无菌台上医疗废物的规范化管理

目的规范手术间无菌台上医疗废物管理,防止污染扩散和传播感染性疾病,并提高手术室工作效率和护理质量。方法按照《医疗废物管理条例》及有关规定在我院手术室12个手术间无菌台上实行医疗废物分类收集,进一步规范手术间医疗废物的管理。结果①实验组手术伤口感染率、外科医院感染率以及锐器伤发生率分别为16.5%、8.9%、7%。②手术医生、麻醉医生、保洁员的满意度分别为:95%、98%、100%。结论无菌台上医疗废物的规范化管理是手术间医疗废物的管理的重要环节,不仅保证了手术间的干净整洁,减少了医疗废物在手术间的二次污染,防止了污染扩散,避免了手术台上产生医疗垃圾的混放,减少了医务人员的锐器伤率,防止了感染性疾病的传播。优化了手术间的保洁流程,提高了手术团队人员的工作效率和手术间的利用率。     

上海市某儿童专科医院建设手术麻醉系统提升手术安全

随着信息化建设的发展,大量医院在手术室内已经部署了完善的信息系统,通过信息系统的设计,在手术室内能实现医疗质量控制。文章通过介绍一所三级甲等儿童专科医院运用手术室内信息系统,实现对医疗质量环节控制、提升手术室内医疗质量的方法,进而分析医疗质量控制的成效,总结和探索手术室内信息化建设的方向。     

子宫肌瘤手术医疗临床路径与非临床路径对医疗费用控制的对照研究

目的探讨手术医疗临床路径管理对子宫肌瘤医疗费用控制的效能和可行性,为医疗付费方式改进提供循证医学证据。方法以子宫肌瘤手术医疗临床路径为基础,识手术类型为基点设计相应临床路径,对不同临床路径控制下的同类手术治疗医疗费用情况和相同临床路径控制下的不同类手术治疗医疗费用情况进行对照研究,通过医院HIS系统提取相关数据并建立数据库,并对各组数据进行相关的统计学分析。结果不同临床路径控制下的同类手术治疗产生的医疗费用不同、各种医疗费用构成不同、变异也不同,相同临床路径控制下的不同类手术治疗产生的医疗费用不同、各种医疗费用构成不同、变异也不同。结论子宫肌瘤手术医疗临床路径对医疗费用控制效果良好,为其他病种医疗费用控制提供了新思路,也为建立一种全新的付费机制和临床路径的设计提供了新的思路。     

医院手术麻醉信息系统的构建与实施

本文介绍手术麻醉信息系统的结构、系统功能和工作流程。手术麻醉信息系统在医院的应用,实现了手术麻醉信息电子化,有效地规范了手术流程,提高了医疗管理水平和医疗质量。     

医患助理助力提升围手术期管理质量

目的了解医疗团队增设医患助理岗位对围手术期管理质量的影响。方法回顾分析2018年1月-2019年12月某院消化外科单一医疗组在不同围手术期管理模式下的工作量数据,以2018年为对照组,以2019年为观察组,对比分析两组医疗资源指标、医疗服务能力指标、医疗服务效率指标以及患者满意度指标的差异。结果观察组在人力资源保持不变、床位资源降低33.3%的条件下,收治患者量、日间手术量增长,单位资源收治量提高,平均住院时间缩短,患者满意度略有提升。结论计划性手术模式下,通过增设医患助理岗位,可以提高医疗团队的医疗服务效率,改善患者的医疗服务体验,值得在围手术期管理中推广。     

日间手术质量安全管理:上海市第一人民医院的实践

日间手术是一种新型的医疗模式。为了确保日间手术的医疗质量和医疗安全,上海市第一人民医院建立了规范化的日间手术准入制度、日间手术人员的配置标准、有效的沟通机制和麻醉安全等日间手术质量管理体系,保障了日间手术模式的健康、稳步发展。     

综合医院高风险手术科室推行患者医疗意外保险的实践与建议

目的:分析医疗(手术)意外险的重要性与必要性,探讨推广医疗(手术)意外险的途径。方法:对医方进行访谈,对购买手术意外险的投保人进行电话回访调查,了解其人口学资料和医疗(手术)意外险主题相关问题。运用描述性分析、卡方检验等统计学方法,对数据进行分析。结果:医方较为认同医疗意外险的作用,购买手术意外险可在一定程度上减轻医患双方的心理负担,并弥补术后出现并发症患者的经济损失,但目前总体推广效果欠佳。结论:医疗(手术)意外险是补充和完善医疗风险分担机制的重要途径,其推广的效果需要政府、医院、患者公众及保险机构等多方协同。     

