硅油黏附的眼科手术器械洗消管理现况的调查

摘要 目的 了解硅油黏附的眼科手术器械的洗消管理现况,为提高其清洗效果提供参考。方法 采用分层抽样和问卷调查方法,对国内22个省市区61所医院消毒供应中心(CSSD)硅油黏附的眼科手术器械清洗管理现状进行调查与分析。结果 在调查的医院中,有8家对硅油黏附的眼科手术器械未实行封闭式回收|有10家医院硅油黏附的眼科手术器械的转运时间＞1 h|有40家医院未配备专用洗消盒/槽和清洗刷|仅有10家医院配备眼科全自动清洗消毒机|有49家医院采用肉眼观察法检测洗消后的残留硅油。结论 国内医院针对硅油黏附的眼科手术器械的回收有待规范,专用清洗用具及设备配置率低,硅油残留检测方法过于简单。     

河南省眼科手术器械处置及管理现状的调查

摘要 目的 了解河南省各级医疗机构眼科手术器械清洗、消毒、灭菌及管理的现状,为今后制订具有针对性的管理及质控方案提供依据。方法 采用便利取样法,借助国家级医院消毒供应中心实践基地平台,选取河南省三级综合医疗机构35家,二级综合医疗机构38家,眼科专科医疗机构8家进行问卷调查。结果 河南省各级医疗机构眼科手术器械的主要管理方式为消毒供应中心集中处理,占77.50%,53.75%的医疗机构是由消毒供应中心专科护士负责处理眼科手术器械,配置专用清洗池有24家(30.00%),专用变频超声清洗机30家(37.50%),仅有3.75%的医疗机构在清洗内眼器械时未采用任何清洁剂。在清洗消毒及灭菌方面,63.75%的医疗机构采用手工清洗消毒配合超声清洗,仍有14家(17.50%)采用卡式灭菌器灭菌,2家(2.50%)采用戊二醛浸泡灭菌,存在较大的安全风险。结论 河南省各级医疗机构眼科手术器械的处理与管理较前明显规范,但仍需进一步加强专项培训,提高专业素质,进一步推进规范及指南在工作之中的应用,保障医疗安全。     

陕西省144所医院眼科手术器械处置情况调查

摘要 目的 了解医院消毒供应中心(CSSD)处理眼科手术器械的现状,加强相关器械消毒规范化管理。方法 采用问卷调查方法,对陕西省所属144家医院CSSD处理眼科手术器械的实际情况及面临的问题进行调研。结果 有112家医院CSSD在处理眼科手术器械时发生器械损坏;有半数以上CSSD眼科器械处置人员培训不到位;有103家医院未匹配专用的清洗工具和设备;69家CSSD没有建立眼科精密器械处理流程。结论 陕西省半数以上医院CSSD存在处理眼科器械不专业、不规范和设备不配套问题,应加强专业人员培训,配备专用清洗工具和设备,建立眼科器械标准的处置操作流程,提高眼科手术器械质量。〖HT〗     

贵州省149所医院手术器械再处理质量调查

摘要 目的 〖HT5"SS〗调查医院手术器械再处置情况,分析现状及存在问题。方法 采用问卷调查方式对贵州省二级（含二级）以上医院手术器械的处置地点、清洗设备进行调查。结果 149所医院中,手术器械集中运送至CSSD清洗的医院占40.94%,59.06%医院在手术室进行清洗。手术室清洗设备调查显示,7.95%医院购置全自动清洗消毒机,17.05%的医院有超声清洗机,52.27%医院配置高压水枪及气枪,18.18%医院有干燥柜。按流程将厂家器械接收至CSSD处理的医院占62.79%,26.36%的医院直接在手术室清洗,在手术室灭菌厂家器械的医院占27.13%。结论 多数医院在手术室清洗手术器械,但清洗设备不完善,厂家器械尚未完全由CSSD接收处理,需要进一步加强手术器械再处理管理,保障医疗安全。     

不同包装材料包装灭菌物品的有效期探讨

摘要 目的 探讨无菌物品不同包装方式灭菌后保质期。方法采用无菌实验方法,对不同包装材料包装物品灭菌后无菌保质期进行观察。结果在本研究设计的5组包装中,双层无纺布包装组、纸塑袋包装组、棉布与无纺布混合包装组、双层棉布包装组和单层无纺布包装组等各组灭菌包保质期依次为210 d、180 d、150 d、90 d和30 d。结论包装材料性质决定灭菌包保质期,结合实际使用需求,推荐较大无菌手术器械用无纺布与棉布混合包装,一般单用器械宜采用纸塑袋包装。     

