医疗器械沾染血迹后的保存方式对清洗效果的影响

目的探讨沾染血迹后的医疗器械安全有效的保存和清洗方法,以确保清洗灭菌质量和控制医院内感染的发生。方法将600把经人工染血的血管钳随机分成湿式保存组和干式保存组,每组分别在人工染血后1 h、2 h、3 h、6 h、12 h时各取出60件,再随机分为机械清洗组(30件)和手工清洗组(30件),经清洗后进行隐血试验,并进行统计分析。结果两种不同清洗方法组在染血后1 h、2 h、3 h的清洗结果比较差异无统计学意义(P0.05);手工清洗组在染血后6 h和12 h的清洗结果比较差异有统计学意义(P0.01),机械清洗结果比较差异无统计学意义(P0.05);6 h、12 h的干式保存组,机械清洗与手工清洗结果比较差异有统计学意义(P0.01),6 h、12 h的湿式保存组,机械清洗与手工清洗结果比较差异均无统计学意义(P0.05)。结论湿式保存能有效保证染血器械的清洗质量,机械清洗能更有效地保证清洗质量,只要采用合理的保存方式和清洗方法,都能达到保证器械清洗质量的目的 。     

乌鲁木齐市二级及以上医院标准预防相关物品的配备现状调查及分析

目的了解医院标准预防相关物品配备现状。方法采用分层随机抽样的方法,参照美国疾病控制中心提出的标准预防,自行设计调查表,对22所医院的300个科室调查标准预防相关物品的配备情况。结果手部卫生设施配备严重不足,仅55.00%的医生办公室配备洗手池,44.67%的护士站配备洗手池;防护用具配备不到位,仅22.33%的科室配备护目镜、防水围裙;职业暴露登记制度不健全,仅27.67%的科室有针刺伤上报制度。结论应进一步完善标准预防相关物品配备以保证医务人员执行标准预防。     

Survey of Geriatricians on the Effect of Fecal Incontinence on Nursing Home Referral

OBJECTIVES: Determine the effect of fecal incontinence (FI) on healthcare providers' decisions to refer patients for nursing home (NH) placement. DESIGN: Survey. SETTING: Questionnaires were e‐mailed to participants' homes or offices. Participants could also volunteer at the 2008 American Geriatric Society annual meeting in Washington, DC. PARTICIPANTS: Two thousand randomly selected physician members and all 181 nurse practitioner members of the American Geriatrics Society were surveyed. MEASUREMENTS: The survey presented a clinical scenario of a 70‐year‐old woman ready for discharge from a hospital and asked about the likelihood of making a NH referral if the patient had no incontinence, urinary incontinence (UI) alone, or FI. Subsequent questions modified the clinical situation to include other conditions that might affect the decision to refer. A second survey of respondents to Survey 1 addressed possible moderators of the decision to refer (e.g., family caregiver presence, diarrhea or constipation, other physical or psychiatric limitations). Significance of differences in the relative risk (RR) for NH referral was tested using the chi‐square test. RESULTS: Seven hundred sixteen members (24.7% response rate) completed the first survey, and 686 of the 716 (96%) completed the second. FI increased the likelihood of NH referral (RR=4.71, P<.001) more than UI did (RR=1.90, P<.001). Mobility restrictions, cognitive decline, and multiple chronic illnesses increased the likelihood of NH referral more than FI alone (P<.001 for each), but in all scenarios, adding FI further increased the likelihood of referral (P<.001). Having family caregivers willing to help with toileting attenuated the likelihood of referral. CONCLUSION: FI increases the probability that geriatricians will refer to a NH. More‐aggressive outpatient treatment of FI might delay or prevent NH referral, improve quality of life, and reduce healthcare costs.     

Sliding scale insulin: will the false idol finally fall?

Despite a lack of evidence that sliding scale insulin has any clinical benefit, and some evidence that it may even be detrimental, sliding scale insulin is still commonly prescribed in hospitals today. Adopting a proactive rather than a reactive approach to managing diabetes by the use of ‘supplemental insulin’, given in conjunction with either considered adjustments to the patient's regular anti‐diabetic therapy or the provision of basal insulin, is a more effective and safer means of improving glycaemic control in hospital. There are now randomized trial data to support this approach. These data, together with the recognition that there is no evidence base for the use of sliding scale insulin, coupled with changes to insulin prescribing charts in Australia, should lead to the demise of sliding scale insulin use in hospital.     

