases of women among malignancies. Breast cancer risk reduction guidelines (version 2023) was updated by National Comprehensive Cancer Network (NCCN). Based on high-level evidences from evidence-based medicine and the latest research progress, the guidelines provided standardized guidance for breast cancer risk assessment and risk reduction strategies for individuals without a history of invasive breast cancer or ductal carcinoma in situ, which has attracted widespread attention from clinicians worldwide. Breast cancer is also the most common malignancy in Chinese women, and the number of newly diagnosed breast cancer cases each year in China ranks first in the world due to the large population, so the breast cancer prevention has become a major public health challenge in China. Aimed to provide reference for breast cancer prevention in China, this article interpreted the guidelines (the new version) based on the characteristics of breast structure in Asian women and the epidemiological characteristics of breast cancer in China.
Objective To validate the accuracy of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM), and to find out the relationship between clinical risk factors and the predictive value produced by ACPGBI-CCM. Methods The patients diagnosed definitely as colorectal cancer in the department of anal-colorectal surgery, West China hospital from April 2007 to July 2007 were analyzed retrospectively. And the predictive value of mortality for each patient was calculated by ACPGBI-CCM, then the difference of risk factors was compared by classifying the patients into lower risk group and higher risk group by making the median predictive mortality as a cut point. Results From April 2007 to July 2007, a total of 99 patients diagnosed definitely as colorectal cancer accepted treatment, and among which 67 patients included in this study were admitted whose average age was 60.09 years. And there were 34 male and 33 female patients; 15 right hemicolon cancer, 9 left hemicolon cancer, 43 rectal cancer; Dukes staging: A 0 case, B 37 cases, C 24 cases, D 6 cases. The observed mortality 30 days after operation was 0, whereas the predictive mortality was 0.77%-25.75% with a median value of 3.36%. Then the patients whose predictive mortality were ≤3.36% were grouped as lower risk group (34 cases), the others higher risk group (33 cases), and there was strikingly different predictive mortality between two groups 〔(8.86±4.51)% vs (1.76±0.68)%, P＜0.01〕. And between two groups, the age, internal medicine complications, preoperative chemotherapy, ASA grading, cancer resected, and operative time made predominant differences (P＜0.01); and the neoplastic complications, Dukes staging, TNM classification, postoperative pain showed differences, too (P＜0.05); however, the gender, history of abdominal operation, the distance of the neoplasm to anal edge, the cancer location, differentiated degree, postoperative hospitalization time, and total hospitalization time didn’t have any differences (Pgt;0.05). Furthermore, stratification analysis was made for risk factors, and it came out that there were great differences of predictive mortality for different age groups and ASA grading, having internal medicine complications or not, having chemotherapy or not, and for cancer resected or not, and the differences were statistically significant (P＜0.01); also different Dukes staging or differentiation could cause different mortality (P＜0.05); but the difference of mortality didn’t make any sense according to gender, having abdominal operative history or not, having neoplastic complications or not, different TNM staging and cancer location (Pgt;0.05). Conclusion The clinical applicability of the ACPGBI-CCM is ascertained in such a large volume single medical centre, but the ACPGBI-CCM overpredicts the mortality in this study which may be attributed to the different areas, nations, or the different cultures. The complications and the neo-adjuvant or adjuvant therapy are further found out that they may be independent predictive factors of survival, and more research will be needed to prove this.
Objective To comprehensively compare the methods and tools for medical risk management and assessment in the United Kingdom, the United States, Canada, Australia and Taiwan region (hereafter shortened as “four countries and one region”), so as to provide evidence and recommendations for medical risk management policy in China. Methods The official websites of the healthcare risk management agencies in these four countries and one region were searched to collect materials concerning healthcare risk management and monitoring, such as laws, regulatory documents, research reports, reviews and evaluation forms, then the descriptive comparative analysis was performed on the methods and tools for risk management. Results a) A total of 146 documents were included in this study, including 2 laws, 17 regulatory documents, 41 guidelines, 37 reviews and 49 documents about general information; b) The United Kingdom applied the integrated risk management; Australia and Taiwan adopted the classical risk management process, including risk identification, risk analysis, risk evaluation and risk control, while the United States and Canada mainly chose the prospective failure mode and effects analysis (FMEA) for clinical risk management; c) The severity of clinical risk was divided into five grades in the United Kingdom and Australia, and six in Taiwan, respectively. The frequency of medical risk was divided into five grades with four grade responses in above two countries and one region; and d) There were almost the same processes and tools about Root Cause Analysis (RCA), but a little difference in the objects of analysis in these four countries and one region. Conclusion?There are three models of risk management with the same assessment tools in these four countries and one region: the prospective risk assessment, the retrospective assessment based on occurred incidents and the integrated risk management. Although the grading of risk is similar, the definition of grading is different in the United Kingdom, Australia and Taiwan. The methods and processes of analyses on the adverse events are almost the same in these four countries and one region.
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
Surgical operation is the first choice for most patients who suffer from early non-small cell lung cancer. The risk of ordinary thoracic surgery is between intermediate and high risk. Due to the high incidence of postoperative pulmonary complications after thoracic surgery, preoperative cardiopulmonary reserve assessment is extremely necessary and important. In recent years, lots of assessment tools are clinically used, including pulmonary function tests, arterial blood gas analysis, breath-holding test and 6-minute walk test. In addition, cardiopulmonary exercise test is used extensively. This article reviews the current status of preoperative cardiopulmonary reserve assessment in thoracic surgery to guide clinical decisions, reduce postoperative complications and improve outcomes.