PDCA循环降低非计划再次手术发生率的效果评价

目的 探讨降低非计划再次手术发生率的有效方式,为医疗质量改进提供参考。方法 运用PDCA循环原理,对非计划再次手术的发生情况进行分析,找出影响非计划再次手术的主要原因,制定针对性措施实施过程改进。结果 实施改进措施后,非计划再次手术发生率由1.2%降低至0.9%。结论 PDCA循环的应用降低了非计划再次手术发生率,有利于提高手术质量,以实现医疗质量的持续性改进。     

基于PDCA循环的非计划再次手术管理方法设计与实现

目的 针对非计划再次手术管理需求设计了一种管理方法。为医院非计划再次手术的管理以及医疗质量改进提供参考。方法 参考国家对非计划再次手术管理的相关规范及标准文件,遵循 PDCA 循环的思想,结合信息技术,最终建立一个“非计划再次手术”专用的管理方法。结果 方法实施前后非计划再次手术的发生率有了显著的下降,发生率从方法实施前（2014年下半年）的1.02%降低到方法实施后（2015年7—12月）的0.71%。结论 方法有效降低了非计划再次手术发生率,符合医疗管理的需求,有利于提升手术质量,以实现医疗质量的持续性改进。

     

关于加强非计划再次手术监管的探讨

目的 探索非计划再次手术的原因,为提高医院手术病人的医疗质量、降低非计划再手术的发生率提供依据。方法 对42例非计划再次手术进行回顾性分析。结果 非计划再次手术的平均住院日、医疗费用与前一年度院平均值比较差异显著,且有统计学意义。结论 医务人员应加强手术责任心,预防再手术的发生,同时医院应加强非计划再次手术的监管工作。     

非计划再次手术关键环节管理与效果分析

目的 探索有效降低非计划再次手术发生率的管理方法。方法 对2012年1月—2016年12月住院并进行手术的患者进行主动监测,加强管理,发现非计划再次手术病例,统计发生率及引发原因。结果 225 944例手术共发生非计划再次手术914例,平均发生率为0.40%且五年呈显著下降趋势。引发原因以手术部位感染、切口裂开、切口疝或愈合不良,术后出血,出现漏或瘘为主,共占73.9%。结论 完善主动监测与报告系统、加强院科两级管理、注重原因分析与改进可有效降低非计划再次手术的发生率。     

435例非计划再次手术的科室分布及原因分析

目的 通过对非计划再次手术的发生率、科室来源、发生原因进行统计分析,探讨非计划再次手术的防范措施,提高全院的手术质量。方法 对某三级甲等综合医院2014年度所有手术患者的临床资料进行回顾性分析。结果 共回顾性分析62 179份手术患者的资料,其中发生重返手术室的有2411人次,发生非计划再次手术的有435人次,非计划再次手术发生率为6.94‰,非计划再次手术主要发生在男性、40～59岁年龄组患者中,非计划再次手术主要科室来源为神经外科（143例）、心胸外科（39例）及口腔颌面外科（27例）,术后出血/血肿、未达到效果手术再调整、术后漏、切口问题及手术部位感染为非计划再次手术发生的主要原因,占总原因的78.85%。结论 加强围手术期质量管理,严格执行非计划再次手术的上报制度,对非计划再次手术发生率高的重点科室、重点手术进行监管,是降低非计划再次手术发生率的有效措施。     

肿瘤患者非计划再次手术原因分析及对策

目的 为提高手术质量、保障医疗质量提供管理依据。方法 回顾性分析某三甲肿瘤专科医院2008—2013年442例非计划再次手术病例,对非计划再次手术的发生情况进行分析。结果 肿瘤手术患者非计划再次手术发生率为1.0%,发生的主要原因为术后出血、吻合口瘘、手术切口问题。非计划再次手术的发生与手术难度、手术者专业水平及患者病情因素等因素有关。结论 作为手术质量评价的重要指标,医院应将非计划再次手术监管作为提高质量管理的抓手。     

周六手术在医院运行管理中的价值和意义

目的 通过开展周六手术,缩短病人平均术前等待日及平均住院日。在保证医疗质量的前提下,达到提高效率,增加产能的目的。方法 在多部门协作的基础上,开展周六手术,改变原有人力配置方式和手术流程,以配合周六手术的进行。结果 手术流程再造后,与之前同期相比术前等待日缩短25.00%, 月平均手术台次增加12.35%, 病人平均住院日降低9.22%。结论 开展周六手术,能缩短患者平均住院日和术前等待日,为患者节约宝贵的时间和金钱,在一定程度上解决了患者看病难、看病贵的问题,提高了医院的工作效率。     

