浅谈提高医院病案质量的有效途径

病案是某种疾病发生发展的重要信息资源,每份病案都是临床实践的经验总结。本文就提高病案管理队伍的素质、抓好病案书写质量的规范化、转变管理方法、更新管理手段、提高病案利用价值等方面分析各个因素对提高医院病案质量进行了如下论述。     

医院病案管理中存在的问题分析及解决方案

目的分析医院病案管理中存在的问题并且制定实施解决方案,以达到优化病案管理的目的。方法通过加强医院的相关人员对病案管理工作的重视程度、加强病案的管理质量、积极的利用病案信息以及加强医院病案管理人员的专业素质等方式来加强医院病案管理工作,观察实施前后医院的病案质量、患者投诉以及患者满意程度的变化。结果在医院开展了病历管理的相关措施之后,在病案完善率、患者投诉率以及患者满意率等方面都有很大的改善。结论实施有效地措施是可以切实的提高医院的病案管理工作质量的。     

病案首页质量与病案信息利用的研究

目的：探讨如何开发和利用病案信息价值,更好为医院管理提供服务。方法：选择我院今年来住院病案首页书写质量和病案信息资料,并进行回顾性分析。结果：通过调查分析,发现的病案首页填写中常见问题及影响病案首页质量的因素和如何提高病案首页填写质量的具体措施。结论：科学合理的书写病案首页和管理病案资料,更好地体现病案信息的利用价值,为医院与社会提供服务。     

提高病案质量管理的体会

病案管理是医院管理的一个重要方面,随着医学科学的发展和医学模式的转变,对病案管理工作提出了更高的要求,加强病案管理工作,是提高医院医疗质量的一个中心环节。笔者结合自己的工作实际,就如何加强病案质量管理工作谈如下几点体会。1 病案管理是随着医学的发展而发展起来的 现代临床医学的研究表明,病案管理直接影响着医学的发展,同时病案管理的科学化程度越高,所提供的服务就越多,病案的利用也就越高,从而能更好地推动病案为临床医疗服务。2 加强对病案管理基础理论的研究 目前,大多数病案管理人员仅偏重于对现有的病案管理技术方法的研究,对病案管理其他理论的研究比较少。从提高病案质量管理角度,管理人员应该从系统工程,多层次、全方位来加以考虑,如从社     

加强病案质控 提升医院内涵管理

目的加强病案质控,提高医院管理水平,减少医疗纠纷。方法总结2008至2010年归档病案存在的常见问题,提出应对对策,通过加强过程管理,与临床一线医护人员沟通联系,进行病案评比。结果病案合格率由73%提高到97%。结论病案质量是医疗质量的具体反映,加强病案质量管理,可减少医疗纠纷,提升医院的内涵管理。     

加强病案质控 提升医院内涵管理

目的加强病案质控,提高医院管理水平,减少医疗纠纷。方法总结2008至2010年归档病案存在的常见问题,提出应对对策,通过加强过程管理,与临床一线医护人员沟通联系,进行病案评比。结果病案合格率由73％提高到97％。结论病案质量是医疗质量的具体反映,加强病案质量管理,可减少医疗纠纷,提升医院的内涵管理。     

某院规范病案管理工作的方法研究

目的对我院病案规范化管理工作的方法研究。方法严格规范病案管理工作的各个环节,规范病案书写、提高病案管理的法律责任意识、定期培训病案管理人员、发挥电子病案管理优势。结果对病案进行规范化管理使得医护人员的法律责任意识得到了加强,每个工作流程都有章可循,有法可依,减少了工作纰漏。结论加强病案规范化管理,是提高病案内涵质量和医疗质量的基础,是保障医疗机构正常利益不受损的关键。     

探析科学现代化病历管理的重要性

目的探讨科学现代化病历管理的重要性,以加强对病案管理重要意义的认识。方法结合病案管理的重要性、社会性等相关实际情况,分析提升病案质量的关键要素,进一步阐述病案管理的重要意义。结果科学的病案管理在医院的全面管理中发挥着重要作用,医院的全面提升需要以病案管理质量的提高作为支持,且大量的病案记录又为医院提供了真实而又准确的资料,为医院的长期发展奠定了基础。结论病历质量管理是一个持续的动态管理过程,因此提高医疗质量,加强病案管理能提高医疗质量,能有效地减少医疗纠纷,确保医疗安全,促进医院科学发展。     

