目的 了解我院住院患者抗菌药物的临床应用现状及存在问题，为临床合理使用抗菌药物提供参考。 方法 采用回顾性调查方法，对本院2008年11月-2009年4月的出院病历资料进行统计、分析。 结果 共调查病历1 000份，抗菌药物总使用率58.70％；其中预防用药使用率62.35％，治疗用药使用率37.65％；联合用药的比例为37.31％；不合理用药占19.76%。 结论 抗菌药物使用率较高，且使用存在一些不合理现象。医院应加强监管，对存在的问题应制订相应措施。
ObjectiveTo compare the clinical effect of day surgery mode and inpatient operation mode for intertrochanteric fracture in elderly patients.MethodsThirty-seven elderly patients with intertrochanteric fracture treated in day surgery mode in the Second Hospital of Shanxi Medical University from July 2018 to July 2019 were retrospectively included. At the same time, another 37 elderly patients with intertrochanteric fracture treated in general inpatient operation mode in the same period were randomly selected. The preoperative waiting time, operation time, length of hospital stay, hospital expenses, postoperative complications, and clinical effect were compared between the two groups.ResultsThere was no significant difference in operation time [(56.21±10.75) vs. (58.81±12.56) min] or postoperative Harris hip scores (1 month after surgery: 61.03±7.74 vs. 59.47±7.42; 3 months after surgery: 85.40±4.22 vs. 85.03±4.33) between the two groups (P>0.05). In terms of the preoperative waiting time [(23.17±3.18) vs. (52.64±10.12) h], length of hospital stay [(2.01±0.97) vs. (8.34±4.22) d], hospital expenses [(4.012±0.771)×104 vs. (4.679±1.117)×104 yuan], and the incidence of deep venous thrombosis during perioperative period (10.8% vs.37.8%), the day surgery mode group had more obvious advantages than general inpatient operation mode group (P<0.05).ConclusionsDay surgery mode is safe and effective for intertrochanteric fracture in elderly patients. It is worthy of great application for clinical work in the future.
ObjectiveTo analyze the current situation of day surgery patients’ withdrawal from hospitalization, and put forward reasonable and effective measures and suggestions.MethodsDescriptive statistical analysis and trend chi-square test were conducted on the hospitalization withdrawal rate of day surgery in the Day Surgery Ward of the Second Affiliated Hospital Zhejiang University School of Medicine from 2012 to 2020. The reasons for hospitalization withdrawal and the operation methods of withdrawn cases from 2019 to 2020 were descriptively analyzed.ResultsFrom 2012 to 2020, the hospitalization withdrawal rate of day surgery decreased from 4.48% to 2.19%, with a significant decrease and a linear downward trend (χ2trend=138.500, P<0.001). From 2019 to 2020, patient factor was the most important reason for hospitalization withdrawal of day surgery, accounting for 79.72%; secondly, long waiting time for surgery, abnormal examination results, inadequate preoperative evaluation, medical insurance reimbursement, epidemic situation in 2020 and other reasons had affected the patients’ hospitalization withdrawal of day surgery to varying degrees. Endoscopic lithotripsy accounted for the largest proportion (210 cases, accounting for 20.87%) in the withdrawn procedures from 2019 to 2020, followed by minimally invasive rotary resection for breast lesions (126 cases, accounting for 12.52%).ConclusionImproving preoperative evaluation, strengthening preoperative communication, implementing efficient medical treatment, and shortening the waiting time for surgery can reduce the rate of hospitalization withdrawal of day surgery.
The ideological and political education in standardized residency training plays an important role in cultivating medical talents with noble medical ethics and exquisite medical skills. Teaching evaluation is an important method to promote teaching improvement and optimization. However, there are still some problems and challenges in the evaluation of ideological and political education for standardized residency training. This article proposes the ideological and political education of standardized residency training can be comprehensively evaluated by the context-input-process-product evaluation model from four aspects: background, input, process, and result evaluation. The aim is to provide solid support and guidance for the ideological and political education route in standardized residency training.
