Electronic Diabetes Management System Replaces Paper Insulin Chart: Improved Quality in Diabetes Inpatient Care Processes Due to Digitalization

Background:GlucoTab, an electronic diabetes management system (eDMS), supports healthcare professionals (HCPs) in inpatient blood glucose (BG) management at point-of-care and was implemented for the first time under routine conditions in a regional hospital to replace the paper insulin chart.Method:To investigate quality of the eDMS for inpatients with type 2 diabetes mellitus a monocentric retrospective before-after evaluation was conducted. We compared documentation possibilities by assessing a blank paper chart vs the eDMS user interface. Further quality aspects were compared by assessing filled-in paper charts (n = 106) vs filled-in eDMS documentation (n = 241). HCPs (n = 59) were interviewed regarding eDMS satisfaction.Results:The eDMS represented an improvement of documentation possibilities by offering a more structured and comprehensive user interface compared to the blank paper chart. The number of good diabetes days averaged to a median value of four days in both groups (paper chart: 4.38 [0-7] vs eDMS: 4.38 [0-7] days). Median daily BG was 170 (117-297) mg/dL vs 168 (86-286) mg/dL and median fasting BG was 152 (95-285) mg/dL vs 145 (69-333) mg/dL, and 0.1% vs 0.4% BG values <54 mg/dL were documented. Diabetes documentation quality improved when using eDMS, for example, documentation of ordered BG measurement frequency (1% vs 100%) and ordered BG targets (0% vs 100%). HCPs stated that by using eDMS errors could be prevented (74%), and digital support of work processes was completed (77%). Time saving was noted by 8 out of 11 HCPs and estimated at 10-15 minutes per patient day by two HCPs.Conclusions:The eDMS completely replaced the paper chart, showed comparable glycemic control, was positively accepted by HCPs, and is suitable for inpatient diabetes management.     

军队中心医院聘用人员管理的SWOT分析

SWOT分析法是一种战略分析方法,它通过对企业的优势（strength）、劣势（weakness）、机会（opportunity）和威胁（threat）进行系统分析,从而对企业发展做出科学决策。通过这种分析方法,将影响企业发展的各种因素列举出来,并以矩阵的形式进行排列,从而可以对各种因素进行分类,最后通过综合分析和比较提出发展战略。随着市场经济和医学科学的发展以及健康观念和医疗需求的变化,     

Effects of Vein Width and Depth on Ultrasound-Guided Peripheral Intravenous Success Rates

Background: Increasing numbers of operators are learning to use ultrasound to guide peripheral intravenous (i.v.) catheter insertion in patients with difficult access. Unfortunately, failed cutaneous punctures are common. Some veins seen on ultrasound may be better choices than others. Objectives: To estimate the effects of vein width and depth on the probability of success in ultrasound-guided i.v. catheter insertion. Methods: We prospectively collected data from attempts at ultrasound-guided venous catheter insertion between the antecubital fossa and mid-humerus. Each ultrasound machine's ruler function was used to determine depth from the skin to the closest vein edge and that vein's largest diameter. Success was defined as being able to freely withdraw blood or inject saline after the first skin puncture, considering each encounter independently. We calculated relative success rates, confidence intervals, and p values using reference groups selected by histogram analysis. Results: Thirty-five operators recorded 180 encounters; 100 (56%) were successful on the first skin puncture, and 152 (84%) were eventually successful. Success rates were not linearly related to vein width or depth. Success rates were higher for veins with diameter ≥ 0.4 cm vs. those < 0.4 cm (63% [78/124] vs. 39% [22/56], relative success 1.6 [95% confidence interval (CI) 1.1–2.3], p = 0.005) and for veins of depth 0.3–1.5 cm vs. veins of depth < 0.3 or > 1.5 cm (58% [96/165] vs. 27% [4/15], relative success 2.2 [95% CI 0.9–5.1], p = 0.04). Conclusion: Success rates are higher in larger veins (≥ 0.4 cm) and veins at moderate depth (0.3–1.5 cm).     

