降低静脉药物配置中心护士作业流程缺陷发生率的管理对策

【】 目的 探讨对静脉药物配置中心护士作业流程中发生的缺陷进行原因分析,并对其提出有效管理对策,保证临床患者用药安全。 方法 收集实施管理对策前（2012年4月-2013年3月）和采取管理对策后（2013年4月-2014年3月和2014年4月-2015年3月）我院PIVAS护士作业流程中出现的各类缺陷,进行分类原因分析,落实对应改进对策并循环检查。 结果 实施管理对策后,PIVAS护士作业流程缺陷发生率由采取管理对策前0.132%降至采取管理对策后0.009% ,差异有统计学意义,（P<0.001）。 结论：通过管理对策的持续改进,有效降低静脉药物护士作业流程缺陷发生率,为临床静脉用药提供安全保障。     

药品监管小组运用PDCA模式提高血液病房用药安全

目的加强血液病房药品的安全管理,确保患者用药安全。方法建立药品监管小组,运用PDCA循环法,对给药流程中涉及的医嘱处理、药物储存、药物配制、床边给药各个环节进行质量控制和持续改进。结果 2016年全科实施安全用药质量管理后,医嘱处理、药物储存、药物配制、床边给药环节缺陷发生率分别由第一季度1.57%、2.83%、3.46%、8.18%下降至第四季度的0.4%、0、0.8%、2.81%,给药接近差错发生率和差错发生率分别由第一季度的0.31%和0.63%下降到第四季度的0和0.4%。护士药理知识合格率从第一季度的53.33%上升到第四季度的93.33%。结论病房成立药品监管小组运用PDCA用于安全给药质量管理,能够逐渐降低安全给药环节缺陷率、接近差错率和差错发生率,保障患者用药安全。     

化疗药物集中配置室管理模式探讨

目的 探讨化疗药物集中配置的安全管理与职业防护.方法 在肿瘤科科内建立化疗药物集中配置室,配备防护设备和物品,建立健全各项规章制度,规范化疗药物配制操作方法,规范处理废弃物.结果 肿瘤科化疗药物集中配置管理后,未发生1例与化疗药物相关的职业伤害及环境污染,化疗药配置相关的缺陷发生率明显下降,从化疗药物集中配置管理前2011年7～12月的0.00263％下降为2012年1～6月的0.00036％.结论 肿瘤科科内建立化疗药物配置室,对化疗药物实行集中配置管理模式提高了化疗药物的配制质量,保证了患者的用药安全,加强了配制人员的职业防护.     

非惩罚性医院护理安全文化建设

通过实施系列非惩罚性医院护理安全文化建设的措施,包括强化"四层"管理体系与职能,构建公平文化、报告文化、学习文化、现场管理文化与指标文化等,从2014年到2016年,院内压力性损伤发生率下降幅度为65.63%;针刺伤发生率下降幅度为44.00%;护理缺陷发生率降幅为100.00%。2014年至2017年,主动上报不良事件增幅为39.17%,发挥了患者在安全文化中重要作用。     

警示标识在心胸外科管道安全管理中的应用

目的:探讨警示标识在心胸外科患者管道安全管理中的应用效果。方法:对2008年11月～2009年10月心胸外科收治的患者1882例,全部采用管道警示标识管理措施。结果:规范管道警示标识管理后,住院患者的满意度从89.80%上升到97.08%,护理投诉、护理缺陷、潜在护理隐患发生率由0.31%、1.42%、3.40%下降至0、0.37%、0.48%,与实施前比较,差异有统计学意义(P0.01或P0.05)。结论:对心胸外科加强管道警示标识管理,可保障患者管道治疗的安全性和提高其满意度。     

护理安全管理实施探讨

[目的]探讨护理安全管理的有效途径,保障病人安全,提高护理质量.[方法]建立健全护理安全管理组织机构,完善临床护理应急预案与关键流程,构建护理安全文化,建立畅通的护理不良事件上报系统.[结果]护理隐患上报率由62.5%上升至88.9%,护理缺点上报率由48.2%上升至85.1%,一般护理缺陷由75.8%上升至94.7%,同时护理缺陷、意外事件发生率明显下降,护理质量提高,病人安全得到保障.[结论]良好的护理安全管理方法能够提高护理人员的安全意识,加强护理安全的前瞻性管理,提高护理质量,确保病人安全.     

