六西格玛管理方法在手术室一次性无菌物品管理中的应用

目的探讨六西格玛质量管理方法对一次性无菌物品管理过程进行优化的可行性和效果。方法项目小组通过六西格玛五步法,对一次性无菌物品管理进行持续性改良,从手术医生满意度、供货及时性满意度、环境管理满意度、术前物品准备完善率、护士责任意识方面与实施六西格玛管理模式前进行效果比较。结果实施六西格玛质量管理后,手术医生满意度、供货及时性满意度、环境管理满意度明显提升,一次性无菌物品术前准备完善率明显提高,护理人员责任意识明显提高。结论应用六西格玛质量管理理念与方法可提高手术室护理管理质量及工作效率。     

六西格玛管理法在急诊内科心肺复苏急救护理的应用

目的分析总结在急诊内科心肺复苏急救护理中采用六西格玛管理法的具体效果。方法选取本院在2014年8月至2015年8月接收的140例实施心肺复苏急救的患者,并于本院设立六西格玛管理小组,对科室的护理工作人员进行相关知识的培训和讲座,将此种管理方法应用于急诊内科心肺复苏患者的急救护理工作当中,观察实施后的效果和质量。结果通过实施六西格玛管理法后,心肺复苏患者的抢救成功率由60.7%上升到78.6%;实施后患者的气管插管时间、心肺复苏开始时间、呼吸道通畅判断时间都明显优于实施前,实施前后比较差异有统计学意义,具有可比性(P0.05)。结论在急诊内科心肺复苏急救护理中,采用六西格玛管理法能够提高患者的抢救成功率,提高抢救的效率,优化各个环节可能出现的问题,从而保证患者的生存质量,此种管理方法在急诊科中具有重要的应用价值。     

六西格玛管理法在急诊内科心肺复苏急救护理的运用研究

目的:研究对护理人员实施六西格玛管理法在急诊内科心肺复苏急救护理中的应用.方法:选取急诊内科的护理人员20人,然后对其进行知识培训,使上述20名护理人员全面掌握六西格玛管理的具体方法,将这种管理方法应用于急诊内科中,比较在对护理人员实施六西格玛管理的前后心肺复苏效果.结果:从研究结果看,在对急诊护理人员实行六西格玛管理之后,心肺复苏的开始时间、气管插管时间以及呼吸道通畅判断时间均较实施前短,且心肺复苏的成功率较实施前显著高(78.49%vs60.89%).所以可以说明六西格玛管理可以有效的提高心肺复苏的成功率,还能改善患者的基本情况(心肺复苏开始的时间、气管插管时间、呼吸通畅判定时间).结论:六西格玛管理法在急诊内科心肺复苏急救护理工作中,具有显著的效果,能够有效的提高心肺复苏的成功率,所以,研究证明,值得广发应用于急诊内科心肺复苏急救工作中.     

六西格玛在医院人力资源管理中的应用

阐述医院人力资源管理引入六西格玛的意义,并通过薪酬体系设计、平衡计分卡、建立培训体系三个方面分析六西格玛在医院人力资源管理中的价值,最后介绍六西格玛在医院人力资源管理中的应用。医院人力资源管理中实施六西格玛,以＂界定—测量—分析—改进—控制＂流程改进模式达到消除或减少误差和失误,使医院获得最大回报。     

六西格玛管理方法在优化健康体检服务流程中的运用

目的探讨在健康体检服务流程中应用六西格玛管理的方法对体检平均时间、体检者满意度及流程能力的影响。方法运用六西格玛五步法,通过调查和分析,对健康体检的各个流程及步骤进行分析,改进对影响体检时间及体检者满意度的关键因素,并与改进前进行比较。结果六西格玛管理实施后,体检平均时间下降,体检者满意度及流程能力上升。结论六西格玛管理方法的实施,能优化健康体检服务流程,提高体检者满意率。     

