医疗设备采购管理中的三级安全风险控制

该文从医疗设备采购的定义、识别及重要性出发,分析医院医疗设备采购管理的现状和风险问题,提出三级安全风险控制模式,通过以采购中心科室级监督,设备科、财务科的部门级监督,纪检监察及审计部门的医院级监督,以期更加合法合规地进行医疗设备采购,避免采购风险问题的发生.     

医疗设备档案资料的系统化管理效果分析

目的探究医疗设备档案资料的系统化管理的效果与意义。方法以2012年4月至2013年4月首都医科大学附属北京天坛医院未实行医疗设备档案资料管理随机选取60例患者作为对照组,以2013年5月到2014年5月行系统化医疗设备档案资料管理随机选取同期60例患者作为观察组,对比分析两组患者的医疗纠纷率、经济纠纷率、医院所获效益与患者满意度。结果观察组医疗纠纷(8.33%)、经济纠纷发生率(13.33%)显著低于对照组(26.67%,35.00%)。差异均有统计学意义(均P0.05)。观察组直接效益(789.52±120.15)万元、间接效益(389.61±86.25)万元均显著高于对照组[(658.57±122.18)万元,(235.54±72.83)万元],差异均有统计学意义(P0.05)。观察组非常满意占比86.67%,显著高于对照组70.00%。不满意占比5.00%,显著低于对照组。差异均有统计学意义(P0.05)。结论实行系统化管理医疗设备档案资料,可显著减少医疗纠纷、经济纠纷的发生率,显著提高医院经济收益,同时增加了患者满意度,为安全医疗提供必要的保障。     

天玑骨科手术机器人的临床使用风险分析与对策探讨

探讨天玑骨科手术机器人在临床使用中的潜在风险及管理措施,以保证它在临床使用中的安全性和有效性。基于天玑骨科手术机器人的工作原理和技术特点,应用失效模式和效果分析法评估其使用风险和危害性,再应用鱼骨图法分析导致其故障的各种潜在风险要素。通过骨外科、手术室、医工处及供应室等多部门协作,制定并实施护理配合、消毒灭菌、质量控制及应急处理环节的风险控制措施,为2020年81台天玑骨科手术机器人提供了安全保障。基于风险评估和分析结果,制定并实施天玑骨科手术机器人在各临床使用环节中相应的风险管理措施,具有重要的临床意义和参考价值。     

医疗设备维修备件库存控制与耐用性分析探讨

目的 针对当前医疗设备维修备件管理模式粗放随意的现状,提出了一种维修备件库存控制和耐用性分析方法,以提高维修备件管理水平。方法 选择某院近2年内某品牌监护仪的血氧探头库存管理数据,内容包括血氧探头的出库时间、出库数量、库存余量;近1年内监护仪心电导联线的损坏记录数据,包括每条心电导联线的品牌型号、申领时间、损坏时间。借助指数平滑法和滑窗法探究血氧探头库存控制方法,利用心电导联线生命周期时长的概率分布分析其耐用性评价指标。结果 某院监护仪血氧探头未再出现库存短缺情况,其他维修备件短缺或过剩情况得到有效改善;得到心电导联线耐用性衡量指标,为后续维修备件品牌的选购提供了有价值的参考依据。结论 提出的方法应用到医疗设备的维修备件管理中,能够有效改善备件供保现状,提高维修备件精细化管理水平,更好地服务于临床和保障医院利益。     

加强病案管理，降低医疗风险

从强化医务人员的法律意识,加强病案的质量控制和管理质控等方面入手,探讨了加强病案管理以降低医疗风险的问题,指出制定严格的病案管理规章制度和保证每一份病案的质量,对病案进行完整、准确的归档,是防范医疗风险的基本保证。     

应用品管圈降低可穿戴医疗设备故障率

目的 应用品管圈活动来降低可穿戴医疗设备故障率.方法 选择南京市第一医院内分泌科320台可穿戴医疗设备为研究对象,调查2018年10月至2019年10月可穿戴医疗设备发生故障的数据292次.于2019年10月至2020年1月、2020年5月至7月实行品管圈管理,收集可穿戴医疗设备发生故障的数据.组建品管圈小组,通过头脑...     

