医院医疗器械维修中存在的问题及维修管理对策研究

近几年来,随着科学技术的发展和医院规模的扩大,社会对医疗技术要求不断提高,因此,高端医疗器械和新型医疗设备需求加大,医疗器械管理与维修也需跟进。医疗器械的正常使用在医疗工作中有着举足轻重的作用,可提高医疗人员的工作效率,提升临床诊治的水平,但其在改善医疗条件的同时也存在一系列的问题,若无法保质和及时维修医疗器械,对正常医疗设备的使用具有严重影响,延误患者的就诊与治疗。目前医院医疗器械维修中存在的维修人员整体素质偏低、管理机制不健全、维修技术落后、医疗器械维修人员不足、缺乏积极性及再学习的机会、医疗器械缺乏定期保养和管理等实际问题,导致医疗器械维修效率低,本文就以上问题展开讨论,旨在为医院维修管理的制定提供参考。     

Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities

BACKGROUND: The pharmacological treatment of bipolar disorder has dramatically improved with multiple classes of agents being used as mood-stabilizers, including lithium, anticonvulsants, and atypical antipsychotics. However, the use of these medications is not without risk, particularly when a patient with bipolar disorder also has comorbid medical illness. As the physician who likely has the most contact with patients with bipolar disorder, psychiatrists must have a high index of suspicion for medical illness, as well as a basic knowledge of the risks associated with the use of medications in this patient population. METHODS: A review of the literature was conducted and papers addressing this topic were selected by the authors. RESULTS AND DISCUSSION: Common medical comorbidities and treatment-emergent illnesses, including obesity, diabetes mellitus, dyslipidemia, cardiac disease, hepatic disease, renal disease, pulmonary disease and cancer are reviewed with respect to concomitant use of mood stabilizers. Guidance to clinicians regarding effective monitoring and treatment is offered. CONCLUSIONS: Mood-stabilizing medications are necessary in treating patients with bipolar disorder and often must be used in the face of medical illness. Their safe use is possible, but requires increased vigilance in monitoring for treatment-emergent illnesses and effects on comorbid medical illness.     

大型医疗设备成本绩效考核数学模型的建立

目的探讨医疗设备绩效管理的新模式,提高医疗设备的经济效益。方法研制医疗器械成本效益分析评价模型,对医疗设备使用中影响成本的元素进行分析,并提出合理的改善方法。结果通过开展医疗设备使用效益分析,为决策提供可靠的数字依据,对医疗设备的投资及使用进行监督核算。     

国家尺度自然保护地生态系统联网监测指标体系构建与应用研究

自然保护地是维护国家生态安全, 提升生物多样性保护成效的重要载体, 对保护地生态系统进行实时、高频、多尺度的监测是认知其动态变化的有效手段, 也是实现自然保护地生态系统健康管理的基石。由于目前我国没有形成自然保护地生态系统监测网络, 缺少统一的联网监测指标体系, 导致多数自然保护地生态系统组成家底不清、动态不明, 应对生物多样性保护新问题的能力不足, 并且在国家尺度上的自然保护地生态系统健康状况及保护成效评估缺乏联网监测数据支撑。因此, 亟需构建国家尺度的自然保护地生态系统组成和动态监测网络, 以及一套科学、系统、规范的自然保护地生态系统联网监测指标体系。该文针对自然保护地生物多样性和生态系统监测的目标和内容, 参考国内外现有的生态系统监测网络的指标体系, 确定了自然保护地生态系统联网监测指标体系建立和选取的基本原则, 建立了一套适用于国家尺度的自然保护地生态系统联网监测指标体系, 并在6个国家级自然保护区进行示范。构建的指标体系针对构成生态系统的6类关键要素(生境要素、生物要素、气象要素、土壤要素、大气和水环境要素、景观要素)制定了30个监测指标, 有效应用于森林、草地、荒漠、湿地等生态系统类型的自然保护地, 能够实现对不同类型自然保护地生态系统组分和结构的现状和演变特征进行长期、动态化监测, 并可为自然保护地保护成效评估和健康管理提供规范化、标准化的基础数据。     

A surface plasmon resonance array biosensor based on spectroscopic imaging

We have developed a multi-element transduction system which combines conventional SPR spectroscopy with one-dimensional SPR microscopy to create an effective platform for monitoring binding events on macro- or micro-patterned receptor arrays created on disposable sensor chips. This creates an effective platform for monitoring simultaneous binding events on each of the regions patterned with the receptors. This system has been specifically designed with commercially available components to allow relatively easy duplication. Furthermore, this system can use a proven, simple method to compensate for changes in the bulk index of refraction of the solution containing the analytes due to changes in temperature or solute concentration with simple modifications to the sensor chips alone. Preliminary results demonstrate how this system can be used to monitor several independent biospecific binding events simultaneously.     