眼科显微器械专用清洗固定架的研制与应用

摘要 目的 解决眼科显微器械能自动化机械清洗问题,提高清洗效率,保证清洗质量,减少器械耗损。方法 针对眼科显微器械的结构特点和器械个性化管理要求,设计专用的清洗固定架,应用于眼科显微器械的机械清洗。结果 使用专用清洗固定架机械清洗显微器械450件/h,清洗人员由6人减少到4人,器械基数配置由3 000多件减少至1 500多件;经带光源放大镜检查清洗合格率均在99.50%以上;每月显微器械的平均报损数由62件下降至27件。结论 使用清洗固定架可以提高工作效率,保证清洗质量,减少精细器械的耗损,满足眼科规模化手术的需要,降低清洗人员职业暴露的风险。     

消毒供应中心外来医疗器械首次接收处理现状调查

摘要 目的 了解医院消毒供应中心(CSSD)外来医疗器械首次接收处理的现况,为加强外来医疗器械管理提供参考。方法 分层抽样选取上海市使用外来医疗器械与植入物的医院49家,采用问卷调查的方法对CSSD外来医疗器械管理现况进行调查。结果 所调查的49家医院中,有55.10%的医院外来医疗器械首次接收时对灭菌参数实施有效性测试;有67.35%医院对外来医疗器械设置了专用灭菌程序;有44.90%的医院将外来医疗器械称重后拆包,以7 kg为单位包装;有18.37%医院由器械厂商提供了全部处理流程的培训。结论 医院CSSD应对外来医疗器械首次接收灭菌参数有效性测试,设置专用灭菌程序,把控器械包装重量,以更好地保障外来医疗器械的处理质量。     

手工预处理在复用手术器械清洗中的应用

摘要 目的 〖JP2〗探讨手工预处理对消毒供应中心复用手术器械清洗质量的影响,持续提高消毒供应中心复用手术器械清洗质量。方法 采用随机抽样方法选择复用手术器械分为对照组与实验组,对照组使用直接机械清洗,试验组为手工预处理后机械清洗,对比两组清洗合格率。结果 对照组与试验组器械清洗质量合格率分别为69.23%和91.18%,差异有统计学意义（Ｐ＜0.05）。结论 复用手术器械清洗前进行手工预处理,可以显著提高清洗质量。     

不同清洗剂对消化内镜生物膜的清除效果研究

摘要 目的 观察不同清洗剂对消化内镜生物膜的清除效果。方法 采用细菌定量检测法和残留蛋白检测法,对不同清洗剂清除模拟内镜管腔人工生物膜的效果进行观察与评价。结果 用全效多酶清洗剂、无酶清洗剂和生物膜清洗剂等3组清洗剂清洗后,用细菌培养法检测生物膜清除率依次分别为93.54%、96.01%和99.29%;用残留蛋白检测法检测清除率分别为83.72%、90.35%和95.74%;3组清除率差异有统计学意义（P＜0.05）。结论 本研究3组清洗剂对模拟内镜管腔人工生物膜清除效果,以生物膜专用清洗剂清除效果最好。     

Changes in left ventricular function in shocked newborns

Objective: To assess whether the change in cardiac output after volume replacement is due to elevation of stroke volume or heart rate and to determine the effect of mechanical ventilation on the hemodynamic situation. Design: Prospective study. Setting: A ten-bed neonatal intensive care unit (level III) at a university hospital. Patients: 15 consecutive newborns with blood pressure below the 10^th percentile related to age and weight. Interventions: Volume replacement with Ringer's lactate 20 ml/kg body weight. Measurements and results. Before and after volume replacement, arterial pressure recordings, blood gas analysis, and an echocardiographic study were carried out. Left ventricular and aortic diameters were measured by the two-dimensional M-mode technique and velocity time integral of aortic flow by the pulsed color Doppler technique. From these data, stroke volume and cardiac output were calculated. Cardiac output (703 ± 204 vs 826 ± 166 ml/min, p < 0.005) and cardiac index (267 ± 69 vs 302 ± 55 ml/min per kg body weight, p < 0.01) changed significantly due to an appreciable elevation in stroke volume (5.2 ± 1.7 vs 5.8 ± 1.7 ml, p < 0.05), whereas heart rate was unaltered (140 ± 12 vs 142 ± 20 beats/min; NS). The change in blood pressure (32 ± 5 vs 38 ± 8 mm Hg, p < 0.01) was also significant. Cardiac index before and after volume replacement showed a significant inverse correlation with the severity of respiratory disease expressed as alveolar-arterial oxygen difference (A-aDO₂) (A-aDO₂ vs cardiac index before volume replacement: r = − 0.77, p < 0.001; after volume replacement: r = − 0.73, p < 0.005) or oxygenation index (oxygenation index vs cardiac index before volume replacement: r = − 0.73, p < 0.005; after volume replacement: r = − 0.73, p < 0.005). Changes in left ventricular diastolic diameter, left ventricular systolic diameter, and fractional shortening were not significant. Conclusions: These results indicate that the major regulator of left ventricular output in newborns with hypovolemic or cardiogenic shock is stroke volume and not heart rate and that cardiac output depends on the severity of the respiratory disease. Received: 21 March 1997 Accepted: 8 July 1997     

