全自动口服摆药机模式下提高药品质量

目的:探讨全自动口服摆药机(AODDS)应用模式下的药品质量.方法:通过收集我院药品拆零备药表、AODDS内库存数据以及相同病区手工与AODDS摆药差错统计表等资料,分析在全自动口服摆药机应用模式下药品拆零、库存以及摆药差错管理等方面存在的问题,并提出相应改进措施.结果:AODDS摆药组中人工摆错差错数占总差错数的比例最高,为60.82％,依次为出现碎片或异物(27.84％)、药品串包(9.28％)和种类包错(2.06％).Ⅰ、Ⅱ类药品在采取措施后的AODDS内库存品种误差率显著低于采取措施前,差异有均有统计学意义(Ⅰ类药品:t=15.488,P=0.000;Ⅱ类药品:t=25.737,P=0.000).同时药品拆零以及摆药差错管理方面存在的问题在采取措施后均亦得到较好的解决.结论:规范药品管理制度能有效提高全自动口服摆药机的应用效率,同时保证了患者用药质量.     

门诊西药房药品报损率的调查与分析

目的:调查分析西药房药品报损情况和原因,加强西药房药品的管理,规范药品报损制度.方法:通过调阅2007年至2011年我院西药房药品报损记录以及2010年与2011年医院与医药公司的退药登记本进行分析统计.结果:我院2007年至2011年药品报损率均小于0.002％,且药品报损率呈递减趋势.药品报损的主要原因为药品破损,2007年至2011年药品报损总金额为1549.78元,破损药品金额占63.30％,过期药品金额占20.06％,其他药品金额占16.64％.滞销药品退货金额占退货总金额的80％以上,成为了药房管理的隐患.结论:完善药品报损制度,加强对药品的养护,能有效地降低了药品报损率以及医院资金损失.     

红火蚁饵剂药瓶瓶盖孔洞设计与出药量的关系

红火蚁Solenopsis invicta Buren是一种对人类健康、生态环境等具有严重危害的重大入侵害虫,毒饵诱杀是防控红火蚁的重要手段.在采用人工撒施方法时,如何避免药剂浪费或不足仍需研究.本文研究了红火蚁饵剂药瓶瓶盖出药量与瓶盖上孔洞直径、孔洞数量和施药方式的关系,为红火蚁饵剂施药装置选择合适的孔洞直径、孔洞数量和施药方式提供理论依据.研究发现,在倾倒施药处理下,孔洞直径为3.0、4.0、5.0、6.0和7.0mm时,出药量与孔洞直径有显著的线性关系,线性方程依次为Z =0.02X-0.004、Z=0.007X-0.007、Z =0.015X-0.02、Z =0.026X+0.025和Z=0.097X-0.094(Z代表出药量,X代表孔洞数量),即孔洞越多,倾倒的出药量越多.施药方式为倾倒时,出药量与孔洞直径和孔洞数量有显著的线性关系,线性方程为Z=0.008X+0.106Y-0.464(Z代表出药量,X代表孔洞数量,Y代表孔洞直径),即出药量随孔洞数量或孔洞直径增加而增多.在撒播施药处理下,当孔洞直径为3.0 mm时,撒播的出药量与孔洞数量的线性关系不显著.当孔洞直径为4.0、5.0、6.0和7.0mm时,出药量与孔洞直径和孔洞数量有显著的线性关系,线性方程依次为Z=0.006X+0.037、Z =0.013X+0.018、Z=0.02X+0.093、Z=0.06X+0.03(Z代表出药量,X代表孔洞数量),即孔洞越多,撒播的出药量越多;撒播的出药量与孔洞直径和孔洞数量有显著的线性关系,线性方程为Z =0.006X+0.087Y-0.335(Z代表出药量,X代表孔洞数量,Y代表孔洞直径),即出药量随着孔洞数量或孔洞直径增加而增多.因此,厂家可参考上述线性方程,根据产品物理性状、有效施用剂量在毒饵瓶瓶盖上选择相应的孔洞直径和孔洞数量.     