加强住院病案回归环节的管理

病案管理是医院质量管理的重要环节,住院病案的回归管理亦是病案管理工作的一项主要内容。住院病案的回归能否及时,直接影响到病案管理的质量和工作效率,反映出医院管理水平的高低,因此,要使医院管理水平得到提高和发展,就必须加强住院病案的回归管理,提高住院病案回归率。 我院设有１２个住院科室,病床总数３３５张,以往住院病案均由病案管理人员每日到各科病房收集,回归病案室。出院病案各科无专人管理,乱摆乱放,使很多病案不能及时归档,丢失病案的现象时有发生。病案管理工作比较被动,阻碍医疗信息的统计分析、反馈和利用…     

我院实施病案管理体会

病案是医疗信息的主要来源,作为服务于临床、医疗、科研、教学等特有的医学档案,利用价值高,应用范围广,其质量直接反映医疗技术及管理水平。在当今信息时代,病案管理现代化,已成为医院信息建设的重要基石。要使病案能为医疗、教学、科研、司法裁定、医疗保险提供快捷、及时、准确的服务,就必须借助于现代管理手段,加强电子网络建设,提高病案信息传输速度,扩大病案的交流,实现资源共享。     

Physicochemical properties of maltosyl and glucosaminyl derivatives of beta-lactoglobulin

Maltosyl and glucosaminyl derivatives of beta-lactoglobulin (b-LG) were analyzed for their physicochemical properties: reduced viscosity, ultraviolet difference spectra, intrinsic fluorescence, hydrophobicity and circular dichroism. The viscosity of these derivatives increased as the mass of the carbohydrates covalently linked to b-LG increased. The ultraviolet difference spectra and the intrinsic fluorescence of these proteins revealed that the microenvironments of aromatic amino acid residues of b-LG were increasingly exposed to the surface of the protein as the extent of modification increased; and the polarity of these residues also increased as modification increased. The hydrophobicities of M-b-LG derivatives decreased as the extent of modification increased while the hydrophobicities of G-b-LG derivatives were relatively unchanged. The circular dichroic analysis of these proteins indicated that the ordered secondary structures of the extensively modified derivatives of b-LG were partially unfolded. Thus, the carbohydrates covalently linked to b-LG altered many physiochemical properties. These physicochemical changes of b-LG apparently resulted from an alteration of forces stabilizing the structure of the protein.     

Differential effects of serotonergic and catecholaminergic drugs on ingestive behavior

The serotonergic agonists fenfluramine and fluoxetine and the catecholaminergic agonists amphetamine and phenylpropanolamine are well known to cause a reduction in intake in rats. In the studies reported here we investigated the effects of these drugs on the microstructure of licking behavior of the rat ingesting 0.4 M sucrose. The purpose was to examine the similarities in the behavioral effects within and between these two classes of anorectic agents. The serotonergic agonists fenfluramine and fluoxetine caused a reduction in intake primarily by reducing the size of bursts and clusters of licking within the test meal without affecting the duration of the meal, suggesting a reduction in the palatability of the test solution. The catecholamine agonists amphetamine and phenylpropanolamine reduced intake primarily by reducing the number of bursts and clusters without affecting their size, suggesting a fractionation in the organization of the normal pattern of ingestion. The differences between the two serotonin and the two catecholamine agonists on the microstructure of the licking behavior suggest a different effect of the two neurotransmitters on the motor system that controls ingestive behavior. The similarities between the two different agonists within each class suggests a common neurotransmitter mechanism responsible for these two different effects on the behavior of the animals.Supported by NIH Grant DK41563 (JDD).     