危机管理在急诊外科护理中的应用

目的:探讨危机管理在急诊外科护理过程中的应用效果.方法:将2009年12月～2011年12月实施危机管理两年内我院急诊外科648例患者设为观察组,将2007年11月～2009年11月实施危机管理前两年我院急诊外科597例患者设为对照组.针对影响急诊外科护理安全的相关因素建立和实施严格的危机监控和管理机制,并对危机管理实施前后的护理缺陷发生率、外科手术器械和药品完好率、患者满意度、护理质量评分等指标进行效果评价.结果:与对照组比较,观察组通过实施危机管理防范护理风险,使急诊外科的护理缺陷发生率明显下降,仪器设备更加完善,提高了护士的危机意识和对处理危机的能力,提高了患者对护理的满意程度并改善了护理质量(P＜0.05).结论:急诊外科实施危机管理制度对杜绝护理缺陷和差错事故的发生、全面提高急诊外科护理安全水平、改善护理工作质量、确保患者的护理安全有重要作用,值得临床推广.     

RCA-PDCA模式在护理安全与质量管理中的应用

目的探讨在护理安全与质量管理中应用RCA-PDCA模式对不良事件及护理纠纷的影响。方法选取2016年1月至2017年1月收治的542例住院患者为对照组,2017年2月至2018年2月收治的876例住院患者为试验组。比较两组不良事件发生率及医疗差错或缺陷、投诉、护理纠纷发生率。结果试验组不良事件发生率、医疗差错或缺陷发生率、投诉发生率、护理纠纷发生率均低于对照组(P 0. 05)。结论在护理安全与质量管理中应用RCA-PDCA模式,有效减少不良事件的发生,降低医疗差错、护理纠纷、投诉的发生率,提高护理安全质量和医疗质量,使医疗安全得到有效保障。     

护理安全管理实施探讨

[目的]探讨护理安全管理的有效途径,保障病人安全,提高护理质量.[方法]建立健全护理安全管理组织机构,完善临床护理应急预案与关键流程,构建护理安全文化,建立畅通的护理不良事件上报系统.[结果]护理隐患上报率由62.5%上升至88.9%,护理缺点上报率由48.2%上升至85.1%,一般护理缺陷由75.8%上升至94.7%,同时护理缺陷、意外事件发生率明显下降,护理质量提高,病人安全得到保障.[结论]良好的护理安全管理方法能够提高护理人员的安全意识,加强护理安全的前瞻性管理,提高护理质量,确保病人安全.     

查对制度在ICU护理管理中的应用

目的探讨护理查对制度在ICU护理管理中的应用效果。方法查找并分析我科2008年3月至2009年2月ICU护理工作中查对制度落实不力的原因，并在2009年3月至2010年2月采取相应的有效对策和措施，加强查对制度的执行力度，将护理缺陷的发生率与上一年作比较。结果加强执行查对制度后1年护理缺陷的发生率比上一年有明显下降，差异有统计学意义（P〈0．01）。结论通过加强查对制度的执行，护理工作效率明显提高，护理缺陷的发生率明显下降。因此，查对制度在ICU护理管理中具有重要作用。     

