Medical paper opening report model article 1
Present situation and development trend of clinical medical examination
For decades, China's clinical medicine has made steady and rapid development, and the evidence-based medicine developed with it has also been widely used in clinical medicine. However, the discipline of clinical laboratory has developed from medical laboratory to laboratory medicine. Clinical laboratory is no longer an auxiliary department in the past, but is gradually related to clinic and becomes an independent discipline. Medical examination is a subject that uses scientific modern physical and chemical knowledge and means to make medical diagnosis. Its main research is how to use scientific experimental technology and advanced equipment to provide basis for clinical diagnosis and treatment. Medical examination involves many subjects, such as basic medicine, biochemistry, clinical medicine, management and so on. The application of these subjects can provide a clear basis for the diagnosis of diseases quickly and accurately, and it is an indispensable link in modern medical work.
Development Status of Laboratory Medicine in China
In recent years, China's clinical laboratory education has developed rapidly. In the early 1950s, medical laboratory specialty was set up in secondary health schools in China to train junior and intermediate medical laboratory related talents. 1983 set up undergraduate medical laboratory specialty in medical colleges and universities, and trained a large number of advanced talents related to medical laboratory for China. Up to now, the training system of medical laboratory related talents in China has been initially established, forming a set of professional talent training channels. At present, an education system with clear objectives, complete levels and various forms has been formed, including general laboratory specialty, master's degree and doctoral degree (medical science degree), seven-year continuous postgraduate degree (medical professional degree), adult laboratory specialty and higher vocational laboratory specialty. This perfect talent training system has trained a large number of outstanding talents for clinical laboratory medical service in China and improved the basic quality of clinical laboratory personnel.
China's quality control management system started late, but some disciplines have formed a more reasonable quality control system. At present, quality control before analysis, quality control during analysis and quality control after analysis have all achieved a certain degree of good development, which can basically ensure the accuracy and comparability of the results. At the same time, with the deepening of reform and opening up and economic growth, China is also making great use of international information technology exchanges to learn and introduce advanced professional technology and inspection equipment from developed countries.
Main problems existing in clinical medical examination in China
Unreasonable resource management: At present, many hospitals do not do well in resource management, which is embodied in unreasonable staffing (too many or too few staff in some positions) and unreasonable medical equipment configuration. Unreasonable staffing leads to loose inspection teams and cannot form strong cooperation with each other. There are misoperation and irrationality in the inspection process, which leads to the error of the inspection results. Moreover, this unreasonable allocation of human resources will also bring some problems, such as repeated allocation of personnel and equipment in the same hospital will cause waste of resources; Due to the decentralized staffing, the whole system will not be managed in a unified way, and the professional quality of hospital-related personnel will not be improved.
The theoretical system of laboratory medicine is incomplete: although great progress has been made in clinical medicine in China in recent years, the development of medical laboratory in China mainly focuses on the construction of hardware, and tends to update the equipment, ignoring the importance of laboratory medicine theory. At present, medical examination in China can only be regarded as experimental medical examination, and a set of perfect and new theoretical system has not yet been formed. In view of the low scientific research ability of medical laboratories and the weak awareness of innovation (scientific research) of relevant personnel, this phenomenon has hindered the good development trend of laboratory medicine.
Inadequate quality control: Without good quality control, it will not only affect the accuracy of test results, but also mislead clinical diagnosis and treatment, which will affect the health of patients and even endanger their lives. In any case, we must attach importance to quality control, but due to the development and application of modern equipment, some inspectors began to pay less attention to quality control.
Future development trend of clinical medical laboratory
Improving the quality of talents: Laboratory medicine in China is developing towards informationization and automation. Therefore, we should cultivate high-quality laboratory talents to adapt to the new era according to the needs of the development of society and laboratory medicine. First of all, the inspectors of clinical medical examination must have a solid professional foundation, including basic knowledge of clinical medicine, physical chemistry and other related knowledge. Secondly, clinical inspectors must have professional equipment operation skills, and the standard of equipment operation can affect the accuracy of test results. Finally, we should guide education to broaden the relevant knowledge of clinical laboratory personnel. We should not be limited to our professional knowledge, but also understand other related knowledge.
Strengthen information construction: the new era is the era of information technology, and information technology is the development trend of the new century. At present, many industries have used information technology and achieved good development. It is an inevitable trend to establish an information system in the field of clinical medical laboratory, collect and process information and realize information sharing. Its main performance is that the laboratory will adopt a more automatic way to transmit the test results, and transmit the test results to the laboratory and clinic through the computer Internet, and even realize the information exchange between hospitals, cities and the world. * * * Enjoy resources and promote exchanges and cooperation among industries.
