安徽省各级医疗机构医疗废物管理情况调查

目的了解安徽省各级医疗机构医疗废物管理情况,为规范医疗废物管理提供对策。方法统一调查表,采用分层抽样的方法,2007-2009年连续三年对安徽省各级医疗机构医疗废物管理情况进行调查。结果 2007-2009年安徽省各级医疗机构医疗废物管理及处置各项指标合格率总体呈上升趋势;2009年各级医疗机构在医疗废物管理方面,成立组织、建立制度、人员培训、规范登记及按要求进行包装、贮存、分类收集和集中处置方面的合格率分别为90.30%、75.97%、77.99%、88.41%、26.55%、19.09%、38.01%和22.41%。各级医疗机构在医疗废物管理指标方面的合格率优于医疗废物处置指标合格率;各级医疗机构医疗废物集中处置率总体不高,尤以乡镇卫生院、社区卫生服务中心为突出,2009年合格率分别仅为9.67%和29.02%。结论安徽省各级医疗机构医疗废物管理有待规范,医疗废物的包装、贮存等方面需进一步完善和改进,医疗废物的集中处置率亟需提高。     

医院病房药房药品数量化管理模式的探讨

目的加强药品规范化管理,使药品管理符合财务要求,提高药品账物相符率。方法利用医院信息系统对病房药房药品进行数量化管理,评价药品账物相符率、盘点效率、盘点误差率等指标,对比数量化管理前后这些指标的变化情况。结果数量化管理后药品的账物核算得到简化,盘点效率提高了1倍,盘点花费时间由原来3-4 h缩短为1.5-2 h,药品账物相符率从72%提高到96%,盘点误差率从0.05%下降到0.04%。结论实施药品数量化管理,使药品管理模式发生了＂质＂的转变,为全面提升药学服务质量,规范药品管理提供了有利条件。     

鸡西市医疗卫生机构医疗废物现状及对策

目的:探讨鸡西市医疗废物管理现状.方法:我们于2005年6至10月对鸡西市30所医院的医疗废物管理工作情况进行了横断面调查.结果:各医院对医疗废物的管理工作均很重视,均制定了相应的管理制度,但各医院在医疗废物的收集、暂存、运输、处置、人员培训等各方面仍存在许多不足,仍应进一步抓好医疗废物管理培训学习工作.结论:卫生行政部门和环保部门要加强对医疗废物的监督管理,尽快建立和完善医疗废物集中处置机构,使医疗废物管理工作走上标准化、规范化的轨道.     

In support of circular economy to evaluate the effects of policies of construction and demolition waste management in three key cities in Yangtze River Delta

As the driving force of social and economic development worldwide, a vibrant and environmentally friendly construction industry in every country is a necessary element for a successful and green global economy. China has a vibrant construction industry but faces environmental challenges posed by rapid urban redevelopment that generates huge quantities of construction and demolition (C&D) waste in most of its key cities. An understanding of C&D waste management in such cities, including the effectiveness of low carbon and waste reduction policies, can provide the basis for the sustainable development and economic growth of China’s construction industry. This study therefore evaluated the effectiveness of the C&D waste management policies of three key cities in China’s Yangtze River Delta region: Nanjing, Shanghai, and Hangzhou. Information was collected and presented based on statistical analysis and qualitative assessment of the total C&D waste and governance policies of each of the three cities between 2007 and 2018. The results show that Shanghai’s C&D waste annual total difference over the 11 year period is the largest at 2.85 million tons, a decrease of 36.8%, while Hangzhou has the largest difference in the total annual amount of C&D waste of 0.82 million tons, a reduction of 11.8%. Findings from the study provide scientific-based decision support for local and central government when strengthening construction waste management policies in China, as the country works towards a circular economy.     

