大型组合舱群的管理体会

针对大型组合高压氧舱群结构复杂、安全要求高等特点,本文结合实际工作经验,从设计施工、规章制度、应急预案、专业培训、计量维护等几个方面,对如何有效管理大型组合高压氧舱群进行了探讨研究,有利于加强医疗设备质量管理,确保医患双方诊疗期间的生命安全,为更加科学管理和合理利用大型组合高压氧舱群提供借鉴。     

浅谈高压氧设备检修与保养的重要性

目的；探讨如何加强高压氧舱的检修及保养。方法：通过学习及严格执行“医用氧舱安全管理规定”及GB／T19284-2003国标要求完成检修及保养工作。结果：高压氧设备检修与保养是氧舱安全运作的重要保障。结论：做好高压氧舱设备的检修与保养是高压氧舱安全运行最有效的方法。     

高压氧舱火灾事故预防控制策略的研究

目的:研究制定高压氧舱火灾事故预防控制策略,提高高压氧舱隐患预防能力和安全管理效率。方法:分析高压氧舱火灾事故发生原因,根据燃烧三要素(火三角)的性质,从严格禁止可燃物、严格控制助燃剂和严格消除火源3个方面,制定高压氧舱火灾事故预防控制策略,结合安全管理实践,制定"高压氧舱安全使用与管理制度"。结果:医院高压氧舱火灾预防控制制度实施后,高压氧舱正常开机率、违规操作率、违禁物品入舱率、未签知情同意书发生率和治疗不良反应发生率等相关指标明显改善,违规操作率、违禁物品入舱率和未签知情同意书发生率均降为0;高压氧舱的安全使用率由71%提升到100%,综合管理评价分值由72.25%提升到95.75%,达到了高压氧舱火灾事故的预防控制管理要求。结论:高压氧舱火灾事故预防控制策略可提升高压氧舱医疗安全,规范高压氧舱的业务流程管理和风险防控管理,提高设备安全管理效率。     

隔离电源及其在高压氧舱的应用

目的：提高高压氧舱用电安全性，保障高压氧舱安全、稳定运行。方法：对高压氧舱的单相220V供电采用隔离电源方式。结果：隔离电源的使用能显著提高高压氧舱的用电安全性，保证整个供电系统的稳定性、连续性。结论：隔离电源的使用对于保证高压氧舱的安全运行十分必要。     

高压氧舱的安全使用及管理

我院高压氧舱为2室4门多人舱，自1993年8月建成投入使用以来，安全开舱2500多舱次，取得了较好的社会效益和经济效益，深受广大病人的信赖和欢迎。由于高压氧舱属载人压力容器，是对人体的安全可能具有危险性的一类医疗器械，不仅要求医护技术人员有良好的医德医风，严肃认真的工作态度和精湛的技术水平，而且还要掌握氧舱的装备性能、用途和使用方法，做到严格、正规、准确、熟练地操舱。针对高压氧舱工作的特殊性，提高氧舱设备的安全性和实用性，我们着重抓了以下几个方面：     

高压氧舱计算机控制基本原理及典型故障处理

在医用高压氧舱控制系统中，操舱方式有多种：如手动、气动、电动、计算机等操舱方式。通常多采用计算机操舱方式，使用计算机对高压氧舱各参数进行检测、判别与控制，以保证高压氧舱的安全、可靠和正常运行。其原理示意图如图1。     

医用高压氧舱安全管理与安全事故的探讨

本文主要阐述了医用高压氧舱的安全管理的重要性,安全管理与主要安全事故的关系,并结合我院高压氧舱安全管理经验,对医用高压氧舱的安全管理与安全事故进行了探讨.     

大中型高压氧舱安全治疗监控系统

高压氧舱安全治疗的监控是高压氧(ＨＢＯ)安全有效治疗的重要手段。以往的“氧舱微机控制”只能对加减压、氧浓度实行控制,但不能实时监控影响安全治疗的氧流量、人均吸氧量,从而不能准确地达到高压氧舱安全治疗监控的目的。作者采用氧气流量的检测、人均吸氧量的检测、温湿度的检测以及氧浓度和压力作为氧舱监控的重要指标,并增加图像数据存储、语音提示功能,以进一步提高高压氧舱安全治疗监控的目的。目前,该项目已通过标准审定,并己获得国家实用型专利(专利号ＺＬ992411556)。其研制内容报道如下:一、材料与方珐大中型高压氧舱安全治疗监…     

高压氧舱治疗安全隐患分析和防治措施

高压氧舱作为一种特殊的医疗设备,在临床治疗过程中的应用范围越来越广。患者的安全问题已经成为全社会关注的热点和焦点,在这种情况下,高压氧舱的安全使用得到了人们的广泛关注,在实际使用过程中,由于很多高压氧舱的使用者和治疗病患对高压氧舱使用的安全隐患没有足够重视,在使用过程中出现了很多意外,造成了极为恶劣的影响。基于此,本文对高压氧舱的治疗安全隐患进行了分析,并探究了高压氧舱的安全使用防治措施,以期为高压氧舱的科学使用和安全使用提供一定的参考。     

医用高压氧舱的安全问题

随着高压氧医学的发展，我国已经陆续兴建了2000余台高压氧舱，在临床、潜水医学研究领域发挥了巨大的作用，但由于其结构、使用上的特殊性导致在使用过程中稍有不当就有可能造成重大的伤亡事故。因此高压氧舱在设计、建造、使用、改造过程中必须严格依照国家标准进行，确保每一个环节都能消除事故隐患，杜绝伤亡事故的发生。我所目前有新老两套医用高压氧舱设备，由于对安全问题高度重视，至今没有发生一起伤亡事故。在使用保养过程中，针对安全问题，我们有以下几点做法。1 严格管理 （1）严格操作规程的管理。所有高压氧舱工作人员都必须…     

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.     

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.