2011年版美国用药安全自评量表汉化及应用初测

目的：汉化2011年版美国药物安全自评量表并检验其信度、效度,通过对某医院内科药物安全进行初步评估,探索该量表中文版在我国临床的适用性。方法：获取原作者授权,应用Brislin的跨文化研究翻译理论与方法学形成中文版量表,并检验其信、效度。采用便利抽样选取某医院内科系统,依据ISMP推荐方法成立评估小组对各项指标进行测评。结果：汉化后的量表包括10个维度,20个核心特征及270个条目,Cronbach'sα系数为0.996,重测信度为0.95,内容效度指数（CVI）为0.95。医院内科用药安全自我测评结果显示,患者信息（mean%=61%）、药物信息（mean%=67%）、质量流程和风险管理（mean%=74%）得分较低,提示医院需采取措施给予改进。结论：中文版量表具有较好的信度和效度,在改进我国医院患者用药安全上具有重要作用。     

国内21家三甲综合性医院用药安全自我测评结果变化趋势与分析

目的:调查国内医院用药安全现状,了解用药安全风险变化趋势,为用药安全管理提供依据。方法:运用ISMP用药安全自我测评表(MSSA)对国内21家三甲综合性医院进行用药安全自我测评,与2018年数据比较,分析测评结果。结果:相比2018年,2020年21家参评医院测评达成度均值有显著提升(77.9%±14.8%vs. 63.2%±13.3%,P<0.01)。除关键要素"药品标签、包装和命名"(3.43±0.65 vs. 3.22±0.64,P>0.05)以外,其他各关键要素得分均有显著提升;关键要素"患者信息""药物信息"及"员工能力与教育"的测评结果虽获提升,但平均得分均不足3分。结论:21家三甲综合性医院用药安全自我测评达成度均值显著提升,但患者信息、药品信息等仍然是药物风险管理的短板,用药安全信息化建设方面存在很大的改进空间。     

国内21家三甲综合性医院用药安全自我测评结果与分析

目的：调查国内医疗机构用药安全现状，发现用药安全相关问题，为风险管理提供依据。方法：运用MSSA测评量表（2011版），在国内21家三级甲等综合性医院开展了用药安全自我测评，收集21家医疗机构测评结果，对各关键要素和具体条目得分的中位数、均值及达成度等方面进行分析。结果：21家参评医院各测评条目达成度均值为58.2%。各测评条目达成度均值最高的医院，其达成度为75.9%，最低的为35.8%。"药物治疗设备的采购、使用和监控"和"医嘱及其他药品信息的传递"两项关键要素达成度分别为45.8%和29.0%。结论：参评医疗机构用药安全状况尚存较大改进空间，尤其在信息、药物治疗相关设备等方面亟待改进。     

从患者满意度测评探讨加强医院门诊管理的实证研究

<正>患者满意度测评作为评价医疗服务质量与医护人员工作绩效的有力工具,在国内医疗机构广泛使用,很多学者在这一领域进行了研究[1]。本研究旨在了解当前医院门诊管理在患者满意度测评过程中的方式、方法,分析存在的问题与不足,研究结果可作为开发患者满意度测评体系的基础与推广工作的出发点。调查过程中,从患者满意度测评的形式、频率、规模、测评结果的用途等方面对医院门诊患者满意度的测评现状进行了全     

在医院安全文化的构建中营造团队氛围的现状调查

目的:通过对公立医院安全文化团队氛围的测评研究,找出目标医院患者在团队氛围方面存在的薄弱环节以及问题,并提出相应的改进措施,为提高公立医院的管理水平提供了理论依据。方法:在佳木斯市抽取6家公立医院作为研究对象,并采用个人深入访谈与现场问卷调查相结合的方法进行安全文化团队氛围的研究。结果:在"沟通合作、科间协作、病人安全培训"方面,部分领域存在着问题,两级医院存在显著的差异,安全文化有待加强。结论:目标医院加强病人安全文化建设,运用灵活方式倡导团队协作,完善安全设施,重视病人安全工作,减少医疗不安全行为,营造医疗安全氛围。     

社区医院临床医技人员的患者安全文化认知分析

目的分析我院临床医技人员的患者安全文化的认知情况,为构建医院安全文化提供指导。方法应用患者医院安全文化调查量表(HOSPSC)对我院政管理科、检验科、药房、内科、外科进行问卷调查。结果此次共发放问卷78份,收回78份,回收率100%。5个科室之间科室间的团队合作、事件报告频率、人员配置和医院管理的支持4个维度比较差异具有统计学意义(P<0.05),而其他8个维度比较差异无统计学意义(P>0.05)。结论目前我院医技人员的患者安全文化认知整体水平并不高,并且在各个科室间的差异也非常明显,这对我院今后制定相关措施提供了方向和素材。     

医疗失效模式与效应分析在医院安全用药管理中的应用进展

失效模式与效应分析（Failure mode and effect analysis,FMEA）在医院安全用药管理中应用广泛,本文查阅近期国内相关文献,对其应用现状进行分析总结,结果表明,FMEA能提升医院安全用药管理质量,提高患者用药的有效性和安全性.同时,药学部门应充分借鉴国内外学者应用FMEA的成功经验,开展安全用药管理研究,以保障患者的用药安全.     

