Chapter 441 Deliberately left blank (please subscribe)
When Zhou Cheng rushed to the trauma surgery department, the number of patients inside had recovered slightly from before, but it still could not return to the previous number, and there were still many empty beds.
Even when Zhou Cheng was in the corridor, he heard some patients' family members discussing whether the Affiliated Hospital of Shonan University was as deceptive as the Second Hospital.
Even, because Zhou Cheng's photo was not hanging in the department and he had not put on his white coat when he came in, a family member asked Zhou Cheng how much money your family spent.
Zhou Cheng was slightly embarrassed: "I'm sorry, I'm a doctor in this hospital, and I'm here for consultation. You'd better discuss this issue with other patients."
After Zhou Cheng responded politely, he went directly to the doctor's lounge, casually put on a white coat, and then rushed to the long-lost doctor's shift room.
In the shift room, the people were still the same as before, except that the chief resident, Zhou Cheng, was replaced by the original chief resident, Huang Zong. However, although Huang Zong now replaced the chief resident, because of the emergence of Zhou Cheng and Yang Yifeng, the chief resident was restructured.
Now, his complexion looks much rosier than before.
In the shift room, due to the "temporary absence" of Professor Cai Dongfan and Wang Yunfa, the seats were vacant. After Zhou Cheng came in, both Ding Changle and the head nurse motioned for Zhou Cheng to find a place to sit down.
In the Shonan University Affiliated Hospital, only doctors from our own hospital have enough seats. This is an unspoken secret. In fact, it is the same in most hospitals.
It happened to be the end of the shift shift for the doctor on duty, and then the head nurse said first: "I will convey the content of last week's weekly hospital meeting."
"Dean Lei, once again carefully laid out the development plan of our hospital for the first half of the year. The basis is to ensure the quality of medical care, stick to the bottom line, do a good job in clinical work seriously, and be proactive."
“With the professors leading the team as the working unit, we should develop new surgical procedures, new diagnoses, and new understandings of diseases, and with the director of the laboratory as the scientific research team unit, we should develop new topics and new research development routes.”
"The Scientific Research Department, as an auxiliary and supervisory unit, must deal with the timeliness, ethics and many other issues of all clinical subjects and basic subjects in the hospital. The Ethics Committee takes the lead and conducts random inspections of clinical subjects conducted in the hospital at all times."
"Anything found to be inconsistent with the basics of ethics will be stopped. As long as there are no violations, progress will continue. No one is allowed to disturb the normal progress and operation of clinical and scientific research work."
"Third, we must implement the work of receiving medical treatment, analyze the advantages of the department, and take the lead, aiming to improve the quality of our medical services and integrate teaching, scientific research, etc..."
The content of what Dean Lei Zhong said was very official, very Tilian-like.
But there are a few key points, that is, you must be free to do the project, but you must be free within the rules, and take ethical issues as the lowest line.
Moreover, the scientific research department and other administrative departments must not interfere with the normal operation of clinical and scientific research at will. This is a good thing, and even the business of the medical department has been adjusted to some extent.
Of course, all of this is based on the overall situation, and each department must have its own key points.
Ding Changle quickly took over the words: "We all have to understand what the head nurse conveyed. Now, Director Lei has broadened the road a lot for our clinical and scientific research work. In this way,
In a relatively free environment, if we still cannot run far, we will eventually be left behind."
"If you can't keep up with the requirements of hospital development, if you don't make progress and remain complacent, you will definitely regress."
"As for our entire orthopedics department, we are currently developing at the forefront of joints and sports medicine. Our orthopedics department, our trauma surgery, our hand surgery, and foot and ankle surgery still have a lot of potential.
Expansion capacity."
"Especially, in recent years, as the understanding of diabetic foot has deepened, the number of diabetic foot patients has remained high. There are many patients in our province who do not receive standardized diagnosis and treatment, and their quality of life is worrying. In this situation
Under the premise of "
"Strive to recommend a demonstration site for standardized treatment of diabetic foot in central China and take the lead."