不同盐碱度水体的鱼类区系结构及主要经济鱼类生长的比较

通过对内陆15个盐碱度不同的典型水体中鱼类区系结构和主要经济鱼类生长的比较和分析,阐述了盐碱度对鱼类区系和鱼类生长的影响。比较和分析结果表明,鱼类的区系结构、种类数量和生长速度与水体盐碱度的高低有着密切关系,盐碱度高的水体其鱼类的生长速度较慢。将水体的pH值、盐度、碱度、硬度、电导率等几项盐碱指标与鱼类的种类数量进行逐步回归和相关分析,结果显示水体中鱼类现有的种类数量与盐碱指标的关系式为:LOG(现有种类数)=4.0929- 0.2866LOG(碱度)- 0.1857LOG(硬度),(R2= 0.7520,F=18.1967,p=0.0002);土着的种类数量与盐碱指标的关系式为:LOC(土着种类数)=3.3832-0.3509LOG(盐度)-0.44587LOG(碱度),(R2=0.7116,F=14.8058),p=0.0006).       

斑苦竹无性系种群克隆繁殖的动态与调节研究

本文依据了JLHarper (1977)的构件生物(madular organism)种群理论,将某一特定生境内的斑苦竹竹子的集合作为一个无性系种群,研究了它的克隆繁殖构件的数量动态,以及克隆繁殖与无性系基株年龄和分株密度的关系。结果表明:斑苦竹以Ⅲ龄级基株形成的克隆繁殖构件(笋芽)数量最多,以后,随龄级的增大而逐渐减少。发笋数、退笋数和成竹数均与无性系分株密度相关,它们的最适密度都为2.5×10⁴株/ha。退笋率和成竹率与繁殖构件的出土时间呈直线相关关系。退笋率模型:D=27.253+0.702t(R²=0.636)成竹率模型:M=72.662-0.701t(R²=0.634)     

手术室药品管理方法与体会

我院是一所以服务妇女、儿童为主的妇幼保健院,手术科室设有妇科、产科、小儿外科及普通外科;手术室内设6张手术台,每天平均实施12台手术。手术室的工作十分繁重,人员相对不足,手术及麻醉用药量大,药品种类多,特别是一些贵重新特药的广泛应用,更加重了手术室药品的管理难度。科室于2002年开始对手术室药品管理进行改革,由过去的无固定人员管理,调整为现在的定人、定量管理,并制定了各项管理制度,明确责任,从而使药品管理制度化、规范化,取得了满意的效果,现介绍如下。     

长江口低氧区沉积物表层纤毛虫多样性及其时空变化

利用PCR-DGGE(变性梯度凝胶电泳)指纹图谱和测序技术,以及Ludox-QPS(密度梯度离心-定量蛋白银染色)方法,研究了2011年4月和8月长江口低氧区3个站位表层沉积物中纤毛虫多样性及季节变化.结果表明:不同站位之间纤毛虫分子多样性存在显著差异(ANOSIM分析:R=0.896,P=0.0001),但季节变化不显著(R=0.043,P=0.207).序列数最多的类群为旋唇纲中的寡毛类和舞毛类纤毛虫.Ludox-QPS法研究的纤毛虫活动虫体的种类数及丰度可维持在较高的水平,且在夏季增高2～5倍.Ludox-QPS法与DGGE技术检测到的不同站位间纤毛虫多样性变化趋势基本一致.但Ludox-QPS法检测到纤毛虫活动虫种类数及丰度随季节更替变化显著,该法检获的纤毛虫种类数高于DGGE条带数.长江口低氧区的纤毛虫丰度及多样性较高,可为潜在的水母水螅体提供食物支撑.     

10种鸣禽控制鸣啭神经核团大小与鸣唱复杂性的相关性

为进一步揭示鸣禽鸣唱行为的神经生物学机制 ,本实验先对 8个科 10种鸣禽的鸣唱行为进行了观察和录音 ,并借助声谱软件分析了每种鸣禽的鸣唱复杂性。鸣唱语句复杂性的评价指标包括 :短语总数、每个短语中所含的平均音节数及音节种类数、所有短语的总音节数及音节种类数、最长短语的音节数及音节种类数。然后 ,测定了前脑三个鸣啭学习控制核团和一个与发声无关的视觉参考核团体积 ,分析了鸣唱语句复杂性和这些核团大小间的相关关系。结果表明 :1)HVC和HVC/Rt与 7种鸣唱语句复杂性指标无关 ;RA和RA/Rt与总音节种类数相关 ;AreaX与总音节数及音节种类数相关 ;2 )HVC/RA和HVC/X比值与多个鸣唱语句复杂性指标相关。结果提示 :鸣禽鸣唱复杂性不同特征可能受不同神经控制     