医学装备维护对医院医疗风险控制及工作效率的影响

目的探讨医学装备维护对医院医疗风险控制及工作效率的影响,以降低医疗事故发生率及提高综合效益。方法首先阐述医学装备维护的重要性和必要性,然后分析医学装备维护中存在的问题,最后从有机结合定期维护和事后维修、对维护周期进行动态调整、分类制定维护表、施行计算机系统化管理、基于GSM网络进行远程监测五个方面对医学装备维护的方法进行论述。结果医学装备得到有效维护,推动了医院各项工作的开展。结论医学装备维护能够将有效地控制医院医疗风险提高医院医疗工作效率,值得临床充分重视。     

大型医疗设备经济效益分析系统浅析

本文阐述医院大型医疗设备如何进行经济效益分析的做法及提高经济效益的措施。随着社会主义市场经济的深入和发展,医院对大型医疗设备的经济效益进行统计和分析是相当必要的。对设备经济效益的分析可以起到指导科学投资、改善经营管理、提高综合效益的目的。     

医院医疗设备质量控制管理面临的问题与措施

分析了目前很多医院质量控制管理工作所面临的领导不重视,临床医务人员意识淡薄,专业技术人员缺乏三个问题.我院采取了统一管理、部门分工,重点抓培训、维护、质量检测、计量等环节.构建了切实可效的质量控制体系,医疗设备的质控管理有明显的改善.实践证明,医疗设备质量控制工作是一项系统工程,只有严格遵守各项规章制度,操作规程,院领导、临床医务人员及质量控制人员共同配合才能做好.     

医学工程质量控制风险评估方法

本文应用医疗设备间期分布函数研究了医学工程质量控制的风险分析方法,该方法能够根据医疗设备故障间期计算设备故障风险率在服役期或修复期内的变化曲线.故障率变化曲线是制定医学工程质量控制方案的重要依据.     

Optimizing usability and signal capture: a proactive risk assessment for the implementation of a wireless vital sign monitoring system

Wearable vital sign monitors are a promising step towards optimal patient surveillance, providing continuous data to allow for early detection and treatment of patient deterioration. However, as wearable monitors become more widely adopted in healthcare, there is a corresponding need to carefully design the implementation of these tools to promote their integration into clinical workflows and defend against potential misuse and patient harm. Prior to the roll-out of these monitors, our multidisciplinary team of clinicians, clinical engineers, information technologists and research investigators conducted a modified Healthcare Failure Mode and Effect Analysis (HFMEA), a proactive evaluation of potential problems which could be encountered in the use of a wireless vital signs monitoring system. This evaluation was accomplished by focussing on the identification of procedures and actions that would be required during the devices’ regular usage, as well as the implementation of the system as a comprehensive process. Using this method, the team identified challenges that would arise throughout the lifecycle of the device and developed recommendations to address them. This proactive risk assessment can guide the implementation of wearable patient monitors, optimising the use of innovative health information technology.     

基于数据仓库技术的医疗保险基金风险管理模型及其实现

自《国务院关于建立城镇职工基本医疗保险制度的决定》（国发[1998]44号）发布以来,全国各地相继建立了以个人账户和统筹基金账户相结合的新的医疗保险制度。截止到2004年底,参加医疗保险个人达到12386万人,收缴医疗保险基金1000亿元,支出800多亿元。要使如此巨大的医疗保险基金充分地发挥社会保险的保障功能,对于基金的风险管理至关重要。本文介绍了采用数据仓库技术建立医疗保险基金风险分析系统的模型和软件的实现方法。并介绍了该系统的具体应用。     

颅内动脉瘤三维几何形态信息数值计算分析方法

目的 探索两种主要的三维重建算法对颅内动脉瘤(intracranial aneurysm,IA)几何形态特征参数计算的影响.方法 分别建立了基于移动立方体(marching cubes,MC)和移动四面体(marching tetrahedral,MT)三维重建算法的颅内动脉瘤几何形态特征参数计算方法,并分别对5种主要的几何形态参数:动脉瘤的尺寸(size),纵横比(aspect ratio,AR),非球形指数(nonsphericity index,NSI),尺寸比(size ratio,SR)和动脉瘤倾斜角度(aneurysm inclination angle,AIA)进行分析.结果 对6例动脉瘤几何形态特征参数的计算结果表明MC和MT两种重建算法在重建时间上差异显著且对动脉瘤几何形态参数计算结果有差异,其中对AR、NSI、SR和AIA的影响较大,而对动脉瘤尺寸影响较小.结论 考虑到两种重建算法在重建时间上的差异显著,因此在计算尺寸等几何形态参数时可使用速度较快的MC算法,而在需要计算AR、NSI、SR和AIA等参数且要求一定精度时可优先使用精确度较高的MT算法.     