医院药房信息化及自动化建设浅析

医院药房是反映医院医疗服务质量高低的窗口,直接影响到医院的社会形象及患者就医的选择。因此,加快药房信息化、自动化建设,一方面可节省人力资源,将药房药师从目前手工摆药中解放出来,将工作重点转移到对处方的审核与临床用药安全的指导上,减少药物的不良反应,另一方面药房自动化的实施,在很大程度上可以减少人工摆药的差错率,药品进行单剂量分包,可防止患者服错药,极大的保证了临床用药安全,提高患者的满意度,药房改革是医院改革的重要组成部分,笔者现就目前我国医院药房的现状进行分析,对加快医院药房信息化及自动化建设进行简单分析。     

病人安全文化评估量表在我院护士中的测试研究

目的 测试修订版病人安全文化评估量表的信度、效度,为医院病人安全文化的测评提供有效工具,同时确定我院病人安全文化的优势区域和待改进区域.方法 翻译美国医院病人安全文化评估问卷,将所形成的中文版量表对我院801名护士进行评估,以评价其信效度.结果 中文版病人安全文化评估量表简便、易测,具有很高的信度和较高的效度.12个维度中,“组织的学习与持续改进”和“科室的团队合作”为优势区域,“人员配置”等6个为待改进区域.结论 中文版病人安全文化评估量表具有较好的可信度和可靠性,有一定的实用价值.     

医院网站评价现状的调查

目的：分析医院网站服务、评价的现状,找出其不足,提出改进对策。方法：使用文献检索CNKI和万方数据库,检索时间为2000～2010年。结果：经文献研究后发现,对于构建医院网站评价体系的研究较少;搜索到的几篇地区医院网站建设情况的调查也多从网站构建和医院需求的角度评价医院网站服务,缺少从医院网站使用者角度测评医院网站的指标。结论：我国医院网站评价体系还不成熟,目前没有形成一个科学、完善、全面的评价模型。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

HACCP在学校集体食堂卫生管理中的应用研究

目的 通过HACCP在学校集体食堂管理中的应用,提高食品卫生水平,保障学生的身体健康。方法 HACCP原则。结果 食品卫生达到较高水平,极大地减少了食物中毒的发生。结论 提示HACCP原则可在学校集体食堂的卫生管理中发挥有效作用。     

半导体激光治疗老年人压疮疗效观察

目的探讨半导体激光局部照射治疗老年人压疮疗效.方法:收集2012年1月-2015年6月48例压疮患者,分为半导体组和常规组各24例.常规组采用常规治疗,半导体组采用半导体激光加常规治疗,10 d为1个疗程,不超过3个疗程.疗程结束后比较两组疗效.结果:半导体组压疮愈显率为83.33％,创面愈合时间为(12.75±5.51)d,常规组分别为54.17％和(19.63±8.65)d,组间差异有统计学意义(P＜0.05),两组均未见不良反应.结论:半导体激光加常规治疗压疮效果肯定,无明显不良反应,且操作简便.     

脑卒中恢复期患者社区综合康复的疗效观察

目的：探讨社区开展康复活动对于脑卒中患者肢体功能康复的影响。方法：选取2014年4至10月参与社区“陈睿健康工作室”康复活动的脑卒中恢复期患者50例作为观察组,选取同期延吉社区卫生服务中心门诊的50例脑卒中恢复期患者作为对照组（进行门诊随访、服药、自我康复）。采用知识、信念、行为（KAP）量表对观察组患者进行问卷调查。采用简化Fugl-Meyer肢体运动功能评分表（Fugl-Meyer assessment of motor function,FAM）比较两组患者入组时和入组6个月时的肢体功能恢复情况及对家庭医生（门诊医师）的满意度。结果：入组6个月时,两组患者的FAM均有所改善,观察组FAM得分[上肢（50.92±7.05）分,下肢（33.01±1.37）分]较对照组[上肢（34.85±6.55）分,下肢（25.20±4.88）分]更高,差异有统计学意义（t上肢=11.8215,t下肢=10.8595,P均＜0.01）。观察组患者的满意率为92%（46/50）,明显高于对照组的30%（15/50,P＜0.05）。结论：在社区开展康复活动可以促进脑卒中患者肢体功能的康复,提高患者的满意度。     

Evaluation of the safety of enalapril in the treatment of heart failure in the very old

