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The Research on Factual Clearing Method for Group Physical Examination with the Management of Six Sigma

目的　探討團體體檢據實結算的方法，提高體檢中心接檢人員的工作效率和質量。 方法　采用六西格瑪法, 并通過其定義、測量、分析、改進、控制5個步驟，研究并改進團體據實結算的方法，同時對比分析方法改進前后，“清理分檢未完”的單次工作量、單次制表時間、單次核實時間以及缺陷發生率。 結果　方法改進后，“清理分檢未完”的單次工作量變化無統計學意義（P＞0.05）；單次制表時間由（4.23 ± 0.43）h縮短至（0.06 ± 0.01）h、單次核實時間由（3.18 ± 0.46） h縮短至（1.07 ± 0.01）h、缺陷率從4.83%降至0.69%（P＜0.01）,達到了預期目標。 結論　運用六西格瑪法可以發現流程中存在的關鍵問題,從而提出有針對性的改進措施,提高工作效率和質量。

The Optimization and Control of Process in the Peak Flow of Physical Examination

【摘要】　目的　探討如何通過流程優化應對體檢高峰期。　方法　通過體檢高峰期流程優化前后（2008年與2010年）的管理成效對比，評估高峰期流程控制的有效性。　結果　體檢高峰期流程優化后，平均候檢人數由8人下降至3人、平均侯檢時間由11.9 min下降至4.2 min，平均體檢時間由175 min下降至130 min。體檢者對體檢環境、服務態度和服務質量的滿意度均高于優化前，差異有統計學意義（Plt;0.05）。　結論　通過流程優化與控制有效地緩解了高峰期體檢人員等候時間過長現象，極大地提高了體檢者滿意度，保障了健康體檢工作質量。【Abstract】　Objective　To explore how to cope with the peak flow of physical examination through the process optimization.　Methods　Evaluate the utility of the process control at physical examination peak flow, by contrasting the management effect before and after the physical examination peak flow optimization (2008 and 2010).　Results　After the process optimization in peak flow, the average number of people waiting to be checked is down to 3 from 8, the consumers′ satisfaction with the medical environment, service attitude and the service quality is higher than before optimization, the difference was significant (Plt;0.05).　Conclusion　Through the process optimization and control effectively relieve the time for waiting to be examined, greatly enhance the satisfaction of people who take physical examinations and ensure the quality of physical examination.

先天性動眼神經麻痹伴上瞼運動反常現象一例

尿道下裂術后傷口敷料包扎新方法的效果觀察與護理

目的 探討尿道下裂矯治術后傷口敷料包扎新方法的臨床效果。 方法 將 2015 年 9 月—2016 年 3 月 80 例擬行尿道下裂矯治術的患兒按入院床位的單雙號分為對照組和研究組，每組各 40 例。術后對照組采用傳統的尿道下裂手術敷料包扎方式將陰莖直立包扎，研究組采用新的包扎方式讓陰莖貼近下腹壁包扎。觀察比較兩組患兒每次傷口換藥耗費的時間和出血量、傷口感染發生率和患兒家屬的焦慮評分。 結果 研究組與對照組每次換藥時耗費的時間分別為（21.80±2.54）、（21.45±2.65）min，差異無統計學意義（t=0.614，P=0.541）。研究組與對照組每次換藥時傷口出血量分別為（0.74±0.62）、（0.82±0.87）mL，差異亦無統計學意義（t=–0.517，P=0.607）。研究組傷口感染 3 例，傷口感染率為 7.5%；對照組傷口感染 2 例，傷口感染率為 5.0%，兩組比較差異無統計學意義（χ2=0.213，P=0.644）。研究組與對照組患兒家屬的焦慮評分分別為（1.90±0.11）、（2.50±0.12）分，差異有統計學意義（t=–4.088，P<0.001）。 結論 尿道下裂敷料包扎的新方法可提升患兒的舒適度，敷料不易松脫，尿管不易打折，護理更方便，減輕了患兒家屬的焦慮，值得推廣。

Effects of Disease Classification Early Warning System on Operation Quality of Health Examination Center

Objective　Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods　By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results　Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion　The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.

