德国医院透明管理制度与标准解读

在美国JCI及国际ISO质量认证体系逐步进入我国后,德国KTQ评审也以其科学的方式和精确的标准得到了国内的广泛关注,文章将从KTQ评审机构、KTQ评审方法、KTQ评审标准、KTQ信息发布及监管几个方面对德国医院评审制度进行解读,以期为我国医院评审提供借鉴.     

德国医疗机构认证体系的运行及其对我国医疗机构评审工作的启示

笔者于2011年在德国研修医院管理期间,对德国主要医疗机构认证体系之一的德国医疗透明管理制度与标准委员会KTQ认证体系(Kooperation fuer Transparenz und Qualit(a)t im Gesundheitswesen,KTQ)进行了较为全面的考察和研究,并针对其运行机制和特点进行了专访.KTQ是一个以病人为中心、严格遵守PDCA(计划-实施-检查-处理)原则、被德国医疗机构广泛认可的认证体系.现将有关情况介绍如下,以期对我国正在进行的新一轮的医疗机构评审工作有所借鉴.     

KTQ质量认证体系在提高电子病历质量中的作用

目的探讨借鉴KTQ质量认证体系提高电子病历质量的方法。方法根据KTQ质量认证体系的相关标准,按照P(计划)、D(实施)、C(检查)、A(处理)持续提高电子病历质量,并分析改进效果。结果执行KTQ质量管理体系后,各类病历质量问题均得到明显改善,甲级病案率由93.0%提高至99.0%,差异均具有统计学意义(P<0.05)。结论 KTQ质量认证体系可显著提高电子病历质量,具有较好的推广价值。     

基于德国KTQ质量认证理念的医院安全管理研究及启示

对德国KTQ质量认证体系的安全管理理念进行分析，总结认证体系中对中国医院安全管理具有借鉴意义的内容，以期对我国医院安全管理建设和发展带来启发。     

医疗设备中计算机用电源标准及认证探究

文章对当今计算机用电源的标准和认证进行了具体详细的分析对比，使医疗设备工作者既了解了计算机用电源标准的发展历程、版本的更新，又把握住了选择电源的关键，从而从源头上保证了减少干扰、杜绝故障，确保医疗设备节能环保、安全稳定。     

ISO9000:2000族标准在医院管理中的应用

近年来,通过贯彻ISO9000族标准,进行质量体系认证来加强医疗服务质量管理,向顾客(患者、孕产妇)提供满意的医疗服务,已成为许多医疗单位探讨的热门话题。我院在2000年初开始按ISO9000:2000草案稿进行培训,并于当年12月通过认证。通过在全院范围内宣传、贯彻、实施ISO9000:2000族标准,我们充分体会到引入ISO9000族标     

JCI国际医院认证标准与病案质量管理

医疗机构国际联合委员会的质置管理和医院评审是一套结构完整且科学的医疗质量评价体系，《JCI标准》的每一章内容均可用于指导医疗活动，规范医疗质量管理，标准的衡量要素在医疗文书病案中应有体现。文章以JCI国际医院认证对病案质量的评估，结合我国病案质量管理的现状，详述了《JCI标准》对加强病案质量管理、提升医疗质量管理的必要性。JCI国际医院认证对病案质量的评估是在医院评审中占有重要地位的项目之一。病案质量关系到医疗质量水平．因此加强病案质量管理是医疗质量管理中需持续改进的日常重要工作之一，规避因病案质量造成的医患纠纷．提高医疗质量，构建和谐医患关系．是我国医院管理者面临的重要课题之一。     

我们离“国际三甲”有多远？

近日,天津秦达国际心血管病医院荣获美国医疗机构认证联合委员会国际部（Joint Commission International简称JCI）颁发的国际医院标准认证金章。国际医院标准认证被有些人形象地称为“国际三甲”认证。通过了JCI的评审,意味着秦达国际心血管病医院从综合管理到医疗服务质量均已达到国际先进水平。     

采用国际认证标准提高医院质量管理水平

文章通过ISO9000标准、英国保柏“医院管理以及医疗服务质量”评估体系标准、JCI国际医院认证标准等的特点分析,旨在探讨适合于中国医院管理实践的国际化战略思路与方法。     

北京和睦家医院和诊所再度通过国际联合委员会认证

9月19日,北京和睦家医院和诊所再次通过国际联合委员会(JCI)认证,标志着这所中国第一家也是最大一家外资综合性医疗服务机构已经连续三次通过该项认证,确保其医疗质量、患者安全和行政管理均符合医疗领域国际最高标准。认证仪式在北京和睦家医院新近投入运营的二号楼进行,联合委员会总裁Mark R.Chassin及国际联合委     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.