品管圈活动在提高骨科病人正确卧位依从性中的应用

目的通过使用品管圈管理工具提高骨科病人正确卧位依从性,满足治疗需要,促进病人康复,规范流程。方法骨科7名护士自愿成立品管圈,确立“提高骨科病人正确卧位依从性”活动主题,对改进前不正确卧位的原因采用鱼骨图进行分析,制定改进措施,实施2个月后评价效果。结果（1）有形成果：经品管圈活动,骨科病人正确卧位的依从性明显提高,达到并超出了预期目标。（2）无形成果：品管圈活动在解决问题能力、责任心、沟通协调能力、自信心、团队凝聚力、积极性、品管手法及和谐度8个方面均有提高。结论开展品管圈活动不仅提高了护士主动服务的意识,优化了工作流程,有效提高了骨科病人正确卧位的依从性,提高了病人满意度,同时还提高了圈员的团队精神和质量管理能力。     

运用品管圈活动提高住院肺结核患者口罩佩戴率

目的探讨品管圈活动在提高住院肺结核患者口罩佩戴率中的应用效果。方法某院结核科9名护士组成一个"圈",确立"提高住院肺结核患者口罩佩戴率"为活动主题,制定和落实整改措施,并对品管圈活动前后住院肺结核患者口罩佩戴率进行统计分析。结果应用品管圈活动后住院肺结核患者口罩佩戴率为87.50%(147/168),高于活动前的65.54%(116/177),差异有统计学意义(P0.05)。圈员解决问题能力、责任心、沟通协调能力、自信心、团队精神、积极性、品管手法、和谐度8个方面的能力得到提高,总平均分由活动前的23.78分,提高至活动后的33.78分。结论开展品管圈活动不仅提高了住院肺结核患者口罩佩戴率,还提升了圈员质量管理能力和团队精神。     

品管圈在改善术后自控镇痛中的应用

目的探讨品管圈活动在提高术后自控镇痛护理中的作用。方法创立品管圈、选定活动主题、拟订活动计划、分析现状、设定目标、共同分析影响镇痛质量的主要原因,采用头脑风暴法拟定对策并按计划实施,比较活动前后环节质量及病人自控镇痛效果和总体满意度。结果实施品管圈活动后影响镇痛效果的管路问题、护士疼痛知识、镇痛观念、疼痛处置及时性、镇痛护理记录到位率、病人对疼痛控制的总体满意度均得到了明显改善。结论品管圈活动能有效改善自控镇痛效果。     

品管圈活动在ICU盲插鼻肠管中的应用

目的探讨品质管理圈活动在提高重症加强护理病房(ICU)护士盲插鼻肠管成功率中的应用效果。方法开展以'提高ICU护士盲插鼻肠管成功率'为活动主题的品管圈活动,对盲插鼻肠管操作中存在缺陷以及现状进行统计、分析查找原因,并制定和落实整改措施。结果品管圈活动开展后盲插鼻肠管成功率高于品管圈活动开展前,由54.24%提升到81.03%,差异有统计学意义(P<0.05)。结论品管圈活动能有效提高ICU护士盲插鼻肠管成功率,而且提高了员工运用品管圈管理工具解决实际问题的能力。     

品管圈活动在降低内镜下黏膜剥离术后尿潴留发生率中的作用

目的探讨品管圈活动对于降低内镜下黏膜剥离术(endoscopy submucosal dissedtion,ESD)术后患者尿潴留发生率的作用和效果。方法 2016年10月起成立品管圈活动小组,以"降低ESD患者术后尿潴留发生率"为主题,对2016年10月至12月收治的64例(对照组)进行现状调查,分析发生尿潴留的原因,设定目标,制定对策,并实施于2017年2月至4月收治的64例(观察组)患者中,通过比较两组术后尿潴留发生率进行品管圈活动效果评价。结果对照组64例中25例术后发生了尿潴留,发生率为39.1%;观察组64例中8例发生了尿潴留,发生率为12.5%,两组比较差异有统计学意义(P0.05)。品管圈活动前后圈员的品管手法、工作积极性、责任心、解决问题能力、自信心、沟通协调能力、团队凝聚力及幸福感8项分值均有提高。结论品管圈活动对降低ESD患者术后尿潴留发生率具有较好的效果,能够激发护理人员参与管理的意识,提高护士的工作积极性,使圈员在日常工作中形成"问题意识",增强了独立思考和解决问题的能力,也增强了团队精神。     