Development towards automation: At present, all kinds of automatic analysis instruments in most domestic inspection departments are single-machine automation, while the development trend of inspection instruments in developed countries is to connect connected machines in series to form an assembly line operation mode, that is, automation. Therefore, in order to improve the efficiency and results of inspection, we must also keep up with developed countries and realize the automation of inspection. With the development of computer technology and the improvement of modern inspection science, many manual inspection items have been gradually replaced by automatic instruments, and the inspection speed and the number of inspection items have been greatly improved. This is the development trend of medical laboratory equipment in China in the future.
Model essay on opening report of medical papers II
The basis, purpose and significance of the topic selection;
Fracture nonunion is a common clinical disease in orthopedics, in which there are many long bones in limbs, such as tibia, femur and humerus. In view of the second operation of nonunion of long bone fracture of limbs, bone grafting combined with LCP internal fixation is often used in our hospital. Autologous iliac bone as bone graft material has the advantages of simple material, good histocompatibility, no graft rejection and strong bone induction. These advantages make ilium the best donor for bone transplantation, and it has formed a knowledge in clinic. Bone grafting is an important method to treat nonunion of fracture, and its mechanism is the role of scaffold and mineral supply caused by creeping substitution. The smooth progress of creeping substitution requires precise reduction, adequate bone grafting and firm fixation. In order to achieve full bone grafting and promote fracture healing as soon as possible, we adopted 36? Bone grafting, external wire ligation and LCP rigid internal fixation were used, and the postoperative follow-up was 3~ 1 month. The clinical effect of the operation was analyzed according to the healing and functional recovery. The purpose of this topic is to explore the improved surgical method and curative effect of treating nonunion of long bone fracture of limbs, and to provide reference for clinical treatment.
Current research trends and levels of this subject at home and abroad.
The treatment of nonunion of fracture can be divided into surgical treatment and non-surgical treatment, among which the most important surgical treatment is the improvement of bone grafting and internal fixation of broken end. Autologous bone transplantation is effective in the treatment of fracture nonunion, and has formed a * * * understanding. Bone grafting is an important method to treat nonunion, and the combination of intramedullary and extramedullary bone grafting is often used in clinic. Enter along the muscle space, carefully peel off the subperiosteal fracture, take out the internal fixation device, remove the scar between the broken ends of the bone, bite off the hardened bone, open the medullary cavity, trim the broken ends, reset by hand, and take the bone according to the bone defect. Intramedullary bone grafting used a bone rod slightly thicker than the medullary cavity and clung to the medullary cavity bone; Bone grafting of extramedullary upper cover should be fixed with screws; Bone fragments can fully fill the residual gap, so as to truly achieve the purpose and requirements of bone grafting. Creeping substitution with autogenous skin-cancellous bone graft shortens the process of fracture healing. Fresh autogenous bone has biological activity, no immune rejection, no risk of infectious diseases, and bone conduction and bone induction.
The following principles should be adhered to in the replacement of internal fixators in the opening report of medical papers. If the original steel plate is fixed internally, the interlocking intramedullary nail or longer steel plate can be replaced and placed on the tension side; If the original interlocking intramedullary nail is used for internal fixation, a larger intramedullary nail or steel plate can be used for internal fixation; The original short steel plate can be replaced with a longer steel plate. All cases need bone grafting. After replacing the internal fixator, those who use plaster external fixation after operation should do muscle contraction as soon as possible. After the callus grows, remove the plaster and start the joint flexion and extension movement. However, doctors should treat specific problems in clinic and deal with them according to the growth of callus. When leaving the hospital, they must give the patient detailed doctor's advice and cooperate with the doctor until the fracture is completely healed. LCP plate internal fixation is suitable for nonunion of long bone fracture of limbs. Broken bone and transplanted bone can be fixed by lag screw, and the broken bone end can be locked by axial compression. The key to the operation is to remove all scar connective tissue at the fracture end, bite off all hardened bone at the bone end, expose normal bone and drill through the medullary cavity. The implanted bone block must be firmly embedded in the defect area, and the gap should be filled with cancellous bone. We should actively and correctly guide postoperative functional exercise, and strictly follow up regularly. Avoid premature and incorrect loading. To sum up, for the treatment of fracture nonunion, autogenous bone transplantation is effective, safe and reliable, with mature technology and wide application, which is worth popularizing.
The main content of the subject research
Case source
All the cases in this study were collected in the orthopedic ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine.
Collection time
May ~ 1 year 1 month
Case selection
diagnostic criteria
(1) medical history: definite history of trauma, no healing after 6 months, and no further healing trend after 3 months.
