PDCA循环在标准预防中的应用

目的 运用计划-实施-检查-处理(PDCA)循环提高急诊科护士对标准预防知识的认知度和标准预防行为依从性,降低医务人员职业暴露.方法 通过问卷调查、现场观察,了解急诊科护士对标准预防知识的知晓和标准预防执行情况,同时对护士进行访谈,了解其对执行标准预防的困难和建议,最后运用PDCA循环制定相应的计划,并组织实施、检查,对检查结果进行修正和处理.结果 培训该院急诊科注册护士139人,理论考试合格率为97.84％,操作考试合格率为100.00％;参加培训的护士对标准预防知识的认知度有明显提高(P＜0.05);实施PDCA循环后,护士洗手、戴口罩和手套依从性最高,为100.00％;护士对标准预防知识知晓率和标准预防行为依从性均有提高,针刺伤下降56.1％.结论 PDCA循环在标准预防中作用是明显的,但在执行过程中要体现持续改进,使循环不断提升.     

沟通管理与医疗纠纷防范

处理医疗纠纷是医院管理部门的一项重要工作，而医疗纠纷的防范与医院沟通管理密切相关，本结合军队小医院地处特区的特点，谈谈如何做好沟通管理以防范医疗纠纷。     

计算机医疗质量警示系统的建立与应用

为认真贯彻落实《医疗事故处理条例》，进一步加强医院管理，提高医疗质量，借助于医院计算机系统，在电子病案开发的基础上建立医疗质量警示系统，开展环节质量缺陷的防范工作。通过这项工作提高管理效率，促进医疗行为更加规范化和医疗质量的提高。     

热疗联合放疗和化疗治疗恶性肿瘤不良反应的观察与预防

目的：探讨在局部热疗中导致肿瘤患者皮肤烫伤的原因和预防对策,观察热疗联合放化疗的临床效果。方法：回顾性分析1999年11月至2012年5月我科收治的345例射频热疗患者和439例微波热疗患者的常见并发症,制定热疗前、中、后防范措施。结果：所有患者均安全完成治疗,临床疗效显著。观察治疗中和治疗后不良反应发生的情况,射频热疗中发生脂肪硬结9例,没有患者出现皮肤烫伤;微波热疗中发生浅Ⅱ°烫伤4例,Ⅰ°烫伤5例。所有并发症经对症处理后消失,无后遗症发生。结论：局部热疗联合放疗、腹腔灌注化疗及基因治疗是一种安全有效的治疗方法,能显著提高患者的治疗效果,改善生活质量,副作用可以耐受。在热疗过程中,应全面了解患者的情况,实施温度监测,落实各项防范措施,可有效防止皮肤烫伤,保证患者顺利地完成治疗。     

某综合医院2010--2011年手术室医护人员职业暴露情况分析

目的了解手术室医护人员职业暴露情况,探讨有效的防护对策。方法使用“医务人员职业暴露个案登记表”记录2010、2011两年手术室医护人员职业暴露相关情况。结果共发生职业暴露46例,其中医生14例,护士30例,护生2例。HBV31例为主要暴露源,锐器损伤38例为主要暴露方式,器械分类和手术缝合各10例为主要环节。暴露后均能正确处理伤口,46例职业暴露无1例感染。结论手术室医护人员易发生职业暴露,应加强医护人员职业安全教育,强化标准预防,做好医院感染环节质量控制。     

小儿腹股沟斜疝术后复发14例临床分析

[目的 ]探讨小儿腹股沟斜疝术后复发原因及其防治措施。 [方法 ]回顾性分析 1 4例复发性腹股沟斜疝患儿的临床资料。 [结果 ]1 4例患儿均痊愈出院 ,随访无复发 ,治疗效果满意。 [结论 ]预防小儿腹股沟斜疝术后复发一定要做到疝囊高位结扎 ,加强腹股沟管前壁的修补以及手术操作认真细致。     

A novel autonomic activation measurement method for stress monitoring: non-contact measurement of heart rate variability using a compact microwave radar