基本医疗保险对医院的影响及对策探讨

对城镇职工基本医疗保险制度的建立给医院带来的影响进行初步探讨;提出要通过加强职工思想教育、搞好优质服务和医院经济管理、改变医院经营及服务方式和内容、加快人事分配制度改革等措施,使医院摆脱困境,求得生存和发展。     

How to engage healthcare providers in preventing medication waste through individualized prescribing and dispensing: A qualitative study

BackgroundMedication waste is a threat to healthcare's sustainability. To prevent medication waste in patients' homes, medication quantities prescribed and dispensed to patients could be individualized. Perspectives of healthcare providers on engaging in this strategy however remain unclear.Objective(s)To identify factors influencing healthcare providers in preventing medication waste through individualized prescribing and dispensing.MethodsIndividual semi-structured interviews were conducted via conference calls with pharmacists and physicians prescribing and dispensing medication to outpatients of eleven Dutch hospitals. An interview guide based on the Theory of Planned Behaviour was developed. Questions related to participant's view on medication waste, current prescribing/dispensing behaviour and intention to personalising prescribing/dispensing quantities. Data was thematically analysed, following a deductive approach based on the Integrated Behavioural Model.ResultsNineteen out of 45 (42%) healthcare providers were interviewed, of whom eleven were pharmacists and eight physicians. Factors influencing individualized prescribing and dispensing by healthcare providers were identified and categorized in seven themes: (1) attitude: beliefs about consequences of waste, as well as perceived benefits and concerns of the intervention; (2) perceived norm: professional and social responsibilities; (3) personal agency: available resources; (4) knowledge and skills: intervention complexity; (5) salience of behaviour: perceived need from past experiences and evaluation of actions; (6) habit: prescribing and dispensing habits; and (7) situational factors: support for change, momentum for sustainable actions, need for guidance, triad collaboration and information provision.ConclusionsHealthcare providers perceive a strong professional and social responsibility to prevent medication waste yet feel bound by limited resources available to engage in individualized prescribing and dispensing. Situational factors, including leadership, organizational awareness and strong collaborations, could help healthcare providers to engage in individualized prescribing and dispensing. Through the identified themes, this study offers directions for designing and implementing an individualized prescribing and dispensing program to prevent medication waste.     

第二军医大学长海医院静脉药物配置中心的药品管理

目的：探讨医院静脉药物配置中心科学、有效地管理药品的方法。方法：从8个方面介绍第二军医大学长海医院静脉药物配置中心的实践经验及体会。结果：在各个工作环节建立并实施双复核制度，可以实现药品完全相符，以保证输液成品的质量。结论：静脉药物配置中心的药品多环节的管理是保障临床用药安全，避免药疗差错的有效手段。     

浅谈药品损耗情况及管理措施

目的进一步提高该院药品管理水平,降低药品报损率。方法对该院2006～2010年药品损耗状况和原因进行统计、分析,并对降低药品报损率的方法进行探讨。结果该院通过对药品进行科学合理的管理,药品损耗率由2006年的0.21%降至2010年的0.03%,但是关于药品超过有效期的损耗仍在70%左右,药品的破损和患者退药两方面的损耗率呈逐年上升的趋势,由4.3%升至24.72%,这方面的损耗是以后需加强管理的重点。结论该院的药品耗损率逐年呈下降趋势,但是还有进一步降低损耗的空间,只要对药品进行科学、合理的管理,药品损耗率能降低到最有效程度。     

Occurrence and ecological risk assessment of fluoroquinolone antibiotics in hospital waste of Lahore,Pakistan

In the present study, wastewater and sludge samples of two major hospitals of Lahore, Pakistan were analyzed by developing an HPLC-UV method for the possible occurrence of five frequently used fluoroquinolone antibiotics i.e. ofloxacin, ciprofloxacin, sparfloxacin, moxifloxacin and gemifloxacin. The highest detected concentration was for moxifloxacin in both wastewater (224 μg/L) and sludge samples (219 μg/kg. The highest concentration of ofloxacin, ciprofloxacin, sparfloxacin and gemifloxacin were found to be 66, 18, 58 and 0.2 μg/L respectively. Risk quotient (RQ) was also calculated based on maximum measured concentrations and the RQ values were very high particularly for ofloxacin and ciprofloxacin. The maximum RQ values for ofloxacin against Vibrio fisheri, Pseudomonas putida, fish, Daphnia, Green algae and Pseudokirchneriella subcapitata were 3300, 66,000, 124, 46, 3300 and 6000, respectively. In case of ciprofloxacin, RQ values were found to be 1750 and 3500 against green algae and Microcystis aeruginosa, respectively.     

