PDCA循环在抗菌药物管理中的应用

目的探索对抗菌药物合理应用的管理方法。方法应用PDCA循环建立合理应用抗菌药物的管理制度,加强对医务人员的培训考核,定期进行住院患者细菌培养和耐药趋势的分析,发挥临床药师监督、指导作用,依靠电子病案信息化系统平台提升职能部门监督检查能力。结果干预前后抗菌药物使用率由76.89%下降71.33%、抗菌药物使用强度由64.13DDD下降至50.11DDD,I类切口抗菌药物使用率由96.19%下降至36.38%、差异有统计学意义。结论运用PDCA循环对临床抗菌药物的使用进行管理,促进了管理水平的提升,提高了抗菌药物临床合理应用水平。     

医院感染管理科参与抗菌药物应用管理的成效

目的观察医院感染管理科积极参与抗菌药物临床应用管理的作用。方法比较医院感染管理科积极参与管理前(2012—2014年)、管理后(2015—2017年)的抗菌药物临床应用管理评价指标的变化情况。结果医院感染管理科积极参与抗菌药物应用管理后,住院患者抗菌药物使用率由积极管理前17.18%下降至15.24%,特殊级抗菌药物使用率由1.45%下降至1.02%、接受特殊使用级抗菌药物治疗的住院患者抗菌药物使用前微生物送检率由87.12%上升至91.15%。积极管理后Ⅰ类切口手术患者预防性使用抗菌药物使用率为10.86%,术前0.5～1 h给药率为89.32%,预防性使用疗程24 h患者比率为86.77%,均高于积极管理前的8.74%、75.87%及57.81%,差异均有统计学意义(均P0.001)。积极管理前Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.27%、0.92%、1.29%,积极管理后Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.20%、0.67%、4.42%。Ⅱ类切口感染率积极管理前后比较,差异有统计学意义(P=0.011)。结论医院感染管理科积极参与抗菌药物应用管理能使抗菌药物临床应用管理评价指标得到明显改善,可促进抗菌药物合理应用。     

抗菌药物临床应用质量控制实施与成效研究

目的运用有效的质量控制管理方法,通过现代化、信息化的综合干预措施,促进抗菌药物的临床合理应用。方法建立抗菌药物专项质控管理评价体系,实施三级质控管理及细化控制目标;通过开发及应用"阳光监测系统"、"抗菌药物分级管理系统"及"Ⅰ类切口手术和介入治疗抗菌药物使用管理系统"等多套软件管理系统,实行多途径的信息化质控管理;开展抗菌药物临床合理应用专项病历检查及典型病历讨论会等,从而实现抗菌药物临床应用的全程监控。结果通过多元化的质量控制手段,已经收到良好的工作成效:整治工作前后对比,门诊抗菌药物使用率由19.0%降至8.9%;住院抗菌药物使用率由61.6%降至38.9%;Ⅰ类手术切口预防使用抗菌药物率由84.2%降至30.2%;介入治疗预防使用抗菌药物率由82.1%降至10.3%;抗菌药物使用强度由65.4DDD降至37.7DDD,整治前后各组之间差异均有统计学意义(P<0.01)。结论通过多元化质量控制手段可以实现抗菌药物使用的规范化管理,促进了抗菌药物的临床合理应用。     

处方点评在抗菌药物临床应用中的干预作用

目的通过处方点评对临床使用抗菌药物进行干预,使临床更加合理应用抗菌药物。方法从2012年1月起强化处方点评及干预工作,由临床药师、主诊医师、医院领导、院外专家4个层面开展抗菌药物处方点评,按点评意见落实奖惩措施;采用SPSS13.0软件进行统计分析。结果经过强化处方点评,门诊、急诊、住院部、Ⅰ类切口抗菌药物使用率从24.52%、45.33%、68.17%、86.74%下降至19.15%、34.78%、57.61%、39.58%;抗菌药物使用金额比从19.47%下降至15.36%;抗菌药物使用强度从95.07DDD/100人/d,下降至60.51DDD/100人/d;差异均有统计学意义(P<0.05)。结论处方点评是临床合理使用抗菌药物的有效干预工具,降低了抗菌药物使用率、使用金额比和使用强度,减轻了患者经济负担,提升了医院药事管理与药物治疗内涵质量。     

抗菌药物运用一体化项目型管理模式效果研究

目的 研究一体化项目型(IPMT)管理模式对抗菌药物管理有效性.方法 选取2011年11月1日-2012年10月31日I类切口手术出院16 641例,逐月调查I类切口手术围术期抗菌药物使用率、合理率(包括选药、疗程及术前给药时机均合理)以及手术部位感染率,并对同期59 951例住院抗菌药物使用率、使用强度、住院用药比例、治疗性抗菌药物微生物送检率进行调查.结果 I类切口手术抗菌药物使用率逐月下降,从2011年11月的50.35％下降至2012年10月的24.39％,同时合理率由80.13％上升至92.57％;I类切口手术部位感染率0.19％～0.36％;同期住院抗菌药物使用率由57.31％下降至48.07％,抗菌药物使用强度由64.9 DDD下降至49.8 DDD;住院用药比例由35.44％下降至29.97％;治疗性使用限制类抗菌药物微生物送检率由60.78％提高至64.25％,治疗性使用特殊类抗菌药物微生物送检率由71.88％提高至84.65％;经检验手术部位感染率和治疗性使用限制类抗菌药物微生物送检率,差异无统计学意义,其他调查结果差异均有统计学意义(P＜0.01).结论 IPMT管理模式可有效降低I类切口手术抗菌药物使用率、提高合理率,同时有效降低住院抗菌药物使用率、使用强度以及用药比例,有效提高治疗性使用特殊类抗菌药物微生物送检率.     

