医院外科门诊退换号成因及改进措施

目的探讨三级综合医院外科门诊退换号的成因,提出改进措施,为三级综合医院降低退换号率提供借鉴。方法回顾分析外科门诊2013年12月2~29日的退换号量,对比同期全院门诊退换号总量,对患者退换号原因进行手工编码,分别统计前12位的原因,并对退换号的原因进行调查研究,分析不足之处并实施对策。结果外科门诊退换号率为10.1%,造成退换号的首位原因是候诊时间长,占18.2%;其次是挂号人员失误和改换专家号,分别占全部就诊原因的16.2%和15.6%,对比全院同期门诊退换号总量6.9%相对较高。结论医院应建立规范的退换号管理制度,加强挂号人员、预检分诊人员及出诊医生的多方管理培训,提高外科门诊医疗服务质量。     

疑难病例会诊在门诊诊疗服务中的作用

门诊是医院救死扶伤的重要阵地,是每个患者诊疗过程的必经之路.门诊的科学管理才能适应医疗发展的需要.我院是江苏省医疗、教学、科研的中心,年门诊量达300万人次,门诊工作量大,分诊任务繁重,我院高级专家会诊中心疑难病例会诊在门诊诊疗服务中发挥着重要作用.门诊导医台成立了疑难病例会诊咨询联系处,设专人咨询分诊,对3次门诊不能明确诊断或涉及2个专科以上疾病需要制定综合性诊疗方案的患者,直接与专家会诊中心联系,这一举措对提高门诊诊疗服务质量,有效分流患者起到了积极的作用,方便了患者,提高了医院的社会认知度.本文回顾性分析疑难病例会诊的临床资料及效果,报道如下.     

电子叫号系统在门诊分诊中的应用

随着新形势的发展,我院门诊于2011年应用了门诊分诊叫号系统.至今已两年多,极大地改变了我院门诊就诊秩序,使患者得到了一个良好的就诊环境和优质的护理服务,分诊护士满意度达98.8％. 1 门诊工作特点及以往门诊分诊方法 门诊是医院医疗服务工作中的一个重要组成部分,是医院面向社会的重要窗口,每天接待大量的患者及其家属,分诊任务繁重.以往的门诊对于就诊的患者,挂号后将挂号单及病历本交给分诊护士,分诊护士手工按挂号时间编号、排序,然后按序呼叫患者进行就诊.在传统的管理模式下,就诊高峰期,患者候诊时间长,常常造成分诊台、候诊厅人声嘈杂,人员拥挤,患者反复询问是否轮到自己了,部分患者因各种原因要求提前就诊,门诊秩序混乱.     

门诊护理服务满意度的调查与分析

目的分析门诊护理服务满意度的调查结果以及解决影响患者服务满意度的相关对策。方法采用医院自制调查表对2015年1月至2015年5月来我院门诊就诊的560例患者进行调查,分析本次调查结果。结果 560例门诊患者对门诊护理服务综合评价满意率为96.07%,其中护理人员操作技能满意率为98.93%,仪容仪表满意率为96.43%,护理人员语言及态度满意率为95.89%,就医环境满意率为94.82%,耐心回答患者问题满意率为93.75%,护理人员协助患者解决困难满意率为92.68%,候诊时护理人员主动关心满意率为91.25%。结论我院通过对门诊就诊者护理服务满意度调查可知,门诊护理服务总体评价基本是满意的,但其服务态度上还需进一步改进。     

医院门诊分诊准确率的影响因素及对策探讨

目的分析并总结医院门诊分诊准确率的影响因素,在提高门诊分诊准确率与服务质量的前提下,增强医院门诊分诊导诊的服务效率,最终构建一个方便、快捷、有序、和谐的就诊环境。方法回顾性分析淮安市第一人民医院自2009年12月—2010年11月期间的400 691人次的门诊分诊资料,对400 691人次中存在的总分诊失误的42 879人次的影响分诊准确率的相关因素进行统计分析。结果本研究中共进行门诊分诊400 691人次,其中总分诊失误有42 879人次,本组对42 879次分诊失误的影响因素进行了归类与统计分析。结果表明患者与家属因素造成分诊失误率位于第一位,占31%(13292/42879),其次是疾病因素28%(11577/42879)和医护人员因素23%(10291/42879),最后是医院管理因素18%(7719/42879)。结论患者与家属因素、疾病因素、医护人员因素以及医院管理因素都会影响医院门诊分诊准确率,提高护理人员业务素质,加强对疾病因素的分析,完善医院管理,能够有效减少分诊失误率。     

