运用品管圈降低颅脑外伤患者便秘发生率

目的探讨品管圈(QCC)活动在降低颅脑外伤患者便秘发生率的作用。方法江门市新会区人民医院神经外科在2017年4-12月期间开展实施QCC活动,将2017年9-10月收治的颅脑外伤患者117例作为观察组;将2017年4-6月开展QCC之前收治的颅脑外伤患者152例为对照组;成立QCC活动小组,确立"降低颅脑外伤患者便秘发生率"为活动主题,分析颅脑外伤患者发生便秘的原因,提出改进对策并予以实施;最后进行对策标准化处理。结果开展QCC后,颅脑外伤患者便秘发生率由32.8%下降至改善后11.1%,差异有统计学意义(P0.05)。结论 QCC活动在降低颅脑外伤患者便秘发生率方面效果明显,能有效提高护理质量,提高护士科学应用质量管理工具的能力,减轻患者痛苦,提高患者满意度。     

肠内营养在溃疡性结肠炎治疗中的应用

目的:研究EN支持在溃疡性结肠炎(UC)治疗中的适应证、耐受性、不良反应和疗效.方法:回顾分析220例活动期UC病人,有85例应用EN支持.结果:应用EN支持者,全结肠型占(70.6%)明显多于左半结肠型(18.8%)、直肠乙状结肠型(9.4%)和直肠型(1.2%);重度(56.5%)多于中度(32.9%)及轻度(10.6%).EN组病人BMI<18 kg/m2比例明显高于对照组(P<0.05);ALB水平(28.91±6.64)g/L低于对照组(36.03±6.59)g/L.不同类型EN制剂增加至3 347 kJ/d时间无显著性差异(P>0.05).在不良反应中,腹泻的发生率为14.1%,占所有不良反应的57.1%;EN组与对照组比较,激素减量时间、手术率和缓解率无显著性差异(P>0.05).总蛋白、ALB、PA水平在EN支持后有显著提高(P<0.05).结论:①对病变范围广,中、重度的UC病人,应给予充足的EN;②对存在中、重度营养不良UC病人,应补充EN;③UC病人对不同类型营养制剂耐受性无差异,腹泻是最常见的不良反应;④EN可作为UC活动期的一种辅助治疗.     

基于信息化的肠内营养耐受性动态管理对重症病人喂养效果的影响

目的:探讨基于信息化的肠内营养(EN)耐受性动态管理方案在重症病人喂养实践中效果。方法:选取浙江省人民医院ICU自2018年4月1日至2019年3月31日收治的EN病人,按入科先后分为对照组和观察组,每组各72例。对照组采用常规EN护理方案,观察组在常规EN护理基础上,实施基于信息化的EN耐受性动态管理方案。比较两组病人EN一周内喂养中断例数、第3天和第7天喂养达标率,喂养不耐受发生率,血清白蛋白、血红蛋白,机械通气时间、ICU住院时间。结果:观察组EN一周内喂养中断例数较对照组少;观察组第3天喂养达标率(58.8±13.9)%较对照组(53.6±13.3)%高,第7天喂养达标率(82.4±16.3)%较对照组(75.8±15.1)%高;观察组喂养不耐受发生率(9.7%)较对照组(40.3%)低,观察组血清白蛋白、血红蛋白指标较对照组高,ICU住院时间、机械通气时间较对照组短,差异均有统计学意义(P 0.05)。结论:基于信息化的EN耐受性动态管理方案可减少重症病人喂养中断,增加喂养达标率,降低喂养不耐受发生率,改善病人营养状况,缩短重症病人ICU住院时间,提高EN护理质量。     

品管圈在急诊科护理质量管理中的效果评价

目的探讨品管圈在急诊科护理质量管理中的实践效果。方法选取急诊科开展品管圈活动前后各120例患者作为研究对象,对两组患者护理质量效果进行对比分析。结果急诊科先后建立5个QCC小组,各小组均完成QCC活动目标值的设定,达标率为100%;开展QCC活动后科室在护理文书书写、急危重症病人护理、护士急救技术方面均显著优于活动前,护理不良事件的发生率由7.50%降至1.67%,急救物品缺陷率由13.33%降至5.00%,患者满意度由活动前91.67%增至97.5%,与活动前比较差异均有统计学意义(P<0.05)。结论品管圈活动的开展有利于护理质量的持续改进,能有效保证护理安全。     

品管圈活动对实习护生行为规范管理控制的效果研究

目的:探讨品管圈在实习生行为规范管理的应用效果.方法:运用"临床护理教学质量评分标准(实习生版)"回顾性调查某院护理实习生临床实习过程的不良行为发生率,通过确立主题、设立目标及可行性要因分析、制定对策及措施、进行效果评价及巩固措施等一系列活动,并对开展QCC活动前后的调查结果进行比较.结果:开展QCC活动后某院护理实习生不良行为发生率从73.73%下降至27.95%,活动前后比较差异有统计学意义(P<0.05).结论:QCC活动可促进护理质量的持续性改进,提高护理实习生临床工作规范.     

