常熟市医学检验区域化集成平台的建立与应用

摘要： 常熟市医学检验所应用市卫生信息专用网络和“数据集中式和分布式混合模式”创建了医学检验区域化集成平台,使全市各医疗卫生单位间实现检验信息互联互通、数据交换和信息共享;建立了人员、成本及工作量等管理指标的信息化管理系统,实现了检验报告发布,检验标本流转、检验质量控制的全程信息管理;为全市客户提供了更及时、高质量的检验数字化服务。     

两种方法清洗消毒腹腔吸引管的效果观察

观察两种不同方法清洗消毒腹腔吸引管的效果,寻求最佳清洗消毒方法。采用目测+放大镜检测法和隐血试验法,分别对使用不同清洗程序的实验组和对照组的腹腔吸引管清洗质量进行检测。结果 采用拆卸至最小单位温水浸泡+手工刷洗+多酶液超声清洗+手工刷洗+高压水枪冲洗+高压气枪注气+置于专用清洗筐内全自动清洗消毒器清洗方法的实验组腹腔吸引管洁净度、潜血试验以及干燥度的合格率明显高于对照组。结论 清洗流程中拆卸腹腔吸引管至最小、管腔倾斜置于专用清洗筐内上架至全自动清洗消毒器清洗是实验组保证腹腔吸引管清洗消毒灭菌效果的关键。     

两种不同清洗方法对管腔器械的清洗效果比较

摘要 目的 比较两种不同清洗方法对管腔器械的清洗效果,提高管腔器械的清洗质量。方法 随机抽取管腔器械100件,分为2组,分别用专用清洗架清洗管腔器械的全自动清洗消毒机与减压沸腾清洗机两种不同方法清洗后,使用带光源放大镜进行目测、ATP生物荧光监测法和残余蛋白定量法进行洁度检查,比较2组器械清洗效果;同时应用两种清洗方法将管腔类器械拆分到最小化后,对装载所需时间进行比较。结果 试验组和对照组清洗质量检测,目测法合格率分别为100%和95%;ATP生物荧光监测法合格率分别为99%和81%;残余蛋白定量法合格率分别为96%和53%。试验组和对照组装载时间比较,腔镜器械清洗平均用时分别为5 min和25 min,呼吸机管道平均用时分别为2 min和10 min。结论 减压沸腾清洗技术对管腔器械的清洗质量优于全自动清洗机,在前期人工处理时间上明显短于使用专用清洗架进行器械清洗的全自动清洗消毒机,显著提高了清洗效率。     

专用清洗刷在精细管腔器械清洗中的应用研究

[目的]探讨在传统的精细管腔器械的清洗流程基础上增加专用毛刷,刷洗管腔内部的清洗质量。[方法]选用直径≤2mm精细管腔类器械200支,随机分为对照组和观察组各100支,对照组清洗流程为回收拆卸后按照传统方法进行清洗,观察组在传统清洗流程的基础上,增加专用清洗刷清洗,通过5倍放大镜下镜检、杰力试纸、ATP生物荧光测试、微生物培养检测清洗质量。[结果]放大镜镜检、ATP生物荧光、杰力试纸、微生物培养3种检测结果显示观察组清洗合格率高于对照组(P0.05,P0.01)。[结论]根据精细管腔内径的大小,选择合适的专用清洗刷可提高清洗质量。     

2010型自动血沉仪与经典魏氏法测定ESR的相关性评价

随着临床检测技术的不断提高，自动血沉仪检测红细胞沉降率(ERS)已为一些大、中型医院普遍使用，其具有操作简单、检测时限短、可定时打印结果、工作温度易于控制等优点。我们在工作中发现，自动血沉仪与传统魏氏法有很多不同，如专用血沉管与魏氏血沉管的孔径不一致，观察结果的时间也不一样。     

石油溶剂油（涂料稀释剂）致皮肤烧伤[英]／Mackie IP，Rubin P，Wilson DI／／／Burns．

松节油是一种天然产品，可从欧洲松、臼杉、美国长叶松等一类植物中提取的油脂蒸馏产生。长期以来，松节油被当作涂料稀释剂和油漆清洁剂使用。但近年来，诸如石油溶剂油的复合物被更频繁地使用。石油溶剂油(或称为松节油替代品)是一种便宜的物品，可很容易地从许多杂货店及日用品店购买。石油溶剂油从原油中蒸馏提取，     

医学检验数据质量链与数字化技术

<正>数字化技术正在全球范围内迅速渗透到各个领域,这也导致近年来多种形式的数字化技术的发展,并不断推动医院的信息进程。检验科作为提供检测数据的实验室,发出的报告在健康评估、临床诊断、疗效评估及预后判断等方面扮演着越来越重要的角色。数据质量的保证由检验数据质量链决定,将数字化技术应用于检验数据质量链中的各个环节将会显著避免由于人为因素对检验结果的干扰,最终提升检验科工作效率,使     