荆条节肢动物群落时序动态的研究

本文对荆条上节肢动物群落的种群数量、种类数、所属科目数量、多样性指数及主要节肢动物个体数量的时序动态进行了研究.结果表明,荆条上栖居的节肢动物的种群数量、种类数、所属科目数量、多样性指数及主要节肢动物个体数量与荆条的花期密切相关,且荆条上栖居的节肢动物多为天敌和传粉昆虫,而园林绿化中常见灌木上栖居的节肢动物种类和数量极少或多为植食性昆虫.因此,荆条对于提高园林绿地的自我调控能力有着非常重要的作用.     

新疆猪毛菜属4种植物核型分析及进化研究

采用常规压片法,对钠猪毛菜、准噶尔猪毛菜、小药猪毛菜和薄翅猪毛菜等4种新疆猪毛菜属植物的染色体核型进行了分析,并对已报道的12种新疆猪毛菜属植物核型进行了比较.结果表明:(1)钠猪毛菜体细胞染色体数2n=2x=18=12m+6sm,准噶尔猪毛菜、小药猪毛菜体细胞染色体数为2n=2x=18=18m,该3种均属于1A型;薄翅猪毛菜体细胞染色体数为2n=2x=54=50m+2sm+2st,属2A型;(2)12种新疆猪毛菜属植物核型比较结果证明,猪毛菜属植物的染色体基数为9,钠猪毛菜、准噶尔猪毛菜和小药猪毛菜均为二倍体,薄翅猪毛菜为六倍体,钠猪毛菜和准噶尔猪毛菜具有随体.准噶尔猪毛菜、小药猪毛菜、薄翅猪毛菜属植物的核型均属于首次报道.     

基于DRGs死亡风险分级在医疗质量评价中的应用

目的 基于DRGs探讨死亡风险分级评价医院医疗质量的方法。方法 以死亡风险分级方法评价医院整体医疗质量,进行科室间、专业间横向对比,并与总住院死亡指标进行比较。 结果 （1）总死亡率2015年0.137%低于2014年0.236%,低风险死亡率2015年0.008%高于2014年0,高风险死亡率2015年3.341%高于2014年1.773%;（2）非手术科室A和手术科室A在两类科室中总死亡率都是最高的,其中非手术科室A在中高风险和高风险死亡率是最高的,而手术科室A仅在中高风险死亡率是最高的。非手术科室B出现1例低风险死亡患者;（3）MDCR专业组总死亡率为0.15%居第六位,低风险和中低风险死亡率分别为0.01%和0.24%,其他专业组这两个死亡率都为0。 结论 基于DRGs死亡风险分级是评价医院医疗质量的有效方法。     

Structuration des liens entre médecine nucléaire et radiopharmacie

Radiopharmaceuticals are nowadays under the responsibility of the radiopharmacist because of their medicinal product status. Radiopharmacy belongs to the hospital pharmacy department, nevertheless, interactions with nuclear medicine department are important: rooms are included or located near nuclear medicine departments in order to respect radiation protection rules, more over staff, a part of the material and some activities are shared between the two departments. Consequently, it seems essential to formalize links between the radiopharmacy and the nuclear medicine department, setting the goals to avoid conflicts and to ensure patients’ security. Modalities chosen for this formalization will depend on the establishment's organization.     

Which patients are likely to die in an accident and emergency department?

Four hundred and eighty-eight deaths occurring in an accident and emergency department over five years were analysed. Their causes were categorised as medical, surgical, or traumatic. Medical causes accounted for 87% of the deaths, of which 60% were from cardiac conditions. Blood loss was an important factor in over half the deaths from surgical and traumatic causes. Lives might have been saved by considering infectious disease in patients with medical conditions and by undertaking more rapid blood transfusion, earlier chest drainage, and lateral cervical spine x rays in appropriate surgical or traumatic cases. The admission to casualty departments of people with terminal neoplasms should be discouraged. The management of medical emergencies should be emphasised when training accident and emergency department staff.     

