PDCA循环在消毒供应室护理管理中的应用

目的探究分析PDCA循环在消毒供应室护理管理中的应用效果。方法自2017年1月至2017年12月在我院消毒供应室实施PDCA循环,将消毒供应室进行PDCA循环的相关资料收集作为观察组;将其自2016年1月至2016年12月期间未进行PDCA循环的相关资料收集作为对照组,比较实施PDCA循环前后我院消毒在消毒供应室护理管理水平、物品清洗灭菌消毒合格率、临床医护人员满意度3个主要方面的差异。结果观察组消毒供应室护理管理水平较对照组显著提高,观察组物品清洗灭菌消毒合格率较对照组明显增加,对观察组工作人员的总满意度较对照组显著提高。两组之间在上述3个方面的差异显著且具有统计学意义(P<0.05)。结论 PDCA循环显著在消毒供应室护理管理中的应用效果显著,有效提高了消毒供应室护理管理质量,值得在消毒供应室护理管理中进行推广和应用。     

PDCA循环管理对降低医院消毒供应室手术器械感染率的效果分析及其对策

目的:分析应用PDCA循环管理法对降低医院消毒供应室手术器械感染率的影响及其对策。方法:抽取2017年1月—12月间医院消毒供应室手术器械灭菌资料为管理前组;另抽取2018年1月—12月间应用PDCA循环法进行质量管理后的医院消毒供应室手术器械灭菌资料为管理后组;统计和分析因手术器械灭菌原因导致医院感染发生率;比较实施PDCA管理前后相关技术人员操作情况、器械消毒灭菌合格率差异及对医院感染的影响。结果:管理后组应用PDCA循环管理后手术器械、气管内套管、麻醉喉镜及氧气湿化瓶检查合格率均显著优于管理前组,且手术器械医院感染率显著低于管理前组(P<0.05)。结论:在医院消毒供应室应用PDCA循环管理法管理有助于降低手术器械消毒灭菌不合格率及患者手术切口的感染率,提高了消毒供应室器械消毒质量和患者的手术质量,降低了医院感染发生率,确保了手术的医疗质量。     

PDCA循环应用于消毒供应室护理管理效果研究

目的 分析在消毒供应室护理管理工作中应用PDCA循环管理方法的效果。方法 以我院消毒供应室的工作人员为研究对象,按照时间段进行分组,其中20名人员为对照组,在2017年6月至2018年6月采取常规护理管理;20名人员为研究组,在2018年7月至2019年7月采取PDCA循环护理管理方法,评价并比较两组护理管理方法的应用效果。结果 对研究组消毒供应室工作人员应用PDCA循环护理管理方法后,工作人员满意度和各项操作的依从性均高于对照组,差异显著（P <0.05）,有统计学意义;同时,研究组工作人员器械清洗合格率、服务意识、安全防范、差错防范意识均高于对照组,差异显著（P <0.05）,有统计学意义。结论 PDCA循环管理方法在消毒供应室的应用价值优于常规护理管理方法,可明显提高工作人员满意度和各项操作的依从性,保证器械清洗合格率,增强工作人员服务意识、安全防范意识、差错防范意识,高效完成消毒供应工作且工作质量较佳。     

PDCA循环管理对降低医院消毒供应室院内感染率的成效分析

目的:探究PDCA循环管理对降低医院消毒供应室院内感染率的成效。方法:抽取2017年1—12月间100例患者、100件清洗消毒器械及物件和30名医护工作人员资料作为管理前组,采用消毒供应室常规管理;另抽取2018年1—12月间100例患者、100件清洗消毒器械及物件和30名医护工作人员资料作为管理后组,采用消毒供应室PDCA循环管理;比较管理前后患者院内感染的发生率、器械及物件清洗消毒合格率、以及医护工作人员和患者对医院消毒供应室消毒管理的满意率的差异。结果:管理后组患者院内感染发生率低于管理前(P<0.05),器械及物件清洗消毒合格率高于管理前组(P<0.05),医护工作人员和患者对医院消毒供应室消毒管理的满意率高于管理前组(P<0.05)。结论:在医院消毒供应室管理中运用PDCA循环管理的效果较好,有效减少了院内感染的发生,规范了器械及物件的清洗消毒流程,减少了院内感染的发生,提高了医护工作人员和患者对医院消毒供应室消毒管理的满意率。     

