哈尔滨市综合医院手术室病人安全管理现状与对策研究

采用随机抽样的方法,在哈尔滨市随机抽取5家三级、5家二级综合医院的手术室进行病人安全管理现状调查。从手术室护理人员构成、人员培训、规制、布局流程、设备配置、病人辨识、消毒灭菌、医护配合8个方面全面分析了目标医院在手术室病人安全管理方面存在的问题,并提出改进对策,旨在改善手术室管理现状,保障手术室病人安全。     

陕西省枣疯病的潜在风险分析及管理对策

[目的]枣疯病是我国枣树的一种毁灭性病害。近年来,该病害在陕西枣区发病面积日益扩大,造成枣树成片死亡,对陕西的红枣产业构成严重威胁。本文旨在明确枣疯病在陕西省的风险等级,为枣疯病的管控提供依据。[方法]采用有害生物风险分析程序和方法,从枣疯病发生现状、潜在危害性、寄主的经济重要性、定殖扩散的可能性以及风险管理的难度等5个方面,对枣疯病在陕西省的风险性进行了定性和定量综合评估。[结果]枣疯病在陕西全部枣区适生,在陕西省的风险综合评价值R=2.84,危险等级为Ⅰ级。[结论]枣疯病在陕西属于特别危险有害生物,对陕西红枣产业有很高的风险。根据其危险等级,提出应清除病原和严格检疫、加强枣园管理和防治媒介昆虫等管理对策。     

新形势下推进农机安全监理工作对策探讨

随着农业现代化的发展以及国家惠农政策力度日趋加大,农民购买农业机械的积极性普遍高涨,全市农业机械化呈现出快速发展的良好势头,拖拉机保有量急剧增加,到2012年末,吉林市拖拉机保有量达到十九万余台,如何正确使用和管理好这些农业机械及其驾驶操作人员,充分发挥其效能,保证全市农机化安全生产,使其真正促进农村经济发展,值得探讨。     

基层医院综合内科护理安全隐患原因分析及对策

目前基层医院中多数内科为综合内科。综合内科由于其特殊性,存在着很多安全隐患。本文通过临床实践,找出综合内科存在或潜在的护理安全隐患并作相应分析,提出了切实可行的防范对策,为降低医疗纠纷打下坚实的基础。     

产科护理中潜在的不安全因素调查及防范对策

目的:调查产科护理潜在的不安全因素,提出针对性的防范对策。方法:选取产科患者及家属100例、护士23名行护理不安全因素调查,进行归类分析,循证进行改进,对比2012-2013年相关指标。结果:患方产科护理不安全因素主诉率前四位分别为:环境与设施条件不足34.00%、医患沟通32.00%、环境设施存在缺陷30.00%、自我护理能力不足27.00%,护士则为医患沟通86.96%、产妇及其家属依从性低65.22%、医院相关管理未落实47.83%与产妇及家属自我护理能力低47.83%;经循证改进,2013年,护理不良事件例次率3.56%、不良妊娠结局率1.70%低于2012年8.04%、3.78%,差异具有统计学意义(P0.05)。结论:患方缺乏安全感,对医院硬软件水平不信任,加之部分护士可能存在工作态度欠佳现象,医患沟通效用较低,致患方不依从、自我护理能力不足,两者是产科护理潜在的不安全因素;医院应注重培养护士职业素养,建立和谐的护患关系,以提升健康教育质量、促医嘱落实,从而全面提高孕产妇住院期间护理质量,规避风险因素,保障母婴安全。     

医院输血安全管理现状分析与对策

目的：通过对某省七家三级医院输血科管理现状调查,了解医院在输血管理制度的制定与实施、技术操作的规范性、输血流程的安全性、输血科人员配置等方面存在的问题,明确今后医院输血安全管理工作的重点,并提出相应的管理对策,旨在为医院及政府职能部门制订有关医院输血安全相关策略提供科学的佐证。方法：1、文献法：对CNKI、维普数据库近五年相关文献进行系统回顾;2、现场调查：对某省7家三级医院输血安全管理现况调查。结果：所调查的7家医院输血安全管理制度知晓率较低,储血冰箱未按照正确的时间进行监测,医务人员对病人输血反应观察不到位,输血前医患沟通较好,输血差错自愿报告系统超过60%的医院尚未建立,输血不良事件发生后,只有14%的医护人员愿意主动上报,输血科医务人员30岁以上的不到30%,专科以下学历占66%,专业背景37%为检验专业,无学历的占8%。结论：医院输血安全管理存在许多问题：管理制度知晓率低、执行不到位,储血过程未按相关要求进行监测,输血科医务人员过于年轻化,学历层次较低,专业背景单一。建议医院应根据存在的问题,采取应对策略。     

