精神病专科医院危急值项目报告现状与评估分析

目的了解徐州市东方人民医院检验科危急值报告频率及科室分布情况,对危急值报告进行总结、评估,持续改进。方法通过Lis信息系统查询检验科报告的危急值病例,统计年内发生率,项目分布、病区分布。结果一年内共报告危急值总例数是358例,年内总发生率为0.143%。危急值发生率排前3位的是血锂、血糖、钾,构成比排在前3位的项目分别是血糖、钾、氯。排在前3位的科室分别是七病区(老年二科)、门诊、一病区(老年一科)。结论通过对危急值报告的评估,采取适当的措施对危急值报告项目和报告范围进行持续改进,可提高危急值报告的有效性。     

危急值电子报告系统的临床应用分析

目的探讨危急值电子报告系统的临床应用价值。方法通过医院信息管理系统(eHIS)查询2015年8月1日至2016年1月31日的危急值数据,分析危急值的发生率、项目分布和科室分布。结果共报告危急值3 405项,危急值发生率为0.45%;危急值报告数量排前5位的分别是血氯(25.76%)、磷酸肌酸激酶同工酶(19.97%)、血钠(9.43%)、血小板计数(9.05%)和二氧化碳分压(6.40%);危急值报告数量前5位的科室分别是心血管内科病区(18.94%)、神经重症医学科病区(12.04%)、重症医学科(9.52%)、神经外科二病区(5.11%)和血管神经病区(5.02%);危急值报告的中位数时间降低了33.33%,四分位间距时间降低了40.00%。结论危急值电子报告系统的使用,降低了危急值报告所用时间,提高了危急值报告的及时性和准确性,对于保障医疗质量具有重要意义。     

医学检验危急值报告评估分析与持续改进

目的对检验科1年来危急值报告数据进行评估分析,为持续改进危急值报告制度提供科学依据。方法通过实验室信息系统(LIS)系统,统计2014年的危急值项目及结果数据,经数据处理,计算出危急值项目的发生率、临床科室分布、天内分布、周内分布、评估危急值范围。结果该院检验科医学危急值项目17项,报告共5 066例,危急值报告的发生率是1.86%,出现率最高的项目是钾,占危急值报告总量的13.48%,其次是血小板(10.09%)和血肌酐(9.08%);危急值报告集中在9:00~13:00,占全天46%左右;每周一危急值报告最多,周日较少;危急值报告最多科室是ICU,占危急值报告总量的28.37%,其次是肾内科(16.86%)和血液科(12.16%)。结论急值报告制度需要不断进行总结、分析,加强与临床沟通,共同探讨,持续改进,才能提高检验科与临床的满意率。     

某院危急值的临床分析及持续改进

目的通过该院危急值项目的报告频率、发生年龄、临床诊断及科室分布情况,探讨危急值的重要性和改进方向,探讨危急值改进的效果。方法用描述性统计方法对该院2016年全年报告的危急值项目及科室分布、种类、年龄、病种等情况进行分析。结果全年危急值共5 384例,危急值占总标本比率为0.49%,危急值项目前5位分别是:白细胞、血小板、凝血酶原时间(PT)、细菌培养、氧分压(PO2),科室分布前5位分别是:妇瘤科、内科、放疗科、肿瘤内科和门诊。危急值好发年龄段在41~60岁,患者诊断前5位分别是:肺癌、宫颈癌、乳腺癌、恶性淋巴瘤、鼻咽癌。结论对危急值制度的不断改进,促进实验室与临床联系,就能更好的救治患者、提高实验室及临床工作效率,不断提高医疗质量水平。     

某医院检验科危急值项目评估分析

目的了解某综合院检验科危急值项目报告的频率及科室的分布情况,对检验科危急值进行评估分析。方法通过查询检验科危急值报告实验室信息管理系统,对某院2012年检验科产生的危急值数量、科室来源等进行统计分析。结果报告检验科危急值数量为11003例,危急值发生率为0.45%,构成比前4位的是血小板(PLT)、凝血酶原时间(PT)、血肌酐、血K+;报告危急值项目前4位为PT、国际标准化比率(INR)、PLT、血K+;报告危急值最多的科室前3位为儿科,监护室一区、二区,急诊科。结论通过评估分析,采取适当措施对危急值项目及范围进行整改,可以有效提升检验科危急值报告的实用性,提升临床工作效率。     

