优化质量管理在口腔科消毒供应中心的应用

目的 探讨优化质量管理在口腔科消毒供应中心的应用及实施效果.方法 将已经使用过的口腔复用诊疗器械进行椅旁预处理后,集中回收到消毒供应中心,对器械进行程序化的分类、清洗消毒、检查保养、包装、灭菌,加强对诊疗器械清洗质量以及灭菌后湿包率的管理力度.结果 实施质量管理后清洗合格率比实施前提高(90.63％比84.00％,P=O.000 2),无菌物品的湿包发生概率明显降低(3.13％比5.56％,P=0.000 7).结论 优化质量管理能够提升口腔科复用器械的清洗质量和灭菌质量.     

WXD-650A微波快速灭菌器在口腔科的应用

目的加强口腔科医疗器械的严格消毒管理,预防交叉感染。方法将口腔科器械用WXD-650A微波快速灭菌后进行灭菌效果监测。结果灭菌效果良好,口腔科器械微波灭菌最佳时间为5min;灭菌后可有效保存3d。结论达到了口腔科器械严格消毒灭菌的目的 。     

口腔科医院感染预防与控制

提高口腔科医务人员医院感染预防意识,加强口腔器械的消毒灭菌,从而杜绝在口腔科诊疗过程中的交叉感染。完善并落实消毒隔离制度,环境布局合理,规范操作,注重器械清洗及消毒的各个环节,提高医务人员的职业素质和责任心。口腔科医务人员的防控感染意识、健全的消毒隔离制度是预防和控制口腔科院内感染的有效措施。     

口腔专科诊疗器械清洗灭菌与保养管理

目的探讨口腔专科诊疗器械集中消毒供应中心清洗、消毒、灭菌处理与保养管理模式的实施效果。方法将集中式管理模式实施前口腔诊疗器械120件作为对照组,口腔诊疗器械在口腔科内处理。120件集中式管理模式实施后口腔诊疗器械作为观察组,将口腔诊疗器械送消毒供应中心集中处理。对两组器械的清洗效果和灭菌效果进行比较。结果观察组清洁率为90.83%,显著高于对照组清洁率79.17%,差异有统计学意义（P〈0.05）。观察组器械灭菌效果为100%,显著高于对照组89.17%,有统计学差异（P〈0.05）。结论口腔诊疗器械集中清洗消毒、灭菌及保养的模式,可明显提高清洗质量和灭菌效果,值得临床推广应用。     

FMEA在消毒供应中心口腔科器械管理中的应用效果

目的 探讨失效模式与效应分析(FMEA)在消毒供应中心口腔科器械管理中的应用效果。方法 自2019年12月起,医院消毒供应中心开始通过FMEA对口腔科器械实施管理。于FMEA实施前后所使用的口腔器械中随机选取1638件,对其展开FMEA分析,对比实施前后的失效模式危急值(Risk Priority Number, RPN)、器械管理效果及服务满意度。结果 FMEA实施后的口腔器械交接数目不符合、器械损坏、器械包装名称错误、器械清洗、消毒与灭菌不合格的RPN值明显比实施前低(P<0.05);FMEA实施后的口腔科器械清洗、包装合格率比实施前高,器械耗损率、湿包发生率比实施前低,及时发放率比实施前高(P<0.05);实施后的服务满意度总分实施前高(P<0.05)。结论 消毒供应中心对口腔科器械展开管理时,应用FMEA并针对分析结果制定相应措施可有效降低口腔科器械管理中的风险,提升器械管理效果,并且有助于提升服务满意度。     

戊二醛对口腔器械消毒效果的观察

目的：探讨戊二醛用于口腔器械消毒的效果。材料与方法：按照《消毒技术规范》，对口腔科使用2％戊二醛浓度及其消毒灭菌效果进行监测。结果：使用4d内的戊二醛及其消毒器械的生物学监测均合格。使用4、5、7、14d的戊二醛有效浓度监测合格率分别为100％、95．1％、90．2％、46．7％。结论：戊二醛是较为理想的口腔器械消毒剂，应加强管理，减少污染，建立定期更换制度，使用时间不宜超过7d。     

