Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients

Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.

Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Anorexia nervosa:Outpatient treatment and medical management

Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The time from AN debut to the treatment initiation is normally unreasonably long.Over the past 20 years there has been empirical support for the efficacy of several treatments for AN.Moreover,outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients.Early intervention improves outcomes and should be a priority for all patients.Outpatient treatment is usually the best format for early intervention,and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable.Inpatient care is more disruptive,more costly,and usually has a longer waiting list than does outpatient care.The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult.The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN.The scientific essentials for outpatient treatment are described,including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated.The following aspects are discussed:early intervention,outpatient treatment of AN,including outpatient psychotherapy for severe and extreme AN,how to determine when outpatient treatment is safe,and when transfer to inpatient healthcare is indicated.Emerging treatments,ethical issues and outstanding research questions are also addressed.

Investigation of Specifics of Self-Management towards Dealing with Cancer Pain among Adult Outpatients

Purpose: This study aimed to identify specifics of self-management towards dealing with cancer pains among adult outpatients. Methods: Semi-structured interviews were conducted with 16 adult outpatients (9 males and 7 females) who suffered from cancer pain and the data obtained were analyzed using the qualitative synthesis method of KJ Ho. Results: An analysis of the results revealed these key findings for the following symbolic wording of the semi-structured interviews: Cooperative relationship with medical professionals;Problems originating from cancer pain;Self-regulation of analgesic medications based on the interactions with medical professionals;Self-regulation of the analgesic medications based on the physical perceptions of the effects;Self-regulation to maintain a balanced and calm mind, Fulfilling life by the pain alleviation and liberation from the restrictions imposed by the cancer;and Efforts to maintain their lives by themselves. Conclusion: Based on the cooperative relationship established with medical professionals, the patient carried out the self-regulation of cancer pain using analgesics, and self-regulation to maintain a balanced and calm mind. Nurses must therefore sufficiently educate patients regarding how to communicate successfully with medical professionals in order to improve cancer patients’ pain management regarding both physical and mental aspects.

Research Progress of Case Management and Evaluation of Quality of Life in Patients with Diabetes by Out-Patient Nurses

Diabetes is the world’s third largest threat to people’s health. In China, the incidence of diabetes is on the rise, the cure rate of diabetes is low, patients with complications are more, and diabetes patients bring a heavy economic burden to the family and society. Compared with developed countries, China still has a big gap in terms of diabetes care, education and management, and even less long-term follow-up of diabetes education and management results. Therefore, the management of diabetic patients should not only stay in the intervention during hospitalization, but also extend to the outside of the hospital. Only by implementing the whole-process nursing case management integrating hospitalization-family/community-outpatient, can diabetic patients better control blood glucose, delay or prevent the occurrence of chronic complications, and improve their quality of life. The nursing work method of case management is adopted to carry out personalized assessment for diabetes patients, design the process of initial outpatient consultation, content and process of follow-up consultation for nurses, and implement personalized guidance. The diabetic complications should be screened regularly, diabetes management should be standardized, self-care ability and behavior compliance of treatment and nursing of diabetic patients should be improved, and comprehensive whole-process nursing management should be provided for every diabetic patient, so as to improve the quality of life of patients and truly benefit diabetic patients.

城市医疗集团门诊质量管理指标体系构建研究

目的:构建城市医疗集团门诊质量管理指标体系,为规范和提高城市医疗集团整体的门诊质量提供循证管理依据。方法:以“结构-过程-结果”模型为理论框架,通过文献回顾形成初级指标池,采用德尔菲专家咨询法对20位专家开展两轮次函询,根据函询结果对指标体系进行修改完善。结果:两轮次函询问卷有效回收率100.0%,专家权威系数均大于0.75,KendallW协调系数为0.13~0.39,最终构建的城市医疗集团门诊质量管理指标体系共包括3个一级指标、15个二级指标、46个三级指标。结论:本研究构建的城市医疗集团门诊质量管理指标体系全面、科学、实用,为城市医疗集团门诊同质化管理、搭建连续性服务、医疗流程优化、质量考核评价提供循证依据。