Flexible automation of cell culture and tissue engineering tasks

Until now, the predominant use cases of industrial robots have been routine handling tasks in the automotive industry. In biotechnology and tissue engineering, in contrast, only very few tasks have been automated with robots. New developments in robot platform and robot sensor technology, however, make it possible to automate plants that largely depend on human interaction with the production process, e.g., for material and cell culture fluid handling, transportation, operation of equipment, and maintenance. In this paper we present a robot system that lends itself to automating routine tasks in biotechnology but also has the potential to automate other production facilities that are similar in process structure. After motivating the design goals, we describe the system and its operation, illustrate sample runs, and give an assessment of the advantages. We conclude this paper by giving an outlook on possible further developments.     

Remote health monitoring for elderly through interactive television

ABSTRACT: BACKGROUND: Providing remote health monitoring to specific groups of patients represents an issue of great relevance for the national health systems, because of the costs related to moving health operators, the time spent to reach remote sites, and the high number of people needing health assistance. At the same time, some assistance activities, like those related to chronical diseases, may be satisfied through a remote interaction with the patient, without a direct medical examination. METHODS: Moving from this considerations, our paper proposes a system architecture for the provisioning of remote health assistance to older adults, based on a blind management of a network of wireless medical devices, and an interactive TV Set Top Box for accessing health related data. The selection of TV as the interface between the user and the system is specifically targeted to older adults. Due to the private nature of the information exchanged, a certified procedure is implemented for data delivery, through the use of non conditional smart cards. All these functions may be accomplished through a proper design of the system management, and a suitable interactive application. RESULTS: The interactive application acting as the interface between the user and the system on the TV monitor has been evaluated able to help readability and clear understanding of the contents and functions proposed. Thanks to the limited amount of data to transfer, even a Set Top Box equipped with a traditional PSTN modem may be used to support the proposed service at a basic level; more advanced features, like audio/video connection, may be activated if the Set Top Box enables a broadband connection (e.g. ADSL). CONCLUSIONS: The proposed layered architecture for a remote health monitoring system can be tailored to address a wide range of needs, according with each patient's conditions and capabilities. The system exploits the potentialities offered by Digital Television receivers, a friendly MHP interface, and the familiar remote control, to make the service effective and easy to use also for elderly people.     

Long-term monitoring for patients after surgical ablation of atrial fibrillation: are all devices the same?

In recent years, the nonmedical management of atrial fibrillation (AF) has rapidly evolved, with more options available to address the arrhythmia. Determining the successful return of sinus rhythm and the medical management after ablation requires the selection of the correct diagnostic method. In May 2007, the Heart Rhythm Society in conjunction with the Society for Thoracic Surgeons, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society identified the need for programs to adopt a consistent method of follow-up and monitoring. Choosing the right monitor for the determination of the success, postsurgical ablation that meets the Heart Rhythm Society guidelines for monitoring especially for asymptomatic patients is imperative. Therefore, we reviewed the current devices available to assist practitioners in determining which monitor best meets their needs The criteria selected to perform the review include (1) ease of use for patients (compliance), (2) ability of the monitor to perform internal analysis, (3) the monitor has >24 hours of storage capability, and (4) external support. Our selection criteria revealed six cardiac rhythm monitors currently available for use. This review compared the different arrhythmia monitors from an established monitoring program perspective to assist practitioners in choosing a monitor that meets their practice needs for determining the return to sinus rhythm postsurgical ablation.     

Online system for faster multipoint linkage analysis via parallel execution on thousands of personal computers

Computation of LOD scores is a valuable tool for mapping disease-susceptibility genes in the study of Mendelian and complex diseases. However, computation of exact multipoint likelihoods of large inbred pedigrees with extensive missing data is often beyond the capabilities of a single computer. We present a distributed system called "SUPERLINK-ONLINE," for the computation of multipoint LOD scores of large inbred pedigrees. It achieves high performance via the efficient parallelization of the algorithms in SUPERLINK, a state-of-the-art serial program for these tasks, and through the use of the idle cycles of thousands of personal computers. The main algorithmic challenge has been to efficiently split a large task for distributed execution in a highly dynamic, nondedicated running environment. Notably, the system is available online, which allows computationally intensive analyses to be performed with no need for either the installation of software or the maintenance of a complicated distributed environment. As the system was being developed, it was extensively tested by collaborating medical centers worldwide on a variety of real data sets, some of which are presented in this article.     

