神经内科跌倒风险评估量表的设计与应用

目的 使用神经内科住院患者跌倒风险评分量表对住院患者进行评分,观察使用该量表前后患者跌倒发生的变化情况.方法 设计神经内科住院患者跌倒风险评估量表,2005年1月-2007年12月对神经内科住院患者跌倒风险进行评估,实施安全护理对策,预防跌倒的发生;同时调查2002年1月-2004年12月神经内科住院患者发生跌倒例数.结果使用神经内科住院患者跌倒风险评分量表后,目标人群预防跌倒的意识加强.患者跌倒发生率显著下降.结论 对神经内科患者是否伴有跌倒风险因素进行评估,并对目标人群采取安全护理对策,可有效预防神经内科患者跌倒的发生.     

消化道间质瘤36例CT影像与病理危险度的相关性分析

目的探讨消化道间质瘤(GIST)CT影像与病理危险度之间的相关性。方法回顾性分析接受手术治疗并获病理确诊的GIST患者36例,分析其CT征象与病理结果所示危险度之间的相关性。结果 36例患者原发于食道1例、胃25例、小肠6例、结肠4例;病理危险度分级:极低危组12例(33.33%),低危组11例(30.56%),中危组7例(19.44%),高危组6例(16.67%)。CT征象中,肿瘤形态、生长方式和强化程度与危险度分级无相关性(r分别=-0.14、0.12、0.05,P均>0.05),CT显示肿瘤大小与危险度呈中度相关性(r=0.53,P<0.05),坏死区域大小和转移情况与危险度分级呈弱相关(r分别=0.38、0.36,P均<0.05)。结论GIST的CT征象中肿瘤大小、是否存在坏死及坏死大小以及是否存在远处转移可用于评估危险度,其中以CT显示肿瘤大小预测意义最大。     

Safe transfusion: Perspective from the blood supply agency

Risk management concepts from the engineering literature suggest that a background risk of one in a million is the intuitive level of acceptable risk. That risk level is being approached by the risk of transfusion-associated malaria and HTV in Australia. However, the risk of transfusion error and the risk of transfusion-associated HBV is still unacceptable by this standard. The risk of transfusion-associated HIV is intermediate. It is likely that improvement in the risk of transfusion-associated disease will come primarily from the extended use of autologous transfusions and by technological solutions. By its very nature, donor assessment is an inefficient way of selecting safe donors, gives progressively diminishing returns and is prone to failure.     

2016年中国媒介伊蚊密度监测结果分析

目的 分析2016年我国23个省份媒介伊蚊密度监测资料,为媒介伊蚊传播疾病风险评估、预测预警、防控提供参考依据。方法 收集我国登革热中转支付项目媒介伊蚊监测系统及病媒生物监测国家级监测点上报的媒介伊蚊密度数据,利用相关性分析等方法分析,2016年我国媒介伊蚊密度及其密度指标间的相关性。结果 2016年我国总平均布雷图指数（BI）为3.80,总平均诱蚊诱卵器指数（MOI）为6.12。Ⅰ类省份中,云南6月下半月至9月上半月BI达到传播中风险;海南6月下半月、9月上半月和10月下半月BI达到传播高风险;福建6-10月BI达到传播中风险;浙江7月上半月和8月上半月BI达到传播高风险。广西3月下半月、4月上半月、5月下半月以及6-8月BI处于传播低风险;6月下半月MOI达到传播高风险。广西和广东BI与同期MOI呈正相关,广西媒介伊蚊成蚊帐诱指数与同期BI和MOI均呈正相关。Ⅱ类省份重庆、江西、河南、湖北和湖南5-10月平均BI均达到传播低风险;自6月开始安徽和四川BI达到传播低风险;上海和江苏7-8月BI达到传播低风险。贵州5-10月、湖南6-9月和河南6月及8-9月MOI达到或超过传播低风险。湖北6月BI达到传播高风险。Ⅲ类省份陕西6-8月和河北8-9月BI达到传播高风险;山东8月BI达到传播中风险;山西7-9月BI达到传播低风险;北京仅9月MOI达到传播低风险。诱蚊灯法白纹伊蚊密度为0.30只/灯次,密度高峰在7-8月。广西、重庆和湖北媒介伊蚊成蚊密度超过2只/顶h。结论 2016年,我国不同类型媒介伊蚊分布省份不同月份传播风险不同,总体南方Ⅰ类省份传播风险高于北方。建议各监测省份应继续加强媒介伊蚊监测、风险评估和控制工作,特别是南方重点省份,为我国媒介伊蚊传播疾病的科学防控提供依据。     

Radiation exposure from imaging tests: is there an increased cancer risk?