常规X线图像数字化成像技术CR与DR的比较

人类正在进入数字化时代，数字化浪潮一浪高过一浪。历史悠久、应用广泛的常规X射线成像技术，近年来也加快了向数字化进军的步伐。21世纪是数字化和网络技术飞速发展的世纪，医院服务水平、诊治水平不断提高，目前解决提高医学影像质量问题的最好方法就是实现影像数字化。在现存放射学领域，已经有CT、MRI、DSA和数字胃肠机等数字化医疗设备，而使用频率最高、占放射学领域70％的普通X线机却一直未能完成数字化革命；CR和DR技术的出现，则为解决此问题提供了两条有效的途径。     

品管圈活动在降低PICC导管堵管发生率中的应用

目的探讨品管圈活动在降低PICC导管堵管发生率中的应用效果。方法比较实施品管圈活动前后两组患者PICC导管堵管发生率及圈员在品管圈的认识、质量改善手法的应用、面对问题的勇气、推广科室质量改善的信心、团队精神、沟通及协调6个方面改善前后的效果。结果 PICC导管堵管发生率较改善前降低,两组比较差异有统计学意义(P0.05),圈员在品管圈的认识、质量改善手法的应用、面对问题的勇气、推广科室质量改善的信心、团队精神、沟通及协调6个方面均较改善前提高。结论通过品管圈活动,制作双针筒专用封管支撑架、修订考核表,细化输血后冲管手法及冲管流量、使用专用针筒冲管、制作提醒标识、拍摄操作视频及制定本院静脉治疗护理技术操作规范并培训,延长了导管的使用时间,减少了医疗资源的浪费,提高了护理人员的综合素质。     

专用采血管对血浆中循环游离DNA保存效果的影响

目的验证专用采血管对血浆中循环游离DNA(cfDNA)保存效果的影响。方法分别用EDTAK2抗凝管和两种cfDNA保存专用采血管采集健康成人外周血,待血样室温保存到固定的时间点时,分离提取血浆中的cfDNA,定量检测不同时间点血浆中cfDNA水平的变化情况。结果采集在EDTA-K2抗凝管中的血浆cfDNA水平随着时间的推移有逐渐升高后达到稳定的趋势,而采集在两种cfDNA保存专用采血管中的血浆cfDNA水平至少7d内保持稳定。结论血液标本在EDTA-K2抗凝管中长期存放会导致血浆中cfDNA水平不稳定,这种变化可能与血液中基因组DNA的污染和cfDNA降解的动态平衡有关,专用采血管能够在至少7d内稳定血浆中cfDNA的水平,对后续cfDNA的定量检测及临床应用有重要作用。     

How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis

Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's “What's the problem represented to be?” was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.     

营销服务理念在大型综合医院体检信息系统建设中的应用

目的探讨营销服务理论(8P)在体检信息系统建设中的应用与实践效果。方法借鉴8P理论与理念,以现代信息技术为手段,设计和构建以客户为中心的体检信息系统。结果体检信息系统的建立,优化了体检流程,提高了服务效率和报告质量,增加了客户满意度,取得良好的经济和社会效益,为健康体检工作的数字化、规范化管理奠定了良好的基础。结论加强体检中心的信息化系统建设,能全面提升中心的工作效率和服务质量,增强市场竞争力。     

质量管理追溯信息系统在消毒供应中心的应用

目的:充分利用信息化的手段改造灭菌物品信息化管理流程,提高消毒供应专业管理水平.方法:采用无线网络信息技术、无线智能手持终端和条码技术实行全部工作过程的质量追溯.结果:该系统的应用,保证了工作质量,准确记录跟踪器械处理环节,数据采集速度快,纠正偏差,无纸化办公,避免了交叉污染,节约管理时间.结论:消毒供应中心质量追溯信息系统的应用,全面提升了工作人员的整体素质,使工作更趋向科学化、标准化和规范化,确保工作质量和效果.     