The case against HIV antibody testing of refugees and immigrants.

Computers are now widely used in medical practice for accounting and secretarial tasks. However, it has been much more difficult to use computers in more physician-related activities of daily practice. I investigated the Desqview multitasking system on a 386 computer as a solution to this problem. Physician-directed tasks of management of patient charts, retrieval of reference information, word processing, appointment scheduling and office organization were each managed by separate programs. Desqview allowed instantaneous switching back and forth between the various programs. I compared the time and cost savings and the need for physician input between Desqview 386, a 386 computer alone and an older, XT computer. Desqview significantly simplified the use of computer programs for medical information management and minimized the necessity for physician intervention. The time saved was 15 minutes per day; the costs saved were estimated to be $5000 annually.     

Foraging costs of vigilance in large mammalian herbivores

Vigilance has been assumed to reduce food intake by taking away time from food processing. Such foraging costs of vigilance have been predicted to have profound effects on the structure of communities. Recently, however, it has been argued that mammalian herbivores might be capable of maintaining their rate of food intake despite being vigilant, because of their ability to scan the environment while chewing vegetation. We conducted behavioral observations to evaluate whether vigilance decreases the bite rate of free-ranging female bison ( Bison bison ) in Prince Albert National Park and elk ( Cervus canadensis ) in Yellowstone National Park. Modeling of foraging processes indicated that chewing time exceeded the time that bison and elk spent searching for food, interacting with conspecifics, and scanning. Consequently, bison and elk might have been capable of maintaining their rate of food intake despite vigilance. The maintenance of intake rate would have required bison and elk to match scanning events closely with chewing bouts, but we did not detect a positive correlation between the duration of scanning bouts and the number of consecutive bites taken just before vigilance events. As a result, vigilance was costly, and as it increased, bite rate declined for both herbivore species. Scanning still overlapped partially with food handling. Indeed, we estimated that 31% of feeding time being vigilant decreased bite rate by 20% for bison and 26% for elk, whereas total absence of overlap between chewing and scanning should have reduced bite rate by 31%. While we observed that vigilance induced foraging costs, these costs were less important than traditionally assumed.     

医院设备利用率管理的探究

分析了医院医疗设备利用率管理的现状,提出了医疗设备利用率管理的前期工作与实施方法。建立设备的性能价值评定标准以及加强设备的维护保养工作都是提高设备利用率的有效途径。     

Use of personal protective equipment for respiratory protection

Management of hazards in biomedical research facilities requires the application of the traditional industrial hygiene responsibilities of anticipation, recognition, evaluation, and control to characterize the work environment, evaluate tasks and equipment, identify hazards, define exposure groups, and recommend controls. Generally, the diversity and unique characteristics of hazards faced by laboratory and animal facility employees and the short-term and low-level nature of the exposures factor into the selection of proper exposure control measures in the laboratory. The proper selection of control measures is based on a hierarchy of elimination and minimization by engineering controls, followed last by personal protective equipment when exposures cannot be eliminated. Once it is decided that personal protective equipment is needed, specific regulations and guidelines define safety standards for research facilities, including the elements of a sound respiratory protection program. These elements include respirator selection (including appropriate protection factors), medical evaluation, fit testing, training, inspection, maintenance and care, quality, quantity and flow of breathing air, and routine and emergency use procedures.     

Dynamic flexibility metrics for capability and capacity

In production environments, such as Flexible Manufacturing Systems (FMSs), the schedule can be disturbed by the occurrence of unplanned events. Machines stop for major failures, maintenance, tool changes due to wear, or tool reassignments. The rescheduling process, however, can be costly. In this study, a dynamic measure of flexibility which helps to determine an appropriate time for rescheduling an FMS has been defined and investigated. Flexibility is defined as a function of Capability and Capacity. Accordingly, two metrics have been developed to monitor the capability and capacity efficiency of each machine in the system for responding to the dynamic system status. The value of each metric falls between 0 and 1 at all times. Higher values in the capability metric mean better machine selection and part distribution strategies among the machines. Higher values for the capacity metric mean higher machine utilization in the production plan. Based on the interaction between the metrics and their respective behavior in the system, four states have been identified and characterized. Simulations of various scenarios can be used to demonstrate the use of these metrics for monitoring FMS operations and determining appropriate times for rescheduling and tool reassignment.     