口腔科诊疗器械消毒灭菌整改措施及效果观察

规范口腔科诊疗器械的消毒灭菌管理方法。分析现状,参照《医疗机构口腔诊疗器械消毒技术操作规范》结合实际,制定切实可行的消毒灭菌办法。最大限度地控制口腔科医院内感染,保护医生的健康安全。加强诊疗器械及物品的管理,有利用于控制医源性感染及医院交叉感染。     

口腔科器械的消毒灭菌与院内感染控制

由于口腔科门诊的患者比较多,其具有流动性大的特点,在口腔疾病的诊疗时,需要确保器械与双手的卫生,避免出现细菌感染。尤其是在医务人员的器械与双手与患者唾液、血液接触的时候,需要注意避免出现院内感染清理。然而,目前医院口腔科随着牙钻高速涡轮机的广泛使用以及在诊疗操作过程中没有严格按照无菌操作要求来执行,引起的院内感染比较常见,不断对患者的身体健康带来危害,部分器械的时候还会污染空气。需要对口腔科器械消毒灭菌与院内感染加强控制,降低交叉感染的发生。本文就口腔科病原体污染主要来源进行分析,并探讨口腔科器械消毒灭菌与院内感染控制的有效措施,以便提高口腔科的诊疗质量与水平。     

口腔科器械消毒现状分析与对策

口腔科是医院感染管理的一个薄弱环节。口腔科医生在给病人诊疗过程中基本上都是使用器械,如何才能所使用的器械真正无菌是口腔科避免交叉感染要解决的一个重要问题,只有做好对口腔科器械的消毒管理工作才能降低和避免医院感染的发生。现将我们在工作中的体会报道如下。1口腔科器械污染的现状口腔科常用的器械有诊疗用手机、拔牙钳、牙挺子、镊子、口镜、手术用刀、剪及微小物品如车针、扩大针等。这些器械在诊疗过程中是完全接触血和粘膜的,而且使用后污染程度是非常高的,有报道说口腔科治疗盘上微型器械、诊室空气及医务人员的合格率分别…     

口腔科控制感染的临床意义及实用方法

口腔是微生物侵入机体的主要途径之一。因此制订严格的口腔无菌操作规范及器械消毒方法,具有极其重要的临床意义。 口腔科器械大多数采用高压灭菌、煮沸灭菌、干烤和化学灭菌法。化学灭菌法有酒精、新洁尔灭、来苏、过氧乙酸和84消毒液等。在一般无条件下可将牙钻、扩大针、砂石磨头、成形夹等口腔器械采用消毒方法如下:将器械浸泡于已于1％次氯酸溶液中     

Maintenance treatment of severe tardive dyskinesia with clozapine: 5 years' follow-up

\Drug-induced tardive dyskinesia (TD) affects approximately 20% to 30% of schizophrenic patients. Although it is usually mild, from 1% to 8% of patients may develop severe TD. Second-generation antipsychotics have demonstrated a lower risk of inducing TD. However, despite the advances brought by second-generation antipsychotics, the treatment strategies for TD remain problematic, given both the lack of an established therapeutic choice and the need for long-term use of antipsychotics in the treatment of schizophrenia. Clozapine is an atypical antipsychotic with minimal risk of inducing TD. Furthermore, it has been suggested that clozapine might actually improve the symptoms of TD. Accordingly, we evaluated the effects of clozapine on severe TD over 5 years. Seven patients meeting Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for chronic exacerbated schizophrenia (mean age 28.5 +/- 10.2 years) and presenting severe TD, defined as Abnormal Involuntary Movements Scale score above 13, were treated with clozapine and followed up for 5 years. Extrapyramidal Symptoms Rating Scale assessment was performed in all patients at baseline, after 6 months and 3 and 5 years. Mean Extrapyramidal Symptoms Rating Scale scores decreased 83% after 3 years and 87.5% after 5 years. Mean dose for all patients was 428 +/- 269 mg/d after 5 years. Results from this open-label study suggest that clozapine may be a further option for the treatment of TD over long term.     