Symptoms: angulation, rotation, lateral displacement, shortening deformity or segmental bone defect, pain or inability to bear weight, local pain under pressure, etc.
(3) Signs: local sinus formation, pus discharge, pseudojoint or local soft tissue scar and defect.
(4) Auxiliary examination: X-ray findings: the bone end was hardened and the pulp cavity was closed; The bone end is atrophic and loose, with a large gap in the middle; Or the end of the bone is hardened and becomes Chu Jiu pseudojoint with each other, then any one of these three forms can be defined as fracture nonunion.
Selection criteria:
(1) accords with the diagnostic criteria of this disease;
The average healing time of fracture is more than half a year, forming pseudojoint;
(3) The average healing time of the fracture is more than half a year, and the X-ray photos of many times show the fracture line.
Clearly visible, there is no or little callus inside and outside;
(4) X-ray showed that the fracture line was widened, the bone surface at the fracture end was compact and hardened, the bone marrow cavity was closed, osteoporosis was found, there was no trabecular formation between callus, or there was obvious bone defect;
(5) Clinical manifestations include bone infection, defect, deformity, limb unequal length, local sinus formation, pus discharge, etc.
Exclusion criteria:
(1) does not meet the above diagnostic criteria.
The patient has a serious medical disease and can't tolerate the operator.
(3) Patients with mental illness
Observation method of curative effect
The evaluation of nonunion should include the double evaluation of bone healing and functional recovery:
(1) Evaluation criteria of bone healing: The evaluation results depend on four indicators: bone healing, infection, deformity and limb length. Among them, the criteria of bone healing are that the X-ray shows that the fracture line is blurred, there are continuous bone spurs passing through the fracture line, the fracture has no abnormal activity after removing or trying to loosen the external fixator, the lower limbs can walk painlessly, and the upper limbs have a sense of stability at the fracture site. Evaluation criteria:
Excellent: fracture healing, no infection, broken end deformity? , bilateral limbs are not equal in length "cm.
Good: Fracture healing and two of the other three criteria.
It can be: fracture healing and one of the other three criteria.
Poor: the fracture did not heal or re-fracture, or healed but did not meet any of the other three criteria.
Functional evaluation criteria
Functional evaluation is divided into upper limbs and lower limbs. The upper limb mainly considers its flexibility, and the lower limb mainly plays the role of carrying weight.
Evaluation indexes of lower limbs: ① obvious claudication; ② Ankle joint or any joint of knee joint is stiff (when knee joint is completely straight or ankle joint is completely straight, the range of motion is normal or the contralateral side is lost 15? Above): ③ The soft tissue condition is poor; ④ Pain that restricts activities or affects sleep: ⑤ Loss of working ability or inability to take care of oneself in life.
Excellent: working ability, no other four indicators.
Good: Strong working ability, with one or two of the above four indicators.
Ability: Ability to work, with the above three or four indicators.
Poor: loss of work ability or inability to take care of themselves, regardless of whether there are other indicators.
For the evaluation of upper limb function, refer to Seu and Hdlly's upper limb function evaluation standard [3]
There are three observation indexes: pain, range of motion of joints and ability of daily activities.
L: evaluation criteria of upper limb function
Partial pain, pain, any limited joint activity, daily activities.
Teahouse
After fatigue or fatigue
Sustainability ~4? 》4? Completely unrestricted
Slightly limited
Seriously limited
Project progress and arrangement:
Case collection and follow-up action
Write a paper and finalize it.
feasibility analysis
Non-union of long bone fracture of limbs is difficult to cure because of many complications, and the process of functional recovery after operation is long. It is very necessary and feasible to sum up experience in the treatment process. This topic mainly studies the application of steel wire hoop 36 in Shandong Provincial Hospital of Traditional Chinese Medicine in recent years. The curative effect of bone grafting combined with LCP internal fixation in the treatment of nonunion of long bone fractures of limbs is analyzed, so the topic selection is feasible. The research of the subject has also been strongly supported by schools, affiliated hospitals and other departments. I believe this project can be successfully completed.
Main references
[1] Xu, Ge Baofeng, Xu Yinkan, et al. Applied Orthopedics [M] Beijing People's Military Medical Publishing House,
Wang Yiqian, et al. Bone and joint injuries [M] People's Health Publishing House,
[3] Introduction of Xia Hetao's combined external fixator [EB/OL] Beijing Institute of External Fixation Technology, 5
[4] Ginger Orthopedic Clinical Efficacy Evaluation Criteria [M] People's Health Publishing House, 5