医院感染管理科参与抗菌药物应用管理的成效

目的 观察医院感染管理科积极参与抗菌药物临床应用管理的作用。方法 比较医院感染管理科积极参与管理前（2012—2014年）、管理后（2015—2017年）的抗菌药物临床应用管理评价指标的变化情况。结果 医院感染管理科积极参与抗菌药物应用管理后，住院患者抗菌药物使用率由积极管理前17.18%下降至15.24%，特殊级抗菌药物使用率由1.45%下降至1.02%、接受特殊使用级抗菌药物治疗的住院患者抗菌药物使用前微生物送检率由87.12%上升至91.15%。积极管理后Ⅰ类切口手术患者预防性使用抗菌药物使用率为10.86%，术前0.5~1 h给药率为89.32%，预防性使用疗程<24 h患者比率为86.77%，均高于积极管理前的8.74%、75.87%及57.81%，差异均有统计学意义（均P<0.001）。积极管理前Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.27%、0.92%、1.29%，积极管理后Ⅰ、Ⅱ、Ⅲ类切口感染率分别为0.20%、0.67%、4.42%。Ⅱ类切口感染率积极管理前后比较，差异有统计学意义（P=0.011）。结论 医院感染管理科积极参与抗菌药物应用管理能使抗菌药物临床应用管理评价指标得到明显改善，可促进抗菌药物合理应用。     

眼科Ⅰ类切口手术预防使用抗菌药物治理效果分析

目的:规范眼科I类切口手术抗菌药物预防使用,探索有效的干预措施,促进眼科抗菌药物临床合理应用。方法:对2011年1月-2013年10月51 110例接受I类切口手术眼科住院患者进行目标监测,对I类切口手术抗菌药物预防使用率、住院患者抗菌药物使用率、医院感染发病率等指标进行统计学分析,以评价干预效果。结果:2011年1月-2013年10月共51 110例眼科I类切口手术患者,抗菌药物预防使用率由2011年的63.90%下降至2012年的25.93%,2013年1-10月份下降到17.81%;住院患者抗菌药物使用率由2011年61.86%下降至2012年25.86%,2013年1-10月份进一步下降到19.41%;在降低眼科I类切口手术抗菌药物使用率的同时,3年间手术部位感染率、医院感染发病率差异无统计学意义。用药及未用药I类切口手术病例院内感染率进行比较,差异无统计学意义。结论:通过多项科学有效的综合干预措施,显著降低了眼科I类切口手术抗菌药物预防使用率,同时不会增加患者医院感染发生的风险。     

综合干预措施对血管外科合理使用抗菌药物的影响研究

目的通过综合干预措施促进血管外科抗菌药物的合理使用,以保证患者得到安全、有效、经济的药物治疗。方法采取行政管理和宣传教育等多种方式对医院血管外科抗菌药物的合理使用进行干预,选取2011年1-3月和2014年1-3月血管外科所有出院患者405例,将其分为干预前组151例、干预后组254例,对干预前后各项评价指标进行对照研究。结果住院患者抗菌药物使用率由干预前的(83.02±8.40)%下降至干预后的(16.77±6.78)%,Ⅰ类切口手术患者预防性使用抗菌药物比例由干预前的(93.90±5.31)%下降至干预后的(7.71±3.84)%,抗菌药物使用强度由干预前的(57.86±11.68)DDDs下降至干预后的(18.71±6.77)DDDs,其他多项指标均有显著改善。结论采用综合干预措施对医院血管外科抗菌药物的合理、经济使用起到了积极的促进作用。     

PDCA循环在围术期预防使用抗菌药物管理中的应用

目的探讨PDCA循环在医院I类切口手术和介入治疗抗菌药物预防使用管理中的应用及意义,促进临床抗菌药物的合理使用。方法从2011年5月-2012年12月利用医院信息系统对Ⅰ类切口手术和介入治疗抗菌药物预防使用进行调查分析,根据PDCA循环制定干预计划、检查、总结,对应用PDCA循环前后Ⅰ类切口手术和介入治疗抗菌药物预防使用率进行统计分析,以2011年5-6月住院患者作为干预前组,2011年7-12月住院患者作为干预早期组、2012年1-6月住院患者作为干预中期组、2012年7-12月住院患者作为干预后期组。结果应用PDCA循环管理后,Ⅰ类切口手术和介入治疗抗菌药物预防使用率显著下降,分别从干预前的87.9%和78.5%下降至干预后期的33.9%、16.2%;第一、二代头孢菌素使用率、术前30min²h给药时机合理率、24h和48h内使用率逐渐提高,分别从干预前的56.6%、37.8%、3.5%和13.0%提高至干预后期的95.7%、91.5%、34.8%和61.9%,差异均有统计学意义(P<0.01)。结论 PDCA循环在I类切口手术和介入治疗抗菌药物预防使用管理应用中持续改进效果显著。     

我院2011~2013年抗菌药物用药分析

目的介绍我院实施抗菌药物专项整治和药学干预措施的效果,为促进合理用药提供有用信息。方法利用医院信息系统,收集我院2011²013年抗菌药物使用数据,对抗菌药物的费用比例、使用强度(AUD)、用药频度(DDDs)等进行统计、分析。结果我院抗菌药物品种由整治前111种降到50种;门诊患者抗菌药物处方比例由30.0%下降至18.0%;住院患者抗菌药物应用率由65.0%下降至44.0%;AUD由整治前的63.8 DDD下降至整治后的48.6 DDD,降幅达23.8%;Ⅰ类切口手术预防用药比例由69.8%下降至7.3%。结论通过实施抗菌药物专项整治和药学干预,我院各项抗菌药物应用指标发生明显改善,但抗菌药物使用水平与卫生部要求还有一定的距离,仍需进一步加强管理。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.