自体骨植骨修复膝关节置换术中胫骨平台骨缺损

目的观察全膝关节置换术中利用截骨获得的自体骨植骨的方式修复胫骨平台骨缺损的近期疗效。方法从2008年11月至2011年3月,对10例(15膝)有胫骨平台骨缺损的膝关节行全膝关节置换术。术中测量胫骨平台平均缺损深度15.6 mm,平均截骨10.0 mm,截骨后残余骨缺损平均深度7.68 mm,使用摆锯或磨钻打磨清除缺损表面硬化骨壳达松质骨,同时修整成台阶状水平形骨缺损。采用截骨获得的松质骨片,修整后厚度和形状与缺损处相匹配,覆盖植骨后的缺损处截骨面,形成与胫骨截骨面一致的平面,打实,并用松质骨螺钉或门型钉载桩固定,常规安装胫骨假体,缺损植骨部位完全覆盖于假体下。结果术中胫骨平台骨缺损可有效修复,承载假体可靠;术后X线片显示胫骨假体下方无骨质缺损表现,假体位置良好。术前美国膝关节学会(KSS)评分平均33.9分,术后随访1个月至3年,平均随访1.8年,KSS评分平均87.6分。X线示植骨处无骨质吸收和假体松动现象。结论使用自体骨植骨修复全膝关节置换术中胫骨平台骨缺损,可合理利用截骨获得的自体骨,达到缺损部位的理想修复,既最大限度地保留了胫骨平台的骨量,又重建了胫骨假体的均衡力学支撑。     

经唇下-单侧鼻腔-蝶窦入路鞍区肿瘤切除术38例报告

目的 :探讨经唇下 单侧鼻腔 蝶窦入路显微手术治疗鞍区肿瘤方法。方法 :CT扫描或MRI明确手术适应症38例 ,手术均采取经唇下 单侧鼻腔 蝶窦入路显微手术切除肿瘤 ,其中 5例采用扩大经蝶入路。结果 ;全切 2 3例 ,次全切除 11例 ,部分切除 4例。视力视野恢复 17例 ,并发症主要有尿     

Meningococcal septicaemia: treatment with protein C concentrate

Meningococcal septicaemia is a devastating disease with the potential to develop severe vascular complications. The incidence in Northern Ireland has risen from 27 cases notified in 1992 to 56 notified in 1997. We describe the first use of protein C concentrate in addition to antithrombin III infusion in the management of a life-threatening case of meningococcal septicaemia in the Regional Intensive Care Unit, Royal Group of Hospitals, Belfast, UK. The rationale and the evidence to support the use of protein C concentrate are discussed. Despite the apparent efficacy and safety of this treatment, subsequent cases of meningococcal septicaemia have not received protein C concentrate due to a lack of availability. Received: 16 March 1999 Final revision received: 17 November 1999 Accepted: 1 February 2000     

A multi-center study of repairing articular cartilage defects of the knee using cultured autologous chondrocytes

背景:由于关节软骨再生修复能力有限,自体软骨细胞移植技术为关节软骨损伤的修复提供了较好的修复材料.目的:多中心评估自体软骨细胞移植的短期疗效与安全性.设计、时间及地点:自身前后对照观察,于2001-03/2006-04在韩国80所附属医院完成.对象:软骨缺损患者261例,男169例,女92例,年龄15～70岁,平均36.47岁.软骨缺损面积2.0～20.0 cm2.其中股骨髁损伤215例,滑车30例,髌骨25例,胫骨2例.方法:取关节非负重区软骨组织200～300 mg,体外培养扩增后将软骨细胞植入患者关节缺损区.于移植后6个月对所有患者进行随访,膝关节功能评估标准采用美国膝关节协会评分系统[Knee society score-A(KSS-A)和Knee society score-B(KSS-B)].主要观察指标:自体软骨细胞膝关节缺损区移植后KSS-A和KSS-B评分.结果:获得随访患者261例.患者移植前KSS-A评分为63.55±18.47,移植后6个月为88.74±11,47,差异有显著性意义(P＜0.05)移植前KSS-B评分为59.56±24.92,移植后6个月为85.13±14.67,差异有显著性意义(P＜0.05).患者移植前后膝关节疼痛、活动度、前后稳定性、屈曲挛缩、伸直迟滞、行走能力和上下楼能力均明显改善(P＜0.05).综合评价移植有效率为97.3%,优良率为89.3%.结论:自体软骨细胞移植可有效的治疗关节软骨缺损,促进膝关节功能的恢复.     