呼吸科与重症监护室院内获得性肺炎预后因素分析

目的通过对浙江大学医学院附属第一医院呼吸科和监护室（ICU）院内获得性肺炎（HAP）患者资料进行回顾性分析,以寻找不同科室患者HAP发生的危险因素的异同,从而针对不同人群建立特异的预防HAP的决策。方法采取回顾性研究,收集2011年6月1日至2013年9月30日浙江大学附属第一医院呼吸科和ICU出院诊断为肺炎（年龄≥18岁）的病历资料,比较两科室患者基本资料、基础疾病等方面的差别,然后对HAP患者危险因素进行分析,对筛选出来的P〈0.05的因素再进行Logistic多因素回归分析。结果逐步Logistic回归（Backward：Wald）分析提示,呼吸科危险因素为血液及实体肿瘤病史而ICU危险因素为感染性休克与近期重大手术史。结论两科室存在不同的影响预后的危险因素,ICU院内获得性肺炎的发病率、死亡率明显高于呼吸科,这与患者基础疾病有密切关系。     

医疗职业风险要素分析及在薪酬分配中的应用

目的 分析职业风险要素并应用于医师薪酬分配体系中，合理补偿因承担医疗风险带来的健康及经济损失。方法 采用文献法和Delphi法对以往研究进行文献分析提炼要素并征询意见，专家评分法对试点医院各科室职业风险进行评价。结果 职业风险三个要素分别是职业暴露、医疗纠纷及医疗暴力，Delphi专家意见一致。各科室职业风险评价结果中，风险最高的部门是PICU、骨科急诊、外科急诊，最低的是皮肤科门诊、康复科门诊、成人门诊、中医门诊及儿童保健门诊。结论 评分结果与以往职业风险相关的定量研究结果基本一致，职业风险系数可以适度调整科室之间奖金分配。     

National survey to set diagnostic reference levels in nuclear medicine single photon emission imaging in Croatia

PurposeIn order to introduce the concept of diagnostic reference levels (DRLs) in the national nuclear medicine practice a survey was proposed and completed through all nuclear medicine departments in Croatia. An additional aim was to increase the awareness of importance and full implementation of a comprehensive quality program that includes devices used in the nuclear medicine chain.MethodsData were collected for more than 30 nuclear medicine single photon emission procedures. National DRLs (NDRLs) as administered activity and also as administered activity per unit mass were calculated in accordance to International Commission on Radiological Protection (ICRP) recommendations. Additionally, effective doses were estimated using conversion factors published by the ICRP.ResultsNDRLs for nuclear medicine single photon emission procedures were proposed. For procedures performed in only one department typical values were presented as reference. Effective doses related to applied radiopharmaceuticals were calculated to estimate radiation risk related to respective nuclear medicine procedure in more detail.ConclusionThis work presents results of the first national survey on DRLs of nuclear medicine single photon emission procedures and proposes reliable NDRLs that represent an actual status of nuclear medicine practice in Croatia. Results have motivated departments to introduce and set their own typical values to be used, as one of the tools, for further optimization process. One of the drawbacks of the DRL concept in nuclear medicine is the lack of the image quality parameters involved. For this reason, a quantity that considers both radiation protection and image quality should be introduced.     

A rural emergency department.

The appropriate use of emergency departments is of growing concern. By knowing which patients are more likely to make inappropriate visits to these departments, efforts can be directed to encourage more suitable care. Our study was done in a rural county hospital in eastern New Mexico. Data were collected from all emergency department visits over a 4-week period. Patient and physician questionnaires were administered to assess aspects of emergency department use, including appropriateness based on published criteria, physicians'' opinion of appropriateness, groups who made inappropriate visits, and the perception of the need for and the urgency of a visit. We found that 32% of visits were inappropriate based on published criteria and 24% were considered inappropriate by physician opinion. Two groups with a high rate of inappropriate visits were Hispanics and Medicaid recipients. Patients and physicians have differing opinions of the urgency of a visit and of how soon medical treatment is required. To decrease the frequency of inappropriate use of emergency departments, educational efforts should be focused on the subgroups with high rates of such use.     

Snakebites in “Invisible Populations”: A cross-sectional survey in riverine populations in the remote western Brazilian Amazon

In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants’ demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2–49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4–39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.