目的 探讨二级医院神经内外科整合的可行性及优越性，观察组织化医疗模式的临床效果。 方法 将神经内、外科整合为一个一级临床科室——脑系科，建立完善的多学科一体化治疗的组织化医疗网络体系。入选重型颅脑外伤和脑出血患者共289例，其中2004年8月-2008年12月在脑系科住院的重型颅脑外伤、脑出血患者共147例接受组织化医疗模式治疗，作为治疗组；2001年1月-2004年8月分散在我院内科、外科住院的重型颅脑外伤、脑出血患者共142例接受传统常规治疗，作为对照组。比较观察两组患者的治疗效果。 结果 治疗组神经功能缺损评分、日常生活活动能力评分和GCS分别为7.47±5.24、59.74±15.56和13.72±1.06；对照组分别为16.18±9.89、34.00±10.54和10.84±1.58。两组比较，差异有统计学意义(Plt;0.05)。治疗组与对照组比较，临床治愈率提高55.64%，平均住院日缩短10.34 d，病死率降低21.26%，并发症降低20.15%，致残率降低20.24%。 结论 采用组织化医疗模式能明显改善患者预后，缩短住院时间，提高患者的生活质量，是适合我国基层医院神经内、外科危急重症的治疗模式，具有其可行性及优越性。
Objective To explore the safety and feasibility of day surgery program of surgical treatment of mild to moderate gluteal muscle contracture. Methods We retrospectively analyzed the clinical data of the patients who received invasive surgery to release gluteal muscle contracture in West China Hospital of Sichuan University between July 2021 and July 2022. Postoperative telephone follow-up was conducted on the 2nd, 3rd, and 30th day after surgery. The basic conditions, surgery duration, intraoperative blood loss, anesthesia duration, pain score 6 h after surgery, hospitalization expenses, postoperative complications and patient satisfaction were observed. Results A total of 44 patients, 17 males and 27 females, aged 18-51 years with a median age of 30.5 years, diagnosed as bilateral mild to moderate gluteal muscle contracture, were included in this study. All patients except one with unilateral surgery were successfully finished the bilateral surgeries and discharged as planned. The mean surgery duration was (71±13) min, intraoperative blood loss was (20±17) mL, anesthesia duration was (118±21) min. All patients complained mild pain or no pain (Numerical Rating Scale score≤3) except one patient received pain rescue (Numerical Rating Scale score=5) 6 h after surgery. The average hospitalization expenses was (10021.55±1142.10) yuan. Three patients complained the poor wound healing. All patients replied a normal life and work with a good satisfaction and without any severe complications by telephone follow up on the 30th day postoperatively. Conclusion Surgical treatment of mild to moderate gluteal muscle contracture is safe, effective and feasible in the day surgery mode.
Objective To analyze the feasibility, possible problems and application of bilingual teaching rounds in vascular surgery teaching. Methods Ninety participants included internship, interns and residents of standardized training from 2015 to 2016 in vascular department of West China Hospital of Sichuan University were included. The questionnaire named the feasibility of bilingual rounds in surgery teaching was done and analyzed in all of these students. The results of the evaluation score from different teachers on their teaching process were also analyzed. Results Three groups could accept bilingual teaching rounds of this teaching form, and all of them were willing to be involved in, but their English levels and acceptance participate times were different. The CET4 levels of three groups did not have any difference; however, the CET6 levels had significant difference. There were significant differences in the preparation times and the review times (all P values <0.05), and there were no difference in acceptance, value and promote degree (all P values >0.1). In different teaching teachers' self assessment on the same objective, there was significant differences (all P values <0.05). Conclusion Bilingual rounds in surgery teaching have certain feasibility. Different adjustments are needed according to the English level and the grade, and higher request of the teacher is necessary.
Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis. Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University from 2021-2023 were retrospectively analyzed. Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study, 7 of whom had a history of diabetes and (or ) impaired glucose tolerance, suggesting that pancreatic endocrine function was impaired. The median diameter of the main pancreatic duct measured by imaging method was 8 mm (4–20mm). The median operative time was 188 min (120–368 minutes), and the total intraoperative bleeding volume was 50 mL (20–100 mL). Postoperative pancreatic fistula did not occur, one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection, acid and enzyme inhibition, and nutritional rehydration. Postoperative bleeding occurred in 3 cases, including 1 case of intestinal anastomotic bleeding, which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding. The other two cases improved after conservative management such as blood transfusion, plasma, vitamin K, acid inhibition, enzyme inhibition and hemostatic drugs. The median postoperative hospitalization time was 7 days (4–18 days), and no patient mortality happened within 90 days after surgery. Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.
