基于HIS护理不良事件上报系统的构建和应用

目的构建护理不良事件电子上报系统,以完善护理不良事件管理制度,优化护理工作流程。方法基于医院信息管理系统(HIS)构建护理不良事件电子上报系统,4个模块分别是护理不良事件上报模块、护理不良事件审核模块、护理不良事件查询模块和护理不良事件统计分析模块,依据护士层级设置不同权限,对7类护理不良事件进行上报与跟踪管理。结果应用护理不良事件电子上报系统后,不良事件上报数量较之前明显增加,管理时效显著优于传统纸质上报(P0.01)。结论护理不良事件上报系统实现了最大限度地收集、分析、交流、共享安全信息,为护理管理者决策提供科学依据,促进护理质量持续改进。     

给药错误预警项目在护士长总值班质控中的应用

目的 探讨基于失效模型与效应分析的给药错误预警项目在护士长总值班质控中的应用效果。方法 对给药错误进行根因分析，借鉴失效模型与效应分析，形成给药错误相关护理缺陷的红色预警和黄色预警并纳入护士长总值班重点督查内容，比较实施前后预警条目触发次数，预警条目的风险系数以及给药错误不良事件的情况。结果 实施后，红黄预警触发次数显著高于实施前，5个预警条目的发生频次、3个条目探测度、7个条目风险系数显著减少(P<0.05,P<0.01),给药错误发生频次下降。结论 给药错误相关护理缺陷红黄预警应用于护士长总值班中，能有效提高护士长总值班质控精准度，促进用药安全措施落实。     

临床护士共享治理在给药安全管理中的实践

目的 将共享治理的管理理念运用到给药安全管理中,提高护士给药安全的风险管理意识和参与度,降低给药错误隐患事件和给药错误发生率.方法 2019年7～12月将共享治理应用于病房给药安全管理中,并与2019年1～6月未实施共享治理时的给药隐患事件、给药错误发生率、护理人员决策参与程度等进行对比.结果 实施共享治理后给药隐患事件、给药错误发生率显著低于实施前(P＜0.05,P＜0.01);实施共享治理后护理人员决策参与度和给药安全理念得分显著高于实施前(均P＜0.01).结论 共享治理能有效提高护士给药安全的风险管理意识,降低给药错误及隐患事件的发生.     

医院信息系统下给药护理失效模式及潜在风险因素分析

目的应用失效模式对我院医院信息系统(HIS)下临床给药护理风险及潜在因素进行评估分析,为采取有针对性的改善措施提供参考。方法成立临床给药风险管理小组,在回顾55例给药不良事件的基础上,采用失效模式分析HIS下临床给药护理风险及其潜在风险因素,计算风险指数(RPN)。结果确定了20个临床给药护理风险失效模式;RPN排序较高的有患者身份识别错误(222.50),执行错误医嘱(191.84),药品配制错误(186.42),错误执行医嘱(185.62),配制剂量错误(180.88),遗漏给药(179.82),药物不良反应处理不及时(174.42)等;潜在风险因素有护士未严格执行查对制度和给药流程,护士给药相关知识掌握不全,环境干扰沟通不足,HIS本身的弊端等。结论HIS系统下临床给药护理风险主要是护士因素导致的错误给药及不合理给药。应从医院整体环境和护理等多方面加强给药风险管理,降低患者用药风险。     

结构化电子病历在压疮管理中的应用

目的探讨压疮监控科学化、规范化的有效方法。方法制定压疮电子病历结构化模板,完成压疮表格结构化,制定相应的操作流程、上报流程及使用专项制度和相关管理规定,通过试点后在全院推广实施。结果结构化电子病历在压疮管理中规范运行。结论结构化电子病历应用于压疮管理体现出操作、质控的便捷性,数据统计的便捷性及准确性。     

我国护理不良事件上报存在问题及管理策略

从护理不良事件的总体报告率、上报内容及结构、上报管理及对护理不良事件及其报告的认知情况等几个方面对我国护理不良事件上报现状进行分析,指出我国护理不良事件上报中存在总体报告率低、上报内容分类不明确、选择性上报情况明显、管理层对上报管理的忽视及上报认知存在普遍缺陷等多种问题。并从上报系统、组织管理系统及安全文化三个层面,归纳总结提高护理不良事件上报率的策略及效果,以期为后续更好开展护理不良事件上报的实践、管理及研究奠定基础。     

