危重症护理技术协作网络的构建

为了提高医院的危重症患者的护理质量和抢救成功率及生命质量。采用前瞻性的实践方法构建了护理技术协作网络。通过组织危重症患者的护理技术培训、查房与会诊和扩大危重症护理技术协作网范围、将量化手段引入管理，还应用重症病人评估积分网络管理病人，应用危重症护理技术训练测评系统管理护理人员，提高了护理人员的素质，使人力资源得到合理配置，促进了医疗质量和两个效益的明显提高。由此不难看出，危重症护理技术协作网络有应用推广价值。     

开展护理会诊 提升护理内涵

为使危重病人得到全面、合理、科学的护理，我院护理部按照省医疗护理质量管理要求，推行“护理会诊”制。针对病人病情危重，并发症多而造成护理工作困难的问题，护理部召集有关学科护理专家进行会诊，找出护理难点，向提出会诊的科室提供人性化的护理方案，让病人尽快恢复健康。     

建立支援护理人力库加强重症病人的护理管理

1997年,我院成立了重症监护技术协作网络,建立了医院支援护理人力库。当某些科室重症病人多,发生工作负荷骤增、人力短缺的情况下,网络迅速调配该库护理人员给予人力补充。通过4年的运作,改善了专科重症护理质量,促进了科室间重症护理技术的优势互补,护理人力资源得到合理配置,对医院重症护理技术建设起着重要的作用。     

实施危重症病人量化评分的做法与意义

为使重症护理的质量管理更具科学性及规范化,我院建立了危重症护理技术协作网络(简称《网络》),对重症病人实施评分量化管理,以积分为依据进行有目标的质量监控、技术指导及人力调配。     

护理会诊的实施与效果

随着现代医学的迅猛发展 ,医学理论和技术的进步 ,必将对护理提出更高的要求 ,但是由于受各个专科的制约和影响 ,护理质量经受经验、水平的考验 ,医疗效果往往得不到保证 ,突出表现在急危重病人的抢救中[1] 。为了适应现代护理的发展 ,打破各专科的局限性 ,提高护理质量 ,培养护理骨干队伍 ,我院在护理部的组织下成立了护理会诊中心 ,并参与数次重症疑难疾病的护理会诊 ,有效地解决了各专科的重症疑难护理问题 ,降低了各类并发症的发生 ,提高了抢救成功率 ,达到了各专科护理优势互补的作用。1　护理会诊实施的作用和意义1.1　为重症疑难疾病…     

整体护理模式病房的质量控制

整体护理模式的引进及模式病房的试点工作，相继在各大医院展开，但整体护理地实施，必须有一整套的管理手段和质量保证体系，才能促使其沿着正确轨道前进。我院狠抓模式病房的质量控制：①转变管理者的观念，管理者要参与实践。②拟定模式病房质量评价标准，把质控的力度放在为患者做实事上。③模式病房质量控制措施主要是把管理的视角放在发现实施以病人为中心的护理工作过程中所存在的问题和需要行政管理解决的问题，故更多的让病人及亲属进行评价，将搜集的评价表、信息进行综合分析，从而及时改进工作，提高了护理人员以病人为中心的服务意识和质量水准。     

60例神经外科重症病人管饲膳食的护理

目的：本文的主要目的是探讨神经外科重症病人管饲膳食的护理措施。方法：本文主要通过回顾性分析2009年到2013年的60例神经外科重症病人的临床资料，并分析了营养支持方法的效果来探讨其护理措施。结果：通过营养支持之后发现，所有病人中有4例病人出现了反流现象，有6例病人出现了腹泻，有2例病人出现了便秘，最后各有1例病人分别出现了消化道出血与胃潴留。但是经过相应的处理之后，都得到了很好的控制，并且能够让病人维持很好的营养状态。结论：对神经外科重症病人给予管饲膳食护理，能够得到很好的护理效果。     

重症病人评估量化管理的探索

我院重症监护技术协助网络指导小组，参照美国APPCHEⅡ系统评分法和加拿大PRN护理管理工作法，绘制“重症病人评估积分”表。按照该评分内容，对病人进行5个方面的评估，用数字量化出重症病人的危重程度及特定时间内的护理需求，使管理在质量控制中依据量化结果选择监控对象，依据评估分析确定控制内容，依据科室积分调配人力及物力，以目标管理代替经验管理。     

重症胰腺炎病人的早期监测护理

重症胰腺炎病人呈进行性腹痛,高度腹胀,病情危重,自入院后应安置在重症监护室,借助现代化设备和较集中的技术力量,加强监护、治疗和护理,有助于重症病人的管理和恢复,减少并发症,提高治愈率.现将我院60例重症胰腺炎病人的早期监测与护理报告如下: 1 临床资料     

关于建立医院重症监护技术协作网络的实践与思考

随着医学科学的发展,重症技术协作网络的建立越来越显得重要。文章介绍了重症监护技术网络的组织系统,协作的内容及其动作;组织全院性学术活动;组织监护查房;组织危重病人的科间护理会诊;协调专科特护小组;实施定点向轮转培训。指出今后应着眼于进一步完善重症监护技术协作网络实施方案,拓宽技术网络的协作范围,丰富监护技术协作内容,加强技术协作中心建设。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.