聘用护士到文职护士角色转变的实施方法与效果

目的为适应新时期军队医院发展的需要,培养文职护士的综合素质,提升医院护理质量。方法采取集中岗前培训、心理定位指导、观察分析能力的速成训练等方法进行正确引导和培养,并将军人职责教育贯穿始终,以促进其角色转变。结果年底全院护士进行综合考核,23名聘用文职护士理论考核成绩85~96(88.23±4.84)分;操作考核成绩90~98(93.12±3.07)分,实现了从聘用护士到文职护士的角色转变。结论招聘文职护士促使医院护理队伍稳定,人才结构趋于合理,整体护理质量得到提升。     

国有医院护理人员的复合激励研究

医疗质量是医院的核心竞争力,医疗质量主要体现在治疗质量和护理质量,而护理质量的保证依赖于护理人员的素质和工作积极性。本文分析了医院护理人员的激励现状,探讨了护理人员复合激励的思路和方法,期望对国有医院竞争力的提高具有借鉴意义。     

老年护理院医院感染病原菌及其耐药特征分析

目的探讨目前老年护理医院院内感染病原菌及其耐药特征。方法对2000年4月-2004年3月徐汇区两家老年护理院出院病人的病史进行统计分析。结果两家老年护理院共计发生医院感染939例次，医院感染率12．86％，检出病原菌284株，阳性率30．28％；病原菌以革兰阴性菌为主，占44．65％，其次为真菌、革兰阳性菌，分别为29．12％、25．92％，位于前3位的病原菌分别为其他真菌（14．36％）、白色念珠菌（12．23％）、铜绿假单胞菌（8．69％）；除嗜麦芽寡养单胞菌外，革兰阴性菌以亚胺培南最敏感，敏感率87％，对氨苄西林、阿莫西林的耐药率〉51％，对头孢哌酮、哌拉西林的耐药率〉33％；MRSA和MRSE的检出率高达86．76％和76．32％；混合感染率34．51％。结论老年护理院医院感染率高．真菌所占的比例高；细菌对抗菌药物的耐药性相当严重。     

对我院门诊病人投诉的原因分析与对策

目的通过提供良好的投诉接待服务，提高门诊医疗服务质量，进而提高病人满意度。方法回顾我院2007年上半年门诊病人的投诉情况，分析投诉产生的原因，并针对原因提出对策：结果2007年上半年共发生721件病人投诉事件。投诉主要涉及服务态度、医疗护理质量、就医流程、医疗体制、医院规章制度等方面。结论尽管医疗投诉不可避免，但通过良好的投诉接待服务能够重建病人对医院的信心，并获取改进医疗工作有价值的信息，最终使医患双方获得双赢.     

综合性医院老年病人抑郁症状的调查分析

目的 :分析综合性医院老年病人的抑郁症状特征及影响因素。方法 :应用中文版流调用抑郁量表 (CES -D) ,调查同济医院住院和门诊的 3 15例老年患者 (年龄≥ 60岁 )。结果 :①在 3 15例老人患者中 ,共有 70例老年患者 (占 2 2 2 % )肯定有抑郁症状 ,5 3例 (16 8% )可能存在抑郁症状 ;②CES -D总分女性组明显高于男性组 (t=2 0 3 2 ,P <0 0 1) ,且教育程度越低抑郁症状越明显 (F =3 75 6,P <0 0 1) ;③CES -D总分的多元逐步回归分析提示所有被调查老人及内科组老人的CES -D总分明显受其教育程度的影响。结论 :在综合性医院对老年病人进行抑郁症状的常规筛查是必要的     

四论音乐心理学在精神病医院中的地位

目的对综合的行为分析的理论和治疗的应用研究段计进行论证。方法音乐心理学是周用桓辩院模式的理论基础。“税书”是医疗、教育、工疗和娱疗的新四结合治疗的灵魂。结果音乐心理行为治疗促进了病房秩序，方便了譬疗工作的开展井有益于精神康复，提高了患者的自信心．强化了正常行为。结论音乐心理行为治疗是公认的行之有效的康复治疗的方法之一。可帮助慢性精神分裂症患者接受正常社会生活和唤醒他们潜在的正常精神功能。     

综合性医院冠心病病人抑郁/焦虑现况研究

目的：了解综合性医院冠心病患者抑郁和／或焦虑症状患病率及既往诊治情况。方法：采用现况研究方法，于2004年6月1日到12月1日在北京、上海、广州和成都的7家综合性医院的心内科连续收集确诊的冠心病患者359例。由经培训的调查员用统一的调查表进行面对面调查，同时使用综合医院焦虑抑郁量表（HAD）、Hamilton焦虑量表和Hamilton抑郁量表进行心理测评。结果：冠心病患者的抑郁症状、焦虑症状、抑郁合并焦虑症状以及合计的抑郁和／或焦虑症状患病率分别为19．8％，16．7％，13．6％和22．8％；在具有抑郁和／或焦虑症状的非首诊患者中，冠心病患者既往被诊断为抑郁和／或焦虑障碍和接受抗抑郁和／或焦虑治疗的比例均低于4％：住院患者在本次住院期间的抑郁焦虑诊治率低于1％。结论：综合医院冠心病病人具有较高的抑郁和／或焦虑症状和抑郁和／或焦虑障碍患病率．且既往诊治率较低。