ObjectiveTo understand the economic burden of disinfection supply to medical institutions in Yibin City, and explore the feasibility of establishing a regional centralized management model of disinfection supply center in Yibin City.MethodsFrom April to May 2018, 263 medical institutions in the eight counties and two districts of Yibin City were investigated by means of mobile phone application-designed questionnaire, to obtain the information of cost accounting and economic burden of disinfection supply.ResultsThere were 263 medical institutions involved in the survey, in which 61 (23.19%) had set up the central sterile supply department (CSSD), including 43 public hospitals and 18 private hospitals; 202 medical institutions were without CSSD, which were mainly secondary hospitals [195 (74.14%), including 120 public hospitals and 75 private hospitals]. The higher the hospital level was, the larger the average area of the CSSD was; the difference was statistically significant (χ2=40.009, P<0.001). The higher the hospital level was, the more full-time personnel were employed, and the difference was statistically significant (χ2=31.862, P<0.001), and the care staff were the majority (66.23%). The cost burden of CSSD was more than 1 million yuan in the tertiary hospitals, which was 100 000 yuan or above in 61.90% of the secondary hospitals, and was below 100 000 yuan in hospitals below secondary level. The higher the hospital level was, the higher the total cost burden became; the difference was statistically significant (χ2=37.995, P<0.001). ConclusionIn view of the heavy economic burden of CSSD in medical institutions and the unbalanced setting up of medical institutions below secondary level, the establishment of a regional CSSD centralized management model is a new direction, new trend, and new model for future development, which is conducive to improving the quality of disinfection and sterilization, reducing medical care costs, making rational use of health resources, effectively preventing hospital infections, and ensuring the medical safety.
Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (rs=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.
ObjectiveTo summarize the key technical points, applicability, feasibility, and safety of laparoscopic spleen-preserving distal pancreatectomy (LSPDP).MethodA retrospective analysis was performed for the clinical data of 22 patients who were admitted to the Affiliated Hospital of North Sichuan Medical College from September 2016 to November 2019, all patients planned to receive LSPDP.ResultsTwenty of the 22 patients successfully completed LSPDP, and 2 patients converted to laparotomy. One patient was transferred to laparotomy to suture the damaged splenic artery. The spleen was observed to have no ischemia and the spleen preservation operation was continued. One patient was converted to laparotomy due to the difficulty of dissecting the tail of the pancreas which caused by severe abdominal adhesion. The operation time of LSPDP patients was (191±86) minutes (170–480 min), intraoperative blood loss was (365±50) mL (200–1 000 mL), and postoperative hospital stay was (9.9±2.6) days (7–16 d). Six patients of pancreatic fistula occurred after operation, including 3 cases of biochemical fistula, which were cured and discharged after symptomatic treatment, 3 cases of grade B pancreatic fistula, who all improved after anti-inflammatory, acid suppression, enzyme suppression, and double catheter drainage. Twenty patients were interviewed after the operation, and the follow-up time was 3–24 months (median of 15 months). During the follow-up period, no patient had recurrence or metastasis.ConclusionsUnder the conditions of strict screening of suitable cases, adequate preoperative imaging evaluation, intraoperative fine manipulation, and the application of appropriate operating instruments and cutting closure devices, LSPDP is safe and feasible to treat benign tumors of the pancreatic body and tail and some borderline tumors. During the operation, attention should be paid to the reasonable treatment and protection of splenic arteries and veins.
In medical research, pilot and feasibility studies are conducted to reduce the uncertainty of future main trial and enhance its overall quality and probability of successful completion. The objective of a pilot and feasibility study is to answer whether the main trial can be performed, should be performed, and if so, how. Due to the tremendous resources, time, and funding required for a phase Ⅲ clinical trial, conducting a pilot and feasibility study is generally a pivotal step. While pilot and feasibility studies are gaining increasing attention in clinical research, efforts are largely required to promote the dissemination in China. Therefore, in this article, we briefly introduce the concepts of a pilot and feasibility study, its importance to the main trial, and current practice. Examples are also provided to help illustrate the introduction.