手术导航系统及其应用概述

着重介绍了手术导航的发展历程和关键技术,并对其前景进行了分析。手术导航系统既可以在临床中配合医生手术,又可以和医疗机器人结合成为先进的医疗装备。     

围手术期医疗风险评价指标体系构建与应用

运用文献回顾、文献比较、文献归纳法,对围手术期医疗风险管理过程进行分析,突出围手术期管理质控关键点,确定围手术期医疗风险评价要素。在指标明确的基础上,使用专家赋值和层次分析法确定各指标权重,并进行指标可信度分析,建立了一套围手术期医疗风险评价指标体系。     

基于信息技术平台的医院手术分级管理模式重建

手术分级管理制度是保证手术质量的一项基本的医疗制度.利用信息技术平台,制订手术分级目录,明确手术医师准入权限及考核,对于加强手术分级管理,控制医疗质量,确保医疗安全可起到重要的作用.     

Metrological aspects of the study of physical characteristics of the air on the objects in the vicinity of the habitat

The paper considers the problems of measurement of air ions for settle the tasks of medical and environmental monitoring the habitat of various objects. It discusses the metrological assessment of the physical characteristics of the environment and the reasons for the insufficient use of aeroionometry in public health. The paper also compares the characteristics and specific features of the use of devices intended for study of air ion spectra. It shows it necessary to design the devices that measure air ions, which satisfy with the requirements that they measure accurately, are easy-to-use, rapidly operate.     

Role of the environment in the occurrence of noninfectious diseases of the digestive tract in the Primorie Territory

The paper presents the results of a hygienic study to identify the leading regional risk factors for noninfectious diseases of the digestive tract (DT) in the Primorye Territory. Data on 55 environmental factors and registered deaths by 5 groups of noninfectious DT diseases over 15 years were collected for the study. The authors used an original scheme for identifying risk factors for DT diseases, by concurrently applying a correlation and regression analysis. The chemical composition of portable water from the water supply system, soil contamination by trace elements, and socioeconomic factors showed 5.6-23.2% responsibility for the geographical distribution of the bulk of DT diseases. At the same time, many years' rises in morbidity rates among children and adolescents by 5.6-18.2% and adults by as high as 50% are attributable to altered daily diets and socioeconomic factors and to reduced access to medical care. The nature of the found risk factors allows one to direct the main ways to prevent non-infectious DT diseases among the region's population.     

Analysis of the indicators of natural trends in the population of the Tatarstan Republic in the years 1994-1998

A stable tendency to a lower reproduction of population during the studied period has been detected in Tatarstan, both for the entire Republic and for the urban and rural population separately. Coefficients of natural increment of population differed in the regions and some cities of the Republic and varied during the studied period. Negative time course of the natural increment of population is explained by drop of birth rate, increased mortality, and decreased number of new married couples per 1000 in the Republic in general and among the urban and rural population separately. These data are important for evaluating the health status of the population in Tatarstan and can be used for validating regional goal-oriented programs for population health protection.     

社区肢残人辅助器具使用全科医学照顾干预效果分析

目的了解社区肢残人辅助器具需求及使用状况,并对全科医学照顾干预作效果分析。方法全科医生采用入户面访对调查对象进行前后二次问卷调查,问卷调查内容包括：一般的人口学资料、残疾程度及生活自理能力、辅助用品使用情况等相关内容并对全科医学照顾干预前后二次数据进行卡方检验及相关资料分析。结果全科医学照顾干预后比干预前肢体残疾人士使用辅助器具上升了9．68个百分点,使用辅助器具局部症状改善或治愈以及跌倒人数干预前后有统计意义（P〈0．01）,肢体残疾人生活自理能力干预前后对照有统计意义（P〈0．05）。结论适合个性化的肢残人士器具使用服务提升了残疾人“人人享有康复服务”社区卫生服务平台,提高肢残人士器具使用率和干预评估是提高肢残人士生活自理能力的有效措施。     

实施人才战略铸造医院核心竞争力

复旦大学附属儿科医院近年来以教育部“211工程”重点学科建设为契机，积极实施“人才战略”，建立了一系列人才培养制度，使人才培养工作制度化、常规化：通过设立院级科研基金、科研奖励基金、课题攻关小组等措施，调动了医务人员承担重要科研课题的积极性，培养了一批学术骨干：选送优秀中青年出国(境)进修，培养学科梯队，逐步构筑人才高地：多渠道引进人才，进一步完善学科队伍。这些举措明显地提升了医院的核心竞争力。     

A relationship between the molar proportion of propionic acid and the clearance rate of the liquid phase in the rumen of the sheep.