"Our department is doing very well in this regard. Professor Ningling takes the lead and Dr. Zhou assists. This month, our department has had no less than forty patients with diabetic foot, and they have received turnaround in and out of our department.
, which is a good thing.”
"This is also the first development direction for our trauma surgery department."
"Here, I want to do some self-examination. In the first month of this new year, my group has not done any pioneering work, and the diseases we are exposed to are the same as before."
"Then when I looked back and analyzed the disease structure, I found that I felt that there were some patients who should not have appeared in our hospital and we should not have treated them. The diagnosis and treatment process for these patients was very simple, and for us
He said that treating such cases and diseases is a waste of time."
"Actually, prefecture-level city hospitals or other hospitals in Shashi can receive patients normally. Therefore, I hope to see that in the follow-up process, our department must consider this when receiving patients.
Patients, it is necessary to come into our department."
"Although our trauma surgery is the foundation of orthopedics, there are still many directions for development. Apart from fractures, complex fractures, and complex bone defects, I think there is still a lot of room for exploration."
"For example, we can further develop patients with severe infections, patients with muscle atrophy, bone atrophy, and some patients with lower limb deformities."
"For example, foot and ankle surgery, osteotomy and orthopedics, ankle joint replacement, mosaic bone grafting, etc. will also be our development direction."
"Tianzhu, you go down and do the distribution. We must follow Professor Ningling's footsteps and make progress together. We cannot rest on our laurels."
Qin Tianzhu also nodded quickly and recorded Ding Changle's explanation in his notebook, but he was just worried.
"Another point, I think there are still some problems with the teaching in our department, but in the process of teaching, I also found some other problems. That is the students of our basic medical school, what they have learned and been exposed to
The knowledge points are actually out of touch with our clinical practice."
"Then how to combine the specialized knowledge and cutting-edge knowledge applied in our clinical practice with basic knowledge, and then play a good teaching role in clinical practice, is something we need to consider. The interns in our hospital are all very talented.
Yes, I hope everyone will pay attention to it..."
"At the same time, our interns, residents and master's students should also pay attention and be more proactive."
"Our superior doctors are very busy with clinical work and scientific research work, so you must focus on your own learning progress. It is best to find a more suitable anchor point, throw it out, and then let us guide you in the direction, or just do a good job
When we encountered difficulties in the analysis of clinical cases, we made progress by searching the literature and asking superior teachers.”
…
"Okay, there's nothing else to do next. If we need to do ward rounds and discuss incurable diseases, let's go and discuss them."
"Huang Zong, you go and check the ward, and I will discuss the intractable diseases with Professor Ningling's team." Ding Changle told Huang Zong and the junior doctors in his team.
After this, the doctor in charge of Ningling's group released a case.
In fact, he is a patient with diabetic foot. However, this patient's previous routine surgeries and clinical treatments were all done in accordance with the standards and procedures, but the results were not very good.
The doctor in charge of the bed said quite conservatively: "Professor Ding, Professor Ning, Teacher Zhou and all the teachers, I am not complaining. It is mainly the current patients and their families who are speculating because of Professor Liu from the Second Hospital."
"Did we specifically target him and not cure him? We wanted to make more money from him."
"Because the patients who were hospitalized before have actually been discharged from the hospital now."
Ding Changle was a good listener and did not express any opinions after listening. Instead, he looked at Ningling.
Associate Professor Ningling actually came for Zhou Cheng, but Zhou Cheng left halfway, so he stepped in temporarily. Now he met such a difficult patient, Ningling was a little puzzled: "Doctor Zhou, this patient,
In fact, overall, there is nothing special about it.”
"The blood sugar is well controlled, the medication is being used normally, and the principles of debridement are also grasped. However, after debridement, there is still the problem of slow wound healing."
"During this process, the blood sugar level has never been high, and there are no other accompanying diseases."
"We have also checked some information and literature, but we have not found a suitable method. Do you think this patient still needs to go to the last step as soon as possible?"