山西医科大学第二医院门诊西药房处方点评及不合理处方分析

目的：抽查并点评山西医科大学第二医院2016年1-12月门诊处方,对不合理处方进行分析,了解门诊患者处方用药的基本情况。方法：采用回顾性分析方法,对我院抽查处方进行用药品种、注射剂使用率、抗菌药物使用率等统计分析。结果：共抽查处方6000张,门诊人均用药品种数为1.7,抗菌药物使用率6%,注射剂使用率23%,国家基本药物使用率32%,通用名使用率为100%;平均每张处方费用为266元。平均处方合格率为92%。结论：药师定期进行处方点评,对不合理处方提出质量改进建议,通过相应行政与技术干预措施可有效减少处方不合理现象。目前我院门诊处方合格率与相关要求尚有一定差距,应加强对医护人员合理用药宣传,加强对处方质量和门诊用药管理,保障临床用药安全。     

我院优化行政组织架构和推行二级服务模式的举措与思考

目的:深入开展医院管理年活动,持续提高医疗服务质量。方法:在由上海市第六人民医院托管后,积极改革,优化行政组织架构并推行二级服务模式。结果与结论:通过此举,我院医疗安全意识、医疗服务质量、患者满意度逐步提高,使医院步入健康、有序、可持续发展的轨道。     

加强管理促进医疗机构药事管理工作的科学发展

目的确保临床用药的安全、有效、经济和适当,促进医院药学工作全面、协调、可持续发展。方法分析医院药事管理工作的重要性和现状。结果与结论医院药事管理部门应坚持“以人为本”,通过不断完善各项规章制度,优化绩效考核,建立临床药师制,采用产-学-研相结合的模式,协调各部门的关系,才能实现全面、协调、可持续发展。     

继续医学教育管理的经验与体会

从继续医学教育的管理来看,领导重视,制度健全,加大继续教育经费投入,完善继续医学教育的信息化管理,做好继续医学教育工作的计划与总结都是管理的重中之重.医疗卫生单位的各级领导到医务人员都应增加继续医学教育的主动意识,切实加强管理,才能使继续医学教育步入一个新的台阶.     

右美托咪定联合利多卡因用于乳腺癌改良根治术后镇静镇痛

目的：：比较不同剂量右美托咪定与利多卡因联合静注对乳腺癌改良根治术患者术后镇静、镇痛的疗效和安全性。方法：择期乳腺癌改良根治术患者60例随机分为3组：利多卡因组(L组,n=20),术前予利多卡因1.5 mg·kg-1静注后,以1.5 mg ·kg-1·h-1静脉泵注利多卡因至术终;低剂量右美托咪定联合利多卡因组(D1组,n=20),术前予右美托咪定0.3μg·kg-1,10 min内静脉泵注后,以1.5 mg·kg-1·h-1静脉泵注利多卡因至术终;高剂量右美托咪定联合利多卡因组(D2组,n=20),术前给予右美托咪定0.6μg·kg-1,10 min内静脉泵注后,以1.5 mg·kg-1·h-1持续静脉泵注利多卡因至术终。比较3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时,丙泊酚效应室浓度(Ce3, Ce80);术后1 h,6 h及24 h的VAS评分(VAS1~VAS 24);术后24 h内恶心,呕吐情况。结果：3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时各组间丙泊酚效应室浓度比较,差异无统计学意义(P>0.05)。 D1、D2两组术后1 h VAS值较L组明显降低(P<0.05),D1、D2两组间比较,差异无统计学意义(P>0.05)。术后6 h及24 h的VAS值,D2组明显低于L、D1组(P<0.05),L组与D1组比较,差异无统计学意义(P>0.05)。各组间药品不良反应差异无统计学意义(P>0.05)。结论：右美托咪定0.6μg·kg-1和利多卡因联合应用可明显减轻术后急性疼痛,优化患者短期预后,安全性好。     

