我院静脉药物配置中心的建设与体会

静脉药物配置中心（Pharmacy Intravenous Admixture Service，PIVAS）是符合国际标准，在依据药物特性设计的操作环境下，由受过培训的药技人员严格按照程序进行，包括全静脉营养液、细胞毒性药物和抗生素等药物配置，是为临床提供优质服务、集临床与科研为一体的机构。PIVAS在发达国家已开展多年，我国的PIVAS还处于发展阶段。目前，北京、上海等多家医院已陆续建立了PIVAS。我院于2004年9月建成PIVAS并投入使用。     

浅谈我院建立静脉药物配置中心的意义及不足

目的为建立和促进医院静脉药物配置中心(PIVAS)的发展提供参考。方法通过查阅相关资料,并结合我院静脉药物配置中心工作实践,探讨医院建立静脉药物配置中心的意义与建立过程中存在的不足。结果静脉药物配置中心在提高医院医疗质量、降低医疗成本等方面具有积极的意义和作用,但在运行过程中尚存在若干问题,仍有待于不断改进和完善。结论静脉药物配置中心的建立和发展将会促进医院药学的发展,保证患者静脉用药安全,减轻护士负担,具有广阔的应用前景。     

静脉药物配置中心消毒隔离工作初探

静脉药物配置中心（简称PIVAS），是按照《药品生产质量管理规范》（简称GMP）对人员、房屋设计、卫生、管理和标准操作的要求，集中对静脉用药实行无菌配置，对减少和避免配伍禁忌，控制不溶性微粒，避免输液反应，保证药品质量。保护工作人员身体健康等具有重要意义，它为临床提供安全、有效的静脉药物治疗服务，是现代医院药学工作新的亮点和重要内容。     

静脉药物配置中心管理系统的应用

目的:建立静脉药物配置中心(PIVAS)工作和管理的信息系统.方法:利用医院信息系统(HIS)中的部分功能模块,设计适合配置中心工作流程的功能模块,改造临床工作站.结果:建立静脉药物配置中心信息管理系统,其模块功能适用,与医院HIS完全兼容.实现了静脉药物配置中心与临床工作站的信息化传递.结论:该系统的功能适用、运行安全可靠,确保静脉药物配置中心用药的安全性,提高服务质量和工作效率,并可进一步优化医院的管理模式,提高医院的管理水平.     

县级医院静脉药物配置中心的建立与实践效果

目的探索县级医院静脉药物配置中心(PIVAS)建立和科学高效的实践模式。方法对县级医院静脉药物配置中心的建立、标准工作流程、工作制度、实践效果等方面进行研究。结果静脉药物配置中心运行近1年时间以来,在促进临床合理用药、降低成本、减少药品浪费以及职业暴露防护等方面取得显著成效。结论静脉药物配置中心在保证医院医疗质量、促进临床合理用药、降低医疗成本以及职业暴露防护等方面具有积极的意义和作用。     

静脉药物配置中心临床应用探析

目的通过静脉药物配置中心(pharmacy intraenous admixture service,PIVAS)的运行,探讨PIVAS的优点及不足,从而确保患者用药安全性。方法通过医院实行静脉药物配置1年半以来的情况,分析开展PIVAS的意义。结果医院建立PIVAS,实行药物集中配置管理后,消除了以往的工作模式弊端,提高了患者的合理用药,减少了药品的流失和浪费,促进了临床药学的发展。结论建立PIVAS是现代医院药学服务的重要内容。     

净脉药物配置中心如何与病房协作

静脉药物配置中心（PIVAS）是一个新兴部门．它具有在超净化台内无菌操作下集中混合静脉药物的优势，正被很多医院所接受与认可。配置中心的高效运作，建立在与病房各病区细致分工与良好协作的基础上。本文首先明确了配置中心与各病区互相支持与协作的必要性：其次分析了影响配置中心与病房协作的因素，最后提出了解决对策。     

静脉用药调配中心化疗药物调配人员心理健康状况及影响因素分析

  目的  了解静脉用药调配中心（pharmacy intravenous admixture services，PIVAS）化疗药物调配人员心理健康状况及影响因素，为制定PIVAS化疗药物调配人员职业防护提供科学依据。
  方法  采用自填问卷方法于2019年12月对青岛市各级医院139名PIVAS化疗药物调配人员进行SCL-90测评和PIVAS化疗药物调配情况问卷调查。
  结果  139名PIVAS化疗药物调配人员SCL-90阳性率为29.50%，SCL-90总分为（156.71 ±64.94）分，SCL-90的躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执、精神病性8个因子得分及SCL-90总分均高于中国成人常模，仅人际关系敏感因子低于中国成人常模，差异均有统计学意义（P < 0.01）。139名化疗药物调配人员的工作地点均符合《静脉用药集中调配质量管理规范》要求，均配备了生物安全柜，各医院调配化疗药物的物料准备总体充足，但防护物料种类存在差异。PIVAS化疗药物调配人员职业防护信任度为71.94%；有62.59%的人员表示面对调配化疗药物时存在紧张、急躁等负面情绪。
  结论  PIVAS化疗药物调配人员心理健康状况较普通人群差，职业压力明显，须引起关注。医院应尽可能地减小化疗药物配制的职业危害，保证化疗药物调配人员和患者的用药安全。
     

谈医院建立静脉药物配置中心的必要性

静脉药物配置中心(pharmacyintravenousadmixtureservices,PIVAS)是指在符合国际标准、依据药物特性设计的操作环境下,由受过培训的药学技术人员严格按照操作程序进行包括全肠外静脉营养液、细胞毒药物和抗生素等药物配置,为临床医疗提供优质服务的中心,是集药学、科研和临床为一体的部门。现就当前形势下对医院建立静脉药物配置中心的必要性谈谈自己的看法。一、医院静脉药物配置的现状(一)患者得不到药师和护士的正常服务:患者住院治疗,需要医院提供全方位的服务。然而,传统的静脉药物配置是由护士领取药物后,回病房治疗室进行配置,药师…     

临床药师医嘱审核在静脉药物集中配置中的作用

分析医院静脉药物集中配置情况,探讨临床药师通过医嘱审核在静脉药物配置中心（PIVAS）的作用,促进了临床合理用药。方法：针对医院PIVAS为内科病房开展工作,按照随机抽样原则,分别抽取2013年7~12月（A组）及2014年1~6月（B组）的住院用药医嘱中各抽取4000份,进行分析和统计。结果：A组不合格医嘱有377份（占医嘱9.43%）,B组住院用药医嘱中,不合格医嘱有94份（占医嘱2.35%）。结论：通过医嘱审核,临床药师在PIVAS的工作中,将控制不合理用药关口前移,促进了临床合理用药,提高了医院的现代化医疗质量。     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.