采用PDCA循环法规范门诊医疗废物的管理

目的采用PDCA循环法规范医院门诊医疗废物的管理。方法自行设计表格对门诊医务人员及患者在医疗废物管理中存在问题进行分析和整改,通过计划、实施、检查、处理4个阶段进行实施。结果医院门诊医疗废物要达到规范化管理,必须建立有效的组织管理体系、制定切实可行的规章制度及管理质量标准是重要保证:加强培训与宣传教育提高全民管理意识是重要环节;完善医疗废物管理处置中的配套实施是重要基础;认真督促检查考核是重要手段。结论 PDCA循环是规范完善门诊医疗废物管理的一种科学的管理方法。     

探讨PDCA循环法在医院医疗废物管理中的应用

目的加强医院医疗废物科学有效管理。方法应用PDCA循环法发现问题、制定策略、科学实施、有效监督,并建立健全各项符合国家法律法规的制度。结果提高了医院医疗废物管理水平,使医疗废物分类合格率、收纳合格率、扎口率、丢失率等各项考核指标均达到了医疗废物管理的标准和要求。结论应用PDCA循环法进行医院医疗废物管理科学有效。     

PDCA循环在提高医疗废物管理质量中的作用

目的探讨医疗废物管理的有效方法,从而提高医疗废物管理质量。方法按PDCA循环模式,收集资料、找出存在问题,分析原因,制定整改措施,组织培训、考核检查、反馈改进。结果比较实施PDCA循环前后医务人员的医疗废物知识考试成绩、医疗废物的处置合格率均显著提高(P<0.01)。结论实施PDCA循环管理,有利于提高医务人员对医疗废物的认知,提高医疗废物管理质量。     

医院废弃物管理

目的为了加强医疗废物的安全管理,防止疾病传播,保护环境,保障人体健康。方法制定医院废弃物处理感染管制规程;进行新员工、在职员工相关知识培训;实行院科两级巡查、不断持续PDCA循环。结果通过加强医院废弃物管理,提高了医院员工对医院感染风险管理防范的意识,人人重视废物处理,降低了医院感染的发生。结论建立科学、可行、有效的医疗废物管理体系十分重要。     

应用PDCA循环实施医院医疗废物有效管理

目的加强医疗废物有效管理。方法遵照《医疗废物管理条例》《医疗卫生机构医疗废物管理方法》等一系列关于“医疗废物管理”的法律、法规和条例，运用PDCA循环管理模式，完善和健全各项管理制度，建立科学有效的实施细则。结果提高了医院医疗废物管理整体水平，达到了医疗废物管理标准和要求。使医护人员对“医疗废物有效处置重要性”知晓率、医疗废物收集率、分类合格率、包装合格率分别由实施前的92．3％、95．1％、91．5％、92．5％达到实施后的100％、99．8％、99．3％、99．2％，取得明显成效。结论应用PDCA循环管理模式实施医疗废物管理是行之有效的，使我院医疗废物管理工作科学、合理而规范的运行。     

PDCA 循环在提高检验报告单信息完整率中的应用

目的：探讨 PDCA 循环法在改进检验报告单信息完整率方面的应用。方法运用 PDCA 循环法对检验报告单信息缺失现状和原因进行分析,由医院多部门联合组成整改小组,制定整改计划,分别组织宣传、操作培训和信息系统改进,并对改进结果持续监测,评估改进效果,发现存在问题后进入下一个 PDCA 循环。结果通过采用 PDCA 循环法持续改进,检验报告单上医师信息和临床诊断信息的完整率分别达到100％,采样人和采样信息完整率达到90％以上。结论PDCA循环法可有效改进医院实验室质量管理问题;在医疗质量改进过程中,深入的原因分析、多部门通力协作、全员重视和参与是有效改进的关键;信息系统在医疗质量改进中的作用不容忽视。     

医疗废物管理工作的持续改进

目的 为了提高医疗废物的管理水平,通过多重手段的科学管理,使医务人员对医疗废物的分类管理概念更加清晰,最终使医院医疗废物的产生数量更加合理,以达到提高医疗废物管理水平。方法 通过培训和现场指导提高医疗废物分类的准确性,通过动态监测并发布各部门每月医疗废物清运数量的方式,使各部门及时了解可能存在的问题。结果 2012年7-12月医疗废物清运数量与2011年相比下降20.0%,2012年全年医疗废物清运数量与2011年相比下降5.8%,2013年全年医疗废物清运数量与2012年相比下降10.0%。结论 医院应建立完善的管理制度,通过标准化的流程进行管理;要加强医疗废物管理过程中的风险意识,制定相应的应急预案并进行演练,将PDCA循环应用于医疗废物的管理可以使管理更加科学规范,并使医疗废物管理工作得到持续改进。     

浅谈医疗废物的医院感染管理

目的：加强和规范医疗废物的管理,使医疗废物处置进入规范化、制度化。方法：建立健全以主要负责人为第一责任人的医疗废物管理体系,加强医务人员的医疗废物管理相关知识培训,制作各项管理制度及处置流程图;发挥监督部门职能作用;采取提出问题,反馈整改措施,进行效果评价的PDCA循环管理模式。结果：通过对医疗废物的产生、分类、收集、存放、转运、交接登记等全过程进行了严格的规定,可以有效的预防由医疗废物引起的医院感染的发生。结论：加强医疗废物规范管理,是预防和控制医院交叉感染的重要环节。     

运用PDCA循环提高医学影像科感染控制效果的研究

目的探讨PDCA循环法用于规范医学影像科感染控制制度和流程,以不断提高感染控制效果。方法应用3次PDCA循环管理对80名医学影像科工作人员(其中有5名护理人员)进行手卫生、医疗废物处理、室内空气消毒考核和问卷调查,静脉穿刺无菌操作(仅对护士)的考核和问卷调查,并比较实施PDCA前后在上述几个方面的考核效果。结果实施PDCA前后医务人员对洗手指征掌握、洗手步骤实施以及手细菌培养的合格率分别为38.75%和87.50%、50.00%和93.75%、76.25%和97.50%,前后比较差异均具有统计学意义(P0.001);实施PDCA前后医务人员对常见医疗废物分类和医疗废物收集要求掌握的合格率分别为20.00%和86.25%、46.25%和88.75%,前后比较差异均具有统计学意义(P0.001);科室室内空气消毒合格率由实施PDCA前的68.18%提高到实施PDCA后的95.45%,差异均具有统计学意义(P=0.019);护士静脉穿刺无菌操作合格率由实施PDCA前的80.00%提高到实施PDCA后的98.00%,差异具有统计学意义(P0.001)。结论采用PDCA循环法可有效提高医学影像科感染的控制效果。     

PDCA法在改进医疗服务提升患者满意度中的应用

目的探讨患者满意度调查中运用PDCA循环法改进医疗服务的作用。方法对安徽省某三级综合性医院出院患者进行满意度调查,运用PDCA循环法持续改进医疗服务。描述患者满意度变化趋势,运用方差分析检验PDCA循环法实施前后满意度差异。结果实施患者满意度调查并运用PDCA循环管理一年,出院患者满意度由90.54分上升至93.29分,各PDCA循环周期患者满意度均高于基线数据,差异有统计学意义(P<0.05)。结论通过定期开展患者满意度监测,发现医疗服务中的不足,运用PDCA循环法持续改进,是改善医疗服务质量、提升患者满意度的有效方法,具有较好的应用价值。     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.     

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.