Application of the NIAZ frame of reference; impact on a departmental level

The Netherlands Institute for Accreditation of Hospitals generated a general ”quality standard” applicable to the total quality management of a hospital. In addition departmental standards (NIAZ) are used as a frame of reference within their particular section of the hospitals. So two levels of standards (on an institutional and departmental level) are present and mutually tuned. Both levels can either lead towards a departmental accreditation certificate or a total hospital accreditation certificate. This approach represents a potential that will become extremely important in the future. These various levels should assure and assess their independent as well as joined quality to lead to an overall total quality management system. Various systems applied in Dutch health care, such as NIAZ, EFQM (INK), are discussed. Their use in the hospital setting, the application of indicators and the implications at departmental level are evaluated.     

The sonochemical coating of cotton withstands 65 washing cycles at hospital washing standards and retains its antibacterial properties

Hospital-acquired nosocomial infections are a major health, and consequently financial issue, in the world healthcare system. The problem of bacterial infections in general, and in hospitals in particular, has led to extensive scientific and industrial efforts to fabricate antibacterial textiles. A sonochemical coating machine was developed and built and its ability to coat antibacterial nanoparticles (NPs) onto 40–50 meter length of materials on a roll to roll basis at a speed of 22 cm/min. Cotton coated sonochemically with copper oxide nanoparticles (CuO NPs) was found to maintain its antibacterial properties even after 65 cycles of washings according to hospital protocols of hygienic washing (75 °C). This demonstrates the good quality and high stability of this sonochemically produced NPs coating on textiles. Durable antibacterial textiles such as these may be suitable for wide spread use in future hospital environments where hygiene control is of paramount importance.     

医院母婴日常护理工作评估体系浅析

对医院长期母婴日常护理工作进行了总结和分析。从长期医院母婴日常护理工作的实践和总结分析,提出了医院如何把母婴的卫生护理、营养护理和心理护理纳入产期日常护理工作评估体系的新见解,给医院的产期护理工作如何全面的评估和健康发展做参考。     

In-vivo neutron activation analysis for diagnosis and therapeutic monitoring

In-vivo neutron activation analysis (IVNAA) is now routinely used for the diagnosis and therapeutic monitoring of many diseases e.g. those of the skeletal system and those involving nutrition. Total body calcium (TBCa) and total body nitrogen(TBN) measurement are two such procedures. IVNAA facilities are designed for patient comfort and ease of operation in a hospital setting. They use portable isotopic neutron sources and conventional electronics. They are effective, non-invasive and, often, revenue generating in health care settings. They are now becoming common in health care facilities.     

Dithiol proteins as guardians of the intracellular redox milieu in parasites: old and new drug targets in trypanosomes and malaria-causing plasmodia

Parasitic diseases such as sleeping sickness, Chagas' heart disease, and malaria are major health problems in poverty-stricken areas. Antiparasitic drugs that are not only active but also affordable and readily available are urgently required. One approach to finding new drugs and rediscovering old ones is based on enzyme inhibitors that paralyze antioxidant systems in the pathogens. These antioxidant ensembles are essential to the parasites as they are attacked in the human host by strong oxidants such as peroxynitrite, hypochlorite, and H2O2. The pathogen-protecting system consists of some 20 thiol and dithiol proteins, which buffer the intraparasitic redox milieu at a potential of -250 mV. In trypanosomes and leishmania the network is centered around the unique dithiol trypanothione (N1,N8-bis(glutathionyl)spermidine). In contrast, malaria parasites have a more conservative dual antioxidative system based on glutathione and thioredoxin. Inhibitors of antioxidant enzymes such as trypanothione reductase are, indeed, parasiticidal but they can also delay or prevent resistance against a number of other antiparasitic drugs.     