医院的“三个过度”：医改必须破解的连环结

“三个过度”（过度医疗、过度扩张与过度特需）是医院过快发展的畸形经营战略,提高了医院服务质量,也损害了质量,并可能成为政府增大投入的黑洞。医疗行业尚未深刻认识“三个过度”的后果,对看病贵采取了回避态度。应该以区域卫生发展规划为法规,调整压缩公立医院过多的床位,使大医院帮扶基层制度化,以亲民为民的立场投入医改,并对“三个过度”进行经济学研究。     

河南某医院临床专业技术人员现状调查与分析

目的:了解河南某医院临床专业技术人员现状,为该院人力资源的合理配置提供科学依据和政策建议。方法:通过现场调查和文献研究等方法收集该院卫生技术人员的基本信息,采用描述性流行病学方法对人力资源现状进行分析。结果:该医院共有临床专业技术人员346人,占全院卫生技术人员的60.60%(346/571);年龄构成呈纺锤型,25~35岁年龄组为主;学历以本科及以下人员为主;职称以初级为主;不同科室之间人员素质得分不均衡。结论:为提高医院卫生技术人员的能力和水平,促进医院可持续发展,应围绕医院学科发展的需要,优化高层次专业人才队伍建设,提高在职人员综合素质,优化学科专业梯队。     

人本思想在医院管理中的现实需求与功能拓展

目的用以人为本的理论,剖析当前医疗管理中存在的问题,探寻解决问题的方法。方法将马斯洛的人的需求层次说应用于医院管理工作中,解决当前的医疗问题,适应社会发展。结果用人本主义思想指导医院工作,可有效解决医疗工作中的问题,改善就医环境、提高医疗质量、调动广大职工的工作热情,缓解医患矛盾,提高医院的社会效益和经济效益。结论医院文化实质上是人本文化,对内坚持＂以员工为本＂,对外坚持＂以病人为本＂,是提高医疗质量营造和谐医疗环境的有效措施。     

专科医院适应专科医师培养制度的探索

通过对多家专科医院在专科医师培养模式方面的调研和分析,总结了专科医师培养方面存在的问题以及各专科医院的应对方式,认为专科医师培养模式的改革应该考虑专科医院的特殊情况予以适当调整,以利于专科医院的可持续发展。     

基层医院手术室的感染控制与监测

目的探讨基层医院手术室感染管理存在的问题与改进措施。方法深入调查,提出基层医院手术室感染管理存在的问题,采取相应的对策和措施。结果加强手术室医务人员的培训和医院感染管理能有效地控制基层医院感染的发生。结论基层医院手术室的医院感染管理工作需进一步加强,各级人员必须加以重视,控制好手术室的医院感染,确保医疗护理质量与安全。     

综合性医院抑郁症的特点及疗效分析

目的:了解综合性医院神经内科门诊抑郁症的临床特点及抗抑郁治疗的临床疗效.方法:对46例抑郁症患者的临床特点进行研究分析,同时对其中24例患者给予帕罗西汀治疗,对汉密尔顿抑郁评定表(HAMD)的平均总分数、汉密尔顿4因子及临床总体印象量表(CGI)评分在治疗前后进行比较.结果:46例抑郁症患者均以不同程度的躯体症状为主诉,临床表现多种多样,可涉及全身各系统;其中24例抑郁症患者给予帕罗西汀治疗后,汉密尔顿抑郁评定表的平均总分数、汉密尔顿4因子及临床总体印象量表评分分数在治疗后较治疗前显著减少(P＜0.01).结论:了解抑郁症患者躯体症状的临床特点,对于抑郁症的诊断和治疗至关重要.帕罗西汀对抑郁症患者具有明显的抗焦虑作用及早期改善睡眠的作用且整体抗抑郁疗效好.