Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety

MRI is a ubiquitous medical imaging technology typically using superconductivity to generate a strong, homogeneous, and generally ceaseless magnetic field. MRI and its magnetic field pose many safety hazards, including magnetic forces on metals, tissue heating and burns, nerve stimulation, bioeffects, acoustic noise, and contrast agent complications. The primary concern is that a wide variety of patients, staff members, technologists, and physicians can approach the incessant magnetic field, creating great potential for accidents that could occur if metals from the environment, adornments, implants, and other unintended sources are also present in or near the field. Many accidents have occurred and are occasionally reported in the United States and countries all over the world. Through carefully structured oversight and the establishment of strict guidelines regarding access, responsibilities, and training, these risks can be mitigated, and accidents can be prevented. Fortunately, there is currently a wide variety of resources available to facilitate the successful implementation of an effective MRI safety program. This article presents a general overview of and the authors’ experience with an MRI safety program in terms of risk management and training. The MR safety program requirements and regulations in the United States devised by The Joint Commission and the ACR are also discussed. With these resources and a carefully selected team, the risk for MRI-related accidents can be vastly reduced if not completely eliminated.     

Temperature Measurement by Sublimation Rate as a Process Analytical Technology Tool in Lyophilization

Product temperature (T_b) and drying time constitute critical material attributes and process parameters in the lyophilization process and especially during the primary drying stage. In the study, we performed a temperature measurement by the sublimation rate (TMbySR) to monitor the T_b value and determine the end point of primary drying. First, the water vapor transfer resistance coefficient through the main pipe from the chamber to the condenser (C_r) was estimated via the water sublimation test. The use of C_r value made it possible to obtain the time course of T_b from the measurement of pressure at the drying chamber and at the condenser. Second, a Flomoxef sodium bulk solution was lyophilized by using the TMbySR system. The outcome was satisfactory when compared with that obtained via conventional sensors. The same was applicable for the determination of the end point of primary drying. A laboratory-scale application of the TMbySR system was evidenced via the experiment using 220-, 440-, and 660-vial scales of lyophilization. The outcome was not dependent on the loading amount. Thus, the results confirmed that the TMbySR system is a promising tool in laboratory scale.     

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services

A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.     

职业病网络报告系统用户权限管理现状及对策

目的分析职业病网络报告系统用户权限管理现状和问题,为进一步加强权限管理提出建议。方法将截至2018年4月底在"中国疾病预防控制信息系统"的用户身份认证管理系统——"用户认证与授权管理系统"注册的、与职业病网络报告工作相关的系统管理员、业务管理员、本级用户、直报用户,使用SPSS 23.0软件对数据进行处理,对用户分布、用户所在机构设置的用户数、用户权限情况等进行分析。结果职业病与职业卫生信息监测系统共有各级各类用户35 144个,其中直报用户最多(24 788个,占70.53%),业务管理员用户最少(2 138个,占6.08%)。直报用户均设为县区级,绝大部分分布在卫生院(11 208个,占45.22%)和医院(8 435个,占34.03%),88.74%的直报机构仅有1个直报账户,3.06%的直报机构有3个及以上直报账户,个别机构直报用户数甚至超过10个。本级用户分布在3 140家职业病报告业务管理机构中,个别地市级和县区级职业病业务管理机构具有5个以上的本级用户。各类机构中大部分用户设置的角色数在5个以内;有15 022个(占60.60%)直报用户使用了"所有报告卡直报角色",主要分布在卫生院。存在的主要问题:基层尤其是县区级职业病防治机构、职业病报告业务管理机构能力不足;部分基层机构用户数设置过多;部分用户权限设置不合理,业务管理员管理欠规范。结论加强基层职业病报告业务管理机构的能力,进一步规范各级各类机构用户和权限管理,业务管理员严格授权,国家出台细化的用户和权限管理规范等措施来进一步加强权限管理工作。     

医药分开综合改革对公立医院药师队伍影响的调查

目的：研究公立医院药师队伍受医药分开综合改革的影响。方法：通过文献回顾法对既往研究成果进行整理和综述，通过专家咨询法设计了针对6个省市药师队伍和管理者的调查问卷和访谈提纲，并以此为工具开展调查。结果：改革对药师队伍的工作内容、工作量、工作心态等维度均存在影响，药师队伍对改革政策也有不同评价，对继续教育和医院、政府的支持政策有较大需求。结论：改革促使医疗机构运营策略与药学服务转型，不仅需要药师队伍内部提升，更需要外部设计。