Summary We have introduced enalapril, in doses equal to or less than the 2.5 mg currently recommended, as an adjuvant to digoxin and diuretics in 17 patients of mean (SD) age 83 (5) years with severe heart failure. Only eleven patients tolerated its introduction. Unlike those reported in younger patients, all but one of the adverse drug reactions occurred 8 h or more after the first dose. Aged patients started on ACE inhibitors should be observed in hospital until stabilized on a maintenance dose. Three patients had an adverse reaction which differed in nature from those previously reported: acute confusional state, ataxia and mesenteric ischaemia.Ten patients were discharged on 5 mg or 10 mg maintenance doses of enalapril. In nine of them improvement on triple therapy was sustained for a minimum of three months. ACE inhibition was lost in the other patient when her compliance with enalapril therapy fell to around 75%: monitoring compliance is essential when ACE inhibitors are used in low dosages.Enalapril was withdrawn during follow up in three patients because of symptoms of mesenteric ischaemia and in four because of dramatic deterioration of renal function. One of the latter was found subsequently to have severe bilateral atheromatous renal artery stenosis. When isosorbide dinitrate was substituted for enalapril, symptoms of mesenteric ischaemia resolved and renal function returned to baseline. Continuing surveillance for adverse effects is essential in patients of this age group with severe heart failure, and the risk of occult renal artery stenosis requires regular biochemical screening during follow up.The benefit to cost ratio of ACE inhibitors might be improved in aged patients by their use at an earlier stage in the natural history of heart failure, when perfusion of essential organs is not grossly impaired, but carefully monitored trials would be necessary to establish this.     

Effect of the Immunomodulator Tilorone on the in Vivo Acetylation of Procainamide in the Rat

Interferon and interferon inducers have been found to inhibit cytochrome P-450-dependent metabolism in animals and man. The effect of these agents on the acetylation of drugs has not been previously reported. Since these agents stimulate the reticuloendothelial system, together with the abundance of N-acetyltransferase in the reticuloendothelial system, it was hypothesized that these immunomodulators may affect drug acetylation. To test this hypothesis, the effect of tilorone (a synthetic interferon inducer) on the in vivo acetylation of procainamide was examined in the rat. Pretreatment with tilorone hydrochloride (50 mg/kg) 48 hr prior to the administration of procainamide hydrochloride (50 mg/kg) resulted in a 32% increase in the urinary recovery of N-acetylprocainamide and a 35% increase in the metabolic clearance of procainamide to N-acetylprocainamide. These data indicate that interferon inducers increase the N-acetylation of drugs in vivo.     

替普瑞酮治疗老年慢性浅表性胃炎的疗效分析

目的分析替普瑞酮治疗老年慢性浅表性胃炎的疗效。方法100例老年慢性浅表性胃炎患者,通过计算机随机表数字法分为对照组和实验组,每组50例。对照组患者选择西咪替丁作为本次治疗药物,实验组患者选择替普瑞酮作为本次治疗药物。比较两组患者临床疗效、不良反应发生情况以及生活质量。结果实验组治疗总有效率92.00%高于对照组的76.00%,差异具有统计学意义(P<0.05)。实验组不良反应发生率6.00%低于对照组的20.00%,差异具有统计学意义(χ^2=4.332,P=0.037<0.05)。实验组患者治疗后的生活质量评分(68.68±4.11)分高于对照组的(57.73±3.48)分,差异具有统计学意义(t=14.377,P=0.000<0.05)。结论对于老年慢性浅表性胃炎疾病患者,选择替普瑞酮进行治疗不仅疗效更为理想,而且还不易增加患者的用药不良反应,有利于提高患者的生活质量,建议进一步推广。     

药物经济学成本-效果分析应用的相关问题探讨

目的探讨药物经济学成本-效果分析(CEA)应用的相关问题。方法运用文献计量学方法、数学证明方法等。结果与结论在运用CEA进行药品的经济性评价时,尤其需要重视临床治疗指标的选择、成本的确定、增量分析的使用和与最小成本分析的比较。     

Adenosine mechanisms in the regulation of breathing in the rat

The central respiratory effects of various adenosine (A) analogues were studied in halothane-anesthetized rats. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) injections of the A analogues (2-Cla, L-PIA, CHA and NECA) reduced minute ventilation (VE) due to decreases in respiratory frequency (f) as well as tidal volume (VT). Dose-dependent effects were seen after i.c.v. L-PIA in both normal and vagotomized rats. Analysis of the A-induced changes using the occluded breath technique revealed an increase in expiratory time (TE) as well as a decrease in inspiratory drive. NECA, a relatively specific A2 agonist seemed to be somewhat more potent in eliciting respiratory depression than a relatively specific A1 agonist like L-PIA. Pretreatment with the methylxanthine theophylline completely antagonized the respiratory depression induced by L-PIA. It is concluded that central A receptors are involved in the central regulation of breathing and that A interacts with the respiratory control system mainly by decreasing inspiratory neural drive and prolonging expiratory time.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.