远程胎儿监护系统及其临床意义的研究

本文设计的系统由中央监护站、胎儿监护仪和家庭胎儿监护仪联网组成。中央监护站安装于中心医院产科,基于无线传感器技术去除了电缆对孕产妇的束缚,实现对孕产妇在医院内的移动监护;基于Internet,实现社区医疗机构的胎儿监护仪与中心医院的中央站的远程连接,由中心医院对社区医疗机构提供技术支持;基于公共电话网或Internet,实现家庭胎儿监护,为在家的孕妇提供远程诊断与指导。     

远程胎儿监护系统及其临床意义的研究

本文设计的系统由中央监护站、胎儿监护仪和家庭胎儿监护仪联网组成。中央监护站安装于中心医院产科,基于无线传感器技术去除了电缆对孕产妇的束缚,实现对孕产妇在医院内的移动监护;基于Internet,实现社区医疗机构的胎儿监护仪与中心医院的中央站的远程连接,由中心医院对社区医疗机构提供技术支持;基于公共电话网或Internet,实现家庭胎儿监护,为在家的孕妇提供远程诊断与指导。     

Indoor/outdoor PM10 and PM2.5 in Bangkok, Thailand

Twenty-four-hour averaged PM10 and PM2.5 concentrations were obtained by using 4-liter-per-minute-pumps and impactors in microenvironments of a busy shopping district and a university hospital campus. In both areas, most people live directly adjacent to their worksites--minimizing the need to measure commuting exposure as part of total daily exposure. Co-located samplers were set in indoor microenvironments, the near-ambient zone of the households, and at nearby streetside central ambient monitoring stations. Smoking and use of other indoor PM sources were recorded daily via questionnaires. Consistent with previous studies, smoking and the use of charcoal stoves increased indoor particulate matter levels. The sampled air-conditioned hospital area had substantially lower particle concentrations than outdoors. A simple total exposure model was used to estimate the human exposure. The averaged ratios of co-located PM2.5/PM10 concentrations in various microenvironments are reported for each location. A single daily indoor average PM10 concentration for all households measured in a given sampling day is calculated for correlation analysis. Results showed that day-to-day fluctuations of these calculated indoor PM10 levels correlated well with near-ambient data and moderately well with ambient data collected at the nearby central monitoring site. This implies that ambient monitors are able to capture the daily variations of indoor PM levels or even personal exposure and may help explain the robust association of ambient PM levels and health effects found in many epidemiological studies. Absolute PM exposures, however, were substantially underestimated by ambient monitors in the shopping district, probably because of strong local sources.     

口腔专科医院消毒供应中心的运行新模式

目的探讨口腔医院供应中心引进全自动清洗机后的运行新模式。方法应用清洗机,将不同科室高低速手机及门诊器械进行清洗消毒,并根据不同种类实施不同的管理方式。结果该模式不但有效减少医院感染,减轻临床护士工作量,而且使口腔器械得到了专业的保养和养护,节约医院资源,降低成本,使器械清洗、包装、灭菌更加规范。结论新运行模式在临床应用中取得了良好的效果。     

大型医院监护仪血氧饱和度测量性能影响因素的研究

目的初步了解大型综合医院监护仪血氧饱和度测量性能的质量状况,为今后监护仪的采购和管理提供参考依据。方法选择某大型综合医院内科片、外科片两个范围内科室,以计量标准为参考依据设计调查表,采用血氧饱和度测量仪对所有206台监护仪血氧饱和度测量功能的质量状况进行一次横断面调查,对调查结果进行统计分析。结果在206台正在使用中的多功能监护仪中,本次血氧饱和度测定不合格的共有21台;进一步分析显示,监护仪的血氧饱和度测量性能与使用时间、使用频率有关,而且使用时间长短不同其血氧饱和度测量性能存在显著的统计学差异。结论使用时间和使用频率对监护仪血氧饱和度测量性能有影响,管理部门应以此为依据合理制定监护仪的计量检测周期并合理设置使用年限,以确保其测量的精度。     

探讨有创血压监测功能监护仪的合理配置

目的：优化某三甲医院住院部科室有创血压监测功能监护仪的配置方案。方法统计各科室该监测功能使用情况,医疗设备租赁中心的租赁记录并进行计算。结果根据2012年相关使用记录,制定出了具有该监测功能的监护仪的再分配计划表。结论对监护仪使用记录进行研究有助于提高设备使用效率,合理降低成本。     