县级图书馆管理及对策

县级图书馆滞后现状与经费人员素质等问题严重影响图书馆发展,本文根据实际工作实例和经验总结相关对策,希望能改善县级图书馆落后现状。     

我国医院非医疗安全管理存在的问题及治理对策

医疗安全管理、非医疗安全管理是医院安全管理的两大系统。随着医药卫生体制改革深化,就医模式改变,非医疗安全管理的内涵和外延发生变化,非医疗安全管理领域面临更多危险因素和安全隐患。结合医院非医疗安全管理现状,分析非医疗安全管理存在的问题并提出相关改进建议。     

影响我国城市公共交通安全的主要因素及对策

公共交通对城市的发展有着重大意义,极大地方便了市民的出行。伴随着城市化步伐的加快,城市公共交通运行逐渐出现出了许多安全问题。笔者分别从人、车辆、道路环境及管理四个方面分析了影响我国城市公共交通安全的主要因素并提出了提高公共交通安全的相应措施。     

Pharmacogenetics in drug regulation: promise, potential and pitfalls

Pharmacogenetic factors operate at pharmacokinetic as well as pharmacodynamic levels-the two components of the dose-response curve of a drug. Polymorphisms in drug metabolizing enzymes, transporters and/or pharmacological targets of drugs may profoundly influence the dose-response relationship between individuals. For some drugs, although retrospective data from case studies suggests that these polymorphisms are frequently associated with adverse drug reactions or failure of efficacy, the clinical utility of such data remains unproven. There is, therefore, an urgent need for prospective data to determine whether pre-treatment genotyping can improve therapy. Various regulatory guidelines already recommend exploration of the role of genetic factors when investigating a drug for its pharmacokinetics, pharmacodynamics, dose-response relationship and drug interaction potential. Arising from the global heterogeneity in the frequency of variant alleles, regulatory guidelines also require the sponsors to provide additional information, usually pharmacogenetic bridging data, to determine whether data from one ethnic population can be extrapolated to another. At present, sponsors explore pharmacogenetic influences in early clinical pharmacokinetic studies but rarely do they carry the findings forward when designing dose-response studies or pivotal studies. When appropriate, regulatory authorities include genotype-specific recommendations in the prescribing information. Sometimes, this may include the need to adjust a dose in some genotypes under specific circumstances. Detailed references to pharmacogenetics in prescribing information and pharmacogenetically based prescribing in routine therapeutics will require robust prospective data from well-designed studies. With greater integration of pharmacogenetics in drug development, regulatory authorities expect to receive more detailed genetic data. This is likely to complicate the drug evaluation process as well as result in complex prescribing information. Genotype-specific dosing regimens will have to be more precise and marketing strategies more prudent. However, not all variations in drug responses are related to pharmacogenetic polymorphisms. Drug response can be modulated by a number of non-genetic factors, especially co-medications and presence of concurrent diseases. Inappropriate prescribing frequently compounds the complexity introduced by these two important non-genetic factors. Unless prescribers adhere to the prescribing information, much of the benefits of pharmacogenetics will be squandered. Discovering highly predictive genotype-phenotype associations during drug development and demonstrating their clinical validity and utility in well-designed prospective clinical trials will no doubt better define the role of pharmacogenetics in future clinical practice. In the meantime, prescribing should comply with the information provided while pharmacogenetic research is deservedly supported by all concerned but without unrealistic expectations.     

DNA barcoding in animal species: progress, potential and pitfalls

Despite 250 years of work in systematics, the majority of species remains to be identified. Rising extinction rates and the need for increased biological monitoring lend urgency to this task. DNA sequencing, with key sequences serving as a "barcode", has therefore been proposed as a technology that might expedite species identification. In particular, the mitochondrial cytochrome c oxidase subunit 1 gene has been employed as a possible DNA marker for species and a number of studies in a variety of taxa have accordingly been carried out to examine its efficacy. In general, these studies demonstrate that DNA barcoding resolves most species, although some taxa have proved intractable. In some studies, barcoding provided a means of highlighting potential cryptic, synonymous or extinct species as well as matching adults with immature specimens. Higher taxa, however, have not been resolved as accurately as species. Nonetheless, DNA barcoding appears to offer a means of identifying species and may become a standard tool.     

