认真学习两法,公开、公平、公正采购医疗设备

医疗设备的招标采购已被医疗单位越来越多的广泛采用,认真学习招标采购的法律、法规,努力掌握招标采购的规则对医疗单位设备管理者日趋重要.我院近几年委托招标公司进行了多种形式的招标采购,有国际招标、政府招标采购、公开招标、竞争型谈判、询价采购、单一来源采购.采购的设备有CT、ECT、彩超、影像设备、检验设备、手术室设备、ICU设备、科研设备、网络设备等.     

医疗设备招标采购应加强的工作环节

目前大型医疗设备的招标采购工作已经不断完善与规范,但是为了进一步减少设备采购的盲目性、增加设备招标采购工作的透明度、提高设备招标采购的公正性,尚需对设备招标采购过程中的设备前期论证、供货商资质的审验、技术参数及设备配置清单核准等几个关键环节加强管理,以确保医疗单位在遵守公开、公平、公正的原则下,采购到性能价格比从优、真正符合临床实际需求、并可充分发挥社会效益和经济效益的医疗设备。     

医院设备网上竞价采购的实现和应用体会

设备采购作为医院设备管理的主要工作之一,是一项繁重和复杂的工作任务。传统的设备采购方式主要有货比三家、单一来源采购等,不利于引入良性竞争,并且由于信息不及时有效的公开,导致了设备采购信息不对称性,致使人们对采购工作的公正性产生疑问。同时,由于医院设备需求面大而量小,难以开展规范采购,影响了采购工作的开展。为了提高设备采购的效率和规范开展设备采购工作,确保公开、公平、公正,我院加入了中山大学的仪器设备网上竞价系统。实践数据表明,网上竞价能有效地实现"阳光采购",提高设备采购的效率,并有效节约资金。     

医疗设备采购的全流程管理信息化建设

医疗设备是医院医务人员开展诊疗活动的重要工具，是维持医院正常运行的重要物质保障。医疗设备采购是医院采购工作中的重点和难点，现阶段医疗设备采购全流程管理信息化建设不健全易造成采购效率低下，采购风险增加。该研究通过对医疗设备采购管理现存的普遍性问题进行分析，对医疗设备采购信息化建设提出建议，旨在规范医疗设备采购流程、控制医疗设备采购风险、提高医疗设备采购效率，同时为医院发展的决策提供一定的信息数据支撑。     

医院消毒灭菌设备采购存在的问题及对策分析

目的研究消毒灭菌设备采购活动过程中遇到的问题和相应对策。方法结合医院采购实践经验,对消毒灭菌设备采购存在问题进行多方面、多角度分析。结果提出采购前有计划、采购中有论证、采购后有管理;规范采购行为;制定更加灵活的采购方式、建立统一的专家库等多种措施和办法解决消毒灭菌设备采购过程中所遇到的问题。结论在医院消毒灭菌设备采购取得了良好的效果。     

血站设备的采购程序探讨

目的：对本中心目前设备采购的程序进行归纳与总结。方法：从建立质量体系文件、设备购置申请（申请前评估、购置申请、购置论证、购置计划）、设备参数制定（参数制定原则、参数分类）、设备的选择（参数选择、厂商资质、型号选择、价格选择）和设备的采购（政府采购、自行采购）等五个方面探讨本中心近年来设备采购的程序。结果：设备的采购依据规范的程序进行，避免设备采购中的盲目现象和不正之风，确保采购的设备符合国家标准，满足质量要求和工作需求。结论：建立正确的设备采购程序必不可少。     

卫生技术评估在医院大型医疗设备采购中的应用

目的 为进一步提升医院大型医疗设备采购工作的质量,满足医院对医疗设备采购精细化管理的要求,该研究引入卫生技术评估技术对医院大型医疗设备采购流程进行优化。方法 对医院采购流程中存在的问题进行梳理,对采购流程进行优化,并在采购项目论证阶段充分引入卫生技术评估技术,制作论证评估表格进行指标的量化,并以3.0T MR系统的采购对优化后的采购环节进行验证分析。结果 医院大型医疗设备采购流程得到了有效优化,优化后的采购流程应用于大型医疗设备的采购环节,有效量化了采购论证环节的指标评分,采购的设备月均收益率为5.30%,反映了该医疗设备运行效率和经济效益良好。结论 卫生技术评估技术应用于大型医疗设备采购环节,可有效提升设备的采购效率,并提升采购设备临床应用的经济性和有效性。     