Familial thrombophilia and lifetime risk of venous thrombosis.

BACKGROUND: We started a large multicenter prospective follow-up study to provide reliable risk estimates of venous thrombosis in families with various thrombophilic defects. OBJECTIVES: This paper describes data collected at study entry on venous events experienced before study inclusion, i.e. the baseline data. PATIENTS/METHODS: All individuals (probands, relatives) registered in nine European thrombosis centers with the factor (F)V Leiden mutation, a deficiency of antithrombin, protein C or protein S, or a combination of these defects, were enrolled between March 1994 and September 1997. As control individuals, partners, friends or acquaintances of the thrombophilic participants were included. Incidence and relative risk of objectively confirmed venous thrombotic events (VTEs) prior to entry were calculated for the relatives with thrombophilia and the controls. RESULTS: Of the 846 relatives with thrombophilia (excluding probands), 139 (16%) had experienced a VTE with an incidence of 4.4 per 1000 person years. Of the controls, 15 of the 1212 (1%) controls had experienced a VTE with an incidence of 0.3 per 1000 person years. The risk of venous thrombosis associated with familial thrombophilia was 15.7 (95% CI 9.2-26.8) and remained similar after adjustment for regional and sex-effects (16.4; 95% CI 9.6-28.0). The highest incidence per 1000 person years was found in relatives with combined defects (8.4; 95% CI 5.6-12.2), and the lowest incidence was found in those with the FV Leiden mutation (1.5; 95% CI 0.8-2.6). CONCLUSIONS: Considerable differences in the lifetime risk of VTE were observed among individuals with different thrombophilia defects.     

两种不同关节软骨替代材料对兔肝肾功能毒性的比较

背景:目前已对纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶材料进行了细胞毒性、致敏、刺激及局部反应试验,证明均具有良好的生物相容性和安全性,但是对肝肾功能的影响尚不清楚.目的:观察两种不同关节软骨替代材料纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶植入兔骨组织后对其肝肾功能的毒性反应.设计、时间及地点:血液生化指标观察,随机对照动物实验,于2008-11/2009-03在解放军南京军区总医院比较医学科完成.材料:纳米羟基磷灰石/聚乙烯醇水凝胶及聚乙烯醇/吡咯脘酮水凝胶均由南京理工大学生物材料研究所熊党生教授提供.方法:健康清洁级新西兰大白兔30只,随机分成3组,纳米羟基磷灰石/聚乙烯醇水凝胶组10只,聚乙烯醇/吡咯脘酮水凝胶组10只,空白对照组10只.分别将两种关节软骨材料植入已制备好的兔模型股骨软骨缺损部位.空白对照组施行同样的手术,但不作任何材料植入.主要观察指标:于术后1,4,8,12周行肝肾功能检测,对比3组动物植入前后肝肾功能变化.结果:植入前3组肝肾功能指标差异无显著性意义(P均>0.05).3组植入后丙氨酸转氨酶、天冬氨酸转氨酶、白蛋白、球蛋白、尿素氮、肌酐水平分别与植入前比较,差异无显著性意义(P均>0.05).植入后3组各项肝肾功能指标差异也无显著性意义(P均>0.05).结论:两种不同的软骨替代材料对兔肝肾功能无影响.     

The frequency,appearance, and significance of splenic perfusion defects on CT arterial portography

Background: The purpose of this study was to determine the frequency, appearance, and significance of splenic perfusion defects on computed tomographic arterial portography (CTAP). Methods: CTAP was performed with dynamic scanning at 1-cm increments on 46 consecutive patients prior to laparotomy. Two readers retrospectively reviewed these studies in consensus and recorded the number, size, and shape of focal splenic perfusion defects. These defects were later correlated with surgical findings and at least one of the following imaging modalities: delayed CT 4<+>–<+>6 h after CTAP, intravenously enhanced CT, sonography, or magnetic resonance imaging (MRI). Results: Splenic perfusion defects were present in 14 of 46 CTAP studies (30%), and in seven patients these defects were multiple. Most defects were wedge-shaped and peripherally located, although several round defects simulating metastases were also present. The spleen was normal at surgery in all patients, and comparison imaging revealed only a small splenic infarct in one patient on MRI. Conclusions: Splenic perfusion defects occur in about one-third of patients referred for CTAP, are usually wedge-shaped but may be round, and should not be interpreted as metastases without other evidence of a space-occupying mass. Received: 11 October 1994/Accepted: 6 November 1994     

Seasonal modulation of the circadian time structure of circulating T and natural killer lymphocyte subsets from healthy subjects.

