护理给药错误事件的危险因素分析及预测模型的构建

目的快速筛查护理给药风险事件,提出全面而有针对性的防范措施,以期指导临床护理工作,确保患者用药安全,提升护理质量,为药物护理质量管理体系提供较为可靠的理论框架和依据。方法采用回顾性病例对照研究设计,选取2016年1月—2018年12月某三甲医院上报的688例护理给药错误事件作为病例组,以病例组例数的2倍数在同时期药物执行数据库中进行随机抽样,抽样1376例未发生给药错误的护理给药事件作为对照组。对给药错误事件发生的相关客观因素及人为因素进行单因素及多因素Logistic回归分析,探讨护理给药错误事件的潜在危险因素,构建护理给药错误事件的风险预测模型。结果单因素分析显示,护士职称、护龄、患者性别、患者文化程度、患者年龄、给药班次、交接班时段、工作时长、给药途径、药物执行的科室是护理给药错误事件的影响因素(P<0.05)。通过多因素Logistic回归分析将护龄、科室、给药途径、患者年龄、是否处于交接班时段纳入最终的护理给药错误事件风险预测模型(P<0.05)。绘制并计算ROC下面积(AUC)=0.765,AUC>0.7,显示该模型有较好的临床预测能力。结论护理给药错误预测模型的构建可为临床药物护理提供理论依据,对于保障医院药物护理管理体系更具针对性及实用性,能够保证护理安全。     

Fumarylacetoacetase mutations in tyrosinaemia type I

Sixty-two hereditary tyrosinaemia type I (HT1) patients of various ethnic origins were classified clinically into acute, chronic, or intermediate phenotypes and screened for the 14 published causal mutations in the fumarylacetoacetase (FAH) gene. Restriction analysis of PCR amplified genomic DNA identified 74% of the mutated alleles. IVS12+5G→A, predominant in the French Canadian HT1 patients, was the most common mutation found in 32 alleles in patients from Europe, Pakistan, Turkey, and the United States. IVS6-1G→T, encountered in 14 alleles, was common in Central and Western Europe. There was an apparent “Scandinavian” 1009G→A combined splice and missense mutation (12 alleles), a “Pakistani” 192G→T splice mutation (11 alleles), a “Turkish” D233V mutation (6 alleles), and a “Finnish” or northern European W262X mutation (7 alleles). The remaining mutations were rare. Some of the mutations seem to predispose for acute and other for more chronic forms of HT1, but in our material no clearcut genotype phenotype correlation could be established. © 1996 Wiley-Liss, Inc.     

Malpractice protection: Communication of diagnostic uncertainty

Malpractice claims against pathologists for misdiagnosis have been sharply rising, especially in the areas of breast fine-needle aspirations (BFNAs) and cervical (Pap) smears. The current state of medical malpractice law is reviewed as it relates to pathologists' anatomic reports. Communication is one of the best medical malpractice prevention tools. This article examines anatomic pathology reports in terms of the merits of communicating diagnostic error rates to the clinician/patient. In the areas of BFNAs and cervical smears, dissemination of diagnostic error rates in the cytology report is recommended. This would help safeguard against malpractice liability being imposed without showing a deviation by the cytopathologist from reasonable practice standards. Diagn Cytopathol 1996;14:385–389. © 1996 Wiley-Liss, Inc.     

基于光学表面监测系统对头部肿瘤放疗中摆位误差的研究

目的比较分析头部肿瘤两种固定技术的摆位误差,评估以光学表面监测系统（optical surface monitoring system,OSMS）为辅助手段引导摆位并进行监测的可行性。方法头部肿瘤患者A组26例采用发泡胶+头部热塑闭合面罩固定,B组20例采用发泡胶+头部热塑开口面罩固定+光学表面监测系统。A组摆位后进行锥形束CT( cone beam computed tomography, CBCT )扫描共178次,B组摆位经过OSMO调整后进行治疗前CBCT扫描162次,将获得的CBCT图像和计划CT图像匹配,得到X、Y、Z轴方向上的平移及旋转误差,并对摆位误差进行比较分析。通过OSMS调整摆位误差的标准为三维方向上平移误差≤ 1mm、旋转误差≤1°,调整后OSMS监测的摆位误差与治疗前CBCT 扫描配准摆位误差的差异定义为OSMS的精度。运用OSMS跟踪监测整个治疗过程中患者的实时摆位误差,并记录分次内的最大三维矢量误差、旋转误差及治疗时间。结果B组与A组分次间的三维矢量误差（1.73±0.90）mm/（2.24±1.25）mm,X、Z轴上的平移误差（0.04±1.00）mm/（-0.34±1.48）mm、（0.06±0.86）mm/（0.29±1.14）mm,X轴旋转角度误差（0.01±0.09）°/（0.18±0.95）°和平均摆位时间2.5 min/2.0 min,经比较差异具有统计学意义（P＜0.05)。B组OSMS的精度在三维矢量误差为（1.28±0.74）mm。OSMS跟踪监测患者分次内的最大三维矢量误差（0.71±0.47）mm,旋转角度误差为（0.46±0.40）°。结论与常规的采用闭合面罩固定相比,采用开口面罩固定并应用OSMS辅助摆位,不仅可便捷有效地减小头部肿瘤患者的分次间摆位误差,而且能实时跟踪并监测分次内的摆位误差。     

我院精神科护士差错归因分析及管理对策

目的通过对精神科护士差错归因进行分析,以减少差错的发生。方法采用自行设计的精神科护理差错归因调查表,对2003~2005年我院50名精神科护士进行调查。结果50名精神科护士中有22名发生过护理差错,共计52人次。差错的内归因占75.00%,外归因占25.00%。低学历、低年资的年轻护士易发生护理差错。结论在护理管理过程中需加强对护士责任心的培养,督促其严格执行各项规章制度和操作程序。加强专业知识学习,创造优良的工作环境,运用归因理论针对个体差异进行培训。     

