《出生医学证明》书写和办理中存在的问题分析与对策

目的：通过对《出生医学证明》质量的检查，指出存在的问题，分析产生的原因，提出改进的方法。方法：2011年3月～2013年5月办理证件6398例，分成两组，比较文书书写管理改进前后的质量。结果：书写管理改进后质量较前有明显好转，差错率分别为0．6％和0．2％。结论：加强护理人员法制教育、文书质量管理及业务培训，可有效提高护理文书书写质量。     

多脏器粘连的小肠间质瘤1例围手术期的护理

目的：报道1例多脏器粘连小肠间质瘤围手术期护理方法。方法：回顾分析手术前、手术后护理要点、并发症的观察预防及治疗效果。结果：通过围手术期和术后的精心护理，患者术后恢复良好。结论：加强围手术期的护理对提高小肠间质瘤的手术效果和预后具有重要的临床意义。     

两种消毒液取用装置对外科手消毒效果的影响

目的：检测医护人员使用两种消毒液取用装置外科手消毒的效果，比较两组的无菌率、消毒液的使用量，探讨外科手消毒的最佳方法。方法：按随机分组抽样100名手术医护人员，将感应式消毒液取用装置外科手消毒作为实验组，将按压接触式消毒液取用装置作为对照组。结果：两种消毒液取用装置均达到卫生部《消毒技术规范》标准，但感应式消毒液取用装置用液量少于按压接触式消毒液取用装置。结论：感应式消毒液取用装置使用方便，节省消毒液。     

浅谈技术进步对医院建筑设计的影响

随着医疗和信息技术的迅猛发展,医院建筑设计也随之改变。文章论述了智能化系统的运用、医院管理模式的变化对医院建筑设计的影响,建议建筑师将医院整体的物流、人流进行有序组织与优化,为就诊患者和医务人员提供良好的就医和工作环境。     

卫生监督在个体口腔诊所推行医院感染管理标准操作规程（SOP）的实践和思考

2012年，张家港市在个体口腔诊所中推行医院感染管理标准操作规程（SOP）行政指导工作，作者就张家港市个体口腔诊所推行医院感染管理标准操作规程（SOP）工作的做法和成效进行了初步探讨，并对个体口腔诊所医院感染管理标准操作规程（SOP）制订与现行卫生标准、规范如何衔接、医院感染管理监督执法的发展方向、卫生监督执法人员如何有效履职作出思考。     

Study of anemia in long-term care (SALT): prevalence of anemia and its relationship with the risk of falls in nursing home residents

ABSTRACT

Objective: The objectives of the current study were twofold. First, this study examined the prevalence of anemia in nursing home residents in the USA and its relationship with key resident characteristics and medical conditions. Second, the study explored whether an association between anemia and falls is evident in this same population.

Research design and methods: Chart review was conducted in 40 nursing homes across the USA. Residents were randomly sampled and considered eligible if they: were ≥18 years of age; had ≥1 hemoglobin (Hb) level reported during the data uptake period of 1/1/04–2/1/05 (first occurrence defined as index Hb); had a recorded serum creatinine level; maintained residency in the facility; and did not receive dialysis during the 6-month post-index follow-up period. Resident demographics, laboratory values, comorbid conditions, medication regimens, falling events, physical functioning measures, and hospitalizations were obtained from chart data. The relationship between selected resident characteristics and comorbidities was explored with index Hb level, using multiple linear regression. Logistic regression was used to analyze the relationship between falling and recurrent falls with anemia (index Hb <13 g/dL and <12 g/dL in men and women ≥15 years, respectively) adjusting for selected variables presumed to be related to falls.

Limitations: Study limitations include the retrospective design and limited follow-up, potential for biased selection of relevant covariates, gaps in time between index Hb levels and falling events, non-random selection of nursing homes, limits to quality and detail in data extracted from residents’ medical charts, and confounding of anemia therapy with index hemoglobin level.

Results: A total of 564 sampled residents met the criteria for data completeness and were retained for analysis; of these, 70% were female. Mean age was 81 ± 12.3 years (±SD). Mean index Hb level was 11.9 ± 1.8 g/dL (12.2 ± 2.0 for males, 11.7 ± 1.6 for females). Of all residents studied, 56% were identified as anemic (64% males, 53% females) from index Hb level. In all, 53% of anemic residents were receiving an identified therapy, with 72% of these treated residents receiving iron. None received an erythropoietic-stimulating agent (ESA). For index Hb level, the regression coefficient was significant for female (p = 0.002), African-American race (p = 0.012), glomerular filtration rate (GFR) <60 mL/min/1.73 m² (p < 0.001), diabetes (p = 0.004), cancer (p < 0.001), asthma (p = 0.002), GI bleeding (p = 0.012), and inflammatory disease (p = 0.039). Except for asthma, these factors were associated with a decrease in Hb. In the regression model for the dependent variable of falling, anemia (OR = 2.26, p < 0.001), psychoactive medication use (OR = 2.18, p = 0.001), and age 85+ years (OR = 2.08, p = 0.016) were associated with more than twice the risk of falling.

Conclusions: Anemia in nursing home residents appears to be under-recognized. For residents over 70 years, the prevalence of anemia in both male and female residents was approximately four times the rate reported in a study of older community dwellers (Salive et al., 1992). Both anemia and the use of psychoactive medications are potentially modifiable factors strongly associated with falling. Since falls and related fractures are events associated with high morbidity and mortality, each of these factors deserves special consideration for potentially reducing the risk of such events in the nursing home.     

危机管理在消毒供应中心优质服务中的应用

目的 研究危机管理在消毒供应中心优质服务中的应用效果.方法 本院消毒供应中心共有26名工作人员,年龄18～50岁.2011年12月份共回收处理器械1218件（实施危机管理前）,2012 年6月份共回收处理器械1224件（实施危机管理后）,对两个时间段发生的风险事件进行比较分析.结果 采取危机管理措施后,与实施危机管理前相比较,风险事件从39起下降至14起（P＜0.01）,科室满意度从87%提高至97%（P＜0.01）,工作人员职业满意度评分从88.09±1.69提高至97.21±2.46（P＜0.01）.结论 消毒供应中心在提供优质服务中采用危机管理措施,可以明显提高工作效率,降低风险事件的发生,同时还可以提高工作人员的职业满意度,并提高医院其他科室工作人员对中心的满意度,有利于为中心营造出一个安全和谐的工作环境.     

老门诊楼改造工程施工管理难点及对策

文章以山东省金乡县人民医院老门诊楼改造项目为例，介绍了施工过程中遇到的困难以及解决办法，供进行医院改建项目的基建管理者参考。     

急性颅脑损伤患者院前急救与护理效果分析

目的研究急性颅脑外伤患者的院前急救及护理方法。方法采用病例对照研究的方法，对院前急救组与对照组进行比较，分析死亡率及预后情况。结果对照组院前死亡率为13．26％，而急救组仅为4．67％，二者比较差异存在统计学意义（X^2=4．72，P〈0．05）；急救组的恢复情况明显好于对照组，二者比较差异存在统计学意义（X^2=5．00，P〈0．05）。结论院前急救和护理对提高急性颅脑损伤患者的治疗和康复具有重要意义。     

STAFFING PATTERNS

Unsolved staffing pattern issues are viewed in the current context of funding pressures, third party payment, and management necessity for program and cost projections. Relevant factors are mustered for consideration with their implications. Use of differentiated skill levels and response as well as development of departmental services mandate are considered. The author also shares his experientially derived throughts on staff ratio to certain institutional assignments.