Risk factors for orofacial and limbtruncal tardive dyskinesia in older patients: a prospective longitudinal study

Although there is a consensus that orofacial and limbtruncal subtypes of tardive dyskinesia (TD) exist and may represent distinct pathophysiologic entities, few studies have examined the incidence of and risk factors associated with the development of these TD subtypes. Two hundred and sixty-six middle-aged and elderly outpatients with a median duration of 21 days of total lifetime neuroleptic exposure at study entry were evaluated at 1- to 3-month intervals. Using mild dyskinesia in any part of the body for diagnosis of TD, the cumulative incidence of orofacial TD was 38.5 and 65.7% after 1 and 2 years, respectively, whereas that of limbtruncal TD was 18.6 and 32.6% after 1 and 2 years. Preclinical dyskinesia was predictive of both orofacial and limbtruncal TD. History of alcohol abuse or dependence was a significant predictor of orofacial TD only whereas tremor was a significant predictor of limbtruncal TD only. Findings support suggestions that orofacial and limbtruncal TD may represent specific subsyndromes with different risk factors.     

无水酒精涮洗清除手术器械肿瘤细胞污染的效果

目的探讨无水酒精涮洗清除手术器械携带肿瘤细胞的效果。方法选择60例行肝脏切除手术的原发性肝癌患者,将肿瘤切除阶段使用的手术器械随机均分为两组,分别置于无水酒精(实验组)和生理盐水(对照组)涮洗10s后再分别放入生理盐水中进行2次涮洗。两次涮洗后均用液基薄层细胞学检查(TCT)检测涮洗后器械上残留肿瘤细胞数目,并计算肿瘤细胞阳性率。结果第1次涮洗后,实验组肿瘤细胞数和阳性率均低于对照组[(0.12±0.09)个vs.(3.05±1.40)个和4.67%vs.63.33%](P<0.01)。第2次涮洗后,实验组阳性率仅为1.67%,显著低于对照组的26.67%(P<0.01)。结论肝癌手术中,无水酒精涮洗能快速有效灭活手术器械上的肿瘤细胞。     

Update on the Epidemiology of Traveler's Diarrhea in East Africa

Background: Traveler's diarrhea (TD), the most frequent health problem in visitors to subtropical and tropical regions, needs to be reassessed in view of the development of vaccines against its most frequent causative agent, enterotoxigenic Escherichia coli.
Methods: Passengers returning from Mombasa to Europe were interviewed by self-applied questionnaires during the flights. Main outcome measures were subjective TD, defined as having had more diarrhea in East Africa than at home, objective TD as traditionally defined, and the cumulative incidence calculated by the method of Kaplan-Meier survival analysis.
Results: Subjective TD was reported by 1117 (49.3%) of the 2268 tourists. The cumulative incidence of subjective TD reached 36.7% after a 1-week stay and 47.6% after 2 weeks.
Conclusion: Subjective TD attack and incidence rates continue to be high even at frequently visited destinations.     

Tryptophan depletion does not modify response to CCK-4 challenge in patients with panic disorder after treatment with citalopram

Rationale Data by [Bell et al. J Psychopharmacol (2002) 16:5–14] suggest that a decrease in 5-HT neurotransmission predisposes to panic attacks and that the antipanic effect of SSRIs depends upon the availability of 5-HT in the brain.Objectives Our aim was to assess the effect of acute tryptophan depletion (TD) on cholecystokinin-tetrapeptide (CCK-4)- induced symptoms in patients with panic disorder (PD) who had responded to a 10-week treatment with a selective serotonin (5-HT) reuptake inhibitor (SSRI), citalopram.Materials and methods A total of 18 patients (6 males and 12 females, mean age 34.5 years) received a tryptophan-free amino acid drink and a control drink, each followed by a CCK-4 challenge (25 μg), 1 week apart in a double-blind crossover design.Results The results showed no significant differences in response to the CCK-4 challenge between the TD and the control conditions. Panic rate after the CCK-4 challenge was 27.8% after depletion and 33.3% after control drink (χ ²=0.13, p=0.72). No significant effects of TD were observed in panic intensity scores, subjective anxiety, or cardiovascular indices.Conclusions This study demonstrates that an acute lowering of brain 5-HT availability with TD does not affect response to a CCK-4 challenge in PD patients successfully treated with citalopram. Thus, the reduction of CCK-4 sensitivity following SSRI-treatment in patients with PD may be related to mechanisms other than 5-HT availability in the brain, possibly to a reduction in brain cholecystokinin receptor sensitivity.     

