Midwives as drivers of reproductive health commodity security in Kaduna State,Nigeria

Objectives: The significant improvement in the contraceptive prevalence rate in Kaduna State, Nigeria, from 8.4% in 2008 to 18.5% in 2013 is a notable achievement. This article analyses the role of midwives as drivers of reproductive health commodity security (RHCS) and their impact on contraceptive use in Kaduna State. Methods: The United Nations Population Fund (UNFPA) supported the bimonthly review resupply meetings facilitated by midwives at State and local government area (LGA) levels. The midwives deliver contraception to the LGAs for onward distribution to 6974 of the 25,000 health facilities across the country according to usage data from the previous 2 months. They also collect requisition, issue and resupply form data from the previous 2 months. Results: The active participation of midwives at the bimonthly meetings improved data timeliness by 23% and data completeness by 50% in 1 year. Only one health facility ran out of intrauterine devices and only 17% reported running out of female condoms. The total number of contraceptives issued increased from 31,866 in 2012 to 177,828 in 2013, resulting in a couple–year protection increase from 3408 in 2012 to 102,207 in 2013. Conclusions: Creation of increased demand and engagement of midwives in providing family planning services, especially long-acting contraceptive methods, coupled with the removal of cost to the user and the strengthening of the supply chain have been major factors in more than doubling the contraceptive prevalence rate.     

Evaluation of the quality of radiology requisitions for intensive care unit patients

RATIONALE AND OBJECTIVES: The study aim is to evaluate the quality of radiology requisitions for plain film radiographs on intensive care unit (ICU) patients. MATERIALS AND METHODS: Radiology requisitions for 58 patients in ICU units at our children's hospital and the corresponding original orders for the study, written in patients' charts, were obtained. We reviewed each of the resident's written chart orders for completeness and then directly compared the information on the radiology requisition with the actual order written in the patient's chart by the ward resident physician. RESULTS: In 10% of cases, no "written order" was found in the patient's medical record for the imaging study. Clinical indications for the study were provided by the resident in only 71% (41/58) of cases. The resident's name was missing in the chart in eight of 58 cases (14%). The resident's name was provided in 50 cases, but was legible in only 28 of 50 cases (56%). In 84% of cases, the resident failed to provide his or her pager number. For one patient, the incorrect study was ordered. In only 73% (30/41) of cases did the ward clerk exactly copy the clinical indication that was handwritten in the chart by the resident. In 21% of cases, no resident's name was provided as the ordering resident on the radiology requisition. Inadequate or incomplete clinical information was provided in 24% of cases. CONCLUSION: Our study identifies a large number of problems in the quality of our radiology requisitions. Improving the process has been approved by our hospital as a major quality improvement project for this year.     

The effect of laboratory requisition modification,audit and feedback with academic detailing or both on utilization of blood urea testing in family practice in Newfoundland,Canada

ObjectivesMeasuring blood urea at the same time as serum creatinine in stable ambulatory patients in family practice is largely unnecessary. The objective was to assess the relative impact of changing the laboratory requisition versus audit and feedback and academic detailing on the volume of orders for blood urea.Design and methodsA natural experiment was observed over the period April 2015 to March 2018 in the Canadian province of Newfoundland where three health regions had different approaches to trying to reduce such urea testing. The Eastern and Western regions removed urea from the standard laboratory requisition but the test could still be ordered by writing it on the requisition. Central region requisitions continued to list urea. Audit and feedback was undertaken with family doctors in Eastern region after the requisition change and that was followed by academic detailing. A nephrologist gave presentations to groups of family doctors on one occasion in Central region.ResultsThe volume of serum creatinine testing was largely unchanged over time in each region. The volume of urea testing reduced by 73%, 48% and 28% in Eastern, Western and central regions. Interrupted time series analysis showed significant changes in test volume after requisition change in Eastern and Western regions as well as after audit and feedback in Eastern and the presentations in Central region. The incremental impact of academic detailing was not statistically significant.ConclusionWe conclude that removing urea from standard test order menus was the most effective in reducing test volumes, but combination with audit and feedback augmented the impact.     

一次性医用材料零星领用影响因素及控制策略分析

目的:分析四川大学华西医院一次性医用材料零星领用情况,并对零星领用较多的A类一次性医用材料的领用原因做出解释,提出控制零星领用的策略。方法:对华西医院的医用材料出库、入库量进行统计与分析,用ABC分析法得出零星领用次数较多的A类,并用ISM法解释这些材料零星领用次数较多的原因,在控制策略中选择合适的预测模型。结果:华西医院医用材料库房2010年7月-2011年6月全年内产生零星领用次数为14526次,708种,其中143种占零星领用次数的80.00%。一次性医用材料零星领用次数较多的原因是一个多级递阶结构,导致A类一次性医用材料零星领用次数较多的最低一层的原因是科室二级库房与总库的信息传递不及时。结论:分析A类一次性医用材料零星领用次数较多的主要原因,提出控制策略,每种策略中都包括控制方法。     

新冠肺炎疫情下大理市“征用”口罩引发的法律思考

此次新冠肺炎疫情蔓延,形势严峻,大理市对途径该市的口罩“征用”。本研究从法律角度对该事件进行了系统分析,认为大理市取得口罩的行为是征用而非征收;该行为具有公共利益,但其侵犯了他省的合法权益,造成了严重的社会不良影响;大理市对本行政区域内的口罩享有管辖权,但口罩是公共物品,不能成为征用对象。大理市征用口罩的行为违法。     

输血申请单质量调查分析

目的分析输血申请单质量缺陷的种类以及相关比例,探讨其质量缺陷的现状以及相应的提高方案和必要性。方法对2009年9月～2010年9月本地区6家医院的《输血申请单》中患者整体信息、医院级别分类、医生级别分三方面进行分析统计。结果《输血申请单》20个小类错误需要同等重视对待;省级医院《输血申请单》质量明显优于其他级别医院;主任医生的《输血申请单》质量优于其他级别医生。结论在各级医疗机构中有效提高《输血申请单》填写质量,规范临床用血行为,增强医护人员责任心和自我保护意识,有利于临床用血安全。     

我国重大疫情应急征用制度研究

以我国新冠肺炎疫情防控为背景,探讨风险应急状态下"公共利益"的判定、应急征用权与公民私权的法益冲突等问题,拟通过完善法治体系、平衡法益冲突、法定化应急征用程序、填补免责条款空白等策略,构建我国法律法规下的重大疫情应急征用制度,进而完善重大疫情防控体系,提升国家治理体系和治理能力。     

电子手术申请单与手术排班系统的改进与应用

目的完善电子手术申请单内涵,改进手术排班系统,满足手术需求,使手术室整体资源高效运转。方法重整电子手术申请及手术排班工作流程,规范了电子手术申请单内容的填写,完善了手术患者的信息,也设置了临床医师提交和取消手术申请单的权限,建立了急诊手术的绿色通道,为手术患者的术前准备工作提供依据和保障。结果运行3个月期间,特殊仪器设备与器械安排有误、手术信息取消、手术切口分类与手术安排有误等不良情况发生率明显下降。结论该系统为手术室整体资源共享,确保手术患者的安全,提高工作效率等方面提供了保障。