ObjectiveTo compare whether the training process of commissioned training residents from Tibet and non-commissioned training residents have achieved homogenized.MethodsThe training time and operation frequency data of 170 commissioned training residents from Tibet and 96 non-commissioned training residents of grade 2016 during the 19 months from September 2016 to April 2018 were collected. The 25 operational data of 11 departments that are representative and comparable are compared.ResultsThe two types of trainees completed the rotation of 47 different departments within 19 months, of which 45 departments were the departments where both types of students were rotated. Among these 11 departments, the average training time of trainees from Tibet in the Departments of Anesthesiology was lower than that of non-commissioned trainees (Z=–4.543, P<0.001). There were statistically significant differences in 7 of the 25 operating data (P<0.05). The operation number of arterial puncture and ventilator management (Intensive Care Unit); patient treatment (Department of Emergency); arterial puncture, ventilator management and intraoperative monitoring (Department of Anesthesiology) of trainees from Tibet were lower than those of non-commissioned trainees (P<0.05). The operation number of lung and mediastinal examinations (Department of Radiology) of trainees from Tibet was higher than that of non-commissioned trainees (P<0.05).ConclusionsDuring the training of the two types of trainees, the rotation schedule was basically the same, but there were differences in the clinical practice operations. Trainees from Tibet have higher requirements for radiology training. Trainees from Tibet will return to Tibet with independent practice needs, so their requirements of medical imaging skills operation would be higher. Due to language and training time, the critically ill, emergency first aid, and surgical skills of trainees from Tibet are not as good as those of non-commissioned trainees, and they need to gradually strengthen and improve these skills in subsequent trainings.
Standardized residents training is a necessary way to cultivate qualified clinical physicians, and the teaching ability of their mentors will be a key factor affecting the quality of standardized residents training. In view of the problems existing in the current teachers training of standardized residents training, West China Hospital of Sichuan University has innovatively built a “coordination of six priorities” teachers training system to conduct hierarchical training for different types of mentors, in order to improve the quality and achieve homogenization of training. This article mainly elaborates on the problems in the current residents teachers training, the “coordination of six priorities” teachers training system of West China Hospital of Sichuan University, and the effect of the teachers training.
Objective To investigate drug usage and costs of pneumonia inpatients in Karamay Central Hospital in 2014 and to provide baseline for evidence-based pharmacy study of single disease in respiratory system. Methods The information of drug use and expenditure of pneumonia inpatients were collected from the hospital information system (HIS). We analyzed the data including frequency, proportion and cumulative proportion by Excel 2007 software. Results A total of 309 inpatients were included, among the 78.96% were more than 60 years old. Among the antibiotics single therapy, the frequency of cefoperazone and sulbactam was the highest. Among the antibiotics combination therapy, the frequency of β-lactam antibiotics was the highest. Conclusion Pneumonia inpatients in Karamay Central Hospital are mainly older patients. The β-lactam antibiotics is used most in clinical practice.
ObjectiveTo predict the total hospitalization expenses of bronchopneumonia inpatients in a tertiay hospital of Sichuan Province through BP neural network and support vector machine models, and analyze the influencing factors.MethodsThe home page information of 749 cases of bronchopneumonia discharged from a tertiay hospital of Sichuan Province in 2017 was collected and compiled. The BP neural network model and the support vector machine model were simulated by SPSS 20.0 and Clementine softwares respectively to predict the total hospitalization expenses and analyze the influencing factors.ResultsThe accuracy rate of the BP neural network model in predicting the total hospitalization expenses was 81.2%, and the top three influencing factors and their importances were length of hospital stay (0.477), age (0.154), and discharge department (0.083). The accuracy rate of the support vector machine model in predicting the total hospitalization expenses was 93.4%, and the top three influencing factors and their importances were length of hospital stay (0.215), age (0.196), and marital status (0.172), but after stratified analysis by Mantel-Haenszel method, the correlation between marital status and total hospitalization expenses was not statistically significant (χ2=0.137, P=0.711).ConclusionsThe BP neural network model and the support vector machine model can be applied to predicting the total hospitalization expenses and analyzing the influencing factors of patients with bronchopneumonia. In this study, the prediction effect of the support vector machine is better than that of the BP neural network model. Length of hospital stay is an important influencing factor of total hospitalization expenses of bronchopneumonia patients, so shortening the length of hospital stay can significantly lighten the economic burden of these patients.