A seasonal modulation of the circadian time structure of circulating T and natural killer (NK) lymphocyte subtypes was documented in five healthy men aged 24-36 yr. Venous blood was obtained every 4 h for 24 h from each subject in January, March, June, August, and November 1984. Three subjects were also studied in April and/or August and/or November 1983 for the T subsets only. Mononuclear cells were isolated on Ficoll-Paque gradient and aliquots were incubated with OKT3, OKT4, OKT8, or HNK-1 monoclonal antibodies for characterizing all, T, T helper, T suppressor-cytotoxic, and NK lymphocytes, respectively, under an epifluorescence microscope. An effect of both sampling time and study month was statistically validated (P less than 0.01) with both two-way analysis of variance and cosinor for the peripheral counts in total, pan-T, T helper, and NK lymphocytes (cells per cubic millimeter). Seasonal changes affected both the circadian patterns and the 24-h mean values. Thus the double amplitude (total extent of variation) of the circadian rhythm in circulating total, T and T helper lymphocytes varied between 0 in March (P greater than 0.30; no rhythm) and up to 46-68% of the 24-h-mean (M) in November, with acrophases (times of maximum, 0) localized in the first half of the night (P less than 0.001). Maximal values were found at 8:30 h for both T suppressor-cytotoxic and NK lymphocytes; a smaller second peak was also found at 20:30 h, and a 12-h rhythm was validated by cosinor (P less than 0.0001), with no patient change in waveform along the year scale. A circannual rhythm was statistically validated by cosinor for total (0 in November), pan-T (0 in March), T suppressor-cytotoxic (0 in December), and NK lymphocytes (0 in October). A rhythm with a period equal to 6 mo was found for circulating T helper cells with 0 occurring both in April and October. Seasonal variations in the incidence of several immunologically related diseases may correspond to an endogenous circannual time structure.     

Combination of Lymphatic and Intravenous Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Preliminary Study

The aim of this prospective study was to evaluate the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) for the identification of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). From November 2018 to March 2019, 24 consecutive patients with PTC were evaluated. All patients underwent routine US, LCEUS and IVCEUS. Pathology was used as the gold standard. After injection of a contrast agent into the thyroid parenchyma, lymphatic vessels and lymph nodes (LNs) could be exclusively displayed as hyper-enhancement on LCEUS. Benign LNs displayed a complete bright ring (100%) and homogeneous perfusion (88.9%) on LCEUS, while displaying centrifugal perfusion (66.7%) and homogenous enhancement (88.9%) on IVCEUS. Perfusion defects (94.9%) and interruption of the bright ring (71.8%) were the two characteristic LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (59.0%) and heterogeneous enhancement (59.0%). After comparison with pathology, perfusion defect was correlated to the metastatic foci in the medulla and interruption of the bright ring to the tumor seeding in the marginal sinus (all p values <0.05). LCEUS had more value (area under the receiver operating characteristic curve [AUC] = 0.850, 95% confidence interval [CI]: 0.682–1.000) in diagnosing CLNM than IVCEUS (AUC = 0.692, 95% CI: 0.494–0.890) and routine US (AUC = 0.581, 95% CI: 0.367–0.796). The combination of LCEUS and IVCEUS has the highest diagnostic value (AUC = 0.863, 95% CI: 0.696–1.000). LCEUS had higher diagnostic value than IVCEUS and US for CLNM from PTC. The combination of LCEUS and IVCEUS has the highest diagnostic value for CLNM.