实验设备采购管理平台在医学院校中的应用

目的：分析首都医科大学实验设备采购现状,设计实验设备采购管理平台。方法：根据医科大学教学和科研工作对实验设备的实际需求进行分析探讨,提出设备采购管理平台的12个功能模块,并应用于实验设备管理的实际工作中。结果：实验设备采购管理平台实现了设备采购的全流程动态管理和数据的查询统计。结论：实验设备采购管理平台的应用极大地方便了设备采购管理工作,达到了优化工作流程、提高工作效率和提升管理效益的目的。     

医疗设备采购全程规范管理的实践探索

医疗设备采购是一项专业性较强的管理工作。设备采购是否科学、规范、合理,关系到医疗资源的利用和医院的成本投入。通过分析当前医疗设备采购中存在的问题,结合医院多年来设备采购管理的实践,总结出一套满足临床需求和医院管理需要的设备采购管理方法:科学的采购计划、充分的调研论证、严格的采购程序和完善的后期管理。这有利于提高设备管理水平,规范医院管理和促进医院发展。     

应用密切值法综合评价某医学院校2015-2018年采购绩效

目的了解某医学院校设备采购绩效,以适应设备采购大数据和信息化需要。方法选择流标率(X1)、采购规模(X2)、规模效率(X3)、人员效率(X4)、质疑投诉率(X5)、采购节约率(X6)和平均项目周期(X7)作为设备采购绩效的评价指标,用密切值法综合评价某医学院校2015-2018年设备采购绩效。结果该院校2015-2018年设备采购质量评价指标的密切值Ci,分别为20.23、16.22、13.93和0.00,2018年的采购绩效排序为第1位。结论该院校2015-2018年设备采购绩效排序结果,基本符合采购工作实际情况,其采购工作规范性、效率性和效益性等有所提高。     

Nutritional composition of uncommon foods and their role in meeting micronutrient needs

Uncommon fruits and vegetables, namely leaves of Bauhenia purpurea Linn., Chenopodium album Linn., Fagopyrum esculentum Moench., and Gleichenia linearis and green and ripe fruits of Ficus roxburghi were analysed for their proximate composition, minerals and vitamin content, in vitro bioavailability of mineral, in vitro protein digestibility and two anti-nutrients, i.e. oxalic and phytic acid. Results showed crude protein, crude fat, minerals, crude fibre, carbohydrate, energy, calcium, iron, and iodine content was in the range of 1.74 to 4.93%, 0.23 to 1.38%, 0.46 to 3.02%, 0.88 to 5.02%, 1.46 to 14.46%, 15 to 76 Kcal, 19 to 355 mg, 1.22 to 6.2 mg and 0.5 to 5.16 mg, respectively, beta-carotene, thiamin, riboflavin, niacin and ascorbic acid content ranged between 169 to 3020 micrograms, 0.03 to 0.1 mg, 0.02 to 0.24 mg, 0.07 to 0.87 mg and 3.26 to 173.13 mg per 100 g, respectively. In vitro bioavailability of iron and calcium ranged between 4.62 to 9.23% and 7.30 to 63.48%. In vitro protein digestibility ranged between 9.78 to 14.48%. Findings of the study indicate that all the samples studied are good sources of micronutrients. To provide food security there is need to explore every possible source of nutrients.     