老年性白内障日间手术临床路径模式效果分析

目的 借鉴国内外日间手术管理经验,在医药分开综合改革的背景下,探索实施老年白内障日间手术临床路径新模式。方法 对首都医科大学附属北京同仁医院2010年（临床路径实施前）、2013年（临床路径实施后）和2016年（日间手术临床路径模式开展后）老年性白内障治疗人均费用、平均住院日、术后感染率进行比较。结果 实施老年白内障日间手术临床路径新模式,平均住院日缩短,人均治疗费用降低,且差异均有统计学意义（P>0.05）。2010年、2013年、2016年的手术感染率都较低,差异无统计学意义（P>0.05）。结论 在保障医疗质量的前提下,老年性白内障日间手术临床路径新模式的实施,不仅提高医院和科室的经济效益,为政府节约医疗资源,而且还能降低患者的治疗费用,提高患者满意度。     

综合性医院平均住院日绩效指标集的构建与应用

目的 构建以平均住院日为核心的绩效指标集,在此基础上,制定绩效目标及关键控制举措,并跟踪实际的执行效果。方法 收集2008年12月—2013年6月共计55个月的重点科室平均住院日数据,运用相关性分析和多元线性回归提取影响平均住院日的显著因素,根据模型结论,研究分析绩效控制目标和举措并进行应用。结果 现阶段有效缩短平均住院日应主要解决“收容收治比及床位资源的利用效率”两对关键矛盾,模型应用后,医院院整体平均住院日由原来的15.7天降低为11.6天,重点科室平均住院日由19.2天降低为14.6天。结论 平均住院日绩效指标集的应用有助于优化医院资源配置,达到显著提高整体运营效率的目的。     

DRGs IE15组在临床路径管理前后的费用影响分析

目的 探讨临床路径对DRGs付费IE15组费用的影响。方法 对某三级甲等医院骨关节科2012年DRGs试点IE15组146例病历实行临床路径管理,分析其平均住院费用和平均住院天数的情况,并与2011年166例病历未实行临床路径管理的结果进行比较。结果 某三级甲等医院骨关节科IE15组实行临床路径管理后的平均住院费用(10 463.65元)和平均住院日（4.03天）明显低于实行临床路径管理前的平均住院费用（11 373.27元）和平均住院日（4.90天）（分别有P＜0.05和P＜0.000 1）。结论 临床路径可以降低DRGs的费用和住院日。     

Antibiotics in the treatment of wounds in the victims of the earthquake in the Armenian SSR

Purulent wounds in 88 victims of the Armenian earthquake with the syndrome of long-term squeezing were examined microbiologically and the experience with using antimicrobial drugs for their treatment was analyzed. In all the cases microbial associations were detected, coliform and nonfermenting gram-negative bacilli, enterococci, anaerobes and yeast-like fungi being isolated from 80, 20, 15 and 25 per cent of the patients respectively. 130 bacterial strains were studied in detail. 80 to 100 per cent of the bacterial isolates were resistant to the antibiotics routinely used in surgical practice, i.e. benzylpenicillin, tetracycline, levomycetin, kanamycin, cephalothin and cefazolin and highly sensitive to new antimicrobial drugs belonging to ureidopenicillins (mezlocillin), quinolones (ciprofloxacin) and cephalosporins of the 3rd generation (cefoperazone and ceftazidime). Retrospective estimation of the antibiotic therapy revealed its inadequacy in 55.7 per cent of the patients for the most part because of the isolates resistance. The 19 variants of the antibiotic use prescribed by the physicians mainly included penicillins, aminoglycosides and their combinations (in 67.2 per cent of the cases). The use of the highly efficient drugs of the groups of ureidopenicillins and quinolones was extremely rare which was likely due to lacking of information on the drugs.     

Histogenesis of the taste buds of the vallate papilla in the in the rat in the postnatal stages of development

The developing taste buds of vallate papillae were studied with electron microscope in rats during the first 7 days after birth. Two types of cells--light and dark--are identified in the taste buds of a one day old animal. The apical parts of dark cells are characterized by numerous dark granules. A distinguishing feature of light cells is the presence of synaptic contacts with afferent intragemmal nerves. On the 4th day of development on the top of the apical parts of the cell, a microvillar apparatus is seen to form, which does not yet communicate with the oral cavity. On the 7th day, basal cells appear in the taste buds. Some of these cells are seen mitotically dividing. The differentiated microvillar apparatus now communicates with oral cavity. The structure of the taste buds is getting similar to that in the adults. The structural and functional peculiarities of the developing taste buds are discussed in association with the period of ontogenesis under consideration.     