一种多特征融合的Web医学信息语义关系抽取方法

目的为给用户提供更为相关、整体和结构化的Web医学信息,提出一种多特征融合的语义关系抽取方法,以解决中文Web医学信息中两两医学实体之间语义关系的抽取。方法首先在混合句法分析算法的基础上构造包含词项、语义、词性、交互词、实体对距离、实体类别以及最短依赖关系特征的特征向量并结合支持向量机实现。对Web医学信息中师徒关系、擅长关系及从属关系抽取实验,比较在不同句法分析下、不同特征作用及不同机器学习算法下的语义关系抽取效果。结果从F估计和算法运行时间来看,混合句法分析下效果最佳。随着特征的加入,抽取效果不断提升,最后,对三类语义关系抽取最终获得81.16%、95.94%和86.16%的F估计值。结论基于多特征融合的语义关系抽取方法对于Web医学信息语义关系的抽取具有很好的效果。     

Work organisation,work environment and the use of medical equipment: A survey study of the impact on quality and safety

In a study of hospital staff's perceived quality of care and worry, related to the use of medical equipment, a systems approach was used. This included training and user aspects on the equipment, environmental ergonomics, work organisation and psychosocial work conditions. In a survey study, 543 hospital staff members from seven departments with various degrees of equipment utilisation participated. By means of factor analysis, factors which were important to perceived quality of care and worry were determined. Adaptation of equipment and environment and training on the use of equipment were shown to be important. However, several organisational and psychosocial factors turned out to have a still greater impact. In the assessment of healthcare technologies which include medical equipment a holistic systems approach is therefore advocated.     

Atypia in the assessment of breast cancer risk: implications for management

Proliferative disease accounts for as much as one-third of all biopsies for benign disease and 5-10% of proliferative lesions show atypia ductal or lobular hyperplasia. Nearly 40% of women with a family history of breast cancer and atypical hyperplasia subsequently develop breast cancer. A quantitative model developed by Gail and colleagues estimates the probability of developing breast cancer over time. Risk factors in the model include current age, ages at menarche and first live birth, number of previous biopsies, the presence of cellular atypia, and the number of first-degree relatives with breast cancer. Atypical hyperplasia approximately doubles the risk of developing invasive breast cancer within any quantitative risk profile. Ductal lavage provides a minimally invasive method of collecting breast epithelial cells. The procedure opens the possibility of repeatable tracking of breast cytology over time, but its role as a risk assessment tool remains to be fully defined.     

A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia

BACKGROUND: Four types of treatment [hysterectomy, endometrial resection/ablation, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral medical therapy] are available for management of menorrhagia. The objective of this study was to compare the cost and quality-adjusted life-years (QALYs) gained by these four treatment alternatives. METHODS: A Markov model was designed to simulate the healthcare resource utilization and QALYs of the four treatment alternatives for patients presenting with menorrhagia over 5 years. Clinical inputs were estimated from literature, and the cost analysis was conducted from the perspective of healthcare provider in Hong Kong. RESULTS: The base-case analysis showed that the hysterectomy group was the most effective (4.725 QALYs) alternative with the highest cost (USD6878, 1USD=7.8HKD). The incremental cost per additional QALY (ICER) gained by hysterectomy was USD23 500. The probability of extra surgery in the endometrial resection/ablation was an influential factor. Probabalistic sensitivity analysis of 10,000 simulations of the Monte Carlo model showed that the hysterectomy group gained higher number of QALYs than the LNG-IUS, oral medical treatment and endometrial resection/ablation groups, 99, 99 and 98% of the time, and it was more costly than the other three groups over 85% of the time. CONCLUSIONS: Hysterectomy appears to be cost effective, with ICER less than USD50,000, for management of menorrhagia.