The last step is to amputate the leg as soon as possible.
In fact, according to the amputation rate of one in 50, which is less than 2%, it is already far beyond the data published by the World Health Organization. It is estimated that in hospitals around the world, such amputation rates are extremely rare.
Zhou Cheng didn't answer and asked instead: "Professor Ning, this patient's current symptoms should not be at the last stage. The indications for amputation are carrion, necrosis, gangrene, etc."
"If conventional medication, debridement, antibiotics, and even vascular reconstruction have not shown any effect on this patient, Professor Ning thinks there is nothing else we can think of?"
When Zhou Cheng heard this, his heart was not very volatile.
The plan he gave is naturally the best and can handle most cases of diabetic foot. It is a perfect plan, naturally.
Of course, no solution can perfectly solve all patients, and the solution given by Zhou Cheng must also be appropriately perfected and repaired.
This was the blank space he deliberately left when he gave the plan, and this is where Ningling can make further progress.
The next topic Zhou Cheng wants to apply for is related to diabetic foot. This disease has a large patient base, and the current treatments are indeed relatively limited.
It’s just that it’s definitely not easy for Zhou Cheng to do it alone, and Zhou Cheng not only wants to do this, he wants to do it together with Ningling. The best way to stimulate enthusiasm is to let Ningling come up with it himself.
"Debridement, blood supply, and nutrition have all been done to the best. Anti-infection is also effective. There is no infection. Microcirculation and other factors are all optimal factors. If such treatment measures still fail to achieve the effect, I am serious.
have no idea."
"There are other ways." Ningling frowned.
Because according to the idea given by Zhou Cheng before, diabetic foot basically has nowhere to hide. Ningling himself has the technical foundation of hand surgery, so it is very easy to get started.
Ningling was very happy to be able to cure such a disease as soon as he took over it.
He thought he was already very good at it due to his previous accumulation, but this patient really baffled him.
Zhou Cheng knew that Ning Ling had thought of many ways, so he added another point: "Professor Ning, since all the preparations have been made, the blood supply is smooth, and the nutrition is good, why can't the wound heal?"
"No infection, adequate nutrition."
"Do you think it's possible that the local pressure is higher because the nutrients are too rich and the blood supply is too rich?"
"In fact, no matter what treatment measures are used, when targeting diabetic foot, the essence is to reduce local pressure."
"What does excessive local pressure mean?" Zhou Cheng gave a little hint.
Ningling was stunned when he heard this.
The occurrence of local ulcers in diabetic foot is local skin necrosis caused by excessive local pressure, but this is mostly due to blocked blood supply or embolism in a hypercoagulable state.
Now that Zhou Cheng has said this, is it because the local blood supply is too rich and the nutritional status is good, which leads to local pressure or is it increased, which is the reason for the non-healing of the wound?
When Zhou Cheng saw Ningling and Ding Changle thinking, Zhou Cheng suggested: "Teacher Ning, I think that when we can't find the missing disease, we can consider whether the dosage is excessive."
"For example, some patients' high blood pressure is a cardiogenic problem, but some patients' high blood pressure is a nephrogenic problem."
"For cardiogenic problems, we can appropriately reduce the pumping capacity of the heart, but for nephrogenic problems, we may not necessarily be able to solve them by reducing the heart's pumping capacity!"
"After the structural foundation is established, we can reduce the overall flow of the body, optimize the nutritional structure, and make the local blood supply less adequate. Try it, and maybe it will work wonders."
All treatment principles must grasp the core.
Ningling was slightly stunned when he heard this: "Dr. Zhou, you mean that the local replenishment was too strong and the blood supply was too rich, which caused the local pressure to increase again, so the ulcer did not heal?"
"We do not rule out the possibility. I think this is a good point for us to study in depth, especially for some patients who have relatively rich nutritional supplies."
"After establishing the local anatomy foundation, we must consider other aspects..." Zhou Cheng timely put forward his ideas for the next step of clinical research.