A prelude of the 2004 Antwerp Quality Conference: Targets and target values—integrating quality management and costing

Questions about the value of services in the health care sector and the quality of them have been addressed frequently during the last decade, but as separate issues. In this article a method is proposed to combine these two issues. The starting point is the observation that competition will become fiercer among providers in the health care sector . Moreover, the patients opinion about quality in terms of convenience, emotional attention, etc., will be important in a competitive environment and will determine which health care service providers will be successful. These developments will have an impact on the engineering of the health care chain. Methods are discussed to integrate the determination of the value of innovations and new products, and the design of quality systems. The system of target costing is focused upon. It takes the outcome of care processes as desired by customers or the users as the starting point both for pricing the services as well as for designing the delivery system. This will not only improve cost control, but also quality improvements in two ways. First, the delivery system will be better adapted (and integrated if more health care providers are involved) to the needs of the patients, and second quality will improve as health care providers analyze, redesign, and monitor their processes more extensively.Presented at the 9th Conference on Quality in the Spotlight, 18–19 March 2004, Antwerp, Belgium     

医院新生儿科的卫生护理及营养管理方法

就新生儿的卫生护理及营养管理方法进行了讨论,包括:新生儿护理的要求和重点,新生儿的营养需要和喂乳方法,对做好新生儿科工作有一定的参考价值。     

A Cerberus‐Inspired Anti‐Infective Multicomponent Gatekeeper Hydrogel against Infections with the Emerging “Superbug” Yeast Candida auris

The pathogenic yeast Candida auris has received increasing attention due to its ability to cause fatal infections, its resistance toward important fungicides, and its ability to persist on surfaces including medical devices in hospitals. To brace health care systems for this considerable risk, alternative therapeutic approaches such as antifungal peptides are urgently needed. In clinical wound care, a significant focus has been directed toward novel surgical (wound) dressings as first defense lines against C. auris. Inspired by Cerberus the Greek mythological “hound of Hades” that prevents the living from entering and the dead from leaving hell, the preparation of a gatekeeper hybrid hydrogel is reported featuring lectin‐mediated high‐affinity immobilization of C. auris cells from a collagen gel as a model substratum in combination with a release of an antifungal peptide drug to kill the trapped cells. The vision is an efficient and safe two‐layer medical composite hydrogel for the treatment of severe wound infections that typically occur in hospitals. Providing this new armament to the repertoire of possibilities for wound care in critical (intensive care) units may open new routes to shield and defend patients from infections and clinical facilities from spreading and invasion of C. auris and probably other fungal pathogens.     

Atmospheric toxic metal contributions from hospital incinerators

Air particulate samples taken downwind of two Toronto hospital incinerators analyzed by neutron activation analysis (INAA) and proton-induced X-ray emission analysis (PIXE) were subjected to factor analysis and chemical element balance to identify various emission sources and their contributions to the amibient aerosols. Hospital incinerators, contributing 22–36% to the ambient aerosols, were the major anthropogenic source at the receptor sites studied. Elevated concentrations of Ag, Cd, Cl, Cr, Sb and Zn were found in the hospital incinerator ash samples. Studies of the elemental concentrations of disposable hospital plastics and their fates during combustion indicate that these toxic elements found in the hospital waste and stack emissions are partly attributable to the extensive use of plastics in hospitals.     

Fast screening of operational aqueous samples by gross alpha and beta counting with LSC systems

At nuclear installations a large number of samples is used to control operational tasks and health physics parameters. A fast screening process can be applied to provide immediate indication on possible contamination, and liquid scintillation counting (LSC) is the preferred method. Many LSC systems, which do not perform pulse shape analysis, are still in use. A screening procedure for these systems is presented based on three windows analysis. It may greatly reduce work and time, compared to using a proportional counter system, besides providing more accurate results.     

High purity oxygen production with a polymer electrolyte membrane electrolyser

Oxygen is required for treatment of patients in hospitals and at home, in industrial processes and for fuel combustion. Most commonly oxygen is produced by cryogenic or pressure swing adsorption routes. Other techniques include oxygen-ion conducting ceramic membranes, polymer membranes and chemical processes used mainly in civil aviation to reduce the condition of hypoxia at high altitudes. Water electrolysis is used mainly for the production of hydrogen with oxygen as a by-product. In order to use this system only for oxygen production, hydrogen must be utilised and disposed off safely. This, however, is not practical in many instances where there is no use for hydrogen and it poses an explosion hazard. In this paper, an electrolyser system based on polymer electrolyte membrane is described in which hydrogen produced on one side of the electrochemical cell is consumed by combining it with atmospheric oxygen, through operating the cell in a carefully configured fuel cell mode. This reduces the power consumed in the electrolysis operation by more than 35% and eliminates hydrogen in exit gases. Oxygen generated is of high quality and can be used for human consumption (portable and plug-in home care oxygen therapy devices, in hospitals, defence or aerospace requirements) and for many other industrial applications.     

