Objective To evaluate the pathways for improving the operational efficiency of medical teams, thereby providing micro-level empirical evidence for the refined management and high-quality development of public hospitals. MethodsBased on panel data from nine surgical teams in the Department of Thoracic Surgery at Sichuan Cancer Hospital from 2021 to 2024, this study employed the data envelopment analysis (DEA) with the BCC model to assess static efficiency, including technical efficiency (TE), scale efficiency (SE), and overall efficiency (OE). The Malmquist index was used to analyze the dynamic total factor productivity (TFP) and its decomposition into efficiency change (EC) and technology change (TC). Input indicators were the number of physicians and the number of open beds. Output indicators included the proportion of surgical patients, the proportion of grade Ⅳ surgeries, and the average length of stay (reciprocally transformed for positive orientation). Results The mean OE of all medical teams showed a continuous upward trend, while the mean SE exhibited a “V-shaped” pattern, initially decreasing and then increasing. The most significant growth was observed in mean TE, which was the primary driver of the OE improvement. All medical teams achieved positive TFP growth, with TC values greater than 1.000 across all teams, indicating that technological innovation was the core engine of efficiency enhancement. However, EC showed a divergent trend among the teams. Conclusion Public hospital performance appraisal policies effectively guide technological upgrading of medical teams through indicators such as “proportion of discharged patients undergoing surgery” and “proportion of grade Ⅳ surgeries”. However, issues of hospital resource mismatch and SE differentiation persist. It is necessary to establish specialized operation groups for dynamic resource monitoring and construct a “technological upgrading, scale adaptation, and management innovation” triangular balanced system to achieve a sustainable mechanism for maximizing healthcare resource input-output.
Objective To systematically analyze and compare the research literature of thoracic surgery simulation-based medical education (SBME) at home and abroad, and provide ideas for the future development of thoracic surgery SBME in China. Methods Using word frequency analysis and cluster analysis as analysis methods, CiteSpace visualization software and Excel statistical software as tools, the domestic and foreign SBME literature retrieved from PubMed and CNKI databases were visualized and statistically analyzed respectively. Results A total of 2 491 domestic and foreign literature on SBME in thoracic surgery were included. The annual number of foreign publications showed an increasing trend. The top three countries in terms of number of publications were the USA (n=581), Canada (n=105) and Germany (n=57); "cardiac surgery", "medical knowledge medical knowledge" and "medical education" are the hotspots of research in the direction of thoracic surgery simulation, while "lung cancer", "surgical training" and "3D printing" were still in the process of explosion. The core research themes were endoscope simulation trainer, scenario-based simulation teaching methods, standardized patients and virtual reality models. Conclusion Domestic SBME in thoracic surgery should learn from foreign development experience, keep up with the frontier and integrate cutting-edge technology, innovate the curriculum and offer non-technical skills teaching, and improve the system and focus on software construction.
Some complex surgical procedures allow for day surgery benefited from the advancement of the concept of enhanced recovery after surgery and minimally invasive surgical techniques. Shanghai Chest Hospital has set up thoracic day surgery ward incorporating some lung tumor surgeries into day surgery. Through process innovation, model innovation and management innovation, relying on the full-process closed-loop day surgery management system, the day surgery ward runs efficiently. It can help effectively alleviate the difficulty of admission and operation, and improve hospital operation efficiency as well as reduce the economic burden of disease. At the same time, we hope to explore an innovative development path for the possibility of day surgery in complex thoracic surgery, and create a new mode of day surgery that can be replicated and promoted.
This paper introduces the development and animal tests of a miniaturized electrical chest compression device. Based on pulse width modulation technology produced by micro control unit, the device can control the frequency and depth of the compression accurately, as well as perform real-time adjustment. Therefore, it can perform continuous and stable chest compression for long time, which may increase the successful rate of cardiopulmonary resuscitation (CPR). Besides, the device can also produce different types of compression waveforms, including trapezoidal and triangular waveforms. Then, the performance and efficacy of the device was assessed with a rat model of asphyxial cardiac arrest (CA).
ObjectiveTo investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. MethodsThe clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. ResultsThere were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). ConclusionAll-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
Resection is crucial for treating non-small cell lung cancer. Routine follow-up after surgery is an effective method for early detection and treatment of tumor recurrence and metastasis or the second primary tumor, which can improve the quality of life of patients and their prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of non-small cell lung cancer patients in China, and further improve the standardization of lung cancer diagnosis and treatment.