Excretion of Noradrenaline in Urine in Hypertension

Abstract

Background. Previously, data on both the within-subject (SD_I) and the between-subject (SD_G) variation of cystatin C in children has not been reported. Thus, this study aimed to determine this biological variation including analytical variation (SD_A) of both cystatin C and creatinine to characterize the two analytes as renal function markers in children. Methods. On two consecutive days blood samples for duplicate analysis of cystatin C (nephelometric, Dade Behring) and creatinine (enzymatic, Roche) were obtained from 30 children (11 females and 19 males, mean age 8.3 range 2–13 years) referred for GFR measurements by ⁵¹Cr-EDTA clearance. For determination of the between-subject variation only children with normal GFR (n=21) were included. Data were adjusted for the well known age-related increase in creatinine. Results. The results are given as coefficients of variation. The within-subject variations were identical for both analytes (6.4%). The between-subject variation was 11.1% for cystatin C and 28.4% for creatinine, though decreasing to 20.1% after adjusting for age. The analytical variation was 1.7% and 2.5% for cystatin C and creatinine, respectively. The index of individuality (IOI = SD_I/SD_G) was 0.65 for cystatin C and 0.25 for creatinine, though increasing to 0.36 after age-adjustment. Conclusion. The within-subject variation was identical and low for cystatin C and creatinine suggesting that the two are equally suitable for serial monitoring of renal function in children. Based on the low IOI neither analyte, however, seems suitable as a screening marker of renal function in a healthy population of children using population-based reference intervals.     

2018年中国卒中管理及研究进展

中国是世界上最大的卒中负担国。随着卒中医疗质量的进步,我国卒中死亡率呈下降趋势,但卒中发生率仍呈上升趋势。近年来,中国在卒中教育、研究和护理方面均取得了巨大成就。本文回顾了近年来有影响力的学术成就,对中国卒中医疗质量提升、溶栓及新的治疗方法探索、中国卒中建设发展等最新进展进行了总结和评价,并展望了中国卒中管理的未来。     

Tracking Changes in Participation With Participation Measurement Scale in Community-Dwelling Stroke Survivors in Africa

Objective

To investigate responsiveness of the Participation Measurement Scale (PM-Scale) for the measurement of participation of stroke survivors.

Changes in airway dead space in response to methacholine provocation in normal subjects

Measurements of bronchial hyper-responsiveness rely on sensitive techniques for measurement of bronchoconstriction, ideally based on tidal breathing. A potentially useful technique is measurement of airway dead space (V_Daw), which reflects the volume of the conducting airways. The aim of this study was to evaluate measurements of V_Daw with the single breath test for CO₂ (SBT-CO₂), compared to spirometric measurements, as a method of measuring bronchial response to methacholine challenge. Nineteen healthy adults were studied. Dosimetric methacholine challenge tests were performed on two study days. Forced expirations or the SBT-CO₂ were used to assess the response. There were dose-dependent reductions in the spirometric measurements, with a 10 ± 10% reduction from the baseline value of forced expiratory volume at the highest dose of methacholine. There was a dose-dependent reduction from the baseline value of V_Daw by 19 ± 9% at the highest dose. There was also a dose-dependent increase in the slope of the alveolar plateau of the SBT-CO₂. This study provides support for measurement of V_Daw as a means of evaluating bronchial responsiveness after methacholine challenge. In a group of healthy adults, this method shows a greater response but with similar dispersion as measurement of forced expiratory volume after methacholine challenge.     