ENM Components: a new set of web service‐based workflow components for ecological niche modelling

Ecological niche modelling (ENM) Components are a set of reusable workflow components specialized for performing ENM tasks within the Taverna workflow management system. Each component encapsulates specific functionality and can be combined with other components to facilitate the creation of larger and more complex workflows. One key distinguishing feature of ENM Components is that most tasks are performed remotely by calling web services, simplifying software setup and maintenance on the client side and allowing more powerful computing resources to be exploited. This paper presents the current set of ENM Components in the context of the Taverna family of tools for creating, publishing and sharing workflows. An example is included showing how the components can be used in a preliminary investigation of the effects of mixing different spatial resolutions in ENM experiments.     

医院计算机化医疗设备的维护管理

现代医疗设备大都采用了计算机化设计,分析了目前医院拥有的计算机现状、医疗设备的分类和管理。最后,提出了维护管理措施。     

Control of nitrate concentration in fermentations of Corynebacterium glutamicum

A nitrate control system has been devised for the maintenance of stable nitrate concentrations throughout fed-batch fermentations of Corynebacterium glutamicum. The feedback control system was based on the use of a nitrate-ion-selective electrode to directly monitor the nitrate levels in the fermentor and an automatic controller to activate a nitrate feed pump. The electrode which was used for controlling the nitrate level was stable through-out the fermentation period. The apparent maximum specific growth rate, biomass production, protein production, biomass yields on glucose and nitrate, and amino acid production were all optimal at approximately 50mM nitrate.     

Vigilance monitoring--review and practical aspects.

Vigilance monitoring is increasingly important in the industrialised world because working tasks are becoming increasingly monotonous and less physically exhausting, resulting in a high risk of falling asleep unintentionally. Among existing tests for the assessment of vigilance, objectiveness plays the most important role in preventing volitional influence by the test subject. In addition, the tests should be simple so that a monotonous situation will emerge. This review gives an overview of important vigilance monitoring systems that are currently in use for research purposes and industrial application. The tests presented are the Mackworth clock test, the VIGIMAR, the Karolinska drowsiness test, tests based on blood pressure and heart rate changes, the psychomotor vigilance test, and experimental tests relying on pupillography and electrodermal activity.     

被动声学监测技术在西黑冠长臂猿监测中的应用

近年来, 被动声学监测技术被广泛应用于陆生哺乳动物的监测, 它能以较低的价格和非侵入的方式在特定区域进行野生动物无人值守监测, 面临的主要问题是需要人工收回数据和后期数据分析整理较为困难。本研究设计了一套被动声学监测系统用于西黑冠长臂猿(Nomascus concolor)监测, 监测系统在野外由太阳能供电, 使用自研的指向性拾音器阵列采集鸣声数据, 并通过无线网桥实时传输数据至管护局办公楼的服务器进行存储, 通过后台的鸣声数据管理系统辅助研究人员识别鸣声和辨认鸣声来源方向, 简化数据采集和处理流程。该系统在哀牢山国家级自然保护区枇杷箐科研监听点对两个西黑冠长臂猿群体进行了351天的连续监测, 特点为: 系统运行长期稳定, 数据通过无线方式传输便捷高效且不受季节天气影响。指向性拾音器阵列能有效分辨长臂猿鸣声来源方向, 弥补了传统监测设备难以分辨鸣声方向的缺陷。该系统与现有人工监测方法相比在数据采集的持续性、连续性、完整度以及鸣声数据处理智能化和监测成本方面均具有一定优势, 符合西黑冠长臂猿持续长期监测需求, 未来可作为西黑冠长臂猿自动化监测的解决方案进行推广应用。     

Giraffe squeeze cage procedure

A squeeze cage at Woodland Park Zoo has become a valuable tool in giraffe management. The cage has been used 63 times in 4 years with no serious injuries to animals or personnel. Conditioning the giraffes to the cage is of foremost importance in planning a successful restraining procedure. Individual giraffes react differently to the stress of being confined, so careful monitoring of behavior throughout is imperative to anticipate and prevent potential problems. Staff should be fully trained in the use of the equipment and familiar with the temperament of the giraffe. The cage is used for hoof trimming and routine medical examinations, including blood collection, X-rays, and giving injections.