医疗器械产品在生产经营企业和医疗机构中的管理情况

对我市医疗器械生产、经营企业,使用医疗器械的医疗机构进行摸底调查,发现各自存在的主要问题,提出在生产、经营和使用环节加强医疗器械管理的对策和建议。     

新“医改”形势下我院医院药学实践的创新与发展

目的:为持续提升医院临床合理用药水平提供参考。方法:就新"医改"形势下我院医院药学实践中管理和服务的特色和创新进行探讨。结果与结论:临床药学特色和创新包括药事考核工作、临床药师培训和工作、用药咨询和患者床前教育、药物临床研究几个方面;药品管理特色和创新包括药品风险管理、实库存管理、零库存管理几个方面;科室管理特色和创新包括绩效管理、质控管理2个方面。在新"医改"形势下,医院药学实践应不断创新和发展,转变管理理念,转换服务模式,为患者、为临床医护人员提供一流的专业药学服务。     

药品检测实验室加强医疗废物质量管理的重要性

目的：阐述药品检测机构医疗废弃物规范管理在质量管理体系中的重要性,规范实验室操作,加强实验室人员安全防护意识,保证实验室人员和周围环境的安全,预防感染,完善实验室质量管理体系。方法：依据《中华人民共和国传染病防治法》《医疗废物管理条例》《医疗卫生机构医疗废物管理办法》,结合药品检测机构工作实际,分析在检验检测工作中医疗废弃物管理过程存在的问题及应采取的措施。结果：通过产生医疗废弃物的实验室自查及质量负责部门检查和相关管理部门督查,提出了强化医疗废弃物管理的对策和合理化建议,健全了药品检测机构医疗废弃物质量管理模式。结论：在实验室质量安全管理中,医疗废弃物管理处于管理链的末端,但重要性应提高至首位,完善制度,加强培训宣传,完善检测督导机制在医疗废弃物的管理工作中至关重要。     

Improving circularity in municipal solid waste management through machine learning in Latin America and the Caribbean

Machine Learning (ML) consists of a set of methods that allow a system to learn data patterns and has applications in many stages of MSWM. Improvements in MSWM focused on resources recovery in LA&C can be speed up by the use of the ML methods. This study aims to analyze the opportunities and challenges faced when using the ML methods to improve circularity in MSWM in LA&C. The methodology adopted was a systematic literature review using the PRISMA protocol in the Web of Science® database from 2010 to 2021, and bibliometric analysis using the Biblioshiny® application, the web interface for Bibiometrix® package from Rstudio® software. A total of 188 papers were obtained from the bibliographic search. The advancement of MSWM in LA&C has as challenges the lack of reliable data on the composition and production of the waste, the low rate of waste used as a resource, the need to change consumption patterns, social inclusion of informal waste collectors, and the inclusion of repair and reuse actions to reduce waste generation. Meanwhile, the main challenges when considering the use of ML in LA&C are the inexistence or dispersion of data with reliable time series and the lack of knowledge of decision makers about the potential use of the ML methods. Specifically in LA&C, it was observed that hybrid models that apply ML to waste composition data, ML methods to improve IoT applications and GIS data usage aggregated with ML methods could speed up the transition to Circular Economy in LA&C.     

浅谈三级综合医院医疗质量管理的基本做法

目的持续改进医疗质量,保障患者安全。方法回顾性分析2007～2009医疗质量管理过程。结果根据法律法规的要求结合医院实际,制定院科二级医疗质量管理方案,以各级各类医务人员违规记分管理为抓手,持续改进医疗质量,保障患者安全。患者满意度得到明显提高,各级医务人员诊疗行为进一步规范,运行病历和终末病历质量明显提高,住院患者平均住院天数从13.6d降至11.85d,入出院诊断符合率、手术前后诊断符合率等16项主要质控指标均达部颁标准,运行病历质量合格率达95%以上。结论完善的院科二级医疗质量管理方案是三级综合医院质量管理的基础;实施医务人员违规记分管理是持续改进医疗质量的重要抓手。     

基层完善医疗器械上市后风险管理体系的思考

根据医疗器械上市后风险管理体系的概念和原理，针对当前面临的形势和现状，分析在基层建立和完善医疗器械上市后风险管理体系的制约因素以及相应的对策。