江苏省淡色库蚊成蚊对常用杀虫剂的抗药性测定

目的了解江苏省淡色库蚊成蚊对常用杀虫剂的抗药性现状,以有效指导淡色库蚊的防治。方法采用成蚊接触筒法测定LC50。结果江苏省南京、徐州、连云港、无锡、南通和淮安市淡色库蚊现场种群成蚊对溴氰菊酯的LC50分别为0.0173%、0.0756%、0.0487%、0.0070%、0.0055%和0.0150%,对氯菊酯的LC50分别为0.2128%、0.2711%、0.1130%、0.1579%、0.0504%和0.0734%,南京、徐州、连云港、无锡、南通、淮安和苏州市淡色库蚊现场种群成蚊对高效氯氰菊酯的LC50分别为0.0224%、0.0420%、0.0843%、0.0023%、0.0114%、0.0180%和0.0108%,南京和南通种群成蚊对敌敌畏的LC50分别为0.0119%和0.0046%,对残杀威的LC50分别为0.0129%和0.0077%。所测种群对溴氰菊酯均产生了中等及其以上程度的抗性,其中徐州和连云港种群抗性倍数均在100倍以上;对高效氯氰菊酯呈低抗至高抗,其中连云港种群的抗性高达94.7倍,无锡种群的抗性仅为2.6倍;对氯菊酯呈低抗至中抗,其中南京和徐州种群的抗性倍数为11～15倍,南通种群抗性倍数为2.8倍;南京种群对残杀威低抗（2.8倍）,南京种群对敌敌畏、南通种群对敌敌畏和残杀威均敏感。结论江苏省在成蚊防治中,应减少溴氰菊酯和高效氯氰菊酯的使用,可增加敌敌畏等有机磷类和残杀威等氨基甲酸酯类杀虫剂的使用;在进行成蚊化学防治时,要从全局考虑,做好杀虫剂使用的整体规划,以延缓或减少害虫抗药性的发生发展。     

PHYSICO-CHEMICAL PROPERTIES OF SOBIA: A TRADITIONAL FERMENTED BEVERAGE IN WESTERN PROVINCE OF SAUDI ARABIA

Sobia samples (14 samples) were collected from Makkah Al-Mukarrmah (Western province) and from Riyadh (Central province). Chemical (moisture, protein, fat, ash carbohydrate, energy, sugars, and ethanol) and physical (total soluble solids, total solids, viscosity, density, refractive index (RI), and specific gravity) properties of the sobia samples were studied. The moisture, protein, ash carbohydrate, and energy contents were found to be in the range of 82.33% to 89.23%, 0.26% to 0.63%, 0.023% to 0.106%, 9.95% to 17.22%, and 41.25 kcal to 70.54 kcal, respectively, and no fat was detected. Glucose and fructose were present in all samples except sample 3. Samples 1 to 10 contained sucrose in the range of 53.93 to 130.89 g/l, while samples 11 to 14 had no sucrose. Only four samples (1, 2, 9, and 10) contained maltose. The ethanol content in fresh samples ranged from 0.00 to 1.00 g/l, and after a week of storage at refrigerator temperature (3-5 C) ethanol content increased in all samples with samples 5 and 6 having the highest ethanol content of 4.24 and 4.54 g/l, respectively. Total soluble solids (Brix ), total solids (%), viscosity (cP), density, RI, and specific gravity values of sobia were found to be in the range of 6.83 to 15.10, 7.60 to 15.40, 1.47 to 4.39, 1.033 to 1.063, 1.3429 to 1.3559, and 1.0303 to 1.0600, respectively.     

Knowledge and attitudes of economically disadvantaged women regarding exposure to environmental tobacco smoke: a Michigan,USA study

BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a global public health problem which is particularly acute in groups where smoking rates are higher than in the general population. A study was undertaken to investigate knowledge, attitudes and preventive efforts with regard to exposure to ETS in a sample of economically disadvantaged women residing in Michigan, USA. METHODS: Analysis-of-variance techniques were used to investigate how knowledge, attitudes and preventive efforts regarding exposure to ETS relate to demographic variables such as smoking status, ethnicity, education, employment, and income; and analysis-of-covariance techniques were applied to determine the degree to which knowledge, attitudes, age, smoking status, ethnicity, education, employment, income and home environment predict these women's preventive efforts regarding exposure to ETS. RESULTS: Generally, women with no high school diploma and women who were smokers were less knowledgeable about the adverse health effects of exposure to ETS, had worse attitudes concerning exposure to ETS and were less likely to take preventive steps to limit their exposure to ETS than were women who had more formal education or who were nonsmokers, respectively. The primary predictors of preventive efforts were knowledge, attitudes and smoking status. CONCLUSIONS: The results suggest that educational efforts focusing on increasing knowledge and improving attitudes regarding exposure to ETS, as well as providing practical strategies for limiting exposure to ETS, should be developed and delivered to at-risk populations.     