We developed a novel method for non-contact monitoring of stress-induced autonomic activation through the back of a chair, using a compact 24 GHz microwave radar (8 x 5 x 3 cm), without large-scale equipment and placing a heavy burden on the monitored individual. Following a silent period of 120 s, audio stimuli using a composite tone of 2,120 and 2,130 Hz sine-waves at 95 dB were conducted for 120 s. From dorsal, LF/HF of HRV reflecting sympatho-vagal balance was determined by microwave radar with the maximum entropy method using eight volunteers (mean age 23 +/- 1 years). Mean LF/HF measured by non-contact and contact (using electrocardiography for reference) methods during audio stimuli increased 34 and 37%, respectively, as compared with those of the silent period. Maximum cross-correlations between contact and non-contact measurements averaged 0.73 +/- 0.10. Our method appears to be promising for future monitoring of stress-induced autonomic activation of operators and may reduce stress-induced accidents.     

HIV-related avoidance and universal precaution in medical settings: opportunities to intervene

Objective. To determine the association between adherence to universal precaution (UP) and avoidance attitudes toward patients living with HIV/AIDS (PLH) among service providers. Data Sources/Setting. A total of 1,760 health service providers were randomly selected from 40 county hospitals in two provinces of China. Study Design. A self‐administered questionnaire was used to collect demographic characteristics, UP knowledge and training, UP adherence, availability of UP supplies at work, and avoidance attitudes toward PLH in a cross‐sectional survey. Data Analysis. A series of regression models were used to examine associations among the UP‐related factors and their relationship to avoidance attitudes toward PLH. Principal Findings. UP training was associated with better knowledge of and adherence to UP and perceived availability of UP supplies in hospitals. UP training, knowledge, and adherence were significantly associated with avoidance attitudes toward PLH in medical practice. Being a nurse was also related to HIV‐related avoidance. Conclusion. UP promotion campaigns, including in‐service training and reinforcement of UP adherence, could play an important role in the battle against HIV‐related avoidance in medical settings. Intervention programs should focus on not only individual providers' attitudes and behaviors but also on structural support for norms shifts in the medical community.     

DDT and malaria prevention: addressing the paradox

Background

The debate regarding dichlorodiphenyltrichloroethane (DDT) in malaria prevention and human health is polarized and can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT.

Objective

We attempted to arrive at a synthesis by matching a series of questions on the use of DDT for indoor residual spraying (IRS) with literature and insights, and to identify options and opportunities.

Discussion

Overall, community health is significantly improved through all available malaria control measures, which include IRS with DDT. Is DDT “good”? Yes, because it has saved many lives. Is DDT safe as used in IRS? Recent publications have increasingly raised concerns about the health implications of DDT. Therefore, an unqualified statement that DDT used in IRS is safe is untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is “good” because it saves lives, and “not safe” because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances, malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. At the very least, it is now time to invoke precaution. Precautionary actions could include use and exposure reduction.

Conclusions

There are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for healthier lives.     

实习护生标准预防行为依从性影响因素研究

目的 了解实习护生标准预防行为依从性现状,探讨其影响因素.方法 采用分层随机抽样方法,用一般资料问卷、标准预防知识问卷、标准预防态度问卷、标准预防行为依从性问卷对950名实习护生进行问卷调查,用Pearson相关分析、多元线性回归分析方法进行统计学处理.结果 实习护生标准预防知识、态度、行为依从性得分分别为(26.05±9.53)、(112.09±19.24)、(114.05±21.92)分,得分率分别为62%、66%、59%;行为依从性影响因素按照作用强弱依次为标准预防行为障碍认知、标准预防知识来源途径、标准预防知识、针刺伤情况、标准预防行为有利条件认知、教育程度、实习医院等级、自我效能.结论 实习护生标准预防行为依从性差,存在多方面的影响因素,应提高培养层次,加强临床实习基地建设,增进护生标准预防知识和技能培训,加强职业防护意识教育,改善标准预防态度,强化标准预防行为.