Changes in the size of the nucleoli of the Purkinje cells in the canine cerebellum in the postresuscitation period

The changes in the size of Purkinje cell (PC) nucleolus in the lateral and medial cerebellum zones were studied in dogs with different degree of neurologic status recovery after clinical death of various etiology and duration. PC always possess one nucleolus in the control and experimental groups. In the case of complete neurologic status recovery of animals the area of PC nucleolus increases in both zones studied, irrespective of the cause of clinical death. In the case of neurologic disorders the increase in PC nucleolus area is clearly expressed only in the medial zone of the cerebellum, being insignificant in the lateral zone. It is suggested that adaptive characteristics of PC are distinct in the two compared zones, which leads to greater PC vulnerability in the lateral zone during deep hypoxia.     

Frequency of the stages in the cycle of the seminiferous epithelium in the rat

This study determined the optimum number of tubules to be counted per testis cross section, and the number of animals per treatment group, when changes in stage frequencies in the cycle of the seminiferous epithelium are criteria for assessing effects of treatment on spermatogenesis. A data base of 9,672 observed and staged tubules was collected from testicular cross sections of 15 Sprague-Dawley rats. A significant variation between animals was found for the frequencies of Stages I, II, IV, VI, VIII, and XIII. Computer simulation was used to randomly select different combinations of animal and tubule numbers from the observed data. Stage frequency means from each simulation experiment were compared statistically to observed mean frequencies. A model that used data from all 14 stages was analyzed. The following conclusions were made: a) a minimum of 200 tubule cross sections/testis is recommended for estimating stage frequencies; b) for a fixed number of tubules scored, the number of animals sampled is more important than the number of tubules per animal in reducing variance; c) to detect a difference of 2 standard deviations from the mean with a 2% error rate and examining 200 tubules/testis, at least 12 animals must be used per group when assessing all 14 stages; d) when individual stages are examined using 10 animals per group, only Stage VII has 80% or greater power of test (alpha = 0.05) to detect a frequency difference; e) pooling stages into 3-4 groups is recommended to improve the power of detecting a treatment difference.     

Psychological Attributes of the Culture of the Ukrainians in the Modern Stage of the Development of Society and Trends in Changes in These Attributes in the Post-Soviet Period

The authors of the article focus on the transition of the former Soviet state of Ukraine to a market economy. One aspect of the analysis is the cultural values and attitudes of the citizens in a new situation. Market economy and entrepreneurship demand new types of motivation and individual values from people. A challenge for social psychology in the country is the further elaboration of methodological basis of research.     

Immunohistochemistry of the cytoskeleton in the excurrent ducts of the testis in birds of the Galloanserae monophyly

The presence, location and degree of immunoexpression of various microfilament (MF) and intermediate filament (IF) systems (actin, cytokeratins, desmin, vimentin) were studied in the excurrent ducts of the testis in sexually mature and active galliform (Japanese quail, domestic fowl, turkey) and anseriform (duck) birds. These proteins were variably expressed between the epithelia and periductal tissue (periductal smooth muscle cell layer and interductal connective tissue) types and between species. Variable heterogeneous co-expression of filament systems was also found in the various duct epithelia and periductal tissue types: co-expression of filament systems was the rule rather than the exception. In the duck, neither vimentin nor cytokeratin was present in any of the tissues, whereas actin and desmin (absent in the rete testis) were co-expressed in the efferent ducts and epididymal duct unit (comprising the ductus conjugens, ductus epididymidis and ductus deferens). Actin, desmin and vimentin were generally co-expressed in the rete testis, efferent ducts and epididymal duct unit of the quail, domestic fowl and turkey, with vimentin being more strongly immunoreactive than actin and desmin in the epididymal duct unit, but more weakly immunoexpressed in the efferent ducts. Cytokeratin was present and co-expressed with actin, desmin and vimentin in the rete testis, efferent ducts and epididymal duct unit of the domestic fowl and turkey, but not in the quail and duck. The periductal smooth muscle cell layer and interductal tissue co-expressed actin, desmin and vimentin variably in all birds. Luminal spermatozoa of both the turkey and duck were immunonegative for all protein systems, whereas those of the quail and domestic fowl co-expressed actin, desmin and vimentin moderately or strongly. The tissues of the reproductive tract of male birds thus contain cytoskeletal protein systems that are variably but mostly co-expressed and whose contractile ability appears necessary and sufficient for transportation through the various excurrent ducts of the voluminous testicular fluid and its high sperm content, characteristic features of male avian reproduction.