A residential recovery program for homeless alcoholics: Differences in program recruitment and retention

This paper describes the Sober Transitional Housing and Employment Project (STHEP), a longterm residential recovery program in Los Angeles for homeless alcoholics. This NIAAA community demonstration project aimed to reintegrate homeless alcoholics into the urban environment and to increase levels of sobriety, housing, and employment. Participants first completed a 90-day program in a rural location and then transferred to a downtown recovery home for an additional 120 days. Services included enhanced vocational and housing assistance and specialized group activities. The evaluation examined patterns of recruitment and program retention, in comparison to a control group which received only the first phase, without enhanced services. Whites, women, and younger residents were less likely to sign up for the project waiting list and to accept entry into the project when randomized. STHEP participants were more likely to complete the first phase, particularly black males, compared to the control group. Upon completion of the second phase, whites were more likely to discharge to a rental situation, blacks to a sober group living facility, and women to live with others. Differences in program recruitment and completion may be explained by employment history, economic status, and gender, race, and age differences in subsistence patterns while homeless. The findings suggest the need for program planners to take into consideration the diverse backgrounds and needs of homeless alcoholics and to match individual needs to services. This study was completed while Dr. Grella was at the Pacific Institute for Research and Evaluation, Venice, Calif.     

Evidence-Responsiveness and the Ongoing Autonomy of Treatment Preferences

To be an autonomous agent is to determine one’s own path in life. However, this cannot plausibly be seen as a one-off affair. An autonomous agent does not merely set herself on a particular course and then lock the steering wheel in place, so to speak, but must maintain some form of ongoing control over her direction in life—must keep her eyes on the road and her hands on the wheel. Circumstances often change in important and unexpected ways, after all, and it is reasonable to think that a crucial part of autonomy consists of the ability and disposition to recognize and properly respond to such changes. This implies, I contend, that a patient whose initial decision to undergo a given treatment satisfied plausible requirements of autonomy, but who is now unable to recognize that available evidence indicates the need to reconsider her medical situation and options has come to lack autonomy with respect to her desire to continue that treatment. However, and despite its importance with respect to both theoretical understandings of autonomy and applications of the concept to clinical ethics, this ongoing aspect of autonomy has received little attention. This paper aims to go some way toward remedying that. I first critically review two of the few theories of autonomy that do address “evidence-responsiveness” so as to identify and elaborate what I take to be the most promising way in which to account for this aspect of autonomy. After considering and responding to a possible objection to the evidence-responsiveness condition I propose, I conclude by discussing its clinical implications. That condition, I argue, is not merely theoretically sound, but can and should be applied to clinical practice.     

Prospective study using standardized methodology for antimicrobial susceptibility of gram-positive cocci isolated from the Puerto Rico Medical Center

The Gram-positive cocci (GPC), Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, have become important causes of community and nosocomial-acquired infections. The prevalence of multiple resistant isolates to standard antimicrobial drugs has significantly increased over the past decades. Few prospective studies have been performed in Puerto Rico (PR) concerning the GPC antimicrobial susceptibilities pattern. The purpose of this study was to evaluate the in vitro susceptibility of GPC clinical isolates from PR to selected standard antibiotics and to the new antimicrobial agents, linezolid (LZ), quinupristin/dalfopristin (Q/D) and gemifloxacin (GM). The in vitro susceptibility utilizing disk diffusion and Etest methods to selected antibiotics was determined for a total of 429 isolates obtained during a period of 5 months from the Puerto Rico Medical Center Bacteriology Laboratory. The distribution of GPC collected was as follows: 213 S. aureus isolates, 162 E. faecalis, 16 E. faecium and 38 S. pneumoniae. The results of the susceptibility test demonstrated: 1) that in S. aureus, 100% of the isolates were susceptible to vancomycin (VAN), LZ and Q/D; 93% to GM; and 61% to methicillin/oxacillin; 2) in S. pneumoniae, 100% were susceptible to LN and GM; 87% to Q/D; and 53% to penicillin; 3) in E. faecalis, 99% were susceptible to ampicillin; 93% to LZ; 79% to GM; 78.6% to VAN; and 0% to Q/D. Sixty eight and 66% of the E. faecalis isolates were susceptible to gentamicin and streptomycin respectively; and 4) in E. faecium, 100% were susceptible to LZ; 94% to Q/D; 69% to GM; 37.5% to VAN and 20% to ampicillin. In E. faecium isolates, 50% and 31% were susceptible to gentamicin and streptomycin, respectively. Of the vancomycin resistant enterococci, 88.9% and 21% of E. faecium and faecalis showed VanA phenotypic resistance, respectively. These results show that there is a significant degree of antimicrobial resistance in GPC, including 38% methicillin resistance in S. aureus, a near 50% penicillin resistant S. pneumoniae, and a significant resistance of enterococcal species to VAN. The new agents, LZ, Q/D and GM, proved to be effective against both, S. aureus and S. pneumoniae. For E. faecium, both, LZ and Q/D were active, while for E. faecalis, only LZ showed consistent activity.     

