各类医用电气设备标准间电气安全指标的差异

本文统计了各类医用电气设备标准，分析了各标准间电气安全指标的差异，以指导临床工程师在不同医用电气设备的安全测试、维修或预防性维护丁作中采用合适的电气安全标准。     

Educating leaders in hospital management: A pre-post study in Ethiopian hospitals

Abstract

Despite recent focus on health systems strengthening, few studies report large-scale efforts to improve hospital management capacity in low-income countries, a central component of improving health care delivery. We sought to assess the contributions of a systems-based approach, the Ethiopian Hospital Management Initiative (EHMI), which established hospital chief executive officers (CEOs) trained through a Masters of Healthcare and Hospital Administration (MHA) degree programme in Ethiopia. We conducted a pre-post study of 24 hospitals that are managed by CEOs in the MHA programme. We measured changes in hospital functioning based on adherence to a set of 86 hospital performance standards across 12 management domains published in the Standards for Hospital Management in Ethiopia. We found that adherence to hospital performance standards increased significantly during the one-year follow-up (27% compared with 51% of standards met at baseline and follow-up, respectively; P-value < 0.001); overall improvement was driven by improvement in seven of the 12 management domains. The EHMI is an example of health systems strengthening with focus on building hospital management capacity. Early evidence suggests that the establishment of hospital CEOs and MHA training to equip them with management skills may promote scalable improvements in health facility functioning.     

Development of a lyophilized soybean paste certified reference material for the analysis of ochratoxin A

A certified reference material (CRM) [²KRISS CRM # 108-10-018] for the analysis of ochratoxin A (OTA) in doenjang (fermented soybean paste and popular food in Korea) was produced to ensure the reliability of analytical results in testing laboratories. A home-made doenjang was chosen as a raw material after testing its OTA level. The raw material was freeze-dried, pulverized, sieved and homogenized. An isotope-dilution-liquid chromatography/tandem mass spectrometric method (ID-LC/MS/MS) which was previously developed and validated in this laboratory was used as a higher-order reference method for characterization, homogeneity studies, and short-term stability studies. The CRM had good between-bottle homogeneity with 0.56% relative standard deviation among 10 selected units. The stability of the CRM at −70 °C (the storage condition in our laboratory) and at −20 °C (the possible storage temperature at user sites) were tested for up to 8 months. No change in the OTA content was observed within the measurement uncertainty. The stability of the CRM at room temperature (for regular use and transportation) was also tested and confirmed. The certified value was (49.50 ± 1.17) μg/kg, where the expanded uncertainty was in the confidence level of 95%.     

The orienting of attention during eye and hand movements: ERP evidence for similar frame of reference but different spatially specific modulations of tactile processing

To investigate which frames of reference guide shifts of attention triggered during eye and hand movement preparation and the specificity of their effects on somatosensory processing, we recorded event-related brain potentials (ERPs) in a Go/Nogo task where a cue indicated to prepare an eye movement toward - or a hand movement with - the left or right hand. Before the imperative stimulus, a tactile probe was presented to one hand. Spatially selective modulations of tactile processing were more sustained for hand than eye movements, indicating stronger attentional modulations for the modality of the effector's sensory organ. Importantly, attentional modulations of somatosensory processing as well as lateralized ERP components in the preparation interval were virtually identical under uncrossed and crossed hands conditions, suggesting that shifts of attention triggered during hand and eye movement preparation are guided by a common external reference frame.     

多发性硬化诊断标准的进展与解读

多发性硬化是一种中枢神经系统脱髓鞘性疾病,临床特点是病灶播散广泛。本文复习了近30年来多发性硬化诊断标准的进展,并作解读。     

Estimating the decline in excess risk of chronic obstructive pulmonary disease following quitting smoking – A systematic review based on the negative exponential model

We quantified the decline in COPD risk following quitting using the negative exponential model, as previously carried out for other smoking-related diseases. We identified 14 blocks of RRs (from 11 studies) comparing current smokers, former smokers (by time quit) and never smokers, some studies providing sex-specific blocks. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We estimated the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block, except for one where no decline with quitting was evident, and H was not estimable. For the remaining 13 blocks, goodness-of-fit to the model was generally adequate, the combined estimate of H being 13.32 (95% CI 11.86–14.96) years. There was no heterogeneity in H, overall or by various studied sources. Sensitivity analyses allowing for reverse causation or different assumed times for the final quitting period little affected the results. The model summarizes quitting data well. The estimate of 13.32 years is substantially larger than recent estimates of 4.40 years for ischaemic heart disease and 4.78 years for stroke, and also larger than the 9.93 years for lung cancer. Heterogeneity was unimportant for COPD, unlike for the other three diseases.     

Developing standards for an integrated approach to workplace facilitation for interprofessional teams in health and social care contexts: a Delphi study

Integration of health and social care forms part of health and social care policy in many countries worldwide in response to changing health and social care needs. The World Health Organization’s appeal for systems to manage the global epidemiologic transition advocates for provision of care that crosses boundaries between primary, community, hospital, and social care. However, the focus on structural and process changes has not yielded the full benefit of expected advances in care delivery. Facilitating practice in the workplace is a widely recognised cornerstone for developments in the delivery of health and social care as collaborative and inclusive relationships enable frontline staff to develop effective workplace cultures that influence whether transformational change is achieved and maintained. Workplace facilitation embraces a number of different purposes which may not independently lead to better quality of care or improved patient outcomes. Holistic workplace facilitation of learning, development, and improvement supports the integration remit across health and social care systems and avoids duplication of effort and waste of valuable resources. To date, no standards to guide the quality and effectiveness of integrated facilitation have been published. This study aimed to identify key elements constitute standards for an integrated approach to facilitating work-based learning, development, improvement, inquiry, knowledge translation, and innovation in health and social care contexts using a three rounds Delphi survey of facilitation experts from 10 countries. Consensus about priority elements was determined in the final round, following an iteration process that involved modifications to validate content. The findings helped to identify key qualities and skills facilitators need to support interprofessional teams to flourish and optimise performance. Further research could evaluate the impact of skilled integrated facilitation on health and social care outcomes and the well-being of frontline interprofessional teams.