我院优化临床路径环节质控的策略与实践

临床路径作为一项有效的管理方法,在保障医疗安全和提高医疗效率中发挥了重要作用。以医院开展临床路径工作的实践经验为基础,从组织管理和执行实施两个方面,介绍了以加强环节质量控制及提高执行效率为目的的临床路径建设及持续优化策略,探讨完善临床路径管理的有效方法。     

浅议信息化临床路径在医院的应用

作为新医改重要内容之一的临床路径管理在国内医院的应用目前仍处于探索阶段.该文从阐述手工模式临床路径的弊端人手,分析了开展信息化临床路径工作的优势及可行性,进一步构建整合多系统数据的信息化临床路径管理模式,并对实际实施过程中的问题与挑战进行探讨.     

社区获得性肺炎在基层医院实施临床路径管理的存在问题与对策

目的 探讨社区获得性肺炎在基层医院实施临床路径管理的效果;分析其在临床路径文本开发,实施过程中产生的问题,并寻求相应的对策.方法 结合医院实际情况,开发社区获得性肺炎临床路径文本并实施,对实施前后的各项指标进行对比、分析,并对实施过程存在问题进行记录、分析.结果 临床路径实施前后对比,诊疗过程更为规范,治愈率提高,患者满意度提高.结论 临床路径的实施为基层社区获得性肺炎的诊治提供了合适的工作模式.     

临床路径管理实践的讨论

实施临床路径(Clinical Paths;CP)管理是医疗质量持续改进、保障医疗安全的重要举措,是医院实现现代化管理的体现;实施CP还可以逐步引导医院做到"三个转变"、"三个提高". 1 我院实施临床路径管理的情况 早在2004年,鼓楼医院就在手术科室试行了"开腹胆囊炎"临床路径管理,制定了"路径流程图"、"标准医嘱"、"变异记录表"以及"胆囊炎临床路径医护版、患者版"等文件,当年有50例手术患者实施了路径管理;2009年被指定为卫生部首批临床路径管理工作的试点医院,经过3年的努力,目前临床路径管理已覆盖住院部全部临床科室,开展了93个病种的信息化路径管理.     

试点医院实施临床路径管理的动力分析

目的:运用理性预期理论分析试点医院实施临床路径管理的动力来源.方法:利用干预研究法和现场调研法对试点医院积极实施临床路径管理的动力进行全面剖析.结果:重庆市黔江中心医院的案例提示,其实施临床路径管理的动力来自于医院和医务人员对改革的期盼,合理的补偿机制以及透明的改革方案.结论:让医院和医务人员对临床路径实施所涉及的社会、患者、医院以及医务人员自身经济利益等方面产生理性预期,可以积极促进临床路径管理工作的开展.     

提高临床路径管理质量的关键环节分析

目的:通过对卫Ⅺ项目临床路径试点研究进行分析,探索影响临床路径管理质量的关键环节,为卫生行政部门和医院推进及开展临床路径管理提供建议.方法:采用文献研究、定性分析、个案研究和经验总结的方法.结果:临床路径管理的关键环节包括操作技术、支持条件、激励机制和质量监管等方面.结论:临床路径的成功实施,需要把握好影响其实施质量的关键环节.     

我国实施临床路径示范研究应关注的几个问题

本文从实际工作出发,从临床路径的诊治项目、费用标准、路径时间、分析研究、绩效评价和路径实施管理等方面进行了有益的探讨,提出了相应的关注要点与工作思路,为我国开展临床路径工作提供参考.     

中医院中西医结合临床路径研究

目的在地级市中医院全面开展中西医结合临床路径研究,通过临床路径的管理降低医疗费用,提高医疗质量,发挥中西医结合治疗优势。方法在2009年,选取我院纳入临床路径的6种疾病各40例,从平均住院天数、住院费用、临床疗效及患者满意度进行对比分析。结果中西医结合临床路径实施有利于规范诊疗程序,提高医疗质量,能够显著的降低医疗费用、提高患者满意度。     

对保健科患者病案管理实施临床路径管理的效果观察

目的 探讨对保健科患者病案管理实施临床路径管理的效果观察.方法 通过对临床路径与病案记录关系的分析,制定保健科患者病案管理临床路径管理的实施措施与配套措施.结果 实施临床路径后,保健科病人的对于医院的医疗环境、服务质量、服务态度、医疗信息等满意度都有了明显提高,实施前后对比差异有统计学意义(P＜0.05).结论 根据临床路径对保健科患者制定病案管理质量的监控标准是可行的与有效的,值得临床推广.     

临床路径在单病种限价管理中的应用

目的评价临床路径在实施单病种限价收费管理中的作用。方法利用医院综合工作报表，HIS系统提供的病案、数据资料制定临床路径，并将之应用于单病种限价收费管理，比较应用前后住院费用、患者满意度等方面的变化。结果实施临床路径的单病种限价收费管理的患者住院总费用、药品费用、住院天数等均较前降低，患者满意度有所提高。结论临床路径在单病种限价管理中应用能提高服务质量，有效降低成本。     

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.