失效模式和效应分析预防护士静脉给药错误的实践

目的运用失效模式和效应分析对临床护士给药的各个环节进行改造,以减少护士静脉给药错误。方法根据FMEA方法,成立预防护士静脉给药错误工作小组;列出临床护士给药的流程;指出子流程下可能导致错误的环节及原因;提出解决问题的整改方案;跟踪整改的成效。结果改进后失效模式和效应分析的风险值(RPN)从1 120下降至270,护士静脉给药错误发生率显著下降(P0.05)。结论失效模式和效应分析作为一种风险管理工具,将发生护理安全事件后的消极处理转变为事件发生前的积极预防,可减少护士发生静脉给药错误的概率。     

预防围手术期给药错误的最佳证据总结

目的 遴选国内外预防围手术期给药错误的相关证据,为预防围手术期给药错误提供依据。方法 系统检索相关指南、系统评价、专家共识和证据总结,采用澳大利亚JBI循证卫生保健中心的文献评价标准、证据分级系统及专家论证会对不同类型研究进行文献质量评价及证据级别评定。结果 共纳入19篇文献,其中指南9篇、系统评价4篇、专家共识4篇、证据总结2篇。最佳证据包括药物采购及存储、药物审查、高危药物/受管制药物、用药流程、转运交接、医嘱管理、给药错误监测、标准化标签、临床决策支持、患者决策辅助、流程制度、安全文化、多学科合作、质量改进和教育与培训15个方面,共68条。结论 医务人员应结合临床情境按照相关级别的循证医学证据,选择有针对性的最佳证据,规范围手术期给药管理,减少围手术期给药错误的发生,提高医疗安全。     

条形码给药系统降低给药错误的有效性研究

目的降低给药错误发生率,保障患者安全。方法配置个人数字助理(PDA),将条形码技术应用于给药流程。结果应用条形码给药系统前给药错误发生率为0.208千病人住院日,应用后为0.096千病人住院日,应用前后比较,差异有统计学意义(P<0.01);应用条形码给药系统后,患者错误、剂量错误、药物错误降低。结论条形码给药系统能有效降低给药错误发生率。     

广东省不同等级医院用药错误及管理现状的调查

目的调查广东省不同等级医院用药错误及管理现状,为制定用药错误的护理质量改善指引提供依据。方法采用便利抽样方法随机抽取广东省一、二、三级医院共66所,采用自行设计的"广东省不同等级医院用药错误发生现状调查表"对各医院护理部进行问卷调查。结果各等级医院共上报用药错误494例,护理不良事件4 048例,用药错误占护理不良事件的12.20%;一、二、三级医院护理不良事件及用药错误发生率比较,差异有统计学意义(均P0.01);各等级医院使用条形码识别腕带、电子化医嘱系统、口服药分包系统及药物中心配置方面比较,差异有统计学意义(P0.05、P0.01)。用药错误类型排名前3位的分别是患者错误(24.57%)、药物错误(21.88%)、剂量错误(12.48%)。结论广东省各级医院应建立良性用药安全文化,提高医院自动化和信息化程度,从系统和个人的角度采取减少用药错误的措施;建立完善的用药错误监测和报告系统,制定用药安全质量改进指引,保障患者用药安全。     

Renewable energy management of an hybrid water pumping system (photovoltaic/wind/battery) based on Takagi–Sugeno fuzzy model

This research work presents an optimal energy management for a hybrid water pumping system driven by a photovoltaic generator (PVG) and a wind turbine. These two renewable energies are used as power generation sources, whereas a battery is added as an energy-storing system, for the purpose of controlling the power flow and providing a constant load supply. The proposed management system, serve to guarantee the pumping system autonomy in a rural region where's no access to the electrical network. As a result, a maximum power point tracking (MPPT) controller is created based on the fuzzy Takagi–Sugeno (TS) model, ensuring maximum power transfer to the moto-pump in spite of wind speed and insolation changes. The synthesis of MPPT control law involves TS fuzzy reference models which generate the desired trajectories to track. A supervisor has been developed for energy management and its major purpose is to effectively use the battery to satisfy the power load requirements, and that is by maintaining the state of charge (SOC) to extend the battery's life. Finally, simulation results have been done based on Matlab/Simulink with the aim of validating the efficiency of the proposed energy management supervisor.     