Extrapyramidal and mesolimbic involvement with the stereotypic activity of D- and L-amphetamine

The electrolytic brain lesion technique was use to investigate the role of the dopamine-containing areas and pathways of the extrapyramidial and mesolimbic systems in the mediation of the stereotyped behaviour patterns induced by D- and L-amphetamine in the rat.Interruption of the ascending dopaminergic neurones from the mesencephalon at the level of the lateral hypothalamus did not modify the dose-dependent stereotypy induced by D- or L-amphetamine, whilst a lesion placed in the rostral hypothalamus to interrupt the dopaminergic innervation to the mesolimbic brain areas was shown to abolish the wearker intensity component of stereotypy (sniffing and repetitive head movements). Of the areas innervated by this pathway, lesion of the tuberculum olfactorium, but not the nucleus interstitialis stria terminalis or nucleus accumbens septi, also abolished sniffing behaviour. Lesions placed in the neostriatal area of the extrapyramidal system were without significant effect whilst lesion of the paleostriatum abolished all components of stereotypy. Lesion of the central amygdaloid nucleus only abolised the more intense components of both D- and L-amphetamine stereotypy (bitting, gnawing and licking).The brain studies demonstrate a differential involvement of the dopamine-containing areas of the mesolimbic and extrapyramidal brain regions, and the associated dopaminergic neurones which ascend from the mesencephalon, with the stereotyped behaviour patterns induced by both D- and L-amphetamine.     

Choice of optimum pharmacokinetic model of orally administered paracetamol

The present work studies the characterization of the pharmacokinetic profile of paracetamol following oral administration of DUOROL tablets containing 500 mg of the active compound. Analysis is made of the influence of statistical weighting on the selection of the pharmacokinetic model chosen. In the model proposed, the uptake of the drug into the systemic circulation is described by two first-order sequential kinetic processes. The values of the first order rate constants that define the absorption process have values of 4.79 and 9.73 h-1. Validation of the absorption model proposed was performed by applying the Wagner-Nelson method, according to which values of 4.63 and 10.95 h-1 were obtained for each of the constants defining the uptake of the drug into the systemic circulation.     

The historical delivery of antibiotics from microbial natural products--can history repeat?

Microbial natural products are the origin of most of the antibiotics on the market today. However, research in antibiotics and natural products has declined significantly during the last decade as a consequence of diverse factors, among which the lack of interest of industry in the field and the strong competition from collections of synthetic compounds as source of drug leads. As a consequence, there is an alarming scarcity of new antibiotic classes in the pipelines of the pharmaceutical industry. Still, microbial natural products remain the most promising source of novel antibiotics, although new approaches are required to improve the efficiency of the discovery process. The impact of microbial biodiversity, the influence of growth conditions on the production of secondary metabolites, the choice of the best approach at the screening step and the challenges faced during the isolation and identification of the active compounds are examined in this review as the critical factors contributing to success in the effort of antibiotic discovery from microbial natural products.     

不同剂量大枣对D-半乳糖衰老小鼠SOD活性和MDA含量影响的实验研究

本实验以昆明种小鼠为研究对象,颈背部注射 Ｄ－ｇａｌ建立衰老模型,同时以大枣作为抗衰老实验药物灌服,测定了脑组织内超氧化物歧化酶（ＳＯＤ）活性、丙二醛（ＭＤＡ）含量．实验结果表明：不同剂量大枣均可提高小鼠脑组织 ＳＯＤ活性,并能降低脑组织 ＭＤＡ含量．说明不同剂量大枣均可提高小鼠脑组织ＳＯＤ活性,并能降低脑组织ＭＤＡ含量,大枣具有一定的抗衰老作用．     

Berberine ameliorates the neurological dysfunction of the gastric fundus by promoting calcium channels dependent release of ACh in STZ-induced diabetic rats

BackgroundIt has been reported diabetic gastroparesis is related to diabetic autonomic neuropathy of the gastrointestinal tract, and berberine (BBR) could ameliorate diabetic central and peripheral neuropathy. However, the influence of BBR on the function and motility of the gastric fundus nerve is unclear.MethodsA diabetic rat model was constructed, and HE staining was used to observe the morphological changes in the gastric fundus. The changes in cholinergic and nitrogen-related neurochemical indexes and the effects of BBR on them were measured using Elisa. The effects of BBR on the neural function and motility of gastric fundus were investigated by electric field stimulation (EFS) induced neurogenic response in vitro.ResultsIn the early stage of STZ-induced diabetic rats, the contractile response of gastric fundus induced by EFS was disorder, disturbance of contraction amplitude, and the cell bodies of neurons in the myenteric plexus of gastric fundus presented vacuolar lesions. Administration with BBR could improve the above symptoms. BBR further enhanced the contraction response in the presence of a NOS inhibitor or the case of inhibitory neurotransmitters removal. Interestingly, the activity of ACh could affect NO release directly and the enhancement of BBR on contractile response was canceled by calcium channel blockers completely.ConclusionsIn the early stage of STZ-induced diabetic rats, the neurogenic contractile response disorder of the gastric fundus is mainly related to cholinergic and nitrergic nerve dysfunction. BBR promotes the release of ACh mainly by affecting the calcium channel to improve the neurological dysfunction of the gastric fundus.     

