医疗设备的循证管理

本文应用了循证医学的理念,提出了循证医疗设备管理的基本慨念、原理、方法,基于目前对医院医疗设备管理的SWOT分析,通过实例介绍了如何应用循证管理的原理,充分利用资源,加强医疗设备质控的实践,多方协作建立起科学、实证的质控管理证据体系,并应用于对临床使用相关医疗设备的指导,贯彻"安全、有效、经济"的医疗设备管理宗旨.     

构建医院医疗设备质量控制体系的几点做法

目的：建立一套全员、全要素、全寿命周期的医疗设备质量控制体系,以加强医疗设备的质量管理.方法：运用全面质量管理理论、医疗设备全寿命周期管理理论、风险管理理论等理论和方法,通过分析目前国内医疗设备质量控制的现状,提出了构建医疗设备质量控制体系的做法.结果：经过在北京某部队的三甲医院试运行,提升了医疗设备的总体质量和管理水平.结论：构建医疗设备质量控制体系能够保障医疗设备的质量与安全,提升医院的诊疗水平,值得推广应用.     

浅论循证医学理念与设备采购

目的：提高医疗设备采购管理水平。方法：从循证医学的理念入手,探讨将循证医学的方式方法应用到医疗设备采购上。结果：建立了一套根据循证医学理念进行医疗设备采购的循证医疗采购体系。结论：将循证医学理念应用到医疗设备采购管理中对于医疗设备采购管理水平的提升具有重要的推动意义。     

循证医学决策模式的建立与应用

循证医学决策模式是建立在对客观的医学研究证据，长期的临床工作经验，及不同患的医疗需求进行综合分析基础上的最佳医疗方案。其建立和应用对提高医疗质量，改善医疗服务质量具有重要意义。树立循证医学决策意识，建立循证医学决策系统，实施循证医学决策管理将为军队医疗系统实现全面品质管理提供可靠依据。     

基于PDCA循环的医疗设备操作规程规范化管理

医疗设备操作规程作为正确指引,是医务人员学习并掌握医疗设备规范操作和维护措施的一个重要途径.对医疗设备操作规程进行规范化管理,是保证医务人员操作规程学习效果的重要前提.PDCA循环是保证全面质量管理体系运转的重要方法,在各类科学管理项目中均有广泛应用.该研究基于PDCA循环,找出现阶段医疗设备操作规程在临床使用过程中出...     

集团医院建立医疗设备供应商管理评价体系的探索

医疗设备为医院医疗服务提供了一个持续可靠的硬件平台,从全面质量管理角度,必须开展医疗设备供应商的管理.本文通过建立一套医疗设备供应商评价体系,并利用它在集团医院内部开展对供应商的评价工作,进一步提高医疗设备管理水平.     

医院医疗设备应用全面质量管理的效果分析

目的：探讨医院医疗设备应用全面质量管理的效果分析。方法：选取2019年4月～2019年10月本院实施常规质量管理的96台医疗设备作为对照组,而选取2019年11月～2020年3月本院实施全面质量管理的96台医疗设备作为研究组。96台医疗设备均属于同一批设备。比较两种管理方式的消毒灭菌以及设备维护检查合格率和设备缺陷发生情况。结果：观察组设备小部件完好（93.7%）、附加物品放置（95.8%）、设备规格和数量（91.7%）以及设备摆放和排列（89.6%）等医疗设备合格率均高于对照组（72.9%、82.2%、64.5%、68.8%）(P<0.05)。研究组医疗设备缺陷发生率（8.3%）低于对照组（39.4%）(P<0.05)。结论：在医院医疗设备管理中,应用全面质量管理,医疗设备的设备小部件完好、附加物品放置、设备规格和数量以及设备摆放和排列等医疗设备合格率明显提高,延长了医疗设备的使用寿命,且降低了医疗设备在使用过程中的不良事件发生率。     

基于对操作者评测的医疗设备质量控制规程探讨

研讨如何提高医疗设备质量管理水平,保证测量的准确度和精确度。按照全面质量管理的要求,结合统计学方法,从质量监督、质量评测和人员培训三个方面,探讨了基于操作者个体评测的质量管理规程。     

医疗设备信息数据集成与应用设计

目的构建以医疗设备个案信息为内容的主题数据集中间库,实现医疗设备由经验型管理向基于网络数据信息的科学管理转变。方法分析医疗设备全寿命周期活动;梳理归纳基于HIS的医疗设备业务信息;抽象主题数据集子集及设置数据项;核查数据质量;构建中间库数据结构表等。结果构建了包括医疗设备基本信息等11个模块为内容的医疗设备主题数据集中间库。满足了各级医疗设备管理者日常管理和重大决策的需求。     

以信息系统平台提升医疗质量管理水平

阐述了医疗质量管理信息化的必要性,介绍了质量管理信息系统平台的设计原则、总体架构、主要业务模块,同时对应用效果进行了分析.认为通过建立信息化全面质量管理平台,基本实现了数据科学化管理,加快了医疗质量管理精细化进程.     

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.