医学检验科危急值报告现状分析与管理

目的统计检验科危急值报告情况,分析我院危急值发生状况,为危急值报告的管理及持续改进提供依据。方法利用瑞美实验室信息系统(LIS)统计检验科2017年1月至2017年12月发生的3587例危急值,对危急值项目的发生率、科室分布、时间分布、标本类型等进行分析,并提出持续改进意见。结果医院2017年发生率为0.48%,危急值排名前五位的项目分别是:肌酐(CR)、活化部分凝血酶时间(APTT)、钠(Na)、钾(K)、白细胞计数(WBC)。发生危急值最多的科室是肾病学科、ICU血液肿瘤科,一天中危急值发生高峰时段为9:00至15:00,低峰时段为凌晨1:00至7:00。一周中分布规律为周一至周五较多,周六、周日相对较少。从标本类型分:住院危急值最多,门诊危急值最少,生化危急值最多,其次为血液分析。结论加强重视对危急值的管理,不断完善危急值项目和范围,解决危急值报告的影响因素,保证快速、高效的将危急值结果报告给医护人员,以提高实验室的服务质量和保障患者安全。     

检验危急值报告现状与分析

目的了解该院检验科危急值报告现状,为危急值报告的规范化管理提供参考依据。方法利用东软实验室信息系统(LIS)对2014年11月至2015年3月检验科各危急值的发生率、危急值发生频度天内分布、危急值发生频数的周内分布、科室分布、危急值登记的合格率进行回顾性分析。结果危急值发生率危急值发生频数排前3位的检测项目依次为cTnI、WBC和PLT,各项目所占比例分别为32.12%、15.07%、12.09%。危急值发生频数天内分布主要集中在00:06~17:59,占危急值报告总数的77.1%。周内分布以周一较多,周末较少,其余各天相差不大;危急值发生频数排前3位的科室依次为ICU、感染性疾病科、急诊内科,发生次数分别为771、477、460;危急值报告总的合格率为99.10%。结论应联系临床进一步调查和评估目前检验科危急值报告的有效性,对危急值项目、范围及危急值报告制度做持续改进。     

cTnI、WBC的危急值报告现状深入分析

目的了解该院检验科肌钙蛋白I(cTnI)和白细胞(WBC)危急值报告现状,为完善危急值报告制度提供参考依据。方法利用东软实验室信息管理系统(LIS)系统统计检验科cTnI和WBC危急值的发生率及科室分布、cTnI危急值的范围分布情况。结果共发生危急值10 179例次,发生率占前两位的项目为cTnI、WBC,占全部危急值的47.07%;cTnI以内科及内干科居多;WBC以重症监护室(ICU)及儿科居多:cTnI危急值范围以小于0.5ng/mL的居多。结论应联系临床进一步调查和评估目前cTnI和WBC危急值报告的可靠性,并制定合理有效的危急值报告范围。     

个性化检验危急值实施后漏报情况的调查研究

目的不断减少危急值漏报,避免发生因危急值漏报所致临床患者诊疗的延误,维护患者安全。方法依照该院不同科室个性化检验危急值报告管理规定,对照该科室急诊检验组2013年危急值报告记录,对该科室在实施个性化危急值报告后的危急值漏报率、漏报项目及科室进行分析。结果该科室急诊检验组实施个性化危急值报告的漏报率从前期的32.17%下降到0.26%。该科室改进前后危急值漏报项目从14项减少为10项。改进后危急值漏报前3位的项目为血红蛋白(Hb)、肌钙蛋白T(cTnT)、血钾(K+)。漏报科室前3位的依次为消化科(49%)、呼吸科一科(9%)、肿瘤科和干部疗养科(均占8%)。结论本科室个性化检验危急值报告管理持续改进方法有效,能不断减少危急值漏报,维护患者安全;另外,漏报率前3位的项目及科室也需要提醒工作人员提高警惕,避免漏报。     

综合医院临床生化危急值的统计分析

目的 了解综合医院临床生化危急值项目报告的频率及科室分布情况.方法 通过查询生化危急值报告登记本和临床实验室信息管理系统,对某院两年报告的生化危急值的项目和科室来源进行统计分析.结果 共报告生化危急值5528项,危急值的发生率0.34％,报告生化危急值项目前五位为:肌酐、氧分压、血钙、血钾、血糖.报告科室前5位为:中心ICU、肾内科、急诊科、呼吸内科、小儿科.结论 通过回顾分析危急值报告的数据,采取适当措施,可以提升实验室及临床的工作效率,满足医疗的安全要求.     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。