PDCA模式QCC活动对新生儿脓疱疮发生率及家属护理满意度的影响

目的探讨PDCA模式品管圈(QCC)活动对新生儿脓疱疮发生率及家属护理满意度的影响。方法选取河南省某医院2016年6月-2017年12月接生的51例足月新生儿作为对照组,选取2018年1月-2019年6月接收的51例足月新生儿作为观察组。对照组新生儿给予常规护理,观察组新生儿在对照组基础上开展PDCA模式QCC活动,比较2组新生儿脓疱疮发生率、家属护理满意度、观察组实施PDCA模式QCC活动前后圈成员综合能力评分。结果观察组新生儿脓疱疮发生率为0.00%,低于对照组的11.76%,差异有统计学意义(P0.05);观察组PDCA模式QCC活动实施后圈成员专业知识、团队精神、服务意识、解决问题能力评分均高于活动实施前,差异均有统计学意义(P0.05);观察组新生儿家属护理满意度为96.08%,高于对照组的76.47%,差异有统计学意义(P0.05)。结论 PDCA模式QCC活动有助于降低新生儿脓疱疮发生率,提升护理人员护理综合能力及家属护理满意度。     

脑卒中术后病人个体化肠内营养支持的临床效果观察

目的:探讨个体化肠内营养(EN)支持对脑卒中颅脑手术后病人的临床效果. 方法:将62例因脑血管意外行颅脑外科手术后需营养支持的病人随机分为两组,试验组33例给予个体化EN支持,根据病情给予不同配方、浓度的EN液,必要时添加营养组件;常规组29例给予标准配方的整蛋白EN液.两组热量供给均为104.6～ 125.5 kJ(25～30 kcal)/(kg·d).检测营养支持前和营养支持3周后血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、淋巴细胞计数(LY)、C反应蛋白(CRP)水平,观察胃肠道不良反应发生情况,记录住院天数. 结果:营养支持3周后,试验组病人血清ALB、PA明显升高,CRP明显降低,与常规组比有显著性差异(P＜0.05).试验组病人的胃肠道不良反应发生率明显低于常规组,住院天数少于常规组(P＜0.05). 结论:个体化营养支持更有利于改善脑卒中术后病人的营养状况,降低炎性反应,减少胃肠道不良反应的发生率.     

营养支持在心脏外科术后体外膜肺氧合病人应用的临床观察

目的:观察营养支持对心脏手术后循环衰竭接受体外膜肺氧合(ECMO)辅助病人的耐受性和安全性. 方法:回顾性分析2009 ～ 2013年间在我院心外科ICU使用ECMO辅助的病人,所有的病人均因为心脏术后发生严重的心功能衰竭接受了VA-ECMO(venoarterial,VA静脉-动脉)辅助治疗,同时采用104.6 kJ(25 kcal)/(kg·d)肠内营养(EN)支持,共7d.营养耐受情况以达到喂养目标的达标率和观察胃潴留量为主.观察其安全性以EN引起的不良反应来评估. 结果:共有12例病人进行了ECMO辅助,EN为唯一的营养支持方式,所有病人第1周内营养耐受率超过70％.无一例出现EN引起的严重不良反应. 结论:接受ECMO辅助的危重症病人给予EN治疗安全、可行,无严重并发症,第1周内EN耐受率达70％.     

综合干预治疗在食管癌病人术后早期肠内营养耐受性及机体康复的研究

目的:探讨综合干预方案在食管癌病人术后早期肠内营养(EEN)耐受性及机体康复中的应用效果。方法:将入选的93例病人按入院时间顺序分为综合干预组和传统对照组。综合干预组病人进行综合干预治疗,传统对照组病人给予常规护理,比较两组病人术后EN不耐受的发生率、首次闻及肠鸣音时间、首次排气和排便时间以及并发症等临床指标。结果:综合干预组47例病人中有36例(76.60%)能耐受EEN支持;传统对照组46例病人中有24例(52.17%)耐受EEN支持,两组比较差异有显著性统计学意义(P0.05)。综合干预组病人首次闻及肠鸣音时间、首次排气和排便时间、住院天数等均优于传统对照组(P0.01)。且综合干预组病人切口感染、肺部感染发生率均低于传统对照组(P0.05)。结论:采用综合干预方案治疗食管癌术后病人可有效降低EEN不耐受性的发生率,促进病人机体恢复,缩短住院时间,降低术后并发症,提高病人术后生活质量。     

脑卒中并发吞咽功能障碍老年病人肠内营养支持的临床研究

目的:探讨脑卒中并发吞咽障碍老年病人进行肠内营养(EN)支持前后营养状况指标、耐受性、感染并发症以及短期预后的情况. 方法:选取128例急性脑卒中并发吞咽困难的老年病人,根据人院营养支持方式分为治疗组(n=80)和对照组(n=48).治疗组再根据营养液的种类分为瑞先组(n=44)和能全力组(n=36),对照组病人为普通鼻饲饮食.病人于人院当天、EN支持第14天和出院时采用美国国立卫生研究院卒中量表(NIH-SS)进行神经功能评分,并观察营养指标、并发症以及短期临床预后情况. 结果:治疗组病人EN支持第14天以及出院时的NIHSS评分均低于对照组,肺部感染发生率降低,住院时间短于对照组,营养状况优于对照组,差异均有统计学意义(P＜0.05).同时,瑞先与能全力由于膳食纤维成分配比不同,两组病人便秘和腹泻的发生率均有显著性差异(P＜0.05). 结论:急性脑卒中并发吞咽功能障碍的老年病人早期EN支持(瑞先)有利于病人神经功能和营养指标的恢复,降低肺部感染发生率,改善病人短期的预后.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.