Cadmium-metallothionein interactions in the olfactory pathways of rats and pikes.

Deposition of cadmium onto the olfactory epithelium results in transport of the metal along the primary olfactory neurons to the olfactory bulbs of the brain. The present investigation was undertaken to determine the intracellular ligand binding of cadmium during this process. (109)Cd(2+) was applied on the olfactory epithelium of rats and pikes, and the subcellular distribution of the metal in the olfactory pathways was then examined. Two groups of rats were used: one pretreated with intranasal instillations of nonlabeled cadmium and the other given physiological saline (controls). Cellular fractionations showed that the (109)Cd(2+) was predominantly present in the cytosol of all samples, both in the rats and the pikes. Gel filtrations of the olfactory epithelium of control rats killed 2 h after the (109)Cd(2+) instillation showed that the metal was recovered in two peaks with elution volumes corresponding to metallothionein (MT) and glutathione (GSH)-the latter peak being the predominant one. However, in the epithelium of the cadmium-pretreated rats killed at 2 h, (109)Cd(2+) was recovered in one peak corresponding to MT. In the olfactory epithelium and bulbs of both groups of rats killed at 48 h, as well as in the olfactory epithelium, nerves, and bulbs of pikes killed at this interval, (109)Cd(2+) was recovered in one peak corresponding to MT. Immunohistochemistry of the olfactory system of rats given cadmium in the right nasal cavity showed induction of MT in the neuronal, sustentacular, and basal cells of the right olfactory epithelium, in the nerve fascicles in the lamina propria of the right olfactory mucosa, and in the olfactory nerve layer of the right olfactory bulb. On the left side, the immunoreactivity was low in these structures. MT immunoreactivity was observed in the glomeruli of both the right and the left olfactory bulbs. However, the staining was homogeneously distributed within the entire glomeruli of the right bulb, whereas it showed a mesh-like pattern corresponding to the localization of astrocytes in the glomeruli of the left bulb. We conclude that exposure of the olfactory epithelium to cadmium results in induction of MT in the primary olfactory neurons and a transport of the metal in these neurons as a cadmium-metallothionein (CdMT) complex. Our results further indicate that GSH is a ligand that can interact with cadmium before the metal binds to MT.     

Intracerebral microdialysis: 30 years as a tool for the neuroscientist

1. Microdialysis is an established technique for studying physiological, pharmacological and pathological changes of a wide range of low molecular weight substances in the brain extracellular fluid. Many studies have proven its sensitivity in sampling the extracellular space in discrete brain locations, such as the striatum, and monitoring the action of exogenous substances. 2. The two main areas of application of microdialysis are the recovery of endogenous substances, primarily the neurotransmitters, and the infusion of drugs through the microdialysis cannula (retrodialysis). 3. Microdialysis in awake animals is the tool of choice for studying the relationship between changes in behaviour and neurotransmitters in certain brain areas. In addition, the concomitant recording of the electroencephalogram at the site of microdialysis has been shown to be extremely useful in determining the role of certain neurotransmitters in paroxysmal activity. 4. Clinical applications of microdialysis have included monitoring of ischaemic injury, subarachnoid haemorrhage, trauma and epilepsy. With the recent availability of standardized equipment, the use of microdialysis in the neurological clinic is likely to become more common.     

Emerging drug treatments for cystic fibrosis

Cystic fibrosis (CF) is one of the most common life-shortening inherited disorders. Mutations in the cystic fibrosis transmembrane regulator (CFTR) gene disrupt the localisation and function of the cAMP-mediated chloride channel. Most of the morbidity and mortality arise from the lung disease which is characterised by excessive inflammation and chronic infection. Research into the mechanisms of wild-type and mutant CFTR biogenesis suggest that multiple drug targets can be identified. This review explores the current understanding of the nature of the different mutant CFTR forms and the potential for repair of the chloride channel defect. High-throughput screening, pharmacogenomics and proteomics bring recent technological advances to the field.