Predictors of depressive symptoms in older adults living in care homes in Thailand

BACKGROUND

Thai culture traditionally abhors elders living in care homes due to the belief that this represents a dereliction of filial piety by their children, thus care homes are stigmatized as the domain of poor older adults with no family. This may impact negatively on psychological wellbeing of residents, although little is known about the key factors influencing depressive symptoms. Therefore, this study explores factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among older adults residing in care homes in Thailand.

Antiphase signalling in the neuroendocrine-immune system in healthy humans

Background

Any quantity varying in the spatial-temporal dimension may be considered as a signal. Human lymphocyte cell surface molecules and subsets present circadian variation and this variation may represent a kind of signalling in the neuroendocrine-immune system. We have analyzed the dynamics of variation of specific lymphocyte subsets in healthy humans.

Subjects and methods

In our study, lymphocyte subpopulation analyses were performed and cortisol, melatonin, GH and TSH serum levels were measured on blood samples collected every 4 h for 24 hours from eleven healthy men, ages 35-53 years (mean = 44 ± 6 SD).

Results

A clear circadian rhythm was validated for CD8 and cortisol with acrophase during the day and for CD3, CD4, melatonin, GH and TSH with acrophase at night. Cross-correlation showed that CD3 correlated positively with CD4 (ρ = 0.67, P < 0.05) and negatively with CD8 (ρ = −0.41, P < 0.05), CD4 correlated positively with melatonin (ρ = 0.90, P < 0.05), GH (ρ = 0.92, P < 0.05) and TSH (ρ = 0.71, P < 0.05), negatively with CD8 (ρ = −0.90, P < 0.05) and cortisol (ρ = −0.18, P < 0.05), CD8 correlated positively with cortisol (ρ = 0.38, P < 0.05).

Discussion

The different profiles of nyctohemeral changes of lymphocyte cell surface molecules and specific lymphocyte subsets realize different relationships with the neuroendocrine hormones and might represent a way of signal transmission among the multiple components of the neuroendocrine-immune system.     

Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden

Aim

To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.

Methods

Prospective and retrospective data for treated OHCA patients in Sweden, 2008–2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register.

Result

In 2008–2010, the number of prospectively (n = 2398) and retrospectively (n = 800) reported OHCA cases was n = 3198, which indicates a 25% missing rate.When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p = 0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p = 0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p = 0.035).

Conclusion

Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias.     

Genomics in oncology nursing practice in Australia

BackgroundAdvances in genetic and genomic science and technology are changing the way healthcare is delivered. There is a new responsibility for all nurses to be knowledgeable of genomics and incorporate genomics into nursing practice.AimThis study seeks to understand how genomics is understood and applied in oncology nursing practice in a regional hospital in Australia. The study was conducted over a six week period from January – February 2018.MethodsSemi-structured interviews were conducted with registered nurses working in oncology departments within a regional hospital in Queensland and analysed using thematic data analysis.FindingsNine semi-structured interviews were conducted. Three key themes were identified: (1) adequacy of knowledge for practice, (2) relevance of knowledge to practice, and (3) applying knowledge in practice. Most participants believed their genomic knowledge was poor or average. While most participants believed genomics is relevant to practice, many were not clear about how genomics can be applied other than ‘targeted treatments’, and were not actively using genomics with any regularity beyond taking a family history.DiscussionFindings indicate that nurses may have limited genomic knowledge and are applying genomics in practice in a reduced capacity that falls below current expectations for competent oncology care.ConclusionThe findings of the study can be used to improve the utilisation of genomics in oncology nursing practice, which in turn may lead to better quality healthcare for patients and their families.     

Nurse-led heart failure follow-up in primary care in Sweden

Background

Little or no knowledge is available about which service is offered to patients with heart failure in primary care.

Aims

To describe nurse-led follow-up of patients with heart failure in primary care in Sweden.

Methods and results

A questionnaire was sent to all primary health care centres in Sweden and 610 of 939 centres returned the questionnaire. Special nurses had designated time for follow-up of heart failure patients at 18% (n = 111) of the centres, compared to 93% and 78% for diabetes and obstructive lung disease. Centres with nurse-led follow-up of heart failure patients more frequently provided heart failure information (p < 0.001), had more doctors interested in heart failure (p < 0.001), more often had special care programmes (p < 0.001) and had more co-operation with the hospitals around patients with heart failure (p < 0.01), compared to centres without such follow-up (n = 499).

Conclusion

In primary care in Sweden, nurse-led follow-up is uncommon for patients with heart failure, despite being common for patients with diabetes and obstructive pulmonary disease. To improve this situation in primary care, an increased number of specially trained nurses is needed, together with further research to ensure a high quality follow-up in primary care.