灰关联分析在医院财务管理中的应用研究

[目的]探讨灰关联分析在医院财务管理中的应用,为医院管理高质量发展提供借鉴。[方法]收集湖北省武汉市某三甲医院2017-2022年的门诊收入数据,计算门诊药费、门诊检查费、门诊挂号费和门诊其他收入与门诊总收入的灰关联度。[结果]计算得到灰关联度排序为门诊挂号费(0.839)>门诊检查费(0.643)>门诊药费(0.626)>门诊其他收入(0.543)。[结论]灰关联分析能帮助医院在财务管理上理解收入结构、提供决策支持、加强风险管理和预测未来趋势,在医院绩效管理上帮助医院辅助绩效评估,制定激励措施和优化资源配置。

基于门诊全流程服务管理的提升患者体验实践探索

提升患者门诊全流程就诊体验是改善患者就医感受的重要举措。首都医科大学附属北京同仁医院在持续改善医疗服务的基础上探索建立门诊全流程服务管理体系,通过理念向前服务前置,聚焦患者诊前体验;流程简化智慧引领,优化患者诊中体验;延续诊疗模式创新,提升患者诊后体验。打造现代门诊医疗服务模式,不断满足人民群众日益增长的医疗服务需要。

门诊护理工作自动化管理系统的构建与实施

目的:构建门诊护理工作自动化管理系统,评价其在临床护理管理工作中的实施效果,为提高管理效率和服务质量提供参考。方法:构建门诊护理工作自动化管理系统,包括自动化排班、自动化工作量统计、自动化绩效统计和自动化薪酬分配四大模块,并将各模块相互衔接,将自动化管理系统应用于临床,比较应用前后护士加班成本、绩效统计和薪酬分配耗时、排班耗时和护士、患者满意度的情况。结果:与应用前相比,应用后护士加班时间减少71.60%;绩效统计和薪酬分配平均耗时、排班平均耗时均明显下降,护士和患者满意度均有所提升,差异具有统计学意义(P<0.01)。结论:自动化工作管理软件系统的应用,有效提高了人力资源成本效益和护理管理效能,提高了护士和患者满意度,提升了管理效率和服务质量。

门诊患者人文关怀管理规范质量评价量表的构建及信效度检验

目的构建门诊患者人文关怀管理规范质量评价量表并检验信效度。方法参考中国生命关怀协会发布的团体标准《门诊患者人文关怀管理规范》,以及相关指南及文献,形成门诊患者人文关怀管理规范质量评价量表条目池,并经专家函询和专家论证构建门诊患者人文关怀管理规范质量评价量表。于2024年1月—2月选取郑州市5家医院的243名医院管理者作为调查对象,对量表进行项目分析和信效度检验。结果分别进行2轮专家函询和2轮专家论证,问卷回收率分别为92.00%和100.00%,专家权威系数均为0.952。第2轮专家函询量表一级指标的重要性均分为4.80~5.00分,满分比为88.00%~100.00%,变异系数为0.04~0.17,肯德尔和谐系数为0.857(P<0.001);二级指标的重要性均分为4.60~5.00分,满分比为80.00%~100.00%,变异系数为0.00~0.21,肯德尔和谐系数为0.775(P<0.001);三级指标的重要性均分为4.60~5.00分,满分比为76.00%~100.00%,变异系数为0.00~0.21,肯德尔和谐系数为0.830(P<0.001)。最终形成包括5个一级指标、25个二级指标、58个三级指标的门诊患者人文关怀管理规范质量评价量表。探索性因子分析产生5个公因子,累计方差贡献率为74.628%。5个因子得分之间的Pearson相关系数为0.648~0.798,各因子得分与量表总分之间的相关系数为0.784~0.938。量表平均内容效度指数(S-CVI)为0.945,条目内容效度指数(I-CVI)为0.725~1.000,总量表的Cronbach’sα系数为0.973,重测信度系数为0.934。结论构建的门诊患者人文关怀管理规范质量评价量表具有较好的科学性和可靠性,可作为门诊患者人文关怀管理规范质量评价的测评工具。

