血液配送的流程改进与管理

目的探讨血液配送流程改进与管理的方法和效果。方法设立送血组,制定规范的管理制度和严格的工作流程,实行人员岗前培训和分时段弹性排班的工作模式。结果流程改进后临床科室对血制品配送的满意度显著提高(P<0.05),配送时间缩短。结论优化血液配送流程与管理,保障了取血工作的准确及时和送血过程的安全,提高了工作效率,有利于患者输血安全。     

Reengineering of blood transfusion process by using Six Sigma

目的 降低输血缺陷,保证患者输血安全°方法 成立输血质量管理小组,按照六西格玛管理体系的定义、测量、分析、改进和控制5个步骤,对输血关键环节展开调查和分析,以数据为基础,找出流程中的关键问题并进行改进和输血流程重组.结果 输血流程重组后,输血各环节双人核对落实率达100％,取血等待时间减少1 267.81 s,取血核对时间减少142.57 s.合血标本合格率由97.04％提高至99.14％,输血缺陷由0.05％下降到0.01％,六西格玛管理法实施前后合血标本合格率、输血缺陷发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 运用六西格玛管理法重组输血流程能有效减少输血缺陷,提高护理工作效率.     

基于临床知识库的智能学习型不良事件管理系统的构建与应用

目的 构建基于临床知识库的智能学习型不良事件管理系统并评价其应用效果。 方法 组建研发小组，构建智能学习型不良事件管理系统，包括不良事件原因分析及对策措施知识库，以及事件上报、分析、整改、分享、数据统计分析5个模块，结合试点病区医务人员反馈的改进需求对系统进行优化后正式上线。 结果 系统应用前后不良事件发生率分别为0.68‰、0.72‰；系统应用后不良事件引发的投诉率由16.85%降低至12.04%，流程改进数量由28个增加至43个；医务人员对医院患者安全文化同意率除组织学习与持续改进、对患者安全的管理支持两个维度外，其他10个维度显著提高（均P＜0.05）。 结论 基于临床知识库的智能学习型不良事件管理系统能为不良事件管理提供精准的决策支持，促进不良事件管理的规范化，增强医院患者安全文化氛围，进一步保障了患者安全。     

六西格玛管理法用于输血流程重组的效果研究

目的降低输血缺陷,保证患者输血安全。方法成立输血质量管理小组,按照六西格玛管理体系的定义、测量、分析、改进和控制5个步骤,对输血关键环节展开调查和分析,以数据为基础,找出流程中的关键问题并进行改进和输血流程重组。结果输血流程重组后,输血各环节双人核对落实率达100%,取血等待时间减少1 267.81s,取血核对时间减少142.57s。合血标本合格率由97.04%提高至99.14%,输血缺陷由0.05%下降到0.01%,六西格玛管理法实施前后合血标本合格率、输血缺陷发生率比较,差异有统计学意义(P<0.05,P<0.01)。结论运用六西格玛管理法重组输血流程能有效减少输血缺陷,提高护理工作效率。     

细节管理在提高血库工作质量中的应用

目的：分析细节管理在提高血库工作质量中的作用。方法收集2012年1月~2013年12月的血库资料,以2012年度血库资料为对照组（未采用细节管理）,2013年度血库资料为观察组（采用细节管理）,对比分析两组工作质量（包括血库工作流程质量评分、临床合理用血率、输血不良反应率）和医护、患者对输血知识的掌握率、满意度。结果细节管理前后,工作流程质量评分为（6.39±1.27）,（8.32±0.91）分;临床合理用血率分别为61.88%,84.01%;因输血而发生的不良反应率分别为3.96%,1.73%;医护对输血知识的掌握率分别为78.33%,95.00%;患者对输血知识的掌握率分别为26.72%,84.17%;医护满意度评分为（69.22±11.86）,（85.62±10.39）分;患者满意度评分为（73.80±10.05）,（86.61±7.48）分。管理前后各指标数据差异均有统计学意义（P＜0.05）。结论细节管理有助于提升血库的工作质量,增强临床合理用血、减少输血不良反应,提高医患输血知识的掌握及满意度。     

临床输血管理护理子系统的设制与应用

目的 利用信息化管理优化临床输血护理流程,完善输血护理管理.方法 设计临床输血管理护理子系统,在43个住院病区护理单元使用,分析输血申请与取血后输血相关护理操作.结果 2009年10月至2010年9月,临床38 210例次输血申请中21 556例次(56.41%)需要配血标本,其中标本布置15 397例(71.43%);发放血液115 479 U/42 540袋,进行输血确认和输血反馈11 769袋(27.67%)和8 992袋(21.14%).结论 临床输血管理护理子系统的应用有效优化了临床输血护理流程;但标本布置、确认和反馈率低;需加强护理人员的培训和完善相应的管理制度,以充分发挥该系统的作用.     

Application of root cause analysis to safety management of blood transfusion in operating room/

目的 探讨手术室输血安全的管理方法.方法 成立根本原因分析团队,利用根本原因分析法对输血流程进行分析,找出存在的风险因素,制订可行性的改进计划,完善取血及输血操作流程、血袋处理流程等并贯彻执行.结果 实施后全体人员安全输血知识及操作技能考核成绩显著提高(与实施前比较,均P＜0.01),无输血不良事件发生及血源浪费现象.结论 运用根本原因分析法对手术室输血流程进行重新评估和设计,采取相应整改措施,可提高输血安全性.     

