静脉用药调配中心24小时全医嘱下临时医嘱的运行模式

目的：探讨24 h工作模式下我院静脉用药调配中心（PIVAS）临时医嘱的运行模式,为临床安全合理用药提供参考。方法：分析PIVAS临时医嘱的审核、提取、批次安排、摆药、贴签、配置及扫描交接的运行模式。结果：临时医嘱PIVAS集中调配后,日均调配人数减少66.67%,调配时间减少77.78%,调配耗材减少13.64%。结论：我院PIVAS 24 h接收并配制临时医嘱,提高了工作效率,满足了临床配置临时医嘱的需求,保证了静脉用药的安全性及合理性。     

品管圈活动对减少PIVAS漏审不合理医嘱的应用及其有效性分析

目的:探究品管圈活动(QCC)对减少静脉用药调配中心(PIVAS)漏审不合理医嘱的应用及其效果。方法:抽取2017年1月-2018年1月期间医院PIVAS 3000份医嘱为管理前组,另抽取2018年2月-2019年2月期间开展品管圈活动后3000份医嘱为管理后组,对其中的不合理医嘱发生原因进行分析;比较两组医嘱中不合理医嘱发生的原因及其发生率差异;以及比较两组医嘱中QCC开展前后PIVAS工作人员的个人能力评分值的差异。结果:管理前组3000份医嘱中,其中563份医嘱存在不合理用药,其类型为给药频次不合理、溶媒选择不合理、给药剂量不合理、给药浓度不合理等,其不合理发生率为18.77%;管理后组3000份医嘱中,仅有67份医嘱存在不合理用药,不合理医嘱的发生率明显下降,其发生率仅为2.23%;管理后组显著低于管理前组(P<0.05);管理后组PIVAS工作人员的责任心、沟通能力、创造能力、积极性和团队精神的评分值均高于管理前组(P<0.05)。结论:QCC对减少PIVAS漏审不合理医嘱发挥着重要的作用,提高患者的用药安全性,充分发挥了PIVAS工作人员的团队责任性和工作能力。     

The trends in EMR and CPOE adoption in Japan under the national strategy

PurposeWe evaluate the status of health information system (HIS) adoption (In this paper, “HIS” means electronic medical record system (EMR) and computerized provider order entry system (CPOE)). We also evaluate the affect of the policies of Japanese government.MethodsThe status of HIS adoption in Japan from 2002 to 2011 was investigated using reports from complete surveys of all medical institutions conducted by the Ministry of Health, Labour and Welfare (MHLW). HIS-related budgets invested by the Japanese government from 2000 to 2008 were surveyed mainly using literatures and administrative documents of the Japanese government (MHLW and Ministry of Economy, Trade and Industry).ResultsThe rates of HIS adoption in Japan in 2011 were: 20.9% for the rate of EMR adoption in clinics, 20.1% for the rate of EMR adoption and 36.6% for the rate of CPOE adoption in hospitals. In hospitals, the rate of EMR and CPOE adoption were 51.5% and 78.6% in 822 large hospitals (400 or more beds), 27.3% and 52.1% in 1832 medium hospitals (200–399 beds), and 13.5% and 26.0% in 5951 small hospitals (less than 200 beds), respectively. Japan has a large number of medical institutions (99,547 clinics and 8605 hospitals) with a low rate of EMR adoption in clinics and a high rate of HIS adoption in hospitals. The national budget to expand HIS use was implemented for medium and large hospitals mainly. The policy target of New IT Reform Strategy was not achieved.ConclusionThe rate of HIS adoption in Japanese medium and large hospitals is high compared to small hospitals and clinics, and this is attributable to the fact that the Japanese government placed the target for HIS adoption on key hospitals with a large number of beds and concentrated budget investment in those hospitals. Besides, legal approval of EMR and the introduction of Diagnostic Procedure Combination system facilitated EMR adoption. There is less financial support for small hospitals than medium and large hospitals. The low rate of EMR adoption in clinics stems from the facts that there was little subsidies or incentives in the national remuneration for medical services, lack of cooperation from medical associations, and a failed attempt to mandate computerization of medical accounting (medical billing). Giving financial incentives is an effective means of raising EMR adoption rate. For wide usage of HIS, more financial support and incentive may be necessary for small hospitals and clinics.     

A ph mesh refinement method for optimal control

A mesh refinement method is described for solving a continuous‐time optimal control problem using collocation at Legendre–Gauss–Radau points. The method allows for changes in both the number of mesh intervals and the degree of the approximating polynomial within a mesh interval. First, a relative error estimate is derived based on the difference between the Lagrange polynomial approximation of the state and a Legendre–Gauss–Radau quadrature integration of the dynamics within a mesh interval. The derived relative error estimate is then used to decide if the degree of the approximating polynomial within a mesh should be increased or if the mesh interval should be divided into subintervals. The degree of the approximating polynomial within a mesh interval is increased if the polynomial degree estimated by the method remains below a maximum allowable degree. Otherwise, the mesh interval is divided into subintervals. The process of refining the mesh is repeated until a specified relative error tolerance is met. Three examples highlight various features of the method and show that the approach is more computationally efficient and produces significantly smaller mesh sizes for a given accuracy tolerance when compared with fixed‐order methods. Copyright © 2014 John Wiley & Sons, Ltd.     

Fixed‐structure controller design for polytopic systems via LMIs

In this paper, a new approach for fixed‐structure H₂ controller design in terms of solutions to a set of linear matrix inequalities are given. Both discrete‐time and continuous‐time SISO time‐invariant systems are considered. Then the results are extended to systems with polytopic uncertainty. The presented methods are based on an inner convex approximation of the non‐convex set of fixed‐structure H₂ controllers. The designed procedures are initialized either with a stable polynomial or with a stabilizing controller. An iterative procedure for robust controller design is given that converges to a suboptimal solution. The monotonic decreasing of the upper bound on the H₂ norm is established theoretically for both nominal and robust controller design. Copyright © 2014 John Wiley & Sons, Ltd.     

Ideal glass transitions by random pinning

We study the effect of freezing the positions of a fraction c of particles from an equilibrium configuration of a supercooled liquid at a temperature T. We show that within the random first-order transition theory pinning particles leads to an ideal glass transition for a critical fraction c = c_K(T) even for moderate supercooling; e.g., close to the Mode-Coupling transition temperature. First we derive the phase diagram in the T - c plane by mean field approximations. Then, by applying a real-space renormalization group method, we obtain the critical properties for |c - c_K(T)| → 0, in particular the divergence of length and time scales, which are dominated by two zero-temperature fixed points. We also show that for c = c_K(T) the typical distance between frozen particles is related to the static point-to-set length scale of the unconstrained liquid. We discuss what are the main differences when particles are frozen in other geometries and not from an equilibrium configuration. Finally, we explain why the glass transition induced by freezing particles provides a new and very promising avenue of research to probe the glassy state and ascertain, or disprove, the validity of the theories of the glass transition.