The increasing exposure to low-dose radiation from diagnostic testing has prompted renewed interest in evaluating its carcinogenic risk, but quantifying health risk from low-dose radiation exposure remains controversial. The current approach is to adopt the linear non-threshold model, which is commonly applied to high-dose exposure, and apply it to assess risk from low-dose exposure. However, existing data are conflicting and limited to epidemiological studies and/or in vitro analyses. In this article, we will discuss the potential cancer risk from low- and high-dose radiation, their effects on DNA repair response pathways, and the best course of action for patients and providers to minimize risk.     

Assessing the risk of occupational acquisition of the human immunodeficiency virus: implications for hospital policy

In determining infection control policy, it is essential to quantitatively assess the risk of transmission of human immunodeficiency virus (HIV) to health care workers and their families. The risk should be placed in perspective by comparing it with other occupational hazards. The risk of seroconversion from a needlestick injury can be calculated from the probability of a needlestick occurrence, the probability that the source patient is infected, and the probability of seroconversion, given an exposure. The risk of seroconversion due to drawing 1000 blood specimens from seropositive patients is between 86 and 470 in 100,000. The risk to surgeons from performing 25 operations on infected patients is approximately 272 in 100,000. The risk of fatal injury in the course of one year's work on a Louisiana oil rig is between 188 and 283 per 100,000.     

住院肿瘤患者营养风险及营养支持状况的调查与分析

目的调查住院肿瘤患者营养风险及营养支持现状。方法对浙江省8家医院916例住院肿瘤患者行营养风险筛查,通过测评体质指数、检测血清白蛋白评定患者营养状况,了解有营养风险患者的营养支持现况。结果 916例患者的营养风险评分0～7分,有营养风险(≥3分)患者334例,其中营养不良167例,实施营养支持121例。结论住院肿瘤患者存在营养风险,需加强管理,规范营养支持。     

医疗风险管理问题探讨

对风险和医疗风险的概念进行了阐述,从疾病本身、医患双方以及社会媒体方面对医疗风险的发生原因进行了分析,并提出了防范医疗风险的具体对策。     

Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations

In the 1966 study of the population of Busselton, Australia, blood sugar and serum insulin levels were measured one hour after an oral glucose load, in addition to the conventional cardiovascular risk factors. The six-year incidence of coronary heart disease (CHD) and the 12-yr mortality from CHD and from all cardiovascular diseases is described in relation to the initial baseline variables measured using the upper 20th percentile values (age-specific and sex-specific) to define the risk ratios. In younger subjects (ages less than 60 yr), elevated blood pressure levels for both sexes (risk ratios from 2.9 to 5.2) and elevated serum cholesterol concentrations for males (risk ratios from 3.0 to 3.3) were strong predictors of cardiovascular risk. In men aged 60 to 69 yr, those with upper range one-hour serum insulin concentrations showed marked associations with the six-year incidence of CHD, the 12-yr mortality from CHD, and the 12-yr mortality from all cardiovascular diseases (risk ratios were 2.0, 2.3, and 2.4, respectively). The relationship of elevated serum insulin and cardiovascular mortality persisted when males of all ages were analyzed, and it appeared to be independent of the other major risk factors. In females, no association between serum insulin and CHD or cardiovascular disease could be found. Although the age and sex specific upper 20th percentile values for one-hour blood sugar concentrations showed a low grade association in patients with subsequent cardiovascular disease end points, more noticeable risk ratios were demonstrated at the higher blood sugar level of 200 mg/100 ml or greater (in the age group 60 yr and over, risk ratios were 2.2 in males and 2.6 in females.     