四川省干部人群幽門螺桿菌感染現狀及健康指導需求調查

目的 了解四川省干部人群幽門螺桿菌（Helicobacler pylori，Hp）感染現狀、對 Hp 感染的認知程度及健康指導需求，為 Hp 感染的防治提供參考。 方法 對 2009 年 1 月—2014 年 12 月在四川大學華西醫院健康管理中心進行體檢的四川省干部人群進行碳 14尿素呼氣試驗檢測，并對檢測結果進行分析。隨機抽取部分人群進行對Hp感染認知程度及健康指導需求的問卷調查。 結果 共納入受檢者 285 例，受檢人群的 Hp 總感染率為 43.5%。收集合格問卷 128 份，對什么是 Hp、Hp 感染的危害、Hp 的傳播途徑、Hp 感染的預防措施、體檢篩查 Hp 的意義 5 個問題的了解率分別為 21.1%、18.8%、16.4%、15.6%、12.5%；有上述 5 個方面健康指導需求的人數占比分別為 84.4%、85.2%、78.9%、86.7%、76.6%。 結論 四川省干部人群 Hp 感染率低于全國平均水平，但對 Hp 感染的認知程度低，迫切需要規范的健康指導。

Immune checkpoint inhibitors-related neuromyopathy

In recent years, immune checkpoint inhibitors have begun to be used in targeted cancer therapy. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events. Neuromuscular disease is more common among adverse events involving the nervous system. With the increasing use of immune checkpoint inhibitors, the early recognition and treatment of neuromuscular immune-related adverse events are very important. In this review, we are focused on the epidemiology, pathogenesis, clinical manifestations, evaluation, diagnosis, and treatment of neuromuscular diseases (including peripheral neuropathy, myasthenia gravis, and myositis) caused by immune checkpoint inhibitors, aiming to provide a theoretical basis for improving the diagnosis and treatment ability of users of immune checkpoint inhibitors for such neuromuscular diseases and reducing the disability rate and mortality rate caused by immune checkpoint inhibitors.

弱視兒童不同遮蓋方式生活質量評定分析

目的 比較弱視兒童行眼罩遮蓋和 Bangeter 壓抑膜遮蓋的生活質量評分。 方法 選擇 2014 年 11 月—2015 年 9 月視光門診 7～12 歲弱視兒童 98 例，自愿選用眼罩或 Bangeter 壓抑膜遵醫囑進行遮蓋，6 個月后復診時采用弱視兒童生活質量評估量表進行評分對比。 結果 眼罩遮蓋組和Bangeter 壓抑膜組男童的生活質量評分的平均得分[（6.00±3.34）、（8.79±4.48）分]均低于女童[（7.30±3.46）、（10.11±4.46）分]，差異均有統計學意義（t=2.032、2.654；P<0.05）。Bangeter 壓抑膜組男、女童的視力狀況、心理狀況、社會交往、疾病擔心得分亦明顯高于眼罩遮蓋組，差異均有統計學意義（P<0.05）。 結論 運用 Bangeter 壓抑膜遮蓋可提高弱視兒童的生活質量。

重復腎輸尿管畸形保留上部腎手術一例報道

詳見正文

PREPUTIAL PEDICLED FLAP PHALLOPLASTY FOR REPAIR OF SEVERE WEBBED PENIS

ObjectiveTo evaluate the effectiveness of preputial pedicled flap phalloplasty for repair of severe webbed penis. MethodsBetween May 2011 and May 2015, 23 boys with severe webbed penis were treated. The age ranged from 2 years and 8 months to 8 years and 3 months (mean, 4 years and 8 months). According to El-Koutby & El Gohary classification, 14 cases were rated as grade 3 simple webbed penis and 9 cases as compound webbed penis (2 cases of type 1, 2 cases of type 2, and 5 cases of type 3). The penis length was 2.1-5.4 cm (mean, 3.4 cm), and the penoscrotal angle was 130-160° (mean, 144°). All the glans could not be exposed. No other urinary system diseases and no history of penile surgery were found in children. All cases underwent one stage preputial pedicled flap phalloplasty. ResultsAfter successful correction, the penis length was 3.6-6.4 cm (mean, 4.7 cm); the penoscrotal angle was 90-110° (mean, 97°). Clear skin boundaries were observed at penile and scrotal parts. No web skin or scrotal skin was left on the penis. Primary healing of incision was obtained, with no necrosis of the flap or infection. All cases were followed up 12 to 41 months (mean, 25 months). No penile curvature, abnormal sensation of glans, or recurrence of the penoscrotal angle occurred, and the patients had normal urination. ConclusionPreputial pedicled flap phalloplasty can be used as one stage repair for severe webbed penis. The penis is close to natural state and had satisfactory appearance, avoiding the possibility of long-term edema and penile curvature.