药品零差率销售政策实施对中心城区社区居民就医影响的逐年变化

目的研究药品零差率销售政策的全面实施,对中心城区社区居民就医影响和政策实施效果。方法随机选择来本社区卫生服务中心及下属服务站就诊的居民,采用自制问卷进行调查,内容:门诊患者对药品价格和药品种类的满意度,均次处方药费和人均就诊次数变化,以及就医意向选择等。每季度调查1次,收集数据并采用SPSS19.0软件进行分析。结果药品零差率销售政策实施后,社区居民对药品价格的满意率从61.26%⁷1%(P=0.000),对药品种类满意率从56.30%71%(P=0.000),对药品种类满意率从56.30%⁵3.00%,不满意率43.70%至47.00%(P=0.05);2012年和2013年门诊处方均次费用和人均就诊次数比较无明显差异(P>0.05);患者就医意向有所改变。结论随着药品零差率销售政策的实施,社区居民对药品价格的满意率逐年提高,但对药品种类满意率有下降趋势;门诊处方均次费用和人均就诊次数逐年比较无明显差异;中心城区社区居民就医意向逐渐向"大病去医院,小病在社区"转变。     

上海郊区二级医院合理用药国际指标调研

目的:了解上海市郊区二级医院合理用药状况,探讨促进合理用药水平提高的措施。方法:随机选择上海市郊区6家二级医院6个月的门诊处方和一个月内的门诊就医患者,现场调查WHO推荐的合理用药指标。结果:处方指标中平均用药品种数为2.7种,抗菌药物的使用比例为43%,针剂的使用比例为25.4%,医院药品目录使用比例为66.6%。患者关怀指标中平均就诊时间为8.67min,药品平均调配时间为24.9s,药物标示完整率为89.2%,患者了解药品正确用法率为88·3%,患者对医疗全过程的满意率为79.2%。结论:上海市郊区二级医院处方平均用药数、抗菌药物使用比例偏高,合理用药水平有待提高,医师、药师对患者的交流关怀有待进一步加强。使用合理用药国际指标来评价和比较不同医疗单位用药状况具有可操作性。     

医院静点观察室护理工作体会

静脉输液是疾病治疗中的重要环节,也是医院静点观察室护理人员每日工作不可缺少的内容。我院是三级甲等综合医院,承担着吉林地区大部分患者的医疗救治及护理工作,平均每日门诊就诊患者达2000余人次,门诊静脉输液患者达200～300人次,笔者在从事静点观察室护理管理工作中,最先思考的问题就是如何提高静点观察室护士的素质及服务质量,进而让来静点观察室的每一位患者都满意,促进疾病早日康复,现将点滴体会汇报如下。     

门诊预检分诊宣教系统在工作中的应用

目的 探讨预检分诊宣教系统在门诊工作中的作用.方法 利用录音广播、语音广播、屏幕滚动和一对一宣教等多种方式相结合的预检分诊宣教系统对门诊患者进行健康教育.结果 预检分诊室教系统应用后患者满意度、就诊流程和健康常识知晓率较实施后明显提高,差异均有统计学意义(P<0.05).结论 预检分诊室教系统在门诊工作的作用,在方便患者就医的同时,增长了患者的健康常识,提升了患者和家属对医院的信任度.     

不同级别医院2型糖尿病患者门诊用药合理性分析

目的了解不同级别医院门诊2型糖尿病患者的用药合理性。方法按入院前主要就诊门诊的医院级别的不同,92例2型糖尿糖高血压肥胖住院患者分为,A组43例,一级医院就诊为主,B组49例,二级或三级医院就诊为主。通过询问和查阅门诊病历,统计比较两组入院前门诊各种治疗方案的患者比例。结果B组较A组,单用磺脲类方案比例低(8.2%vs 39.5%),含非磺脲类方案比例高(91.8%vs 60.4%),含二甲双胍方案比例高(85.7%vs 48.8%),含ACEI和(或)ARB方案比例高(81.6%vs 46.5%),阿司匹林方案比例高(83.7%vs 41.9%),P<0.05。结论二级或三级医院门诊2型糖尿病患者的用药较合理。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.