Palodent成形片系统在Ⅱ类洞树脂修复中的临床应用

目的:主要研究palodent成形系统对Ⅱ类洞树脂修复邻接关系的影响。方法:80颗后牙Ⅱ类洞随机分为试验组(palodent成形片组)和对照组(环周成形片组),每组40颗。充填后即刻检查悬突、边缘嵴形态和外展隙形态;充填后即刻、1周牙线检查邻接触区恢复情况。术后1周和6个月问卷调查患者舒适度。结果:试验组和对照组悬突比例比较没有统计学意义(P>0.05)。试验组在充填体边缘嵴形态、外展隙形态、邻接区恢复情况和患者舒适度均优于对照组,组两两比较有统计学意义(P<0.05)。结论:Palodent在Ⅱ类洞树脂修复中应用优于环周成形片。     

Endomyocardial Biopsy

Endomyocardial biopsy was performed in a series of 25 patients to evaluate the usefulness, reliability and possible complications of the method. All the cases underwent complete cardiac catheterization and cardiac performance was determined immediately before and after. Examples of the microscopical and ultrastructural findings in the specimens are given. No primary or late complications could be noted either in this series of patients or in 59 additional biopsies performed. The advantages of this method are discussed in connection with a survey of other myocardial biopsy methods. Apart from diagnostic purposes, endomyocardial biopsy seems to be useful in other instances. Examples thereof are discussed together with a case report as an illustration.     

Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan

The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: “All people shall have the right to maintain the minimum standards of wholesome and cultured living.” The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee's Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the “medical expenses payment system” and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.     

Trauma care systems in Italy

In this article we analyse the Italian Trauma System, stressing what has been modified over the last decade, in order to provide a more adequate and safe pre-hospital care, as well as a more efficient in-hospital treatment. We describe how the 118 operative exchange is organised, the most important educational courses for the health personnel and the new emergency/urgency structures called DEA.     

机器人胃肠道手术的初步应用浅见

手术机器人是外科医生的手术辅助系统．目前以达芬奇机器人手术系统应用最为广泛。复旦大学附属中山医院自2009年10月开始应用达芬奇机器人手术系统施行胃肠道手术共计27例（其中胃手术18例．结直肠手术9例）。术前准确分期对于达芬奇机器人手术系统适应证的把握十分重要。达芬奇机器人手术系统对于术中淋巴结清扫、神经保护和直肠系膜的完整切除有着明显的优势。采用何种吻合方式（腹腔内或腹腔外）取决于手术方式和术者经验。虽然,达芬奇机器人手术系统的应用还存在一些不足．昂贵的价格也限制其推广。但是．相信其会成为外科发展的趋势。     

Wallis棘突间动态稳定系统在腰椎间盘突出症治疗中的早期疗效观察

[目的]比较髓核摘除术结合Wallis系统与单纯髓核摘除术治疗腰椎间盘突出症的早期疗效.[方法]2008年2月～2010年2月采用髓核摘除术结合Wallis系统治疗腰椎间盘突出症患者18例,以同期行单纯髓核摘除术治疗腰椎间盘突出症的18例患者为对照组.术后12个月为观察点,采用下腰痛及腿痛的视觉模糊评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)等指标来评估2组疗效.[结果]36例患者均获12 ～24个月随访,平均16个月,两组患者术后12个月的VAS评分及ODI指数均有明显下降,较术前比较有统计学意义(P=0.0000＜0.05),Wallis组术后12个月的下腰痛VAS评分及Oswestry指数与对照组比较有统计学意义(P =0.000 0 ＜0.05),而腿痛的VAS评分两组比较无统计学意义(P =0.074 ＞0.05).[结论]Wallis系统置入简单,创伤小,结合髓核摘除术治疗腰椎间盘突出症能提高疗效.     

An optimal regulator for linear systems with multiple state and input delays

This paper presents an optimal regulator for a linear system with multiple state and input delays and a quadratic criterion. The optimal regulator equations are obtained reducing the original problem to the linear‐quadratic regulator design for a system without delays. Performance of the obtained optimal regulator is verified in the illustrative example against the best linear regulators available for the linear system without delays and for two rational approximations of the original time‐delay system. Simulation graphs demonstrating better performance of the obtained optimal regulator with respect to the criterion value are included. Copyright © 2006 John Wiley & Sons, Ltd.     

Cajal间质细胞在胃肠道外分布及其功能的研究进展

Cajal间质细胞在胃肠道中的分布和功能已得到充分的阐述。近年来,研究发现,Cajal间质细胞不仅在胃肠道分布,在其他组织和器官中,如泌尿系统、心血管系统和生殖系统、肝脏、胰腺等,都发现了该类细胞的存在。目前,关于Cajal间质细胞的鉴定已经有了一套比较完整的诊断程序,这在一定程度上促进了对该细胞在胃肠道外器官和组织的分布及其功能的研究。Cajal间质细胞在泌尿系统中的作用似与平滑肌的自发性收缩有关,在循环系统中似与房颤的发生相关,但还需要进一步的研究。Cajal间质细胞在其他器官和组织中的作用和功能还未知。