减少一次性医用耗材系统性浪费的研究

目的：研究一次性医用耗材在医院的发放、请领、使用及收费等管理环节的现状,找出在系统性浪费上存在的问题和漏洞,通过组织行为的改进,有针对性地解决一次性医用耗材在医院传统管理中存在的问题,减少浪费,提高精益化管理水平,为使用监管提供抓手。方法：运用鱼骨图、循证管理等方法,找出主要问题,借鉴精益化管理思路,提出优化管理方案。结果：重新研发了信息化管理软件系统,并对现行的管理流程和方法进行了优化,使一次性医用耗材在医院临床请领、临床二级库管理、医护人员诊疗使用以及患者出院计费流程中形成数据信息的闭环管理,实现医用耗材的流量、流向管理,有效堵塞浪费和监管漏洞。结论：基于临床路径管理的信息化管理软件设计及与之配套的管理流程和方法的优化,可以实现医院一次性医用耗材的精益化管理,助力国家新医改战略。     

医用耗材临床使用环节精益化管理和实现途径

在医院的日常医疗活动当中医用耗材占据着十分重要的地位和比例，各项医疗活动都离不开医用耗材，所以做好医用耗材的管理工作是尤为必要的。医用耗材的管理工作属于医院后勤的主要管理内容，从目前的情况进行分析，可以看出在医院的医用耗材管理方面还存在着诸多的薄弱环节，所以本文主要深入研究医院的医用耗材管理中所存在的相关问题，并试着提出提高医用耗材临床使用环节的精益化管理的策略和实现的途径等，以期待所得的结果可以为医院的医用耗材管理工作提供科学的参考。     

基于供应链管理模式的骨科植入性耗材创新管理模式

近几年来，医用耗材精益化管理模式逐渐在全国兴起，针对种类众多、规格繁杂的骨科耗材，该模式能较好地满足医院精细化高质量管理需求。介绍了在医用耗材供应链管理模式下骨科植入性耗材的创新管理模式，阐述了其管理流程及管理创新点，为各医疗机构骨科耗材管理提供思路和借鉴。     

基于SPD模式的医院医用耗材管理信息化建设

为转变传统医院医用耗材的粗放管理模式,医院通过搭建信息化物资管理平台,创新性地将供应商和医院、信息系统和智能设备、临床需求和专业运营相结合,最终形成了以供应链一体化思想为指导、以供应链管理理论和信息技术为支撑的精益化SPD管理系统。实现了耗材流转全程信息化追溯、院内智能化服务、消耗结算精细化管理。SPD在医院的应用,是医院信息化建设的重要组成部分,有效地提升了医用耗材管理的信息化水平和整体运营效率。     

UDI在医用耗材物联网中的应用价值探讨

目的探讨通过建立医疗器械唯一标识,促进和提升医疗器械全生命周期精益化管理。方法依托国家深化医疗器械UDI系统建设,总结上海试点植入性器械经验,探讨UDI在医用耗材精益化管理的应用。结果通过对植入性医疗器械UDI应用现状分析,进一步加强UDI应用规范性来提升UDI在医疗器械物联网的应用价值。结论通过建立更加规范、有效的医用耗材UDI流通体系,形成医疗器械全生命周期的互联互通互认,降低国家在产品成本和资源消耗中的投入。     

基于精益化管理的医院文化建设

精益化管理来源于企业管理,既是一种管理方式,又是一种理念,一种文化,其最终目标是追求完美,追求卓越。引入精益化管理,可以创新医院文化,丰富医院文化内涵,激活传统医院文化的内在活力,为医院的可持续发展提供原动力。     

基于SPD供应链的医用耗材管理应用效果多视角评估

目的 用SPD供应链理论、信息化物流管理手段开展医用耗材的精益化管理,提升管理质量,保障管理安全,降低管理成本.方法 收集我院推广SPD项目前后的医用耗材库存数据、医务人员耗材管理劳动强度数据、耗材采购效率数据,分析评估项目实施的效果.结果 项目上线后中心库月均库存金额增幅低于月均出库金额增幅,周转率增长1.71％;每...     

以精益化管理深化医疗服务质量建设

质量是医院管理永恒不变的主题。精益化管理的核心就是优化流程,减少浪费,提高效率,节约成本,以精湛的医术,为病人提供安全、有效、便捷、价廉的服务。推行精益化管理必须确立精益化管理的理念,必须坚持以病人为中心,必须以改变粗放式管理为前提,必须把提高人的职业素质摆在首位,必须树立质量第一的发展主题。     

浅析医用耗材管理存在问题及对策

医用耗材的管理和使用是医院医疗质量管理中的重要环节, 加强耗材的管理不仅是医院医疗质量管理的完善,也是医院面对医疗纠纷时的一种自我保护.本文就根据医用耗材的特点与国有大型医院的实际情况相结合,对医用耗材管理存在的问题进行分析,探讨如何进行规范性管理,并提出一些建议.     

新形势下医用耗材的管理

医用耗材的管理是医院质量管理中的重要环节,加强医用耗材的管理不仅体现了医院医疗质量管理的完善,也是医院面对医疗纠纷的一种自我保护。本文就医用耗材管理存在的问题,提出了可行措施,并提出了一些建议。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.