Extrapyramidal syndromes in neuroleptic-treated patients: prevalence, risk factors, and association with tardive dyskinesia.

Prevalence and risk factors for extrapyramidal syndromes (EPS) were investigated in a sample of 1,559 patients. The overall prevalence of EPS was 29.4% (N = 458). Among the EPS-diagnosed patients, parkinsonism as assessed by the presence of core parkinsonian symptoms (rigidity, tremor, bradykinesia) was present in 65.9% of patients (N = 302), akathisia in 31.8% (N = 145), and acute dystonia in 2.1% (N = 10). Old age and long-term neuroleptic drug (NL) treatment were significantly associated with EPS in both the univariate and the multivariate analyses, whereas no relationship was observed with average NL daily doses and current NL treatment. EPS was diagnosed in 50.2% of 285 patients with persistent tardive dyskinesia (TD). Distribution of EPS in patients with TD showed that tremor and akathisia were more frequent in peripheral TD cases than in orofacial TD cases. Furthermore, there was a stronger association of NL-induced parkinsonism with peripheral TD than with orofacial TD. This study suggests that the association between EPS and TD may be limited to specific subtypes of TD. Peripheral TD showed a higher association with parkinsonism and with akathisia, suggesting that these symptoms may share a common pathophysiology.     

TD方案与DF方案治疗晚期食道癌的疗效对比分析

目的比较紫杉醇联合顺铂（TD）与顺铂联合氟尿嘧啶（DF）治疗晚期食道癌的临床疗效。方法选取我院收治的36例晚期食道癌患者,随机均分为对照组和观察组,对照组患者给予DF方案治疗,观察组患者给予TD方案治疗,化疗后随访1—2年。比较两组患者治疗总缓解率、不良反应发生率和1、2年生存率的差异。结果观察组治疗总缓解率为50．0％,显著高于对照组的22．2％（P〈0．05）;两组不良反应发生率比较差异无统计学意义（P〉0．05）;观察组患者1、2年生存率均显著高于对照组（p〈0．05）。结论TD方案治疗晚期食道癌患者明显优于DF方案,临床疗效确切,远期生存率高,不良反应发生少。     

Seven-year follow-up of tardive dyskinesia in Hungarian outpatients

Of 122 Hungarian outpatients treated with neuroleptics, 79 (64.8%) were available for follow-up 7 years after their original assessment for tardive dyskinesia (TD). Ratings on the Abnormal Involuntary Movements Scale and the Simpson Dyskinesia Rating Scale increased significantly. The number of TD cases identified by research diagnostic criteria increased by only 9%: 12 of 28 patients no longer showed TD 7 years later, while 19 of 51 patients developed new TD.     

Tardive dyskinesia in India: a prevalence study

We screened the entire inpatient population (N = 1963) of a state hospital near Bombay, India, for tardive dyskinesia (TD) using specific diagnostic criteria. Prevalence of TD was found to be 9.6%, which was much lower than that reported from the Western countries. Percent prevalence of TD was greatest in the age group 41 to 50, after which it seemed to decline. TD patients had received neuroleptic treatment for significantly longer periods and in significantly greater amounts than non-TD patients. The principal reason for the relatively low prevalence of TD in India is probably the practice of using neuroleptics in comparatively small doses (mean daily dose is about 200 mg of chlorpromazine equivalents). A possible contribution of racial-genetic factors cannot be excluded.