PDCA循环在消毒供应室护理管理中的应用及对降低手术器械感染率的影响效果

目的分析在消毒供应室护理管理中应用PDCA循环对降低手术器械感染率的影响效果。方法随机抽取本院消毒供应室医护人员20例作为研究对象,将2016年1~6月与2016年7~12月作为研究时段,将前者作为对照组、后者作为研究组,对照组实施常规护理管理,研究组实施PDCA循环护理管理,分析两组手术器械感染率、护理管理效果、各科室满意度。结果手术器械感染率研究组低于对照组,差异有统计学意义(P0.05);护理管理效果、各科室满意度对比研究组高于对照组,差异有统计学意义(P0.05)。结论在医院消毒供应室护理管理中应用PDCA循环,既可降低手术器械感染率,又可提高各科室对消毒供应室的满意度及护理管理效果,值得消毒供应室推广应用。     

PDCA循环管理在消毒供应中心中的应用

目的:探讨PDCA循环管理在消毒供应中心中的应用效果。方法:选取2015年3月～2017年2月收集样本资料100份作为观察组,同时选取2014年2月～2015年2月收集样本资料100份作为对照组,对比两组质检情况。结果:实施后消毒供应室各环节质量检查情况优于实施前(P0.05)。结论:将PDCA循环法应用于消毒供应中心管理中,可有效地提高供应室各环节质量,因此可于临床实践中推广应用。     

消毒供应室工作流程中的零缺陷管理

目的探索消毒供应室工作流程中行之有效的管理方法。方法汇总并分析2007年1月至11月我消毒供应室工作中存在的问题,于2008年1月针对这些问题制定改进措施,并把＂零缺陷＂管理理念引入到消毒供应室工作流程当中。结果 2008年我消毒供应室工作缺陷总下降率为84.6%。结论零缺陷管理实现了消毒供应室工作流程的规范化、制度化,有效控制了各流程中工作缺陷,确保工作质量。     

PDCA循环在提高手术人员手消毒管理中的作用

目的观察将计划-实施-检查-处理（PDCA）循环即管理循环模式引入外科手消毒管理中的效果。方法应用PDCA循环模式进行持续质量改进,强化培训后,定期检查手术人员的指甲修剪情况、机械清理指甲依从性及手无菌检出率。结果培训前后护士的指甲修剪率、机械清理指甲率及手无菌率均最高,医生次之,实习生最差;培训后三组人员的上述三项指标（护士的指甲修剪率除外）均有大幅度升高,自身前后比较,差异均有统计学意义。结论 通过PDCA循环进行持续质量改进,提高手术人员修剪指甲、机械清理指甲依从性,对规范免刷式外科手消毒,确保外科手消毒质量起到至关重要的作用。     

PDCA循环在急诊护理质量管理中应用的价值分析

目的探讨在急诊护理质量管理中实施PDCA循环的价值。方法本院急诊科自2012年5月起将PDCA循环管理模式引入护理质量管理中,分别于2012年4月及2012年12月各选取140例有可比性的患者,通过自行设计的量表请患者对护理满意度进行评价,于实施PDCA前后对消毒隔离合格率、无菌物品合格率以及一医一患执行率进行抽查和统计。结果实施PDCA循环管理后,患者在各方面对护理满意程度均有明显提高．患者总体满意度可达94．00％,明显高于实施PDCA循环管理前85．14％的比例;经过PDCA循环护理后,护理消毒隔离合格率、无菌物品合格率以及一医一患执行率分别为97．62％、100．00％和95．29％。明显高于对照组90．48％、96．23％和82．76％的比例,差异有统计学意义（P〈0．05）。结论在急诊护理管理中引入PDCA循环模式,通过4个阶段环环相扣地不断循环,及时发现护理中存在的问题,及时进行不断地改进,逐渐提高护理的质量,并促进护患关系良好发展。     

细节管理应用于消毒供应室护理管理中的效果

目的探讨细节管理应用于消毒供应室护理管理中的效果。方法将2017年6月至2017年12月未实施细节管理的消毒供应室服务数据纳入到对照组;将2018年1月至2018年6月实施细节管理的消毒供应室服务数据纳入到观察组;对照组采用常规管理模式、观察组采用细节管理模式。结果观察组的器械清洗灭菌的合格率、保养损坏率、医务工作人员满意度分别为100.0%、0.1%、92.0%,上述指标均优于对照组(P <0.05)。结论在消毒供应室护理管理中引入细节管理能够提高消毒供应室的服务质量与医务人员的满意度。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.