供应室管理系统在消毒供应管理工作中的应用与体会

以医院信息系统(HIS)为支撑平台,依托无线网络、移动终端、条形码识别等先进技术,将供应室管理系统应用于消毒供应管理工作中,通过信息化管理及质量追溯系统,强化流程控制,提高工作效率,建立完善的数据电子档案,实现消毒质量监控与实时追踪,提高了供应室的护理管理水平,使护理技术逐步走向科技化和产业化。     

液体活检新技术在临床肿瘤诊疗中的应用新进展

液体活体检查(液体活检)能够非侵入性地反映体内肿瘤状态,为肿瘤的早期诊断、个体化治疗监测以及预后判断提供有力依据。根据肿瘤相关物质的类型,液体活检涵盖了循环肿瘤细胞(CTCs)、循环肿瘤DNA(ctDNA)、细胞外囊泡(EVs)和循环肿瘤RNA(ctRNA)等检测靶标。目前,已有多项液体活检产品获准进入临床,更有许多转化研究蓬勃开展。尽管液体活检技术的临床应用仍然面临着诸多挑战,标准化与质量管理体系还有待完善,但是液体活检作为应用前景广阔的检测新技术,将成为临床迫切需求并值得信赖的诊断工具,为肿瘤检测带来极大便利。     

基因检测在精准医疗中的应用与管理

随着现代医学的发展,基因的序列信息逐渐成为临床疾病分子诊断精确的判定依据,基因检测技术也在精准医疗领域逐步推广.通过精准医学、检验医学、病理学等领域专家共同探讨基因检测在精准医疗中的应用与管理,本文明确了基因检测在精准医疗领域中的应用方法,也对基因检测每一步骤的质量控制及改进优化提出了建议,为从事精准医疗检测的实验室提...     

基于FPGA的全数字高精度B超系统的设计

目的 普通B超的图像不够清晰,一些过小的病变不易被发现,设计FPGA作为控制芯片的高清晰数字B超.方法 采用多通道技术保证图像信号的质量,并且在FPGA里实现了对信号的动态滤波、检波、孔径合成、数据压缩等处理.结果 该系统图像清晰,性能稳定,便于携带,能够满足医疗检测的需要.结论 采用嵌入式技术和更好的数字信号处理算法可以提高图像质量,减小B超的体积.     

Endoscopic diagnostic system using autofluorescence

A fluorescence imaging system (Xillix LIFE - Lung Fluorescence Endoscopy system) using fluorescence for the accurate diagnosis and early detection of lesions through an endosocope has been developed. This system has applied an optical diagnostic technology to functionally diagnose lesions which have been difficult to morphologically recognize or are occult with conventional endoscope. The benefit of this system in the diagnosis of lung cancer has already been confirmed in the US and Japan, and feasibility of the system in the gastric intestinal field has also been evaluated.     

Data sources for continual quality improvement in medical rehabilitation- the QS-Reha procedure of the statutory health insurance funds and the Eva-Reha documentation system of MDK Rhineland-palatinate

Rehabilitation centers in Germany with a care supply contract according to section 111 Social Code Book Five - statutory health insurance (SGB V) are legally obligated to implement an internal quality management and to participate in comprehensive measures of external quality assurance which particularly aim at improving outcome quality ( section 135a SGB V). The legislator has left it to the central associations of health insurance funds and to the relevant umbrella organisations of care providers to develop these measures as well as the basic requirements on internal quality management in order to reach a joint agreement about it (cf. section 137d [1] and [1a] SGB V). The corresponding agreement was concluded on April 1, 2004. Whereas configuration of the internal quality management to a large extend lies in the discretion of the individual rehabilitation center, although it has to be geared to the objectives and principles set out in the agreement under section 137d SGB V, participation in the external quality assurance procedures of the central associations of health insurance funds (QS-Reha procedure) is obligatory for all rehabilitation centers with a care supply contract according to section 111 or 111a. The QS-Reha procedure comprises a survey of the central quality dimensions (structural, process and outcome quality as well as patient satisfaction) and permits related quality comparisons, which are utilized by the health insurance funds for quality oriented patient allocation and remuneration. The QS-Reha procedure had been developed to implement the legal requirements for external quality assurance in the field of medical rehabilitation ( section 135a in conjunction with section 137d SGB V) as well as to create a basis for quality focussed remuneration and patients allocation, whereas the Eva-Reha database had been developed by the Medical Service of Health Insurances in Rheinland-Pfalz for single case documentation with the objective of utilizing these data for internal quality management and, beyond this, also for various aspects of quality development across centers. The results generated in the framework of external quality assurance and internal management have to be integrated in the concept of internal quality management as they account for important sources of information with respect to the analysis of strengths or weaknesses of the facility. Irrespective of their origin quality relevant results should be integrated into a benchmarking system providing information to the operational and medical management of a rehabilitation center on the effectiveness and efficiency of the medical rehabilitation services provided. Up-to-date data, such as those generated by the Eva-Reha database, or sample survey data as those from the QS-Reha procedure can equally be used for such a benchmarking system and complement each another in a meaningful way. In this paper the main features of the QS-Reha procedure and the Eva-Reha database are described, with the objective of pointing out the particular perspectives of their data structure and results for continuous improvement in the framework of internal quality management.