多参数监护仪的质控及分析

通过对全院临床科室多品牌监护仪存在问题及质量控制结果进行分析,提出维护保养及提高设备使用率和完好率的可操作性建议,进而达到医疗卫生装备质量可靠、安全有效的目标。     

太空监护仪的维修

目的通过对太空监护仪系列的日常保养及维修,总结其常见故障的排除方法。方法根据近几年对太空监护仪的单机维修和中央台设置的经验,对院内太空监护仪进行全面保养。结果太空监护仪的故障报修率明显降低,故障修复速度明显加快。讨论对太空监护仪工作经验的总结,提高工作效率,缩短维修时间。     

现代监护仪的特点及发展趋势

本文介绍了现代监护仪的特点及发展趋势:监测参数不断增加、应用领域不断扩大、结构组合更加灵活、网络功能日渐完善、操作界面友好简便,着重介绍了监护仪监测参数和应用领域的扩展,以及监护仪网络功能的开发应用,指出监护仪的使用,不仅减轻了医务人员的劳动,提高了医护工作效率,同时也提高了医护工作质量,从整体上提高医院的竞争力与医疗服务水平。     

PDCA管理模式在多参数监护仪质量控制中的应用效果

目的探讨PDCA管理模式在多参数监护仪质量控制中的应用效果。方法选取医院2019年1月至2020年6月的120台多参数监护仪作为研究对象,其中,2019年1—9月未实施PDCA管理,2019年10月至2020年6月实施PDCA管理,比较PDCA管理模式实施前后多参数监护仪的检测一次合格率、维修率及质量控制检测结果。结果实施PDCA管理模式后多参数监护仪的检测一次合格率高于实施前,维修率低于实施前,差异有统计学意义(P<0.05)。结论PDCA管理模式的实施可有效降低多参数监护仪的故障率,提升安全系数。     

The comparative costs of care using apnoea monitors and scales in families with a cot death

This paper reports the findings from a programme, which provided support to families with a subsequent baby following a cot death. One hundred families participated in the study. Fifty families were randomly allocated apnoea monitors, and the remainder provided with scales and weight charts for daily weighing. The results show that the parents in both groups expressed equal satisfaction with their designated method. However, compared with families allocated scales, those using apnoea monitors attended the child health clinics more often, and the number of contacts with the paediatrician was increased. They also had slightly more home and general practitioner contacts and hospital admissions. The capital and running costs of providing monitors was also greater for this group.     

Physiologic monitoring systems

Physiologic monitoring systems, which monitor vital physiologic parameters so that clinicians can be informed of changes in a patient's condition, typically consist of several distinct components, including a central station, bedside monitors, and ambulatory telemetry transmitters and receivers. For this study, rather than focusing on how each component performs individually, we evaluated how the entire system functions as a whole to better parallel the acquisition practices followed by most hospitals. We evaluated systems from eight suppliers, focusing primarily on adaptability, alarm implementation, and human factors design. We included only systems that offer (1) a central station that can concurrently receive information from bedside monitors and ambulatory telemetry transmitters, (2) one or more bedside monitors that can be used in critical care and intermediate care areas, as well as during transport, and (3) ambulatory telemetry monitoring. We rated the evaluated systems based on their capabilities for each of six applications: critical care unit, emergency department, intermediate care unit and general medical/surgical floor, operating room, postanesthesia care unit, and transport. We found that many of the systems are suitable for some applications, but are unable to meet the requirements for others.     

医院心电网络系统的建设与临床应用

目的：研究心血管专科医院内心电网络系统的建设与临床应用。方法：构建院级水平的心电网络化信息平台,在各病区配置网络心电图机,通过院内局域网及服务器与医院心电诊断中心对接,按设定的流程进行病例检查操作、上传、诊断、回传、结果打印与归档。结果：各病区终端心电图机、中央服务器、心电诊断中心通过局域网连接成一个整体,在医院心电网络化试验过程中,系统运行比较平稳,操作比较方便。结论：在医院内建设心电网络系统能明显提高临床心电检查及诊断工作的效率。     

