【摘要】 目的 探討高血壓危象評估和處理原則及對高血壓危象急診處理的指導意義。 方法 依據高血壓危象評估和處理原則對2008年1月-2009年12月期間收治的160例高血壓危象患者進行診斷和治療。結果 160例高血壓危象患者中,高血壓急癥134例,高血壓亞急癥26例。高血壓急癥中,以心腦血管病變為主,包括腦卒中、急性冠脈綜合征和急性左側心力衰竭。依據高血壓危象評估和處理原則進行急診處理,能夠對高血壓危象進行準確評估和有效處理,減少診治失誤,降低死亡率并改善預后。結論 有關高血壓危象的評估和處理原則能夠指導高血壓危象的急診處理,取得良好的預后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, and to provide evidence and recommendations for healthcare risk management policy in China. Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews, and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results (1) A total of 142 documents were included in this study. The United States had the most relevant documents (68). (2) The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses, and now includes all patient safety incidents. (3) The incidence-reporting systems can be grouped into two models: government-led and legal/regulatory/NGO-collaborative. (4) In two cases, reporting systems were established for specific incident types: One for death or serious injury events (the sentinel events database in Britain, SIRL), and one for healthcare-associated infections (NHSN in America). (5) Compared to the four countries, Taiwan’s system put more emphasis on public welfare, confidentiality, and information sharing. The contents of reporting there covered every aspect of risk management to create a more secure environment. Conclusion (1) Britain’s national reporting and learning system was representative of a government-led model; (2) The United States was the earliest country to have a reporting system, which included a limited range of incident types. Management of incidents became more reliable with increased application of laws, regulations, and guidances; (3) Both the Canadian and the Australian systems drew from the American experience and are still developing; (4) The Taiwanese system was comprehensive and is an instructional case.
With the development of economic globalization and the complication of enterprise management, the level of internal control has become an important part for measuring the quality of management, risk prevention, competitiveness and operational efficiency of modern enterprises. As a special economic organization, hospitals have some defects in terms of internal control environment, organization of control system, risk management and implementation system, supervision, control and evaluation system. Based on the “Medical Institutions Internal Control Provisions of Finance and Accounting (Trial)” and “A Lecture on Medical Institutions Internal Control of Finance and Accounting”, this article gives some suggestions on how to improve the management of hospital internal control.
Cutaneous squamous cell carcinoma (cSCC) is the second most common human skin tumor. In recent years, the incidence of cSCC is increasing annually. Although most cSCC is curable after basic treatment, the advanced cSCC progresses rapidly and poses a significant risk for the impact on quality of life and death. In 2017, the latest version of cSCC management guideline was developed by the American Academy of Dermatology (AAD) based on extensive evidence-based medical evidence, including cSCC biopsy techniques, histopathological assessment, clinical staging and grading, surgical and nonsurgical treatment, follow-up, recurrence prevention, and management of the advanced cSCC. The purpose of this article is to briefly introduce and interpretate this guideline.
The management of middle-aged and youth hypertension has become a challenge in clinical practice. The hypertension group of the Chinese Society of Cardiology published the expert consensus on the management of hypertension in young and middle-aged Chinese population in 2019. This paper interprets the key contents of the consensus and provides references for management of young and middle-aged hypertension.
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
Day surgery can shorten the average hospital stay and enhance the recovery of patients, and has great social and economic benefits. In order to provide reference for the establishment of standardized operating room management, West China Hospital of Sichuan University summed up the experience of past years to develop this management specification for day surgery operating room. The main contents of this specification include: the principles of scheduling day surgery; the resource allocation of operating room; operating room nursing care, nursing points, and precautions. The release of this specification is conducive to the improvement of the nursing management for day surgery operating room, and the promotion of day surgery.
The Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease is produced based on important studies published in last five years and published online. So far it is the most influential evidence-based strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease to guide clinical professionals.
ObjectiveTo explore the effect of closed-loop group nursing model on the makeshift intensive care unit (ICU) in a hospital specialized for coronavirus disease 2019 (COVID-19).MethodsSeveral fever wards had been shifted into ICUs and ran by the first medical team from Sichuan Province from January 30th to March 19th, 2020. Closed-loop group nursing model was utilized. The nursing model activated the nurses in management by empowerment and nursing group establishment. To ensure standard of care, measures were carried out in this model, namely, improving the physical work environment, nurse training, optimizing composition of nursing manpower, fine and standardized management of medical resources, “double-chain” medical supply system, “3S” management on first aid kit, protecting patient safety and dignity, and developing emergency nursing workforce deployment plan.ResultsThe implementation of closed-loop group nursing model showed good results in treating severe to critically ill COVID-19 patients regardless of shortages in nursing workforce and facilities. The rescue work was carried out successfully in the makeshift ICUs. All the nurses showed great teamwork and were really involved in the management of the wards. ConclusionsAs the current ICUs were not adequate for the increasing number of critically ill patients during the epidemic, it was unavoidable to transform other wards into ICUs. Closed-loop group nursing model was utilized to break the hierarchy. As a result, all nurses were empowered to participate in nursing management and their potential was fully inspired. Furthermore, this working model presented a clear working framework in multidisciplinary teamwork in a limited time, which also provided patients with dignity and safety.
As the development of medical imageology, radioexamination has become one of the main approaches of disease diagnosis. However, the society and hospital have not taken the hidden danger and harmfulness of radiation seriously. Through discussing the following eight aspects of radiation safety culture management, this paper aims to reduce the risk of radiation and ensure the safety of patients and medical staff: a) Improving the awareness of safety culture and the understanding of patients on safety culture; b) Consummating the safety management system of the radiation; c) Attaching importance to implementing the relevant laws and regulations of radiation; d) Mastering the examination indications, and especially the contraindications of radiation; e) Strengthening the clinical cooperation and exchange; f) Improving the staff’s ability to distinguish hidden danger and identify patients in high risk; g) Strengthening the nursing behavior safety management of the radiation department; and h) Strengthening the biological security management of the radiation department.