北京某肿瘤医院肿瘤心理门诊10年就诊分析

回顾2010—2019年北京大学肿瘤医院肿瘤心理科患者构成、患者特征和门诊处方的变化情况,发现10年间,肿瘤心理门诊患者就诊人次为37 885,年就诊量逐年增长,高于该医院的门诊增长率。就诊患者中前五位常见癌症为肺癌、乳腺癌、直肠癌、结肠癌和胃癌。就诊患者中乳腺癌比例下降,肺癌和胃肠道肿瘤比例上升。患者因疼痛就诊的比例逐渐增加;处方镇痛药物联合精神科用药的比例增高,从84.4%上升到91.8%;治疗失眠的药物使用频率高,为35.9%。可见,恶性肿瘤患者对肿瘤心理服务的需求不断增加,肿瘤心理门诊在疼痛等症状管理方面具有优势。

基于TQM理论的门诊号源削峰填谷质量控制实践

城区内大型综合医院位置的独特性决定了其空间制约与医疗拓展之间的矛盾成为管理的瓶颈问题。通过全面质量管理理论和持续改进工作模式,对某大型综合医院的出诊安排及出诊单元进行削峰填谷,使专家出诊过于集中在某个工作日上午的情况得到了明显改善,缓解了医院周边公共交通的拥堵;同时通过对门诊质量的内涵建设,切实提升了患者就医获得感。

门诊护理人员应用柔性管理的效果分析

目的分析门诊护理人员应用柔性管理的效果。方法新疆医科大学附属肿瘤医院10名门诊护理人员于2023年1—5月应用常规管理,设为对照组,于2023年6—12月进行柔性管理,设为研究组。对比两组管理评价、护理工作能力评价、心理状态和管理满意度。结果研究组的交接班秩序和工作强度、工作反馈及沟通效率评分明显高于对照组,差异有统计学意义(P均<0.05);研究组的接诊态度、主动服务和健康教育、人文关怀和护理流程评分明显高于对照组,差异有统计学意义(P均<0.05);研究组心理状况各维度评分明显低于对照组,差异有统计学意义(P均<0.05);研究组的管理满意度(100.00%)略高于对照组(90.00%),但差异无统计学意义(P>0.05)。结论柔性管理可提高提供门诊护理人员管理评价,可改善其负面心理状态,具有较高的管理价值。

老年友善门诊多元化管理的研究与分析

目的通过优化老年患者的就医服务模式,方便老年患者就医,提升老年患者就医体验。方法选取就诊济宁医学院附属医院内分泌遗传代谢科、神经内科、心血管内科、消化内科的800例老年患者,根据管理的时间不同分为对照组和观察组。将2021年1—6月管理前,就诊内分泌遗传代谢科、神经内科、心血管内科、消化内科的400例老年患者设为对照组,采用常规老年服务模式;2023年1—6月管理后,就诊内分泌遗传代谢科、神经内科、心血管内科、消化内科的400例老年患者设为观察组,采用友善服务模式。分别从老年患者门诊等待时间和门诊服务满意度比较2组管理效果。结果管理后,观察组门诊等待时间短于对照组,差异有统计学意义(P<0.05);观察组老年患者门诊服务总满意度为97.00%,高于对照组的92.00%,差异有统计学意义(P<0.05)。结论多元化的老年友善门诊服务管理可以缩短老年患者就诊等待时间,提高门诊服务满意度,有效改善老年患者的就医体验。

多学科诊疗门诊现状与质量控制——以广西某三甲医院为例

多学科诊疗(MDT)门诊广泛应用于肿瘤、疑难危重复杂疾病及多病共存的患者诊疗。文章旨在研究在三级医院开展MDT门诊一站式就诊模式和诊后闭环管理,在实现医疗资源整合、优化就医流程、改善患者就医体验、保障医疗质量与安全方面起到重要作用。针对MDT门诊管理中职能部门重视不足、临床医师积极性不高、患者就诊主动性不强、MDT门诊信息化建设不完善、质量改进效果不佳等薄弱环节及质量控制难点,采取核心成员引领、配套激励考核机制、定期通报质量情况、完善信息化建设、延伸服务范围、加大宣传力度等有效管理手段持续改进,在提升病例病种数量、扩大品牌影响力、提高会诊质量方面取得了明显成效。