Drug resistance and plasmid profile of shigellae in Taiwan.

One hundred and twenty-eight shigella strains isolated from newborn and infant human faecal specimens at Kaohsiung Medical College Hospital in Taiwan were serogrouped, serotyped and examined for drug-resistance patterns and for the presence of plasmids. Forty-seven per cent of the isolates were found to belong to the Shigella sonnei serogroup, 41% to the S. flexneri group, 9% to the S. boydii group and 3% to the S. dysenteriae group. The serotype with the greatest number of strains was S. sonnei I. (29%) followed by S. flexneri 1 (27%). Each strain was tested for resistance to 11 antimicrobial agents. Eight-eight per cent of the strains were resistant to tetracycline, 87% to chloramphenicol, 84% to streptomycin, 52% to ampicillin, 25% to nalidixic acid, 29% to kanamycin, 11% to cephalothin, 11% to neomycin, 10% to cotrimoxazole, 1% to amikacin and none to gentamicin. The most prevalent resistance pattern was ApCmSmTc (28%). Clinical isolates demonstrating multiple resistance were found to harbour a large transmissible plasmid of 45-75 MDa while isolates without multiple resistance did not. Two large virulence plasmids of 123 and 110 MDa were found in 12 strains of S. flexneri and 4 strains of S. sonnei phase I. Small plasmids of 4.5, 4.2, 3.5, 2.8, 2.5. 2.0 and 1.5 MDa were also present in all strains. These small plasmids were species specific and can be used as marker plasmids to identify species.     

物理研究人员投稿和阅读习惯调查与分析

【目的】 从选择投稿期刊、阅读文献等维度调查物理学相关领域研究人员对期刊服务的需求,为国内物理类期刊进一步优化工作重点提供帮助。【方法】 设计调查问卷,以《物理学报》采编系统人员库中7000多位活跃作者、专家为主要调查对象,对研究人员投稿和阅读的习惯进行统计分析,结合《物理学报》的办刊实践,总结物理类期刊吸引优质稿源、扩大影响力的有效措施。【结果】 期刊声誉、收录情况、出版周期、评价政策、审稿质量和影响因子是物理类研究人员选择期刊的重要参考因素;文献检索和电子版阅读是研究人员获取学术信息、学习科研成果的主要方式;研究人员普遍认为同行邮件推送和评选封面文章、优秀论文是论文宣传的有效途径。【结论】 物理类期刊应努力缩短出版周期、提高审稿质量;应密切关注检索技术和数字出版的相关动态,积极提升文章显示度和读者阅读体验;需要重视对已发表论文进行分类、遴选和再加工,为研究人员提供精准和个性化的学术服务。     

湖南省部分地区2011年致倦库蚊和家姆抗药性研究

目的 了解湖南省长沙、益阳、岳阳市蚊、蝇对高效氯氰菊酯、溴氰菊酯、仲丁威、双硫磷、敌敌畏和残杀威6种常用杀虫剂的抗药性情况,为蚊、蝇防治提供科学依据。方法 蚊虫抗药性检测采用幼虫浸渍法,家蝇采用点滴法。结果 致倦库蚊对溴氰菊酯、高效氯氰菊酯、仲丁威、双硫磷的抗性倍数分别为1.14～2.86、2.25～6.75、1.00～17.24和25.00～65.00倍,均已产生抗性,其中对双硫磷抗性最高;家蝇对溴氰菊酯、高效氯氰菊酯、敌敌畏、残杀威的抗性倍数分别为36.13～109.13、28.46～32.81、1.43～2.25和0.82～2.34倍,亦均产生抗性,其中对菊酯类药物抗性较高,抗性倍数最高的达109.13倍。结论 各地应高度重视蚊、蝇对杀虫剂的抗药性;加强抗性监测,合理地使用杀虫剂,预防或减缓蚊、蝇对杀虫剂抗性的产生和发展。