1. Four rumen-cannulated sheep were given a forage mixture (F) of chopped hay-ground, pelleted, dried grass (92:8, w/w) and two concentrate mixtures (C and S) of ground barley-ground hay-flaked maize (46:24:30 and 56:24:20, by wt respectively) in twenty-four hourly meals each day. Each of the diets was offered in successive periods of 16 d to give a feeding sequence F-S-C-S for one pair of sheep and C-S-F-S for the other pair. 2. The average composition (mol/100 mol) of the mixture of short-chain fatty acids, acetic, propionic and butyric, in the rumen was respectively 70-1, 18-5 and 7-5 with diet F, and 55-8, 24-8 and 13-6 with diet C. With diet S, the pattern of fermentation varied both between animals and in the same animal for different periods having either 'high' (28-39 mol/100 mol) or 'low' (16-21 mol/100 mol) proportions of propionic acid. On average when diet S followed diet F there was less propionic acid in the fermentation mixture than when diet S followed diet C (59-3 acetic, 22-2 propionic and 14-1 butyric as compared with 52-7, 29-4 and 13-1 respectively) but this trend was not significant and there was evidence of interactions between the feeding sequences and the individual sheep. 3. The mean concentrations of ammonia, sodium, potassium and chloride were similar for all diets but the pH and concentrations of calcium, magnesium and phosphorus tended to be higher and the buffering capacity lower for diet F than for diets C or S. In animals receiving diet S there was no relationship between the concentrations of minerals, the pH or buffering capacity and the pattern of fermentation except for ammonia, the concentration of which was high when the molar proportion of propionic acid was low. 4. Rumen volume, outflow rate and clearance rate, determined using polyethylene glycol, were higher for diet F than for diets C and S but within each diet, particularly for diet S, values varied considerably between sheep and between periods. 5. There was evidence of an interrelationship between the molar proportion of propionic acid in the fermentation products and the clearance rate, which indicated that the clearance rate may be an important factor influencing the pattern of fermentation in the rumen.     

边境地区鼠体外寄生虫重要种群的季节消长

目的调查我国东北中朝俄边境地区鼠体外寄生虫重要种群的季节消长。方法采用笼日法捕鼠,收集鼠体外寄生虫。结果东北边境吉林省的和龙、珲春市,黑龙江省密山市和东宁县12种鼠体寄生虫的季节消长观察结果。12种鼠体外寄生虫的活动季节分别为全沟硬蜱4.5个月;同源栉眼蚤指名亚种和二齿新蚤均为5.0个月;纳氏历螨、耶氏历螨和厩真历螨均为5.5个月;高丽新恙螨1.5个月,田宫新恙螨和虾夷五角恙螨均为2.0个月,田鼠新恙螨2.5个月,波氏新恙螨3.5个月,已纤恙螨4.5个月。在整个活动季节期间出现1次高峰的10种分别是:全沟硬蜱8月上旬,同源栉眼蚤指名亚种6月上旬,厩真历螨和耶氏历螨均为10月下旬,已纤恙螨5月上旬,虾夷五角新恙螨和田宫恙螨均为5月下旬,波氏新恙螨6月下旬,田鼠新恙螨和高丽新恙螨均为8上旬;出现2次高峰的2种依次为:二齿新蚤在4下旬和6上旬,纳氏历螨在6月下旬和10月上旬。结论东北中朝俄边境地区鼠体外寄生虫重要种群的季节消长调查结果为深入开展鼠体外寄生虫与疾病关系提供了参考依据。     

Enter the world of the microcomputer

Step aside prejudices and fear, it is time for all medical group managers to find a friend in the microcomputer. This useful tool can eliminate the drudgery of number crunching and help solve the many practical financial and operational problems daily confronting the manager. The purchase of a $4,000 microcomputer system may at first seem ridiculous when a $100,000 system is already in use, but the software available for a microcomputer can offer specific applications for day-to-day management activities for which a " supercomputer " may not be well suited. The electronic spreadsheet applications for medical group financial management available through a microcomputer are explored here in detail.     

Reflections on the care of nursing and the autonomy of the human being under the condition of hospitalized elderly

There has been an increase of chronic diseases with the subsequent need for care and hospitalization, due to the acceleration of the elderly demographic growth. The objective of the present paper is to reflect on the care of nursing and the autonomy of the human being under the condition of elderly hospitalization. Nursing professionals, caring in the hospital ambient, can contribute significantly for the construction of the elderly autonomy and participation on the decision making about their need for attention or health care. The ethics redeeming, under a worthy aging perspective, permeates several discussions in the aging society and, specifically, among health professionals who act in hospital institutions.