Photoshop软件联合超声内镜在胃间质瘤不同侵袭危险性分级中的应用*

目的探讨Photoshop软件联合超声内镜(EUS)对胃间质瘤(GISTs)不同侵袭危险性分级的应用价值。方法选取经病理及免疫组化确诊的GISTs患者97例,根据其肿瘤大小、核分裂象及肿瘤破溃分为极低危组、低危组、中危组以及高危组,利用Photoshop软件分别测定各组病灶EUS图像的灰度平均值(代表回声强度)及灰度标准偏差平均值(代表回声均匀度),行统计学分析,寻找各组差异。结果不同侵袭危险性GISTs EUS图像有时肉眼难以鉴别;极低危、低危、中危及高危组EUS图像的灰度平均值(代表回声强度)分别为(56.54±6.10)、(59.20±7.51)、(77.77±10.90)和(83.43±12.47),极低危组与低危组比较、中危组与高危组比较,差异无统计学意义(P0.05),其余各组两两比较,差异均有统计学意义(P0.05);极低危、低危、中危及高危组的灰度标准偏差平均值(代表回声均匀度)分别为(8.46±2.59)、(12.57±5.89)、(12.84±4.15)、(16.69±4.69),除低危组与中危组比较差异无统计学意义外(P0.05),其余各组两两比较,差异均有统计学意义(P0.05)。结论 GISTs侵袭危险性越高,EUS回声强度总体上越高,而回声均匀性总体上越差,EUS联合Photoshop软件分析EUS图像的灰度平均值和灰度标准偏差可在术前辅助判断GISTs侵袭危险性。     

ICU护士职业风险与防护

目的:分析ICU护士的职业风险及防护策略。方法:通过职业调查观察和自身工作经验,对ICU护士的职业风险和防护策略进行研究。结果:ICU护士职业风险主要来自护理过程、护理环境和工作心理等。ICU护士可从护理规范、人性管理、心理疏导、劳动智能化、优化程序等途径来防护风险。结论:ICU护理是一种高负荷、高风险的工作,ICU护士需要高标准的职业素质和人文精神,也需要对职业风险加强防护,从而健康科学的从事ICU护理。     

Performance of risk indices for identifying low bone density in postmenopausal women

OBJECTIVE: To examine the ability of 4 published osteoporosis risk indices to identify women with low bone density. SUBJECTS AND METHODS: Subjects included postmenopausal women 45 years and older consecutively recruited from US clinics, women from general practice centers in The Netherlands (age range, 50-80 years), women in the Rotterdam Study (The Netherlands) 55 years and older, and women aged 55 to 81 years old screened for a clinical trial of alendronate. Bone mineral density (BMD) was measured at the femoral neck or lumbar spine; T scores represent the number of SDs below the mean for young healthy women. One risk index was calculated from age and weight; the other risk indices included up to 4 additional variables obtained by questionnaire. We calculated the sensitivity and specificity for identifying women with BMD T scores of -2.5 or less or -2.0 or less in the US clinic sample and created 3 risk categories, using each of the 4 indices. RESULTS: Data were available for 1102 women from the US clinic sample, 3374 women in the Rotterdam Study, 23,833 women screened for a clinical trial of alendronate, and 4204 women from general practice centers in The Netherlands. Specificity for identifying BMD T scores of -2.5 or less ranged from 37% to 58% (depending on risk index) when sensitivity was approximately 90%. The prevalence of osteoporosis (defined as T scores < or = -2.5) differed widely across the 3 risk categories, ranging from 2% to 4% for the low-risk category to 47% to 61% for the high-risk category in the US clinic sample. For spine BMD in the US clinic sample, the prevalence of T scores of -2.5 or less ranged from 7% (low risk) to 38% (high risk). The large differences in prevalence across risk categories were consistent across the other 3 samples of postmenopausal women in the United States and The Netherlands for all 4 risk indices. CONCLUSIONS: We recommend measuring BMD in women who are classified as having an increased risk of osteoporosis by using any of these risk indices because all 4 indices appear to predict low bone mass equally well. The Osteoporosis Self-assessment Tool index is easiest to calculate and therefore may be most useful in clinical practice.     

Relative risk of reducing the lifetime blood donation deferral for men who have had sex with men versus currently tolerated transfusion risks