International research supported by the German Research Foundation (DFG)--examples of activities in the field of chemistry

Chemical sciences play an important role in addressing global challenges such as energy supply and storage, health, or environment. Research in these complex areas requires more and more international collaborative work. In fact collaborative research has been common practice for many years in the field of chemistry. This situation is also reflected by the increasing number of German funding programs, which promote international and joint research collaborations, in order to achieve a more effective use of both national and international resources in the field of chemistry.     

优质护理在腹股沟疝合并糖尿病围手术期中的效果和体会

目的分析在腹股沟疝合并糖尿病患者的围手术期护理中,优质护理的临床应用价值。方法选取九江市第一人民医院于2014年1月至2015年1月收治的60例腹股沟疝合并糖尿病患者为研究对象,将所选患者随机分为对照组与干预组,对照组患者接受常规围手术期护理,干预组患者则接受优质护理,对比两组患者的术后疼痛情况、住院时间、并发症发生情况。结果干预组患者的术后疼痛程度明显弱于对照组患者,住院时间较短,并发症发生例数明显少于对照组患者,两组患者的数据经对比后差异存在统计学意义(P0.05)。结论在腹股沟疝合并糖尿病患者围手术期临床护理中,优质护理应用效果较好,值得推广。     

Proteomics: capacity versus utility

Until recently scientists studied genes or proteins one at a time. With improvements in technology, new tools have become available to study the complex interactions that occur in biological systems. Global studies are required to do this, and these will involve genomic and proteomic approaches. High-throughput methods are necessary in each case because the number of genes and proteins in even the simplest of organisms are immense. In the developmental phase of genomics, the emphasis was on the generation and assembly of large amounts of nucleic acid sequence data. Proteomics is currently in a phase of technological development and establishment, and demonstrating the capacity for high throughput is a major challenge. However, funding bodies (both in the public and private sector) are increasingly focused on the usefulness of this capacity. Here we review the current state of proteome research in terms of capacity and utility.     

Point-of-care testing: Implementation and practice of cost-effective total quality management

In the United States of America, point-of-care testing (POCT) generally is defined as laboratory testing performed at or near the patient. The objective is to have results immediately available to clinicians for timely medical intervention. The widespread use of POCT is, in part, a response to advances in technology and increased patient acuity. Theoretically, in the context of the entire health care system, POCT improves "quality" by promoting cost through quicker diagnosis and treatment, which in turn leads to faster recovery, reduced length of stay, more efficient clinicians, and overall better utilization of resources. Total quality management (TQM) generally is associated with improving processes and, therefore in this context, improving patient outcomes. The TQM philosophy focuses on creating products or services, which meet or exceed customer expectations. The successful implementation of POCT in a manner consistent with TQM principles requires assessment of direct, measurable benefits including cost-effectiveness to the health care system.     

Implementation of ISO 9001 in a medical testing laboratory

 The Department of Clinical Chemistry and Molecular Genetics, within the Institute of Clinical Pathology and Medical Research at Westmead Hospital, is a medical testing laboratory operating within the public sector health system of New South Wales, Australia. It provides acute-care pathology services to Westmead Hospital (a 900-bed tertiary referral university teaching hospital) as well as to three district hospitals and three rural hospitals. In addition to these core clinical chemistry services, it offers approximately 150 specialised biochemistry, pharmacology, toxicology, trace metal and molecular genetics assays as a reference laboratory service. In 1993, the Department became Australia's first medical testing laboratory to be registered to ISO 9001-1987/AS3901-1987. In 1995, this certification was extended to AS/NZS ISO 9001-1994. We are currently preparing for further accreditation to ISO/IEC Guide 25-1990, with additional supplementary requirements for medical testing. This paper describes the Quality System that the Department developed and which has been successfully maintained and extended since original certification. Important features of the Quality System are: 1. Primary design of the Quality System to meet medical and customer needs, with subsequent addition of required ISO elements. 2. Use of national Quality Award criteria to identify key business processes. 3. Development of integrated technical non-conformance, customer complaint, staff suggestion, and quality system corrective action procedures. 4. Implementation without external resources. Our conclusions are that ISO 9000 Quality Systems can be applied to medical testing laboratories, and can be implemented with minimum resource costs. Improvements in technical and service quality and business performance have resulted from this process. However, implementation of ISO 9000 at the level of individual Departments is not ideal. Greater improvements are possible when this process is undertaken at the level of the entire organisation. Received: 9 September 1996 Accepted: 5 October 1996     

Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations

In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient‐days. Of these cases, catheter‐associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health‐care costs of £1–2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary‐tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device‐associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.     

