医院制剂室的软件管理

为了探讨医院制剂室的软件管理 ,我们根据《医疗机构制剂配制质量管理规范》的要求 ,分析了我们的软件动态与静态资料 ,提出了自己的一些解决方案。     

我院平均住院日状况的调查分析

目的：通过对医院平均住院日情况的简要分析，以探索缩短平均住院日的有效途径。方法：从统计室提取数据，与病案核对，计算相对指标。结果：我院的平均住院日呈下降趋势，但与卫生部颁布的标准还有差距，中医各科和康复科科别的平均住院日更长一些。结论：我院的平均住院日还有潜力可挖，术前住院日多数病种都较长，应在医疗质量和护理质量上狠下功夫，加强科室间的协作，降低平均住院日，减少无效住院日。     

应用计算机网络系统提高门急诊管理水平

作者介绍的门急诊计算机管理网络系统，应用软件使用ＦＯＸＰＲＯ２．５ＦＯＲＤＯＳ语言，在两台网络服务器之间应用镜像技术，门诊号的录入使用光笔和条形码技术，实行划价、收费一体化，采用星型拓扑网络结构，保证了网络的先进性、安全性、稳定性和可扩充性。网络系统实现挂号、划价收费、调剂、药品使用管理、工作量统计及经济核算的全程闭环管理格局，有效地堵塞了管理和经济上的漏洞，提高了工作效率和管理水平。该系统已正常运行了１２个月，并通过省级科技成果鉴定。     

关于放射治疗科室的组建

论述了医院组建放射治疗科室进行可行性分析时应考虑的因素,从技术设施、诊疗室与住院病房等方面介绍了放射治疗科的基本组建要求。     

Evaluation and Treatment of Children with Primary Immune Deficiency in the Emergency Department

The potential for morbidity and mortality in patients who have PID with febrile and nonfebrile illness is extremely high. Familiarity with the clinical manifestations of PID and collaboration with a pediatric immunologist are prerequisites for optimal short-term care of these complex patients. Conservative management with empiric broad-spectrum antimicrobials, early and aggressive surgical debridement of abscesses, and admission at a tertiary pediatric care center are often indicated.     

试论门诊管理

结合门诊管理的实践,对如何加强门诊管理进行了论述。主要为:①掌握门诊特点,确定门诊管理重点;②做好工作计划,实施目标管理;③充分发挥门诊部办公室的作用,承上启下,及时协调;④健全门诊管理组织,完善门诊管理规定;⑤抓好服务质量,方便病人就医;⑥加强质量考核,确保门诊工作质量。     

急诊科护士对新发传染病知信行调查问卷的编制

目的 编制急诊科(emergency department,ED)护士对新发传染病(emerging infectious diseases,EID)知信行(knowledge attitude practice,KAP)调查问卷,并进行信效度检验。方法 以KAP理论为基础,通过文献回顾、德尔菲专家函询形成问卷初稿;于2021年5月方便抽样上海市3所三级甲等综合医院293名ED护士进行预调查,完成问卷条目筛选和信效度检验。结果 形成含有34个条目的ED护士对EID知信行调查问卷,其中知识维度12个条目、态度维度10个条目、行为维度12个条目。问卷整体Cronbach's α系数为0.926,各维度Cronbach's α系数为0.617~0.968;问卷整体分半信度为0.846,各维度分半信度为0.614~0.958。问卷水平内容效度指数(scale-level content validity index,S-CVI)为0.99,条目水平内容效度指数(item-level content validity index,I-CVI)为0.99~1.00;探索因子分析显示,知识、态度、行为3个维度分别提取公因子4个、1个、2个,累计方差贡献率分别为50.192%、78.319%、73.341%,问卷整体累计方差贡献率67.242%;验证因子分析显示,问卷整体及各维度拟合度较好。结论 EID知信行调查问卷具有良好的信效度,可作为ED护士对EID KAP的评估工具。     

Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma

BACKGROUND: Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. Objective To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence. METHODS: We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use. RESULTS: Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [ R ] = -0.159), the number of fills of an oral steroid ( R = -0.179), and the total days' supply of oral steroid ( R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction). CONCLUSIONS: Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.     

Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.