“6S”管理联合服务流程优化在门诊分诊中的应用研究

目的:探讨“6S”管理联合服务流程优化在门诊分诊中的应用价值。方法:选取2023年3月—2024年3月在我院门诊就诊的160例病人为研究对象,将2023年3月—9月就诊的80例病人纳入对照组,给予门诊分诊常规服务;将2023年10月—2024年3月就诊的80例病人纳入观察组,实施“6S”管理联合服务流程优化,比较两组分诊时间、等待时间、就诊满意度以及护理差错发生率。结果:两组分诊时间、等待时间、满意度、护理差错发生率比较差异均有统计学意义(P<0.05)。结论:“6S”管理联合服务流程优化在门诊分诊中的应用有助于缩短就诊时间,提高就诊满意度,降低护理差错发生率。

基于移动互联网的门诊医疗管理与服务创新研究

目的分析基于移动互联网的门诊医疗管理的应用价值及服务创新。方法选取2019年1月—2022年12月四川大学华西医院门诊20名医务人员为研究对象,按照管理模式不同将医务人员分为对照组(n=10,传统管理模式)和研究组(n=10,移动互联网门诊医疗管理模式),并选取同一时期入院诊疗的100例患者为观察主体,两组各50例。比较两组患者管理前后缴费时间、住院预约时间、退换号率、投诉率、门诊各科室医务人员满意度。结果研究组住院缴费时间、住院预约时间短于对照组,差异有统计学意义(P均<0.05);研究组退换号率与投诉率低于对照组;研究组医务人员满意度为90.00%(9/10),高于对照组的80.00%(8/10),差异有统计学意义(P=0.048)。结论基于移动互联网的门诊医疗管理与服务创新模式的构建可缩短缴费时间与住院预约时间,提高医务人员满意度。

精细化管理在儿科门诊管理中的应用效果

目的 分析精细化管理在儿科门诊管理中的应用效果。方法 选取2022年12月至2023年12月济南市市中区人民医院儿科门诊收治的60例患儿作为研究对象,以随机数字表法分为研究组(n=30)与常规组(n=30)。研究组实施精细化管理,常规组实施常规管理。比较两组门诊预约等候时间、家属管理满意度及治疗依从性。结果 研究组门诊预约等候时间短于常规组,差异有统计学意义(P <0.05)。研究组家属管理总满意率高于常规组,差异有统计学意义(P <0.05)。研究组治疗总依从率(96.67%)高于常规组(80.00%),差异有统计学意义(P <0.05)。结论 精细化管理在儿科门诊管理中的应用效果显著。

1例糖尿病合并心血管疾病患者的药物治疗管理

目的 为糖尿病合并心血管疾病患者的药物治疗管理(MTM)提供参考。方法 1例63岁男性糖尿病患者行冠状动脉介入术后因每日上午出现一过性头痛到我院神经内科就诊,并被推荐到药学门诊。药学门诊药师分析后认为,患者出现的头痛症状、严重便秘和高尿酸血症很可能与其所用药物有关;进一步发现患者血压、心率、血糖和血脂等动脉粥样硬化性心血管疾病影响因素均未达标。药师通过药学问诊与药品不良反应的判断、用药评估、药物重整、用药宣教和药学随访等为患者提供MTM服务。结果 药师经过13周15次的MTM服务,重整优化了药物治疗方案,停用了引起药品不良反应的药物单硝酸异山梨酯缓释片、硝苯地平控释片和吲达帕胺片,使患者用药品种数由15种调减至7种。患者头痛症状消失,严重便秘症状明显改善,血尿酸降至正常范围;血压、心率、空腹血糖、糖化血红蛋白、低密度脂蛋白胆固醇和尿酸等动脉粥样硬化性心血管疾病影响因素分别由MTM服务前的>140/90 mmHg(1 mmHg=0.133 kPa)、70~80次/min、7.71 mmol/L、7.2%、2.13 mmol/L和494μmol/L降至MTM服务后的<130/80 mmHg、55~60次/min、6.22 mmol/L、6.3%、1.55 mmol/L和348μmol/L。结论 药师为患者提供MTM服务,可提高患者生活质量和治疗效果,降低用药风险,提升医院药物合理应用水平和临床药学服务能力。