Behavioral treatment of nocturnal enuresis in children with insulin-dependent diabetes mellitus.

Examined whether a well-established treatment program for functional enuresis, the urine alarm procedure, would be useful for children with both enuresis and diabetes. 5 children between the ages of 7 and 14 whose pretreatment physical examination suggested no neurological impairment were treated. A multiple baseline design across children indicated that the urine alarm procedure was successful in stopping enuretic episodes for all 5 children with treatment gains maintained for the 4 children available for assessment at 2-month follow-up. These results suggest that if no diabetes-related organic impairment is evident, behavioral treatment for enuresis can be beneficial for children with diabetes.     

品管圈在降低呼吸机报警频次中的应用

目的：探讨品管圈在降低呼吸机报警频次中的应用效果。方法严格按照品管圈活动的各个步骤,针对引起呼吸机报警频次较高的原因,提出相应的对策并严格实施。结果实施品管圈前后呼吸机的报警主要类型均为气道压高、呼吸频率高、吸气潮气量超限,报警主要原因均为呼吸道分泌物过多、患者不舒适、呼吸系统泄露,在实施品管圈活动前后的呼吸机报警频次之间,存在显著统计学差异（ P＜0.01）。结论品管圈活动可以降低呼吸机的报警频次,但目前尚无法显著改善引起呼吸机报警的原因。     

“Turn It Off!”: Diabetes Device Alarm Fatigue Considerations for the Present and the Future

Safe and widespread use of diabetes technology is constrained by alarm fatigue: when someone receives so many alarms that he or she becomes less likely to respond appropriately. Alarm fatigue and related usability issues deserve consideration at every stage of alarm system design, especially as new technologies expand the potential number and complexity of alarms. The guiding principle should be patient wellbeing, while taking into consideration the regulatory and liability issues that sometimes contribute to building excessive alarms. With examples from diabetes devices, we illustrate two complementary frameworks for alarm design: a “patient safety first” perspective and a focus on human factors. We also describe opportunities and challenges that will come with new technologies such as remote monitoring, adaptive alarms, and ever-closer integration of glucose sensing with insulin delivery.     

Dynamic probability control limits for risk‐adjusted Bernoulli CUSUM charts

The risk‐adjusted Bernoulli cumulative sum (CUSUM) chart developed by Steiner et al. (2000) is an increasingly popular tool for monitoring clinical and surgical performance. In practice, however, the use of a fixed control limit for the chart leads to a quite variable in‐control average run length performance for patient populations with different risk score distributions. To overcome this problem, we determine simulation‐based dynamic probability control limits (DPCLs) patient‐by‐patient for the risk‐adjusted Bernoulli CUSUM charts. By maintaining the probability of a false alarm at a constant level conditional on no false alarm for previous observations, our risk‐adjusted CUSUM charts with DPCLs have consistent in‐control performance at the desired level with approximately geometrically distributed run lengths. Our simulation results demonstrate that our method does not rely on any information or assumptions about the patients' risk distributions. The use of DPCLs for risk‐adjusted Bernoulli CUSUM charts allows each chart to be designed for the corresponding particular sequence of patients for a surgeon or hospital. Copyright © 2015 John Wiley & Sons, Ltd.     

呼吸机常见报警原因分析及处理措施

机械通气作为生命支持和呼吸治疗的有效手段,已广泛应用于临床各个领域,特别是近年来二级甲等医院急诊科建设不断完善、ICU陆续成立,使呼吸机的应用进一步普及。呼吸机报警是机械通气中经常发生的问题,如果处理不当,不仅影响到呼吸机的使用,而且有可能危及到患者的生命,因此正确判断和及时排除报警是极为重要的。对于不是非常熟悉呼吸机应用的临床医护人员对呼吸机报警感到紧张和压力,甚至对报警感到束手无策,不能迅速明确原因,及时正确处理。对呼吸机报警原因进行归纳分析,旨在为临床医护人员处理常见的呼吸机报警提供帮助,进一步提高危重症患者的抢救成功率。     

多模式神经电生理监测在脊柱手术中的应用

目的:用多模式的神经电生理检测包括体感诱发电位(SEP)、运动诱发电位(MEP)、肌电图(EMG),以及肌松剂四联刺激肌肉收缩试验(TOF)对脊柱手术监测进行研究,探究检查的方法和对报警的判断.方法:用多模式神经电生理监测方法对120例不同类型脊柱手术进行监测.结果:术中报警67例(63.3％),其中SEP报警46.7％,MEP报警19.1％,EMG报警35.0％.术后均无严重的并发症,并且及时发现了1例术后的血肿压迫并及时予以将其清除.结论:多模式神经电生理监测能最大程度地有效降低脊柱手术的风险.     

一种医用报警信号测试系统介绍

本文介绍了一种符合《YY0709-2009医用电气设备第1-8部分：安全通用要求并列标准：通用要求,医用电气设备和医用电气系统中报警系统的测试和指南》要求的报警信号测试系统,对系统的主要组成部分包括视觉和听觉报警信号采集装置、信号转换装置、报警信号处理装置分别作了介绍。针对本标准测试指标繁杂的特点,在报警信号处理过程中引入了智能判定系统,有效提高了报警信号测试的效率和准确性,实现了标准的测试要求。     

输注设备质量控制实践与探讨

为保障输注设备的使用安全,应对其进行质量控制。定期检测各项参数已成为医疗设备质量管理的必要内容。本文采用Fluke专业流量检测设备,并设计了完整的质量检测方案,对输注设备进行质量控制,对实践的结果进行总结与分析。结果表明,本文的质量控制方法能提高输注设备的使用质量与安全。     

失效模式与效应分析在床边监护仪报警管理的应用

目的降低床边监护仪使用过程中的潜在风险,提高护理质量,确保患者安全。方法对5个监护病区60张床位的床边监护仪报警管理,运用失效模式与效应分析(FMEA)对使用流程进行分析,查找每个环节中可能存在的风险,针对操作流程、规范培训、质量监管等关键环节实施改进措施。结果实施FMEA管理后,床边监护仪报警管理质量检查结果、护士监护仪使用相关知识掌握评分与实施前比较,差异有统计学意义(均P0.01)。结论对床边监护仪报警运用FMEA管理,能降低床边监护仪不报警的风险,保障患者安全。