The risks of known and emerging transfusion-transmitted infections (TTIs) from reducing the current lifetime blood donation deferral for men who have had sex with men (MSM) to 1 or 5 years were compared to the risk from continuing to transfuse in the United States 12.5% of platelet doses as pooled whole-blood-derived (rather than single-donor) platelets. Assumptions made in mathematical models and blood donor/transfusion studies of the risks of TTIs since 2000 were evaluated. The number of HIV, hepatitis B virus, or hepatitis C virus TTIs from reducing the MSM deferral to 1 year is, respectively, 0.88, 2.94, or 66.9, many more than 10 times smaller than the risk from pooled platelets. If erroneous release of HIV-positive units (a risk independent of a donor's source of infection) is not considered, the MSM risk is 1 HIV-infectious donation per 17 to 56 million MSM donations. Any purportedly increased risk of human herpesvirus-8 transmission from MSM donors is far smaller than the risk of transfusion-associated sepsis from pooled platelets. Single-donor platelets from MSM after 5 years' abstinence are as safe or 5 times safer than our current pooled platelets--if the next TTI to emerge were transmitted, respectively, sexually or by another route. Thus, acceptance of MSM as blood donors after 1 or 5 years' abstinence may result in a postulated increase in risk that is so much smaller than the currently tolerated transfusion risk and so small in absolute terms that the ethical question of fairness to the MSM group justifies the change in policy.     

Risk in Emergency Research Using a Waiver of/Exception from Consent: Implications of a Structured Approach for Institutional Review Board Review

Objective: To apply component analysis, a structured approach to the ethical analysis of risks and potential benefits in research, to published emergency research using a waiver of/exception from informed consent. The hypothesis was that component analysis could be used with a high degree of interrater reliability, and that the vast majority of emergency research would comply with a minimal‐risk threshold. Methods: A Medline search and manual search were done to identify studies using a waiver of/exception from informed consent published between July 1996 and December 2000. A review panel of physicians and bioethicists independently classified nontherapeutic procedures in each study as minimal risk, probably minimal risk, or probably more than minimal risk. Results: Seventy studies using a waiver of/exception from informed consent were identified. A majority of reviewers classified nontherapeutic procedures in 62 studies (88.6%) as minimal risk. Reviewers classified nontherapeutic procedures in six studies (8.6%) as minimal risk or probably minimal risk. In two studies (2.9%), nontherapeutic procedures were classified as probably more than minimal risk. The intraclass correlation coefficient was 0.89 (95% CI = 0.85 to 0.93), indicating very high interrater reliability. Conclusions: Component analysis can be used with high reliability to review emergency research and may improve the consistency of institutional review board review of emergency research. The vast majority of published emergency research performed using a waiver of/exception from consent complies with a properly‐applied minimal‐risk threshold. A minimal‐risk threshold for nontherapeutic procedures protects subjects better than current U.S. regulations while permitting important emergency research to continue.     

护理风险评估在精神科监护期患者中的应用

目的探讨护理风险评估在精神科监护期患者中的应用效果。方法选取2017年4月至2019年3月在某二级精神病专科医院住院的精神科监护期患者234例,2017年4月至2018年3月的120例设为对照组,2018年4月至2019年3月的114例设为观察组。对照组从入院主因、临床表现、入院护理安检及家庭支持系统等四方面进行护理风险评估;观察组在原有评估内容的基础上增加《精神科住院患者行为风险筛查评估表》等8个量表进行评估,评估后采取相应的护理干预措施。结果风险评估量表使用后,观察组风险评估精准度提高且可以区分高中低风险等级,监护天数下降、约束患者人数下降,护士掌握病情情况显著提高,差异均有统计学意义(均P<0.05)。结论精神科监护期患者采取系统、规范的风险管理能提高风险评估精准度,区分不同的风险等级,为采取个性化干预措施提供依据,降低不良事件发生率。     

Knowledge about cardiovascular risk factors among obese individuals.

BACKGROUND: Obesity is an important biological risk factor for cardiovascular disease (CVD). AIMS: The main aim of this study was to answer the question whether obese individuals differ from individuals with normal weight with regard to knowledge about risk factors for CVD. A further aim was to replicate previous findings that obese individuals are at higher risk of developing other biological risk factors for CVD. METHOD: Normal weights, BMI<25 kg/m(2) (n=385), and obese, BMI> or =30 kg/m(2) (n=159), individuals were identified from a screening program conducted among 50-year-old inhabitants of the County of V?stmanland, Sweden. Participants answered questions regarding their gender, level of education, and items relating to knowledge about cardiovascular risk factors. Total cholesterol and blood glucose levels, height, weight and blood pressure were measured. RESULTS: Obese individuals did not differ significantly from individuals with a normal weight regarding knowledge of cardiovascular risk factors when education was controlled for. Obesity and low level of education are associated with other risk factors for CVD such as high blood pressure and high serum cholesterol. CONCLUSION: Obese individuals are at an increased risk of developing other risk factors for CVD but are just as knowledgeable about risk factors for CVD as normal weighting individuals.     