The usefulness of information on HDL-cholesterol: potential pitfalls of conventional assumptions

Treatment decisions related to disease prevention are often based on two conventional and related assumptions. First, an intervention-induced change in a surrogate marker (such as high-density lipoprotein [HDL]-cholesterol) in the desired direction translates into health benefits (such as reduction in coronary events). Second, it is unimportant which interventions are used to alter surrogate markers, since an intervention benefit is independent of the means by which it is achieved. The scientific foundation for these assumptions has been questioned. In this commentary, the appropriateness of relying on low levels of HDL-cholesterol for treatment decisions is reviewed. The Veterans Affairs - HDL-Cholesterol Intervention Trial (VA-HIT) investigators recently reported that only 23% of the gemfibrozil-induced relative reduction in risk of coronary events observed in the trial could be explained by changes in HDL-cholesterol between baseline and the 1-year visit. Thus, 77% of the health benefit to the participants was unexplained. Other possible explanations are that gemfibrozil has multiple mechanisms of action, disease manifestations are multifactorial, and laboratory measurements of HDL-cholesterol are imprecise. The wisdom of relying on levels and changes in surrogate markers such as HDL-cholesterol to make decisions about treatment choices should questioned. It seems better to rely on direct evidence of health benefits and to prescribe specific interventions that have been shown to reduce mortality and morbidity. Since extrapolations based on surrogate markers may not be in patients' best interest, the practice of medicine ought to be evidence-based.     

Alternative respiratory chain enzymes: Therapeutic potential and possible pitfalls

The alternative respiratory chain (aRC), comprising the alternative NADH dehydrogenases (NDX) and quinone oxidases (AOX), is found in microbes, fungi and plants, where it buffers stresses arising from restrictions on electron flow in the oxidative phosphorylation system. The aRC enzymes are also found in species belonging to most metazoan phyla, including some chordates and arthropods species, although not in vertebrates or in Drosophila. We postulated that the aRC enzymes might be deployed to alleviate pathological stresses arising from mitochondrial dysfunction in a wide variety of disease states. However, before such therapies can be contemplated, it is essential to understand the effects of aRC enzymes on cell metabolism and organismal physiology. Here we report and discuss new findings that shed light on the functions of the aRC enzymes in animals, and the unexpected benefits and detriments that they confer on model organisms. In Ciona intestinalis, the aRC is induced by hypoxia and by sulfide, but is unresponsive to other environmental stressors. When expressed in Drosophila, AOX results in impaired survival under restricted nutrition, in addition to the previously reported male reproductive anomalies. In contrast, it confers cold resistance to developing and adult flies, and counteracts cell signaling defects that underlie developmental dysmorphologies. The aRC enzymes may also influence lifespan and stress resistance more generally, by eliciting or interfering with hormetic mechanisms. In sum, their judicious use may lead to major benefits in medicine, but this will require a thorough characterization of their properties and physiological effects.     

Physiology research in space and the astronaut countermeasure programme--a potential conflict

Potential conflicts between the use of weightlessness countermeasures during space flight and research into the physiological effects of weightlessness are examined. Research and medical operations goals are presented and experiences reviewed. Anticipated countermeasures for the International Space Station and possible solutions to the conflicts are described.     

Genetically manipulated mouse models of lung disease: potential and pitfalls

Gene targeting in mice (transgenic and knockout) has provided investigators with an unparalleled armamentarium in recent decades to dissect the cellular and molecular basis of critical pathophysiological states. Fruitful information has been derived from studies using these genetically engineered mice with significant impact on our understanding, not only of specific biological processes spanning cell proliferation to cell death, but also of critical molecular events involved in the pathogenesis of human disease. This review will focus on the use of gene-targeted mice to study various models of lung disease including airways diseases such as asthma and chronic obstructive pulmonary disease, and parenchymal lung diseases including idiopathic pulmonary fibrosis, pulmonary hypertension, pneumonia, and acute lung injury. We will attempt to review the current technological approaches of generating gene-targeted mice and the enormous dataset derived from these studies, providing a template for lung investigators.     

The potential pitfalls of using 1,1-diphenyl-2-picrylhydrazyl to characterize antioxidants in mixed water solvents

Approaching living systems, aqueous solutions are appropriate to characterize antioxidants, whereas the frequently used standard 1,1-diphenyl-2-picrylhydrazyl (DPPH) is insoluble in water. Therefore, mixed water-ethanol solvents were investigated using the electron paramagnetic resonance (EPR) spectroscopy. Two forms of DPPH were identified: at higher ethanol ratios a quintet spectrum characteristic of solutions, and at lower ratios, a singlet spectrum typical for solid DPPH, were found. Mixed solvents with 0-50% (v/v) water reproduced the same antioxidant equivalent points well and the reaction rate between DPPH and the antioxidant may increase considerably with increasing water ratios, as demonstrated using vitamin E as an antioxidant. But at still higher water ratios (70-90% (v/v)) the antioxidant activities dropped, since a part of the DPPH in the aggregated form does not react sufficiently with the antioxidants. Characteristics of the most common antioxidants were determined in ethanol or its 50% (v/v) aqueous solution.