有效的医疗设备安全管理

长期以来，人们只重视医疗设备的采购和使用，却忽视了医疗设备的维护与管理，致使设备相关医疗责任事故在临床时有发生，不但影响了医疗质量，也影响了医院的综合效益。医疗设备管理包括使用管理、采购管理和医学工程保障管理。在管理过程中，首先要关注医疗设备安全和质量，其次要关注其成本与效益。     

医疗设备的采购风险管理

目的：研究医疗设备采购活动的特征以及行业采购的特性。方法：结合我院多年探索的采购实践经验，对医疗设备采购进行风险分析。结果：提出院内贷款、项目管理和系列的量化考评分析手段等多种降低和规避医疗设备采购风险的方法。结论：取得了良好效益和管理成果。     

总装所属部队医疗设备集中采购改革现状及思考

介绍了总装所属部队医疗设备集中采购改革工作的主要做法和取得的成效,分析了总装医疗设备集中采购工作存在的问题,指出了集中采购将独立分散采购转变为高度统一集中采购,形成批量采购数量优势和规模效益,克服了机关和部队分散采购的忙乱现象,提高了有限经费的建设保障效益,实现了增强保障能力、促进党风廉政建设、提升采购质量效益的目的.     

医院自行招标采购中的常见问题与对策

近年来，由于招标采购的优越性，在医疗设备的购置中已逐步采用招标采购的形式。各级管理部门分别制定了有关招标采购的规定，军队系统规定了B超、大型X光机等8项医疗设备的采购必须全军统一集中招标采购，其充分利用集团招标采购优势。许多医院除上级要求统一集中招标采购的设备外，对其它设备以及消耗卫生材料也自行进行招标采购，体现了采购的公开、公正、合理性，加强了廉政建设。但是，由于医院本身的规模、招标的组织能力和经验、材料准备的充分性等方面因素，在招标过程中往往出现一系列问题，带来一些混乱。本文就我院2000年和2001…     

新形势下医院大型设备采购决策分析——以某二级甲等综合医院为例

概述了当前大型医用设备采购的管理现状、认证流程及决策工具,以某二级甲等综合医院采购CT和MRI的决策为例,构建了新的采购论证流程,利用成本效益分析法评价设备的经济效益,利用数学模糊分析法分析设备的综合效益,为大型医用设备采购决策提供借鉴与思路。     

医疗卫生材料招标采购的实践与探索

招标采购，是公开、公正、合理、廉政的采购方式。医院对大宗消耗卫生材料可自行进行招标方式采购，以年度为单位，全年多项项目进行集中联合招标，医院成立招标采购委员会和评标委员会。采取招标采购的形式，增加了透明度，降低了医疗成本，加强了医院对医疗设备器材的管理。     

规范采购流程提高管理质量

本文阐述了我院自2001年以来，在医疗设备、卫生消耗材料的采购、供应和管理方面，规范各种工作程序和流程，建立健全了一整套的供货商信息、科室申报、招标、商务谈判和签订协议、到货安装和验收及付款等流程，增加了采购过程的透明度，提高设备运行管理水平，做到医疗物资和设备的动态管理，提高了管理效率。     

加大医学院校设备采购改革力度提高设备投资效益

本文主要论述了医学院校在教学设备采购中应加大改革力度，加强设备科学综合管理，提高设备的投资效益。     

医院医疗设备阳光采购模式的探索与实践

医疗设备是医院必不可少的检查和诊疗辅助手段．如何合理有效地利用有限的资金。采购到性价比高的医疗设备．是医疗设备采购中至关重要的问题。2年来．我院遵循“公开、公平、公正、效益、诚信”的原则，在严格执行政府采购的同时．积极探索在医院权限范围内的医院内阳光采购模式．节约了采购成本．杜绝了暗箱操作，有效地遏制了医疗设备购销中的不正之风．净化了医院行风。     

医疗设备采购中常见问题及应对措施探究

医疗设备采购是医院运营管理活动的主要环节之一，加强采购管理能够辅助落实医院的成本控制、运营控制与医疗服务控制，具有综合效益。根据医院运营运行情况，医疗设备采购中经常出现一些问题，影响设备采购的有效性，不利于医院运营管理的有序运行。文章对医疗设备采购常见问题及其应对进行研究，目的是针对当前存在的问题提出解决措施，优化医疗设备采购过程，提高采购效率。简要阐述医疗设备采购中常见问题，分别从预算、组织架构、监督机制、内部控制、现代化技术等多个方面入手，对医疗设备采购常见问题的应对措施进行深入探究。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.