Preventing occupational injuries: women's perception of risk from musculoskeletal exposures.

Perception of injury risk is associated with an individual's propensity to act. This study examined the relationship between women's demographic, occupational, and risk characteristics, and health and occupational stressors as predictors of their perceptions of injury risk to self and other women from occupational musculoskeletal exposures. This cross-sectional study included a random sample of women who were employed in the 12 months prior to survey administration (N = 123, 27% response rate). A telephone survey consisting of 154 items was administered in English or Spanish. For the perception of injury risk to self, the final multiple regression equation explained approximately 66% of the variance with significant unique contributions identified for bodily pain, occupational exposure to repeated strenuous physical activity or repetitive hand motion, perceived seriousness and controllability of the risk, and perception of risk to other women. Similarly, for perception of injury risk to other women, the final multiple regression equation explained approximately 57% of the variance with significant unique contributions identified for household size, occupational exposure to repetitive hand motion, familiarity of the risk, and perception of injury risk to self. Exposure experiences and risk characteristics were found to increase women's perceptions of risk from occupational musculoskeletal exposures.     

建立分娩风险预警评估机制联合宫缩剂对产后出血的临床护理研究

目的研究建立分娩风险预警评估机制联合宫缩剂应对产后出血的临床效果。方法将我院妇产科在2006年6月～2007年5月未建立分娩风险评估前的1838例分娩产妇作为对照组,2008年6月～2009年5月建立分娩风险评估机制后2318例分娩产妇作为观察组,对两组的产后出血发生率、产后出血量、产后出血次数等进行比较。结果观察组产后出血发生率明显低于对照组。观察组1．59％,对照组2．94％。差异有显著意义（P〈0．05）,产后出血量与对照组比较,观察组出血量为（848．92±381．732）ml,对照组出血量为（1198．52±501．057）ml,差异有显著意义（P〈0．05）。结论建立分娩风险预警评估机制联合宫缩剂可有效的防治产后出血。     

Estimating the risk of blood donation associated with HIV risk behaviours

summary .  A blood donor questionnaire and declaration, with deferral of potential donors at a higher risk of blood-borne infections, was introduced in Australia in the mid-1980s to reduce the risk of donation of HIV-infected blood. However, the absolute risk of HIV transmission through blood donation from high-HIV-risk donors has not been estimated. This study presents a new method of assessing the risk posed to the blood supply by selected HIV risk behaviours. A model was developed to estimate the probability of blood donation during the window period for HIV infection. Five scenarios for blood donors were considered: (1) men who have sex with men (MSM), (2) men who have sex with women in Australia, (3) women who have sex with partners from countries with a high HIV prevalence, (4) men who have sex with commercial sex workers in Australia and (5) people injecting drugs used once in a year. Those estimated to be at highest risk of becoming infected and donating in the window period were MSM. Women who have sex with men from countries of high HIV prevalence are at greater risk than men who have sex with female sex workers from Australia. These three groups under current Australian guidelines are deferred from donating blood for 12 months. In Australia, a single episode of injecting drug use is associated with very low risk of HIV transmission. The model presented in this study can be used to assess the impact of selected individual risk behaviours on the safety of the blood supply.     

压疮高危患者临床特征及危险因素分析

目的分析压疮高危患者的临床特征、管理现状及高危患者压疮发生的影响因素,探讨切实的压疮预防对策。方法采用压疮危险因素评估表筛选压疮高惫患者,并对其临床特征、压疮发生的危险因素和管理现状进行分析。结果2007年3-12月共有315例压疮高危患者,以ICU分布最多,占32．4％,其次为神经外科,占18．74％;初评分（16．91&#177;2．29）分;压疮高危期持续时间（13．00&#177;18．00）d;315例压疮高危患者中共发生压疮19例。高危期持续时间是高危患者发生压疮的危险因素,意识清醒、扶助行走、体温正常和压疮终评分是发生压疮的保护因素。压疮高危患者管理中仍存在忽视高危患者家属教育及预防措施落实、记录不全等问题。结论重视ICU等压疮高危高发科室和压疮高危持续期长患者的管理,根据压疮发生的危险因素科学定义难免压疮,建立护理会诊制度和压疮护理指南等规范压疮高危患者的过程管理,可有效预防和减少压疮的发生。