食品药品检验系统质量管理岗位分级模式调研与分析

目的：在食品药品检验机构科室内部设立质量管理员,利用质量管理员的在线监督,保证检验科室全部要素始终处于正确、有效的状态,弥补所级质管部门在持续覆盖全面质量管理和监督工作内容方面的局限性,促进实验室质量管理体系的有效运行。方法：通过设计调查表及调查结果的统计,充分了解检验一线对质量管理员的岗位职责需求。结果与结论：明确科室质量管理员的岗位职责、工作重点、检查频次及人员条件,是质量管理岗位分级模式运行方案的基础。质量管理分级模式的试运行,是一次由内而外的质量改变,不仅将检验一线希望重点关注和提升检验质量的想法付诸行动,而且已初显成效。     

A holistic approach to chronic pain management that involves all stakeholders: change is needed

Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses’, pharmacists’ and physiotherapists’ skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late.

Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels – for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain.

Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain – it is vital they continue.     

Optimizing insulin pump therapy: the potential advantages of using a structured diabetes management program

Use of continuous subcutaneous insulin infusion (CSII) therapy improves glycemic control, reduces hypoglycemia and increases treatment satisfaction in individuals with diabetes. As a number of patient- and clinician-related factors can hinder the effectiveness and optimal usage of CSII therapy, new approaches are needed to address these obstacles.

Ceriello and colleagues recently proposed a model of care that incorporates the collaborative use of structured SMBG into a formal approach to personalized diabetes management within all diabetes populations. We adapted this model for use in CSII-treated patients in order to enable the implementation of a workflow structure that enhances patient–physician communication and supports patients’ diabetes self-management skills.

We recognize that time constraints and current reimbursement policies pose significant challenges to healthcare providers integrating the Personalised Diabetes Management (PDM) process into clinical practice. We believe, however, that the time invested in modifying practice workflow and learning to apply the various steps of the PDM process will be offset by improved workflow and more effective patient consultations. This article describes how to implement PDM into clinical practice as a systematic, standardized process that can optimize CSII therapy.     

重症急性胰腺炎治疗方法的临床探讨

目的探讨重症急性胰腺炎(severe acute pancreatitis，SAP)患者手术时机与指征。方法回顾性分析我院1999年1月～2004年1月79例SAP患者的治疗方法，手术时机选择与并发症发生率、病死率。结果 本组收集患者79例，其中非手术治疗28例，早期手术治疗33例，延期手术治疗18例。非手术组、早期手术组、延期手术组的并发症发生率分别为7．14％(2例)、33．33％(1l例)和11．11％(2例)，各组病死率分别为3．57％(1例)、15．15％(5例)和5．56％(1例)，早期手术组明显高于其他两组。结论 SAP的治疗选择是直接影响预后的重要因素，应根据SAP的病情实施个体化治疗方案。     

新护士长培训与效果的考评与分析

目的 寻求将新护士长培养成为具有科学管理能力的专业型人才的新途径.方法 根据新护士长工作的需要和当前改革对护士长的要求,制定新护士长培训计划及培训内容,实施多种方式培训,系统学习管理理论知识和方法,实践临床护理管理.结果 通过培训,更新了护士长的管理意识,掌握了管理的方法与技巧,提高了综合素质.结论 开展有效而规范的培训是促进新护士长角色转变的有效手段,是提高管理者素质和能力的重要途径.     

日清控制系统在手术室护理管理中的应用

手术室是外科系统的中心环节科室,护理质量直接影响着手术的顺利开展.笔者总结了2003年1月-2004年12月借用企业质量管理方法中的日清控制系统对每人每天每件事进行控制和管理,制定了科室总体目标、个人目标,及每日控制系统和有效的激励机制,把工作质量标准量化到每个岗、每个人,不断提高手术室护理质量.     

特定条件下野战医院的筹建与护理管理

目的 通过汶川地震后在都江堰迅速筹建野战医院的工作体会,探讨特定条件下野战医院护理工作的管理.方法 统计在都江堰野战医院参与震后救护工作的18名护士,完成14 422例伤病员救护工作的临床资料,进行护理工作管理质量分析.结果 合理实施弹性排班工作制,均衡护理人力资源的配置;充分展示了现代军人有文化、懂技术、能吃苦、能战斗的优良素质;在大量的任务到来之际,体现了良好的团队精神.结论 灵活、有效的应用弹性排班管理制度,保证了护理工作质量,出色地完成了抗震救灾任务.