基于SEIPS模型的患者安全管理理论框架构建

患者安全是全球公共健康问题。以高可靠性组织理论为指导,基于患者安全系统工程(SEIPS)模型,构建患者安全管理理论框架。该框架包括人员、组织、技术/工具、任务、环境5个关键要素,10个可能导致患者安全问题的常见情景,患者、医护人员、医院三方结局,以及关注错误、全面反思、流程优化、管理反馈和创新变革5个核心原则。所构建的患者安全管理理论框架可为我国患者安全管理提供依据,提供人因工程学支持,对促进患者安全管理研究与实践具有一定意义。

基于SEIPS模型的认知症激越行为照护体验的质性研究

目的基于SEIPS模型解析养老机构护士对认知症激越行为的照护体验,为提升认知症激越行为照护品质提供参考依据。方法采用现象学研究目的抽样法,对上海市5所养老机构14名护士进行半结构化访谈,运用Colaizzi分析法对访谈资料进行分析、归纳及提炼主题。结果共提炼出感知认知症激越行为发病的复杂性、照护工作获益感与挫折感并存的悖论、激越行为发生现场的主动化多元应对、促进照护微系统伴随阻碍照护宏系统等4个主题。结论养老机构护士需要充分认识激越行为诱发多因素性,管理者则亟需多措并举提升护士主动应对激越行为的能力,并持续优化机构微系统和宏系统建设,提升认知症激越行为照护品质。

An integrative risk assessment approach to enhancing patient safety in Continuous Renal Replacement Therapy(CRRT)

Continuous Renal Replacement Therapy(CRRT)serves as an intervention strategy for the management of acute kidney injury(AKl)in critically ill patients.However,owing to its complex nature and the potential for com-plications,the implementation of CRRT demands continuous monitoring to prevent patient safety risks.This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting,intending to propose preventive measures grounded in expert insights.To systematically categorize and visually depict the risks,their consequences,preventive measures,and recovery controls,our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety(SEIPS)model.In addition to considering patient-related factors that exhibit variability among critically ill individuals,our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters,bleeding risks arising from the necessity of anticoagulation for filter efficacy,vascular catheter-related bloodstream infections,variations in proficiency levels among healthcare professionals regarding CRRT modalities,especially in oper-ating the CRRT machines,high nursing workload,frequent nursing turnover,occurrences of hypophosphatemia,variability in CRRT prescribing patterns,and issues related to communication among stakeholders.This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management.Furthermore,the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.

先天性全身脂肪萎缩性糖尿病的分子发病机制

先天性全身脂肪萎缩性糖尿病（CGL），也称Berardinell—Seip综合征，属常染色体隐性遗传，主要表现为全身脂肪萎缩、胰岛素抵抗、高甘油三酯血症和肝脂肪变性。近年，通过定位克隆的方法，在CGL家系中筛选出2个致病基因，即AGPAT2（BSCL1）和BSCL2，分别编码1-酰基甘油-3-磷酸-O-酰基转移酶2和seipin蛋白。AGPAT2突变导致脂肪细胞甘油三酯合成和储存障碍，而seipin蛋白的功能目前仍不清楚。致病基因的鉴定和克隆有助于CGL的分子诊断。