基于危机管理4R理论护理安全质量管理体系的构建与实施

目的基于危机管理4R理论构建护理安全质量管理体系,应用于临床护理安全质量管理,并对效果进行实用性分析,为临床护理安全质量管理提供新思路。方法以危机缩减、危机预备、危机反应、危机恢复四个环节为节点,建立健全护理安全质量管理架构,围绕"患者十大安全目标"制定护理安全质量标准;采用多种方式进行安全培训,以图表式流程图指引启动应急流程;以现代管理方法引导组织及系统恢复。结果构建护理安全质量管理体系后(2015年),护理安全质量评分、护理人员应急能力、规避纠纷能力显著高于2013年,护理不良事件发生率显著低于2013年(P0.05,P0.01)。结论基于危机管理4R理论构建护理安全质量管理体系并应用于临床,有助于促进护理安全质量管理。     

根本原因分析法在手术室输血安全管理中的应用

目的探讨手术室输血安全的管理方法。方法成立根本原因分析团队,利用根本原因分析法对输血流程进行分析,找出存在的风险因素,制订可行性的改进计划,完善取血及输血操作流程、血袋处理流程等并贯彻执行。结果实施后全体人员安全输血知识及操作技能考核成绩显著提高(与实施前比较,均P<0.01),无输血不良事件发生及血源浪费现象。结论运用根本原因分析法对手术室输血流程进行重新评估和设计,采取相应整改措施,可提高输血安全性。     

院内疼痛资源护士信息化多模式培训实践

目的 探讨院内疼痛资源护士基于信息化的多模式培训效果。方法 第一期选拔78名护士进行现场培训，第二期以90名护士疼痛知识薄弱点和对课程的需求为导向，构建院内疼痛资源护士培训课程体系，采用线上线下相结合多模式培训和客观结构化考试方式对学员进行为期2年的培训和认证。结果 培训后，第二期学员疼痛知识和态度评分及客观结构化临床考试4个站点考核评分显著高于培训前（均P＜0.01）；第二期学员综合测评合格率及学员满意度显著高于第一期学员（均P＜0.01）；患者对护士的疼痛宣教评价显著优于培训前，且护士对患者的非药物干预次数显著多于培训前（均P＜0.01）。结论 基于信息化的院内疼痛资源护士多模式培训有利于提高培训效果及学员满意度，提高患者对护士疼痛宣教的好评率及临床疼痛护理管理质量。     

Countercurrent system

Urinary concentration is achieved by countercurrent multiplication in the inner medulla. The single effect in the outer medulla is active NaCl absorption from the thick ascending limb. While the single effect in the inner medulla is not definitively established, the majority of experimental data favors passive NaCl absorption from the thin ascending limb. Continued experimental studies in inner medullary nephron segments will be needed to elucidate fully the process of urinary concentration.     

Renin-angiotensin system

Renin, a protease that cleaves the prohormone angiotensinogen thereby releasing angiotensin I, plays a major role in regulating blood pressure and electrolyte balance. Although renin is synthesized mainly in the cortical cells of the kidney, the presence of renin or reninlike activity has been recognized in various extrarenal tissues of humans and animals, including such reproductive organs as LH-containing cells of the anterior pituitary, placentral trophoblasts, and Leydig cells of the male gonad. It has also been learned that the renin in these extrarenal tissues generates angiotensins locally, which may interact with angiotensin II receptors in a paracrine or autocrine manner. However, the precise roles of the renin-angiotensin system in extrarenal tissue are not yet understood. We demonstrated the renin-angiotensin system in human testis by measuring the plasma renin activity (PRA), plasma angiotensin II (PAII), and testosterone in the internal spermatic vein (ISV) simultaneously after treatment with hCG, and elucidated the relationship between the renin-angiotensin system and sex steroids from Leydig cells of the male gonad.     

Trauma system evaluation using the fatality analysis reporting system

BACKGROUND: The Fatality Analysis Reporting System (FARS) has recorded detailed data on fatal traffic crashes since 1975. At least three prior studies have used declining mortality rates derived from FARS as evidence of regional trauma system effectiveness. METHODS: FARS and census data were obtained at no cost through the Internet. Previously published studies were replicated graphically including data from additional years before and after the previously reported time periods, and with rates also calculated for control populations. RESULTS: The association of trauma system organization with observed decreases in mortality rates was less convincing when all available data were displayed and other potential factors were considered. Death after traffic crashes, and especially death in hospitals, is becoming less frequent throughout the country. CONCLUSION: FARS is an excellent resource available to all injury researchers, but provides little evidence that some regions have decreased traffic mortality more than others because of trauma systems.     

Polysegmental Dynesys system

Introduction

The advantages of using the Dynesys System are claimed to be sufficient and polysegmental dorsal stabilization of the spine while preserving a certain amount of motion.

Materials and methods

In this study 20?patients with a polysegmental spinal pathology were treated with polysegmental decompression and using the Dynesys Dynamic Stabilization system. None of the patients had had spinal surgery previously. Bone density was measured in all patients preoperatively.

Results

All 20?patients were followed up for an average of 11.8?months postoperatively. The ability to walk was improved from 581.5?m to 1640.0?m after surgery. Complications observed were one leakage of the dura and one hypertensive crisis. Implant loosening was observed in one female patient, which was revised and dorso-ventral fusion was carried out.

Conclusions

The use of the Dynesys Dynamic Stabilization system is a reasonable treatment in patients with polysegmental pathology of the spine. However, the system does not allow restoration of extensive malalignments or deformities of the spine.     

The immune system

The immune system provides the body with both non-specific and specific defence against pathogens. It can recognize foreign from self. The immune system is composed of lines of defence and can mount responses by cellular and humoral mechanisms. It also has memory, allowing a quicker and heightened response on subsequent exposure. It achieves these effects by a complex interaction between the clotting, complement and kinin systems, endothelial cells and the cells and proteins of the immune system.