医用冰箱管理现状调查与对策

目的:了解我院医用冰箱管理现状,找出存在的问题,提高冰箱管理质量。方法:自行拟定调查内容,对全院24个单元共计33台冰箱进行现场调查。结果:8台冰箱有专人管理;12台冰箱定期除霜;3台冰箱定期消毒;9台冰箱内药品为标识化管理;6台冰箱内药品分类放置;4台冰箱有正常运作记录;13台冰箱内存放有不需冷藏的药品;10台冰箱内有私人物品。结论:我院医用冰箱的管理存在较多问题,今后应加强对医用冰箱管理的重视,制定并严格执行管理制度;冰箱内物品实行标识化管理,相关部门进行不定期督查,从而提高医用冰箱的管理质量。     

JCI标准下国际患者安全目标在神经外科病房护理管理中的效果

目的 探讨基于JCI标准下国际患者安全目标在神经外科病房护理管理中的应用方法及效果.方法 于2015年在神经外科病房护理管理中引入JCI标准下国际患者安全目标:准确识别患者的身份,增进医护人员的有效沟通,保证手术部位的正确、操作的正确性及正确的患者,加强对高危药物的管理,降低院内感染的危险,降低患者跌倒或坠床的风险.结果 实施JCI标准后的2015年,各项护理安全目标显著提高,均高于实施前的2013年相应指标(均P<0.05).医源性感染率明显下降,均低于实施前的2013年相应指标(均P<0.05).2015年的患者满意度(94%)明显高于2013年(74.67%),差异有统计学意义(P<0.05).结论 在神经外科病房应用JCI标准下国际患者安全目标管理,能有效提高护理质量、降低护理风险,并提高患者的满意度.     

基于JCI标准对手术室高危药品管理的效果

目的建立基于JCI标准的手术室高危药品进行管理改造流程并实施,为避免患者高危药品用药错误,保障患者手术过程的安全提供参考依据。方法对2014年1月~2014年12月基于JCI标准的高危药品管理下规范对本院手术室高危药品管理流程改造并实施进行回顾性分析与总结。比较实施前后高危药品管理情况及医护双方的满意度和默契度。结果 JCI标准下高危药品管理得分由原来的3.5分升至9分;手术室医务人员对高危药品的标识、放置位置、药理作用、使用方法、不良反应的掌握程度由原来的56%上升到95%以上;医护双方的满意度和默契度由原来的(7.32±2.21)分上升到(12.11±2.35)分。结论手术室高危药品管理流程中引入JCI标准,是引进一种全新的质量管理理念,以通过培养医务人员的责任心和团队合作精神来提高高危药品质量管理水平,对保证高危药品的用药安全,避免医疗纠纷具有十分重要的意义。     

JCI标准下预住院患者安全管理的实践

总结JCI标准下预住院患者安全管理的实践效果。建立质量改进小组,制订预住院预案,严格疾病筛选,有效引导患者进行院前检查,严格危急值管理,保证有效沟通和环境安全。实施2年多来患者满意度由实施前的85.0%上升至98.4%,无不良事件发生,预住院患者例次逐年增加,平均住院时间逐年缩短,提高了工作效率。     

基于JCI标准的急诊专科护理质量指标体系的构建与实践

目的:探讨基于JCI标准的急诊专科护理质量指标体系的构建与实践。方法:通过构建基于JCI标准的急诊专科护理质量指标体系,完善急诊专科护理制度规范与流程指引。结果:在保障护理工作有章可循的基础上,实践了基于JCI标准的急诊专科护理质量指标。结论:基于JCI标准的急诊专科护理质量指标体系的构建与实践有利于提高护理质量管理,确保医疗安全,深化护理内涵。     

基于JCI评鉴标准管理医院有害物质的实践

目的探讨将JCI评鉴标准实践医院有害物质管理的有效性。方法选择我院2014年7月-12月以JCI为标准规范管理实施前的有害物质安全核查数据为对照组,2015年1月-6月以JCI为标准规范管理实施后的有害物质安全核查数据为观察组。监测记录有害物质安全核查合格率。结果观察组有害物质安全核查合格率明显高于对照组,两组比较差异有统计学意义(P0.01)。结论以JCI标准中有害物质管理的衡量要素为实践标准,提高了有害物质安全核查合格率,对提高医院安全管理体系,并持续质量改进,科学、有效地管理医院有害物质具有重要意义。     

基于JCI标准的围手术期患者安全管理

目的：应用JCI标准从根本上提高围手术期的护理管理质量,从而确保患者的护理安全。 方法：通过改进关键流程交接班制度、完善患者身份确认及加强患者及其家属的健康教育等方法,不断改进护理流程和护理重点环节。 结果：经过1年来的实践,护理质量分由96.3分提高到97分;护理缺陷（意外、差错事件）发生由7起降至5起;投诉率为0%;出院患者满意度由91.6分提升到92.6分;手术患者健康教育知晓率97.3%由提升到98.6%。结论：JCI标准对患者安全与服务质量持续改进具有重要意义。     

基于JCI标准的肿瘤患者疼痛管理实践

目的 :探讨基于JCI标准的肿瘤患者疼痛管理方法,以减轻患者的疼痛,提升疼痛管理护理服务品质。方法 :依据JCI评审标准,从完善肿瘤患者疼痛管理的制度、患者疼痛评估和记录、医护人员疼痛管理知识的规范化培训等多方面着手改进,形成一套基于JCI评审标准的疼痛管理方法。结果 :基于JCI标准的肿瘤患者疼痛管理实施前后,对412名本院新护士进行调查,护士疼痛管理理论知识水平评分分别为:(61.85±1.53)、(87.46±2.87)(t=9.52,P0.01);护士使用疼痛护理记录满意度评分分别为:(3.12±0.51)、(4.82±0.64)(t=5.04,P0.05);疼痛护理记录单记录合格率分别为:61.17%、97.72%。结论 :基于JCI标准的疼痛管理,有利于提高护士疼痛管理理论知识水平,提升患者疼痛管理评估正确率,改善患者疼痛控制效果,维护患者安全和提高护理质量,体现了以患者为中心的护理服务理念,值得进一步推广和应用。     

基于JCI评审标准的麻醉科仪器设备风险管理

目的探讨基于JCI评审标准的麻醉科仪器设备风险管理效果。方法参照JCI评审标准,从组织管理架构、管理制度、规范化操作、人员培训及资质管理、质量控制管理等方面进行完善和改进。结果实施JCI评审标准后仪器设备完好率明显高于实施前,相关不良事件发生率明显低于实施前,差异有统计学意义(P0.01)。结论 JCI评审标准应用于麻醉科医疗设备风险管理,有效提升了麻醉科仪器设备品质管理,降低了医疗设备使用风险,提高了医疗安全。     

"五常法"在基于JCI标准下病区药物管理中的实践与应用

[目的]基于JCI标准,确保病区药物管理的安全性.[方法]将"五常法"的理论及管理模式应用在药品管理中,实行全员参与和专人负责制,制定实施计划,定期检查,不断改进.[结果]病区药品管理质量、医务人员及病人满意率等均明显提高,提高了用药安全.[结论]"五常法"具有简单、实用、高效的管理特点,是提高药品管理质量的有效方法.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."