精益管理在提高麻醉恢复室工作效率中的应用

目的探讨精益管理在提高麻醉恢复室工作效率中的应用效果。方法按照精益管理的方法对恢复室进行评估、分析,通过流程的改造和优化后,对精益管理前后PACU入室率、患者在恢复室的停留时间等情况进行效果评价。结果 2015年实施精益管理后,全麻气管插管手术患者PACU入室率较前明显增加(P0.001);患者在PACU平均时程由61min缩短到45min,45min以内完成恢复室流程的患者比例明显增加(P0.001)。结论应用精益管理能有效地提高麻醉恢复室的工作效率。     

结合移动在线技术的全流程信息化管理在健康管理中心的应用

目的观察全流程信息化管理在健康管理中心的应用效果。方法结合移动在线技术,通过体检前预约、体检中智能导检及个性化问诊、体检后远程结果获取与联网随访,建立与实施全流程信息化管理,优化体检服务流程。结果应用全流程信息化管理后,检前登记办理时间从20.00(17.00,24.00)min缩短到8.00(7.00,9.00)min,体检时间从3.00(2.40,3.10)h缩短至2.00(1.33,2.10)h,总检结束时间从8.00(6.00,9.00)d缩短为3.00(2.00,4.00)d;体检客户满意度由92%上升到97%,差异均有统计学意义(P0.05)。结论应用全流程信息化管理缩短了体检各环节时间,客户满意度上升。     

运用精益管理优化中心药房工作流程

目的对中心药房工作流程进行优化，提高工作效率和服务质量。方法运用精益管理模式对中心药房工作流程、工作环境和管理进行优化。结果流程和资源配置优化后，取药时间明显缩短，药品过期和破损率降低，工作效率、发药准确度以及病区医生、护士及患者满意度明显提高，医院用药安全及医疗质量得到大幅提升。结论精益管理是一种行之有效的科学系统管理方法，值得在医院药事管理中推广应用。     

精益管理在一次性无菌物品供配流程中的应用

[目的]探讨精益管理在一次性无菌物品供配流程中的应用效果。[方法]应用精益管理中的"可视化管理"工具改善物品存放环境;应用精益管理中的"面条图"工具改善备物流程;应用精益管理中的"价值流程图"工具优化下送流程。[结果]改进前后备物时间、下送时间、盘点时间比较差异有统计学意义(P<0.01)。[结论]精益管理能加快一次性无菌物品配送速度,提高工作效率。     

肝胆外科日间手术管理流程优化的应用效果分析

目的:探讨肝胆外科日间手术管理流程优化的应用方法与效果。方法:将2019年2月1日～7月31日103例腹腔镜胆囊切除术(LC)患者作为对照组,采用常规患者入院流程;将2019年8月1日～2020年1月31日117例LC患者作为观察组,实施优化的日间手术管理流程。比较两组干预效果。结果:观察组当日手术取消率、15 d内再入院率、非计划性延迟出院率、出院后患者电话咨询率均低于对照组(P0.05),术前平均等待时间短于对照组(P0.05);观察组患者满意度高于对照组(P0.05)。结论:优化的日间手术管理流程应用于LC患者,能有效缩短患者术前等待时间,降低患者当日手术取消率及非计划性出院情况,缓解患者围术期及出院前后的焦虑情绪,提高患者的依从性和满意度。     

精益管理在提高患者出院满意度中的应用实践

总结精益管理在提高患者出院满意度中的应用体会。根据精益管理的理念,调查原出院流程,找出患者出院等待时间长的原因为医嘱开具时间不妥、护士操作系统不够先进、药房配发药方式欠合理、出院宣教方式较单一、出院缴费窗口太少,分析原因制定计划性出院措施、创新出院宣教方式、改良配药及发药方式、医嘱自动计费审核和床边结算等一系列精益管理手段优化出院流程。通过对出院流程实施精益管理,患者办理出院等待时间由2015年下半年的(3.77±2.26)h缩短到2017年上半年的(3.33±2.20)h,患者出院满意度由2015年第4季度的86.9%提高到2017年第2季度的90.6%。     

应用精益管理改进病区被服换洗流程

目的探索精益管理在改进病区被服换洗流程中的应用效果。方法成立改进小组,利用精益管理改进工具,绘制流程图,分析原因,找出病区被服换洗流程改进点,制定改进方法,再绘制新的流程图,分批在试点科室运行。结果洗衣房每日完成所有下收时间由改进前的63.2±15.4 min下降为48.4±15.1 min;改进前病房护士在洗衣房下收时配合清点平均时间为9.5±2.9 min,改进后下降为0min,改进前后比较,差异有统计学意义(t值分别为0.04,-3.38;P<0.05)。结论精益管理可以优化、简化医院流程,建议在医院持续改进中应用。     

麻醉门诊规范化管理的实施与成效

目的 探究麻醉门诊规范化管理的实施与成效.方法 自2019年7月开始对麻醉门诊流程进行优化,以规范化管理为目标进行整改,内容包括增设麻醉门诊护士岗位;规范职责,改善就诊环境,动态调整岗位工作时间,规范就诊流程,充分利用现代信息技术提供智能化导诊服务.统计实施前的2019年1-6月(对照组)和实施后的2019年7-12月(优化组)麻醉门诊患者平均候诊时间、门诊日接诊量、相关投诉率,采用问卷调查法,了解麻醉门诊患者的满意度.结果 优化组的平均候诊时间明显缩短,日就诊量显著提升(P＜0.001);患者满意度显著高于对照组(P＜0.001);相关投诉发生率低于对照组(P＜0.001).结论 实施麻醉门诊规范化管理,增设护理岗位,能够有效提高医疗服务质量,缩短患者候诊时间,提高医疗资源利用率,减轻医生平均工作时间,提高患者满意度.     

基于信息技术的精益管理对手术室护理人员工作效率的影响研究

目的探讨基于信息技术的精益管理对手术室护理人员工作效率的影响,为提高手术室护理人员工作效率提供相关参考。方法在基于信息技术的基础上优化手术室工作流程和软硬件设施,增设术前访视及术后回访专职护理人员,优化绩效考核机制,并通过手术室麻醉信息系统统计各时间节点。比较精益管理前(2018年5月—2018年11月)与精益管理后(2020年5月—2020年11月)手术室平均首台准点开台数、延迟手术数、接台间隔时间、临时停手术数、护理管理工作质量、消毒隔离质量、护理文件书写质量、患者及手术医生满意度的差异。结果与精益管理前比较,精益管理后手术室首台准点开台率提高,平均接台手术时间缩短,延迟手术数和临时停手术数降低,护理管理质量、消毒隔离质量、护理文件书写质量提高,患者及手术医生对护理工作的满意度提高(P<0.05)。结论基于信息技术的精益管理可加快手术运转,增加手术间利用率,提高手术室整体工作效率,并能提高手术医生和患者的满意度。     

六西格玛管理对医院静脉药物集中调配中心化疗药物配制质量的控制

目的探讨六西格玛管理对医院静脉用药调配中心化疗药物配制质量的控制效果。方法应用精益六西格玛法定义、测量、分析、改进与控制等步骤,优化静脉用药调配中心化疗药物配置流程。结果静脉用药调配中心化疗药物的审方时间、排药时间、配置时间缩短(P<0.01);不合格医嘱及差错率下降(P<0.01或P<0.05);肿瘤用药相关医护人员满意度提高(P<0.01)。结论精益六西格玛管理优化了静脉用药调配中心化疗药物的配置流程,提升了配置效率和配置质量。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.