质量持续改进循环管理法在加强护理过程风险管理中的应用

目的:探讨质量持续改进(PDCA)循环管理法在加强护理过程风险管理中的应用效果.方法:2014年1月~2015年1月,心内科护理单元在护理过程分险管理中应用PDCA循环管理法.结果:应用PDCA循环管理法,有效提高了护理过程风险管理.结论:PDCA循环管理模式通过评估风险,分析原因、实施防范、控制检查、巩固成果并处理遗留问题,使护理过程分险管理持续改进提高.     

PDCA循环在门诊护理服务持续质量改进中的应用效果观察

目的探讨在门诊护理服务持续质量改进中应用PDCA循环的效果。方法在我院门诊护理人员中选取24名护理人员进行本组研究,2016年5月到2017年5月未实施PDCA循环模式,2017年6月到2018年6月期间实施PDCA循环模式。对比实施前后护理人员的操作合格率和各项指标满意度评分。结果实施后护理人员的操作合格率和各项指标满意度评分相比于实施前较高,组间数据对比存在显著差异性,有统计学意义(P0.05)。结论在门诊护理服务持续质量改进中应用PDCA循环模式,可使护理人员重视护理工作中的各项操作,且得到患者的认可。     

质量持续改进管理法在病区护理质量管理中的应用

目的:探讨质量持续改进循环管理法在内科系统护理质量管理中的应用.方法:2012年1月~2014年1月,本院病区质量管理应用质量持续改进(PDCA)循环管理法.护士长学习掌握质量持续改进循环管理相关理论知识,并具备实践应用能力,同时对本科全体护士培训学习掌握循环管理法相关理论知识和实践模拟应用能力.结果:通过2年的应用,有效提高了病区护理质量和患者满意度,同时提高了护理人员自我质控和管理能力.结论:质量持续改进(PDCA)循环管理模式通过分析问题、确定目标、制定计划、实施执行、控制检查、巩固成果并处理遗留问题这几方面,使护理质量改进形成螺旋式,不断地循环上升,持续改进.PDCA循环管理模式是提高护理质量管理的基本工具.     

PDCA循环在病区药品管理中的应用效果分析

目的：对比PDCA循环在病区药品管理中应用前后的数据,探讨PDCA循环在病区药品管理中的应用。方法：按照PDCA循环理论,制定实施整改措施,及时检查整改效果,分析检查结果。结果：PDCA应用后病区药品管理达标率提升,病区药品管理更为规范。结论：PDCA循环有助于医院病区药品管理的持续改进。     

PDCA 循环在门诊医疗质量管理中的应用探讨

目的：探讨在门诊医疗质量管理中应用 PDCA循环的效果。方法自2015年2月在我院门诊医疗质量管理中开始施行 PDCA 循环,即计划—执行—检查—处理,对护理工作进行管理。结果相比于 PDCA 循环实施前,实施后门诊患者数量明显增多,预约时间和等候时间缩短,有效投诉事件数量减少,医护人员的满意度明显提升,差异均有统计学意义（P<0.05）。结论在门诊医疗质量管理中应用 PDCA 循环管理能够增加就诊例数,缩短患者预约与等候时间,降低投诉事件的发生概率,另外还可以提升医护人员的满意度,值得推广。     

PDCA循环在我院门诊药房麻醉药品管理中的应用

目的探讨PDCA循环管理模式应用于我院门诊药房麻醉药品管理中的效果。方法:药品质量管理小组每月对门诊药房进行麻醉药品管理质量检查找出存在问题并分析原因,再采用PDCA进行循环质量持续改进。结果:观察组麻醉药品针剂处方合格率明显高于对照组,差异有统计学意义(P<0.05),麻醉药品使用登记本情况明显优于对照组,差异有统计学意义(P<0.05)。结论:PDCA循环应用于门诊药房麻醉药品管理中效果显著,可有效提升管理水平,确保麻醉药品使用的安全性、合理性。     

国家临床重点专科医疗质量管理中PDCA应用与思考

临床科室的发展以医疗质量为根本。为了促进科室医疗高质量发展，运用PDCA循环管理方法，全面、有序地对医疗质量进行管理。以非计划二次手术管理为例介绍PDCA循环管理的实践效果，科室医疗质量相关指标稳步提升；应用PDCA循环管理方法促进了科室医疗质量管理水平的提升，持续改进了科室医疗质量。     

PDCA循环在护理人员手卫生中的应用

目的:探讨PDCA循环管理在护理人员手卫生中的应用效果。方法:随机选取13个易发生医院感染的重点科室的86名护士作为研究对象,应用PDCA循环管理对护理人员手卫生进行持续质量改进,观察实施前后的效果。结果:实施PDCA循环管理后,护理人员的手卫生质量状况显著改善,手卫生知识知晓率由干预前的65.1%上升至干预后的95.3%,手卫生依从率由干预前的70.9%上升至干预后的91.9%,差异均有统计学意义(P<0.01)。结论:应用PDCA循环管理进行持续质量改进,可有效提高护理人员手卫生质量状况。     

PDCA循环在临床路径和持续医疗质量改进中的应用

目的 探讨PDCA(PDCA)循环在小儿腹股沟斜疝临床路径及持续医疗质量改进中的应用价值.方法 选取小儿腹股沟斜疝患儿2 189例,实施了3个PDCA循环的阶段性改进,即进行计划(P)、实施(D)、查核(C)、行动(A)循环,比较实施前后平均住院天数、抗菌药物使用率及费用、患者满意度的差异,寻求一种最优化的临床路径,并将其标准化.结果 实施PDCA循环来管理小儿腹股沟斜疝的住院治疗,明显缩短了住院天数,全程不使用抗菌药,降低了药费,提高了患者的满意度,医疗质量持续提升.结论 应用PDCA循环有利于确立最合理的小儿腹股沟斜疝临床路径,优化诊疗过程,在医疗质量的改进中起到积极的作用.     

运用PDCA循环促进基层医院消毒供应质量持续改进

目的分析探讨运用PDCA循环促进基层医院消毒供应室质量的持续改进。方法有效的运用PDCA循环管理对消毒供应室实施科学的管理。结果 PDCA循环应用后取得了更佳的效果,应用PDCA循环后的效果明显优于应用前,差异有统计学意义(P0.05)。结论有效的运用PDCA循环在促进基层医院消毒供应室质量持续改进的过程中取得了良好的成果,科学的改善了其传统的管理模式,提高了各项消毒灭菌的合格率,有效的阻止了其相关疾病的传播。有较高的应用价值,值得广泛推广。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.