Air pollution and daily mortality in Rome, Italy

OBJECTIVES: To assess the relation between several daily indicators of air pollution (particulates and gases) and daily mortality in the metropolitan area of Rome and in the central part of the city. METHODS: Time series analysis. The associations between daily concentrations of pollutants (particles, SO2, NO2, CO, O3) recorded by five fixed monitors and daily total mortality in the period from January 1992 to June 1995 were evaluated. The analysis included examination of the pollution effect on mortality by place of residence within the metropolitan area, by season, age, place of death (in and out a hospital), and cause of death (cardiovascular and respiratory disease). The Poisson model included loses smooth functions of the day of study, mean temperature, mean humidity, and indicator variables for day of the week and holidays. RESULTS: The mean daily number of deaths was 56.9 (44.8 among people > or = 65 years old). A mean of 36.3 deaths occurred in the city centre; 37.3 deaths a day were recorded in a hospital. Total mortality was significantly associated with a 10 micrograms/m3 increase in particles (0.4%) on that day (log 0), and with a 10 micrograms/m3 increase in NO2 at lag 1 (0.3%) and lag 2 (0.4%) (1 and 2 days before, respectively). The effect of particles (lag 0) and of NO2 (lag 2) on total mortality was higher among those living in the city centre (0.7% and 0.5%, respectively). The risk estimates were higher in the warmer season (1.0% and 1.1%, respectively), whereas no difference was found for those dying in or out of the hospital. The effect of particles was robust to a sensitivity analysis and to the inclusion of NO2 in the regression model. CONCLUSIONS: Increase in particulates and NO2, generated by the same mobile combustion sources, is associated with a short term increase in mortality in Rome. The effect is more evident among residents in the city centre, where the levels of exposure to pollutants recorded by fixed monitors are probably more reliable indicators of personal exposure.

 

     

浅析床旁监护仪中无创血压的测量

本文通过分析模拟血压的测量结果,简单总结了我院在用监护仪无创血压测量的一般规律。     

医院在用监护仪的质量检测分析

目的:通过研究分析监护仪的质控环节、检测项目及技术要求,提高医院在用监护仪的安全性和可靠性。方法:依据监护仪质量控制技术规范(试行),采用专业质控设备对医院在用的134台监护仪各项指标进行检测。结果:不符合质量要求的共31台,不合格率达23.1%。结论:通过此次检测,基本掌握了医院在用监护仪的使用状况,为确保监护仪在今后使用过程中的质量安全打下基础     

控制医院感染的管理

综合性医院应将医院感染的管理,控制纳入医院建设规化中。本文对中国人民解放军总医院在医院内感染控制的统筹计划、实施指导、监督和科学研究、建全院内感染控制组织网络、建立医院感染研究机构和完善控制感染的各项规章制度,以临床为依托,提供一套既有科学性又切实可行的医院内感染预防与管理方法进行了探索。     

临床麻醉仪器设备新进展

目的:介绍麻醉仪器设备近期发展趋势,了解新型麻醉仪器的研究进展及使用范围。方法:主要从临床围手术期麻醉范围进行介绍,分别从麻醉机系列、吸入麻醉蒸发器系列、麻醉电子病历系统、便携超声成像系统、麻醉机呼吸内回路消毒机系统、麻醉深度监测仪系统、多参数监护仪系统、可视气管插管仪器系统等方面进行展示。结果:麻醉相关仪器设备的发展为临床麻醉创造了更好的医疗条件,增加了麻醉的安全性,使医生手术操作变得更加便捷,为患者手术安全提供了保障。结论:临床麻醉仪器的迅速发展为临床进行高难度手术提供了成功的基础,也提高了围手术期的麻醉质量和安全度。     

Innovative approach to the aims for improvement: emergency department patient throughput in an impacted urban setting

Los Angeles County is in crisis with its emergency ambulatory care. Many barriers exist at the hospital level that affect patient throughput. A case study is presented for St. Francis Medical Center, a 384-bed hospital in southeast Los Angeles. Its governing board has put out a call to have its emergency department oversee intraprocess and interprocess improvements to enhance patient movement through the system. These innovative front- and back-end initiatives are examined using the Institute of Medicine's Six Aims for Improvement. Details on each of the initiatives are provided along with how the leadership monitors the progress.     

信息化在医疗费用和药品的监控管理中的作用

目的：探讨医疗费用和药品监控的意义和方法。方法：通过临床药师、财务、医疗科、医保办、质控部门和临床联合,采用软件、规章制度等手段开展监控管理,实施中,突出及时发现、及时纠正、责任到人的原则。结果：监控医疗行为,降低药品费用,减轻患者负担,降低药占比。结论：提高医院的综合竞争力,更好地为患者服务。