军队医院医疗质量管理面临的问题及对策

医疗工作是医院的中心工作,而质量建设是医疗工作的核心和生命。近年来,我院把握机会,注重内涵建设,强化质量管理,使门诊量、住院量、医疗毛收入等指标保持稳定增长,医学科研取得突破,全面建设取得一定成绩。但随着全民医疗保险制度展开,对医疗质量提出了更高的要求,为适应新特点和新要求,进一步提高医疗质量管理水平,我们结合长期医院工作实践,就军队医院医疗质量管理的难点及对策谈几点看法。1当前军队医院医疗质量管理面临的问题1.1对医疗质量管理内涵的理解有偏差当前,部分军队医院在医疗质量管理的形式上,还使用过去传统的医疗质量概念…     

临床护理风险的防范与展望

近年来,“以病人为中心,以提高医疗服务质量为主题”的医院管理年活动已在全国展开。各大医院尽偕以“提高医疗护理质量”为主题,展开医护工作。而临床护理工作更是各项工作的重中之重。因为临床护理的安全直接关系医院和医护人员自身安全,并且直接威胁病人安全;同时也直接影响医院的社会效益与经济效益。因此作为护理工作者如何更新临床护理管理理念,如何改进管理模式,如何提高管理水平以达到医院及患者的要求成为当务之急。作为医疗最前线的临床护理工作,由于受到包括责任、技术、心理、制度、管理等诸多因素影响,在工作过程中难以避免地…     

消毒供应中心供应管理中存在的问题与对策

消毒供应中心能够有效地防范院内感染,有利于对医院医疗质量的提升,因此在医院系统中十分重要。然而在目前,三甲医院的消毒供应中心往往都有很多缺陷需要进行弥补。本文从三甲医院的消毒供应中心在进行供应管理过程中的问题出发,探讨了其解决措施。     

现代化医院医疗设备的管理及维修

在现代化的医院中,医疗设备是其中不可缺少的一部分,对于医院诊治活动及科研活动的开展提供了有力的保障,同时也是医院提升自身医疗水平的保证;但由于在当前多数医院中缺乏专业化的维修与管理,使其在临床使用中存在诸多故障,这对于医院工作的开展带来了不良影响。因此本文将对现代化医院中医疗设备的管理与维修展开进一步的讨论。     

合同制护士管理浅析

随着我国医疗事业迅猛发展，医疗水平不断提高，医院管理逐渐显露出制度缺失问题。目前，由于医疗制度改革及用人方法改变，医院合同制护士越来越多。因此，管理好合同制护士，对提高护理工作和医疗工作的质量都有重大意义。     

应用PDCA循环促进消毒供应中心持续质量改进的研究进展

消毒供应中心是医院供应各种无菌器械物品的重要科室,其工作质量的优劣直接影响医院的医护质量和患者安全.因此,加强消毒供应室的科学管理,防止医院感染的发生,确保医疗安全,已成为医院质量管理及文明建院的需要[1]. 近10余年来,国内外的消毒供应中心管理者都在不断思考和探讨创新消毒供应中心质量管理模式和方法,包括导入ISO9001∶ 2000质量管理体系进行医院管理,应用持续质量改进(QIC)的管理理念探索建立自身发展的长效机制和利用PDCA循环进行消毒供应中心管理尝试等.本文将应用PDCA循环促进消毒供应室质量持续改进的研究进展综述如下.     

浅议消毒供应中心护理人员素质管理的必要性

医院消毒供应中心,负责整个医院的消毒和防感染工作,随着医疗体制改革的不断深化和医疗水平的不断提高,医院对消毒供应中心的工作质量提出了越来越高的要求.而对护理人员进行必要的素质管理,对于确保消毒供应中心工作质量和提高其工作效率无疑具有促进作用.本文阐述了消毒供应中心护理人员素质管理的重要性,并提出了相应的建议.     

基于消毒供应中心的手术器械集中管理践探究

为加强医院结构供应中心的手术器械集中管理,有效控制医源性的疾病传播,确保医院根据集中管理方式要求,所有手术器械的清晰、消毒和灭菌均由消毒供应中心统一管理和供应。因此,消毒供应中心职责涉及了医院多个部门,工作质量的好坏关系着医疗安全、质量,本文主要探讨消毒供应中心在集中管理手术器械上的管理实践。     

消毒供应中心管理之我见

消毒供应中心是为医院提供再生医疗物品的重要科室,是医疗单位中为临床医疗服务的重要保障部门,是控制医院感染的重要环节.在医院的医疗安全管理中发挥重要作用并提供重要保证.因此,每一把器械,每一个包装必须符合质量标准,为临床提供安全的灭菌物品.消毒供应中心的工作环境是特殊的.其各项操作工作程序在许多情况下都有可能由护理人员单独进行.因此,对护理人员的业务及职业道德素质也提出了更高的要求.     

医院中心供应室规范化管理初探

中心供应室是医院消毒灭菌和供应各种医疗用品的重要场所 ,它集中了医院各项工作所需器械、用具等的发放、回收、清洗、消毒、灭菌、保管、发放等环节。其工作质量的高低与医院感染的发生和控制有密切联系 ,直接影响到医疗护理质量及效果。因此 ,对医院中心供应室进行规范化管理显得尤为重要。1　建立健全消毒管理规章制度　　建立健全各项规章制度 ,是强化中心供应室规范化管理的重要举措。我们要严格按照国家卫生部2 0 0 0年 5月颁布的《消毒技术规范》及国家卫生部颁发的《医院消毒供应室验收标准 (试行 )》的要求 ,制定符合工作实际的规…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.