基于六西格玛的降低X医院门诊药房发药差错研究

目的:通过六西格玛质量管理法对X医院门诊药房发药流程进行改进。方法:采用六西格玛管理法,通过定义、测量、分析、改进和控制五个阶段,找出X医院门诊药房产生发药差错的原因并提出相应干预措施。结果:改进项目实施后,X医院门诊药房发药差错率明显低于改进之前。结论:六西格玛质量管理法可以有效降低调配差错率,保障患者用药安全。     

IS09001基础上引入六西格玛管理法对优化急诊住院患者交接流程效果评价

目的：探讨实施ISO9001质量管理体系的基础上引入六西格玛管理方法在护理流程改造中运用的效果。方法：2008年1月起采用ISO9001质量管理体系的基础上引入六西格玛五步法即定义、测量、分析、改进、控制,对急诊患者入院交接流程中的质量关键点及流程中的缺陷进行识别。对比分析流程优化前后各120例急诊患者入院交接的缺陷情况、交接时间、患者满意度及急诊护士对病房护士的满意率,以评价应用ISO9001质量管理体系的基础上引入六西格玛管理法,对急诊住院患者入院交接优化流程的效果。结果：流程优化后护理纠纷及缺陷率从1.60%降至0.48%（P〈0.05）;交接患者等待时间由原来的（9.4±2.3）min缩短至（3.8±1.2）min（P〈0.05）;患者满意度、急诊护士对病房护士满意度均有明显提高（P〈0.01）,达到了预期目标。结论：ISO9001质量管理体系的基础上实施六西格玛管理方法,能提高急诊护士工作质量和工作效率,降低工作缺陷率,在护理管工作中值得推广应用。     

六西格玛管理在呼吸科护理记录改进中的应用

目的 采用六西格玛管理法改进某院呼吸科电子护理记录单,以提高护理记录单书写质量。方法 某三甲医院呼吸科于2021年10月1日实施六西格玛法管理电子护理记录单,随机抽取某院呼吸科2021年1月1日-2021年9月30日患者护理记录单150份作为实施前组,随机抽取2021年11月1日-2022年7月31日患者护理记录单150份作为实施后组。采用SPSS 21.0比较2组护理记录单书写质量及缺陷发生率,比较实施前后护理人员专科知识掌握和护理记录书写能力。结果 实施后组护士专科知识掌握(95.06±8.41)分、护理记录书写能力考核成绩(96.13±8.56)分均高于实施前(89.69±8.76)分、(88.07±8.69)分,差异有统计学意义。六西格玛管理法实施后护理记录出现医护记录不一致、护理记录与病情不符、护理措施无效果评价、未体现专科特点、未使用医学术语和护理记录不完整等缺陷例数均明显少于实施前,差异有统计学意义。护理记录书写质量评分实施前组(92.12±3.98)分高于实施后组(85.02±4.82)分,差异具有统计学意义。结论 六西格玛管理法可提高呼吸科电子护理记录单书写质量,减少...     

六西格码管理在婴幼儿静脉输液的应用

目的:探讨六西格玛管理对提高婴幼儿静脉输液成功率的作用。方法:应用六西格玛质量管理体系中的DMAIC模式,对门诊婴幼儿静脉输液的各个流程、步骤进行分析、评估,找出影响静脉输液成功的主要因素,确定质量关键点,并制定相应的改进措施和控制计划。结果:实施六西格玛管理后,婴幼儿静脉输液成功率由72.8%提高到91.5%,差异具有统计学意义(P<0.05)。结论:运用六西格玛管理方法,提升了护理质量,提高了家长满意度,赢得了医疗市场,取得了相应的经济效益和社会效益。     

六西格玛管理在降低精神病患者跌倒发生率中的应用

目的:探讨利用六西格玛管理减少精神病患者跌倒的效果。方法:应用六西格玛管理的DMAIC流程,即界定阶段(D),测量阶段(M)、分析阶段(A)、改进阶段(I)和控制阶段(C),找出引起跌倒的主要原因,针对这些原因采取护理措施。结果:对实施管理前后跌倒的发生率比较,差异有统计学意义(均P<0.01)。结论:利用六西格玛管理可有效降低精神病患者跌倒发生率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.