加强检验分析前质量管理不断提高检验质量

检验分析前质量管理是实验室质量保证体系中最重要、最关键的环节，本文从加强临床实验室管理、检验项目的正确选择、标本的管理和分析前质量评估四个方面进行叙述，得出：为加强这一环节的质量管理，确保检验质量的提高，除搞好临床实验室的管理外，更需要全体医护人员的共同参与和配合。同时也认识到，检验分析前质量管理工作不仅是一个技术问题，更多的还是管理问题，不仅是检验工作质量管理体系的重要组成部分，也是医院医疗质量管理体系的重要组成部分。     

护士长在护理质量控制管理中的作用

质量控制是护理管理中的基础，建立标准化、统一化的质量管理体系，规范护理管理，落实以人为本的管理职能，树立“以病人为中心”的质量意识，加强环节质量控制，做好质量控制反馈，认真落实前馈控制、同期控制和反馈控制的各项措施，才能持续提高护理质量，实现零缺陷的管理目标。护士长在规范护理管理体系，保证护理管理的有效性和适宜性实施过程中起着非常重要的作用。     

导入OEC管理模式完善护理质量管理体系

就护理质量管理体系建设这一重要课题，引入OEC管理模式进行初步探讨。首先，阐述了护理质量与护理质量管理的概念及其特点。其次，应用OEC原理，完善了护理质量管理体系的内容。最后从强化护理质量管理意识，加大对护理管理人员的培训力度和加强护理管理效能3个方面，推进护理质量管理体系良性运转。     

血站管理评审中存在的问题和解决方法探讨

管理评审是保障血站质量管理体系运行的一项重要评价方式,是血站质量管理体系持续改进的重要手段[1],对提高血站质量管理体系的适宜性、充分性和有效性起着重要作用.《血站质量管理规范》第2.4条款和第12.10条款规定了血站进行管理评审的具体要求,但各血站在执行层面中的方法和具体步骤不尽相同.如何科学地进行血站管理评审工作,减少管理评审的盲目性和形式化是血站管理工作的重点.     

关于建立供应室质量管理体系的探讨

所谓质量管理体系（Quality Control System，QCkS），ISO9001：2005标准定义为“在质量方面指挥和控制组织的管理体系”，通常包括制定质量方针、目标以及质量策划、质量控制、质量保证和质量改进等活动。实现质量管理的方针目标，有效地开展各项质鼍管理活动，必须建立相应的管理体系，这个体系就叫质量管理体系。由于其先进的管理理念，     

引入ISO9001质量管理体系进行病案管理

探索ISO9001质量管理体系在医院病案管理中的有效性，提高医院病案管理质量，使病案管理更加规范。方法：引入ISO9001质量管理体系要求对病案进行管理，建立病案质量管理体系，编制病案管理作业指导书和程序文件，将病案管理的质量要求分解并贯穿于工作流程的每个环节，找出与ISO9001质量管理体系管理实施前的成效。结果：从2006年1月～2007年12月引入ISO9001质量管理体系后共有住院病案33716份．主要管理指标均达到95％以上，病案管理质量明显提高。结论：推行ISO9001质量管理体系，转变观念，有利于病案管理的规范和完善，促进病案管理质量提高，实现目标管理的要求。     

如何提高医院感染管理质量

医院感染管理是医院管理的重要内容，是医疗质量管理的重要环节，河南南阳眼科医院经过探索与实践，逐步完善了系统化的医院感染管理体系，感染管理质量逐步提高，对保证医疗安全起到重要作用，现将具体做法总结如下：     

ISO9000在手术室安全管理中的应用研究

目的探讨和建立控制手术室安全隐患的质量管理体系。方法将ISO9000质量管理标准应用在手术室安全管理中，通过评估、计划、实施、检查、改进五个环节使护理工作达到制度化、程序化、规范化、标准化。结果护理工作质量明显提高，医生的满意度达97％，病人的满意度达99％。结论以ISO9000质量管理为标准而建立的手术室安全管理体系对护理工作中的安全隐患起到了积极的预防作用。更重要的是提高了医生和病人的满意度。     

论本科教学质量管理体系的构建

教学质量是高校生存和发展之本。教学质量管理的目的，既要证明已经取得的“质量”，更重要的在于持续不断地改进学校人才培养活动的效果，不断提高高校人才培养活动满足社会需要的能力，实现教学质量的“动态管理”和“逐步提高”。高等学校教学质量管理体系是对教育教学工作进行全方位、全过程以及全员性质量管理的一套操作系统，是保障高等学校教育教学质量不断提高的有效机制。近年来，我国部分高校在如何构建本科教学质量管理体系方面进行了一系列富有成效的探索，但与科学完善的教学质量管理体系的建立还有一定的距离。笔认为，     

制药企业质量管理体系的探讨

有效的质量管理体系对于保证药品的质量,确保人民群众的用药安全是非常重要的。在通过GMP认证之后,如何不断地完善和改进既有的质量管理体系是目前制药企业普遍面临的重要问题之一。本文分别从组织机构和员工培训、文件管理、质量管理程序及制度、验证等四个方面进行了探讨。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.