Inorganic material coatings and their effect on cytotoxicity

Inorganic materials have become an increasingly researched topic due to their applications in many areas especially health care. One major problem with them is the effect that their surface coatings have on cells. The same coatings that are meant to increase biocompatibility can actually invoke cytotoxicity. This tutorial review focuses on the various types of coatings and how their properties, such as electrostatic charge and hydrophobicity, affect the observed toxicity. The theorized mechanisms by which the coatings induce toxicity are also presented. Finally, the prospects for the future of this field are discussed.     

AAPH-mediated antioxidant reactions of secoisolariciresinol and SDG

Secoisolariciresinol (SECO ) is the major lignan found in flaxseed (Linum usitatissimum L.) and is present in a polymer that contains secoisolariciresinol diglucoside (SDG ). SECO, SDG and the polymer are known to have a number of health benefits, including reduction of serum cholesterol levels, delay in the onset of type II diabetes and decreased formation of breast, prostate and colon cancers. The health benefits of SECO and SDG may be partially attributed to their antioxidant properties. To better understand their antioxidant properties, SECO and SDG were oxidized using 2,2'-azobis(2-amidinopropane), an in vitro model of radical scavenging. The major lignan radical-scavenging oxidation products and their formation over time were determined. SDG was converted to four major products, which were the result of a phenoxyl radical intermediate. One of these products, a dimer of SDG, decomposed under the reaction conditions to form two of the other major products, and . SECO was converted to five major products, two of which were also the result of a phenoxyl radical intermediate. The remaining products were the result of an unexpected alkoxyl radical intermediate. The phenol oxidation products were stable under the reaction conditions, whereas two of the alcohol oxidation products decomposed. In general, only one phenol group on the lignans was oxidized, suggesting that the number of phenols per molecule may not predict radical scavenging antioxidant ability of lignans. Finally, SECO is a superior antioxidant to SDG, and it may be that the additional alcohol oxidation pathway contributes to its greater antioxidant ability.     

Lensless CCD-based fluorometer using a micromachined optical Söller collimator

In this paper, we describe a simple charge-coupled device (CCD) based lensless fluorometer with sensitivity in the range of current ELISA plate readers. In our lensfree fluorometer, a multi-wavelength LED light source was used for fluorophore excitation. To collimate the light, we developed a simple optical S?ller collimator based on a "stack of pinholes" (a stack of black PMMA with array of pinholes machined with laser) enabling the light to be collimated from the LED through the filters and the assay's microfluidics directly onto the CCD without a lens. The elimination of the lens that is used in almost all other current CCD based detection systems has four major advantages: (1) It simplifies the device design and fabrication while reducing cost. (2) It reduces the distance between the sample and the measuring device (without a lens the distance needed to focus the image on the CCD is reduced and the fluorometer can be more compact). (3) It couples the CCD and the detected surface by using an optical S?ller Collimator which allows the use of filters for fluorescence detection. (4) It also uncouples the CCD and the microfluidics to enable the use of interchangeable fluidics while protecting the delicate CCD. The lensless CCD-based fluorometer is capable of detecting 16 samples simultaneously, and was used for in vitro detection of botulinum neurotoxin serotype A (BoNT-A) activity with a FRET assay that measures cleavage of a fluorophore-tagged peptide substrate specific for BoNT-A (SNAP-25) by the toxin light chain (LcA). The limit of detection (LOD) of our lensless fluorometer is 1.25 nM, which is similar to the LOD of a modern ELISA plate reader. Combined with microfluidics, this simple low cost point-of-care (POC) medical diagnostic system may be useful for the performance of many other complex medical diagnostic assays without a laboratory and thus potentially enhancing the accessibility and the quality of health care delivery in underserved populations.