目的:探讨结直肠癌病人完全植入式静脉输液港护理维护学习曲线,为即将开展此项护理维护的同行提供参考和借鉴。方法:采用累积和分析法(cumulative sum analysis, CUSUM)对福建医科大学附属漳州市医院结直肠病区2023年2月1日-4月20日连...目的:探讨结直肠癌病人完全植入式静脉输液港护理维护学习曲线,为即将开展此项护理维护的同行提供参考和借鉴。方法:采用累积和分析法(cumulative sum analysis, CUSUM)对福建医科大学附属漳州市医院结直肠病区2023年2月1日-4月20日连续维护结直肠癌化疗病人输液港(PORT)的护理维护学习曲线进行分析,由同一名护士独立完成输液港护理维护全部操作,该护士参与研究前未曾独立完成该操作。结果:84例接受连续维护的结直肠癌病人被纳入分析。护士操作时间为15.0~25.0 min,平均17.8 min,操作时间随操作例数的积累呈整体下降趋势。学习曲线最佳拟合为三次方曲线,即CUSUM(n)=0.000 47n3-0.081n2+3.372n+10.656(n为操作例数),R2=0.956。拟合曲线在操作例数累积至第27例时达到顶点,以此为分界将学习曲线划分为学习提高阶段和熟练掌握阶段。过渡到熟练掌握阶段后,护士操作时间明显缩短[由(19.8±2.6)min缩短至(16.8±1.1)min,P<0.001]。两阶段均顺利完成维护操作,均无发生输液港堵管,无红肿热痛局部感染症状,无重度疼痛等症状。熟练掌握阶段操作过程违反无菌原则例数、病人满意度明显优于学习提高阶段(均P<0.05)。学习提高阶段出现1例渗血、渗液,发生在学习提高阶段第2例,熟练掌握阶段未发生该类事件。结论:通过CUSUM分析法明确了积累27例输液港护理维护经验后可熟练掌握该项操作,为即将开展此项操作的同行提供参考和借鉴。展开更多
The learning curve in minimally invasive colorectal surgery is a constant subject of discussion in the literature.Discordant data likely reflects the varying degrees of each surgeon’s experience in colorectal,laparos...The learning curve in minimally invasive colorectal surgery is a constant subject of discussion in the literature.Discordant data likely reflects the varying degrees of each surgeon’s experience in colorectal,laparoscopic or robotic surgery.Several factors are necessary for a successful minimally invasive colorectal surgery training program,including:Compliance with oncological outcomes;dissection along the embryological planes;constant presence of an expert tutor;periodic discussion of the morbidity and mortality rate;and creation of a dedicated,expert team.展开更多
文摘The learning curve in minimally invasive colorectal surgery is a constant subject of discussion in the literature.Discordant data likely reflects the varying degrees of each surgeon’s experience in colorectal,laparoscopic or robotic surgery.Several factors are necessary for a successful minimally invasive colorectal surgery training program,including:Compliance with oncological outcomes;dissection along the embryological planes;constant presence of an expert tutor;periodic discussion of the morbidity and mortality rate;and creation of a dedicated,expert team.
