信息化技术在医用耗材采购使用管理中的应用探讨

目的:规范医用耗材采购流程,缩短采购周期,降低管理难度并提高管理质量.方法:采用程序开发工具编制医用耗材采购管理系统,建立系统数据库,收集医院使用各种耗材的品种、供应商、生产厂家信息,以实现对产品、供应商、生产厂家资质等核心事项的动态管理.结果:该系统可以实现对各类医用耗材申报、采购、使用等环节的规范化和标准化管理,并可对使用信息进行分类查询、物流溯源、质量监测、数据分析及统计.结论:该系统可为医院对医用耗材,尤其是高值耗材的采购及使用管理提供依据.     

医用耗材精准管控体系构建

实现医用耗材精细化管理,关键是构建精准管控体系。分析了当前医用耗材在购入和溯源环节存在的缺陷,依托医用耗材来源、流通、使用等过程管理规范,开发出连通供应目录库、中心库、二级库的医用耗材精准管控体系,实现了计划、领用、计费、使用的全过程精准管控,达到供应渠道清晰、出入库业务规范、库存周转快速、收费准确、溯源到位的管理目标。     

浅谈医院医疗耗材管理的现状与对策

通过对目前医院医用耗材存在管理模式落后、入库分类名称不规范、植入性耗材管理可追溯性差等弊端的分析,提出改变医用耗材的管理模式、规范入库分类名称、建立植入性耗材管理系统等改进措施,从根本上科学合理地实现医疗卫生耗材资源的管理。     

医用耗材管理探讨

目的:探讨医用耗材规范化管理的相关要求与方法。方法:从医用耗材的分类管理、引进管理、采购管理、物流与库存管理以及质量控制管理等方面,对医用耗材实施科学、高效、全面的系统管理。结果:通过对医用耗材的规范化管理,优化了物流管理、规范了采购流程、降低了医疗耗材的成本、保证了医疗质量和患者安全。结论:提高医院内医用耗材管理水平、降低医疗成本、加快资金的周转对促进医院可持续发展具有重要意义。     

军队医院实施高值医用耗材监管的探讨

目的:规范高值医用耗材供应商管理,提高以植入性耗材为重点的追溯管理实效。方法:为在实际工作中发挥效能,医院成立监督管理办公室,对医学工程科进货、麻醉手术科使用情况进行监管。结果:确保条型码技术在临床高值医用耗材使用中的推广和应用。结论:高值医用耗材的监管完善了流程,规范了管理,提升了医院高值医用耗材监管工作的针对性和有效性。     

骨科医保患者植入性医用耗材分析研究

目的:规范骨科医保患者植入性耗材的使用,确保医院医保患者的最大利益.方法:对某三甲医院2011年上半年骨科植入性耗材使用情况作描述性统计分析.结果:骨科植入性耗材种类繁多,型号复杂,医院努力做到了在保证医疗质量的基础上使医保患者获得最大收益.结论:通过加强人员培训,严格采购审批程序,加强对植入性耗材安全认证,强化院内监管力度,在全院推行规范化管理制度,加强了对植入性耗材的规范化管理,确保了患者的最大利益.     

基于RFID技术实现医用高值耗材可溯源性管理的探讨

目的：通过采用先进的信息管理技术,对医用高值耗材生产、流通、使用各环节进行科学、有效的管理。方法：以RFID标签为信息载体,在生产、物流和使用各环节进行信息的追加,完成对高值耗材全生命周期的监管。结果：在追溯时,用RFID阅读器找出相应高值耗材的RFID标签即可获取该耗材生命周期的全部资料,该资料的真实性可与各种系统中的信息进行比对,如厂家生产管理系统、供应商物流系统、HIS等,从而做到高值耗材的可溯源性管理。结论：基于RFID技术的医用高值耗材可溯源性管理能够大大提升高值耗材管理的规范化、透明化和信息化水平。     

骨科植入性耗材的信息化管理研究

植入性耗材是骨科高值医用耗材,供应和使用标准要求较高,信息化管理可有效提高骨科植入性耗材的合理使用和有效管理,但传统管理办法存在着信息化水平低、手续繁杂等问题,导致耗材管理不到位,影响患者手术效果甚至生命安全。为此,通过整合骨科及医院现有信息化管理资源,从采购、出库、使用及术中收费等环节入手再造骨科植入性耗材信息化管理闭环流程,实现对耗材的专业、动态及信息化管理,提高高值耗材管理工作的效率及质量,以实现控制医院成本,降低患者治疗费用的目标。     

高值医用耗材规范管理的探讨

作者对医院高值医用耗材的管理各环节进行探讨,包括严格使用准入审批、加强高值耗材集中采购管理、确保仓库管理、规范临床使用、全流程监督等,规范高值医用耗材的采购与临床使用行为,保障医院的医用耗材质量和医疗安全。     

加强医用耗材采购规范化管理

随着医用耗材使用的不断增加,科学的规范医用耗材的采购管理,是采购管理部门面临的重要问题。本文从医用耗材的分类管理、引进管理、采购管理等方面,探讨了医用耗材规范化采购的有关要求与做法。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。