Adrenal function in Smith-Lemli-Opitz syndrome

Smith-Lemli-Opitz syndrome (SLOS) is a multiple malformation syndrome due to mutations of the 7-dehydrocholesterol reductase gene (DHCR7), which leads to a deficiency of cholesterol synthesis and an accumulation of 7-dehydrocholesterol. The SLOS clinical spectrum ranges from multiple major malformations to a mild phenotype with minor anomalies and intellectual disability. Several children with SLOS and adrenal insufficiency have been described. We performed ovine corticotropin (oCRH) testing in 35 SLOS patients and 16 age- and gender-matched controls. We reviewed prior adrenocorticotropin (ACTH) stimulation tests of our SLOS patients (19 of 35 available) and reviewed results of ACTH stimulation tests from 10 additional SLOS patients. Results from oCRH testing showed that patients with SLOS had significantly higher ACTH baseline values than healthy controls (24.8 ± 15.3 pg/ml vs. 17.8 ± 7.5 pg/ml, P = 0.034). However, no statistically significant differences were noted for peak ACTH values (74.4 ± 35.0 pg/ml vs. 64.0 ± 24.9 pg/ml, P = 0.303) and for baseline (14.2 ± 7.8 mcg/dl vs. 14.2 ± 6.3 mcg/dl, P = 0.992) and peak cortisol values (28.2 ± 7.9 mcg/dl vs. 24.8 ± 8.1 mcg/dl, P = 0.156). The area-under-the-curve (AUC) was not significantly different in SLOS patients compared to controls for both ACTH (250.1 ± 118.7 pg/ml vs. 195.3 ± 96.6 pg/ml, P = 0.121) as well as cortisol secretion (83.1 ± 26.1 mcg/dl vs. 77.8 ± 25.9 mcg/dl, P = 0.499). ACTH stimulation test results were normal in 28 of 29 tests. The individual with the abnormal test results had subsequent normal oCRH tests. The slightly increased baseline ACTH level seen during oCRH testing may be due to compensated adrenocortical insufficiency. However, we were able to show that our patients with SLOS had an adequate glucocorticoid response, and thus, in mild to moderate cases of SLOS stress steroid coverage may not be warranted.     

护士长对无惩罚性自愿报告差错制度认知调查研究

目的了解护士长对无惩罚性自愿报告差错管理方式的认知,为建立和实施这一制度提供依据。方法采用自设问卷对96名护士长无惩罚性自愿报告差错管理制度的认知进行调查。结果93．75％的护士长对国内这一制度了解或部分了解,98．96％的护士长了解或部分了解其内涵;97．92％基本知晓该制度是为了获取信息制定预防措施。结论护士长对这一制度的认可程度高,但对其有效性和实用性仍持不确定态度。因此,护理管理者应尽快转变观念,积极构建有效通畅的无惩罚性自愿报告护理差错管理制度,以提高医疗护理安全：     

血红蛋白测定室内质控方法的设计

目的 从临床或医学实用性质量要求的角度，设计血红蛋白测定中的质控方法，即确定质控规则和质控测定值的个数。方法 设计质控方法的步骤：(1)以“允许总误差”形式规定质量要求；(2)确定该测定方法稳定操作下的不精密度或标准差(s)和不准确度(偏差)；(3)计算试验的临界系统误差和随机误差；(4)评价候选质控方法的误差检出概率(Ped)和假失控概率(Pfr)。结果 将这一设计方法应用于血红蛋白测定，结果表明用13a质控规则(N=1)能容易地达到90％以上的误差检出目标。结论 本质控方法对于临床检验项目具有广泛的适用性。     

Inhibitory effects of Geijigajakyak-Tang on trinitrobenzene sulfonic acid-induced colitis

Aim of the study

Water extract of Geijigajakyak-Tang (GJT) consisting of five crude drugs [dried root of P. lactiflora Peony (Paeoniaceae), dried trunk bark of C. cassia Blume (Lauraceae), seed of Z. jujube var. inermis Mill (Rhamnaceae), fresh root of Z. officinale Rocoe (Zingiberaceae) and dried trunk bark of G. uralensis Fish (Leguminosae)] is a folk medicine used for the treatment of chronic colitis. This study was designed to further elucidate the effect of GJT on 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats.

Materials and methods

GJT orally given to mice before and after TNBS intoxication, and their clinical and morphological changes, myeloperoxidase (MPO) activity and malondialdehyde (MDA) levels in colon tissues, were evaluated on Day 8 post-TNBS. Furthermore, the effect of six major constituents of individual herbs on ileum smooth muscle contraction and neutrophil chemotaxis was studied.

Results

GJT had a significant anti-inflammatory effect based on clinical and morphologic changes, MPO activity and MDA levels in colon tissues as compared with sham control. GJT and 5 major active constituents of individual herbs, paeoniflorin, cinnamaldehyde, jujuboside A, jujubogenin, and diammonium glycyrhhizinate significantly inhibited neutrophil chemotaxis. GJT significantly inhibited muscle contraction (IC₅₀; 2.10 ± 0.11 mg/ml), and 1,8-cineol has the most spasmolytic activity (IC₅₀; 0.10 ± 0.03 mg/ml).

Conclusion

GJT has significant anti-inflammatory effects on TNBS-induced colitis via inhibitions of smooth muscle contraction and neutrophil chemotaxis.