关于手术室医疗设备完好率模型的探索

本文在原有医疗设备完好率计算模型的基础上,根据手术室医疗设备的特点及实际使用时间、维修等因素,运用加权系数法建立改进的手术室医疗设备完好率的计算模型。该模型为如何加强手术室医疗设备的科学管理提供了依据,减少了因医疗设备故障对手术的影响。     

The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency

BackgroundDrug-related overdoses were declared a public health emergency in British Columbia, Canada in April, 2016 facilitating the scale-up of responses including rapid sanctioning and implementation of overdose prevention sites (OPSs). OPSs are a health service providing supervised injection and immediate overdose response. In BC, OPSs were operational within weeks of sanctioning. In the first year of operation over 20 OPSs were established with approximately 550,000 visits and no overdose deaths at any site. In this paper, we examine the implementation of OPSs as a novel and nimble response to prevent overdose deaths as a result of injection drug use.MethodsA multiple case study design was used with the Consolidated Framework for Implementation (CFIR) informing the analysis. Three sites in a single city were included with each site constituting a case. In this paper, we focus on qualitative interviews with 15 staff and their perceptions of the implementation of the OPSs as well as provincial and local documents.ResultsThe legislative process to implement OPSs was unprecedented as it sanctioned supervised injection services as an extraordinary measure under a declared public health emergency. Innovative and inclusionary practices were possible within state-sanctioned OPSs, as the sites were government-directed yet community-developed, with PWUD centred in service design, implementation and delivery. OPSs lack permanency and may be limited to the duration of the public health emergency.ConclusionThe rapid implementation of OPSs provides an international example of an alternative to lengthy and often onerous sanctioning processes for supervised consumption services (SCSs). Overdose prevention sites provide an example of a novel service design and nimble implementation process that combines the benefits of state-sanctioned injection services with community-driven implementation. Such evidence questions the continued acceptability of governments’ restrictive sanctioning processes, which have limited expansion of SCSs internationally and the implementation of services that are not necessarily aligned with the needs of PWUD.     

手术室代理决策对开颅手术患者神经功能恢复情况的影响

目的：研究手术室代理决策对开颅手术患者脑氧代谢、脑血流动力学及神经功能的影响。方法：选择2019年1月至2021年12月于我院行开颅手术的患者98例,依据是否同意手术室代理决策分为试验组与对照组各49例,对照组行常规代理决策,试验组行手术室代理决策。观察两组术中出血量、手术时间及住院时间等手术相关指标;术前及术后1 d收缩期峰值流速、舒张末期血流速度等脑血流动力学指标;颈内静脉血氧含量（CjvO2）、颈内静脉血氧饱和度（SjvO2）及脑氧摄取率（CERO2）等脑氧代谢指标及神经功能;以及术后并发症、医疗纠纷发生情况。结果：试验组术中出血量、手术时间及住院时间均少于对照组（P＜0.05）;术后1 d,试验组收缩期峰值流速大于对照组,舒张末期血流速度小于对照组（P＜0.05）;术后7 d,试验组CjvO2、SjvO2及CERO2均大于对照组,NIHSS评分小于对照组（P＜0.05）;试验组术后并发症、医疗纠纷发生率均少于对照组（P＜0.05）。结论：手术室代理决策可有效缩短手术时间,减少患者创伤,改善患者血流动力学、脑氧代谢及神经功能,减少医疗纠纷。 查看全文     

手术患者术前出血倾向筛查结果分析

目的 调查术前患者出、凝血过筛项目在不同科室的差异。方法 取骨科、产科、五官科、普外科、肿瘤外科术前患者血浆,分别检测凝血酶原时间、活化的部分凝血酶原时间、凝血酶时间、纤维蛋白原等项目,结果 行统计学分析。结果上述指标检测值在不同科室有非常显著的差异,P〈0．01。结论 不同类型手术患者具有不同出、凝血的病理生理基础。常规凝血项目可以检测出其差异。     

层流手术室沉降法空气检测方法探讨

目的比较不同级别层流手术室沉降法空气培养多点布控采样与常规布点采样菌落数差异。方法按照《医药工业洁净室（区）沉降菌的测试方法））GB／T16294～1996连续8天在相同温度、湿度专人定时静态下对我院百级、千级、万级手术室各一间进行多点布控与常规布点30min后分别采样检测。结果多点布控与常规布控采样空气中细菌菌落数均达标,无致病菌检出,无统计学差异。多点布控空气沉降菌捕获率高于对照组,P〈0．01。结论采用多点布控是有效的监测方法。     

高校院系资料室特色数字资源建设新模式探讨

针对高校院系资料室特色数字资源建设中存在的问题和困难,提出了以技术托管为手段,以主讲教师为主导,以学科带头人为主体建设特色数字资源的创新模式,具有良好的可操作性和应用价值。     

Ocular discomfort and conjunctival alterations in operating room workers. A single-institution pilot study

Objectives: The aim of this pilot study was to relate the eye symptoms complained of by subjects working in the operating rooms of a hospital in southern Italy, with the observations of alterations of the ocular surface. Methods: An epidemiological study was carried out by a questionnaire aimed at investigating the prevalence of ocular discomfort symptoms among 213 subjects working in operating rooms and 40 subjects working in the wards. The investigated symptoms were the following: tiredness, heaviness, burning, redness, tearing, itching, blinking, foreign body sensation, and photophobia. A randomised comparative study of the ocular surface and conjunctival cytology was also carried out, comparing two groups of age- and gender-matched subjects. Group 1 included 24 subjects randomly chosen from the operating room workers with ocular discomfort symptoms; group 2 included ten subjects randomly enrolled from hospital personnel working in the wards. Ophthalmological examination of the ocular surface was performed on each subject in the following order: slit-lamp examination, break-up time (BUT) of the pre-corneal tear film, corneal fluorescein stain, lachrymal basal secretion test, conjunctival impression cytology. Results: A high prevalence (72.3%) of ocular discomfort symptoms was reported by operating room workers, while in ward personnel the prevalence was 55% (P=0.04). The ocular tests showed that the conjunctival features and BUT were statistically significantly altered in subjects in group 1. Also, the conjunctival impression cytology study showed statistically significant alterations of all the investigated parameters: specimen cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin pattern, goblet cell distribution, keratinisation and the total cytological score. Conclusions: Our results show that self-reported eye complaints and ocular surface alterations have a high prevalence in subjects working in the operating rooms. This seems to indicate that the operating room environment could play a role in the onset of the eye disturbances. Received: 13 March 2000 / Accepted: 13 September 2000     

Establishing a New Research Agenda for Studying Psychiatric Emergency Room Treatment Decisions

With the growing complexity of treatment decisions made at presentation to a psychiatric emergency room (PER) and the increasing influence of managed care on the decision-making process, it is increasingly important to establish a new and more sophisticated research agenda for studying PER decision making. The main goal of this paper is to propose a comprehensive conceptual model of the PER decision-making process that will facilitate active pursuit of such a research agenda. The proposed model presents both traditional and emerging elements of the PER decision-making process (i.e., determinants, mediating mechanisms, and outcomes) and explicates the nature of the relationships among them at different levels of analysis. The model's theoretical and empirical implications for future research are discussed and suggestions are made as to the research designs and methods needed to pursue this agenda.