品管圈在针管回缩式静脉留置针推广中的作用

目的探讨品管圈活动在急诊患者针管回缩式静脉留置针推广应用中的作用。方法成立齐齐圈,通过现状把握、原因分析、目标设定、对策实施、效果确认等程序,开展品管圈活动。结果 (1)有形成果。急诊患者针管回缩式静脉留置针使用率由原来的4 3.5 0%提升至77.6 0%。(2)无形成果。圈员学会了品管手法,增加了团队的协作能力和解决问题的能力。结论开展品管圈活动不仅使针管回缩式静脉留置针的应用得到推广,同时还提高了圈员的团队精神和质量管理能力。     

品管圈活动在降低动脉采血后皮下血肿形成率的应用

目的探讨品管圈活动在降低住院病人动脉采血后皮下血肿形成率的应用效果。方法成立品管圈小组,选定"降低住院病人动脉采血后皮下血肿形成率"为活动主题,进行现状调查,要因分析,确定主要因素,制定相应的措施并组织实施,比较品管圈活动前后动脉采血后皮下血肿形成的下降率和病人的满意度。结果实施品管圈活动后,皮下血肿形成率由活动前的10.84%降到活动后的2.56%,病人满意度由79.52%升至96.15%,差异有统计学意义(P<0.05)。结论开展品管圈活动能降低住院病人动脉采血后皮下血肿形成率,提高病人对护士操作技术的满意度,并提高了圈员工作责任心、自信心和解决问题的能力。     

课题达成型品管圈在构建肿瘤专科护理质量信息化评价体系中应用

目的课题达成型品管圈是指圈员运用新的思维方式与品管手法,达成更具有挑战性的目标,使护理质量达到期望水平。本研究探讨课题达成型品管圈在构建肿瘤专科护理质量评价体系中的应用。方法选择2018-02-01-2019-01-31长沙市中心医院肿瘤内科2个病区8名护士成立"知了圈",依据课题达成型品管圈操作步骤,构建肿瘤专科护理质量信息化评价体系;比较应用评价体系前后,护士专科服务质量、专科核心能力、质控护士满意度和圈能力的得分情况。结果品管圈历时10个月完成。实施后护理服务质量得分为(75.21±7.26)分,高于实施前的(63.23±3.14)分,差异有统计学意义,t=9.386,P<0.001;实施后护士专科核心能力得分为(167.97±32.64)分,高于实施前的(141.80±30.81)分,差异有统计学意义,t=3.064,P=0.005;实施后病区护士工作满意度得分为(45.25±4.65)分,高于实施前的(34.00±7.78)分,差异有统计学意义,t=3.910,P=0.006;圈员自评结果显示,活动成长值由活动前的(25.88±6.55)分提高到活动后的(67.75±5.17)分,差异有统计学意义,t=47.976,P<0.001。结论通过课题达成型品管圈构建的肿瘤专科护理质量信息化评价体系科学、系统、高效,可实现对肿瘤专科护理质量的精细化管理。     

品管圈活动在提高哮喘患者自我管理能力中的应用

目的探索品管圈活动在提高哮喘患者自我管理能力中的作用。方法科室医生、护士自愿加入品管圈活动,选定"提高哮喘患者自我管理能力"为主题,开展为期8个月的活动,探讨提高哮喘患者自我管理能力的方法。结果哮喘患者自我管理能力通过本次圈活动有了很大提高,差异具有统计学意义(P <0. 05)。结论开展品管圈活动,不仅能够提高哮喘患者自我管理能力,也促使科室开展延伸性医疗、护理服务,医护共同参与哮喘患者自我管理,使得哮喘患者疾病得到有效控制。     

品管圈在提高责任制整体护理合格率中的应用

目的探讨护理品管圈在提高责任制整体护理合格率中的作用。方法由9名护理骨干组成的品管圈小组,以"提高责任制整体护理合格率"为主题进行现状调查,对责任制整体护理合格率低的原因进行分析,制订并实施针对性措施,比较品管圈活动前后的责任制整体护理合格率和圈员的各项能力及满意度。结果品管圈活动之前责任制整体护理合格率为50.00%,患者满意度为80.00%,实施品管圈活动之后整体护理合格率为80.00%,患者满意度为96.00%,差异具有统计学意义(P0.05),此外品管圈成员在品管手法、和谐度、解决问题能力、责任心、沟通协调能力、自信心、团队凝聚力、积极性8个方面的能力都得到了提高。结论品管圈活动能有效提高责任制整体护理的落实,而且还有助于提高圈员的综合能力和患者满意度,值得在临床护理工作中推广。     

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.