对护理质量重要程度的认同差异性研究

[目的]了解医院病人、护士和医生对护理质量重要程度认同的差异性,以便于改进护理质量评价标准,使之适应以病人为中心的护理质量管理.[方法]根据质量评价标准和现代护理涉及的内容从7个方面设计23个研究项目,每个项目分为5个等级,以问卷调查形式了解病人、护士和医生对每个项目重要程度的认同状况.[结果]医院病人、护士和医生对评价护理质量内容重要程度总体认同存在差异,表现出不同的护理质量观,有的项目各类人群也存在认同差异(P＜0.05).[结论]医院病人、护士和医生对护理质量重要程度认同的差异的确存在,应从病人的需求改进护理质量评价标准的内容和权重.     

对护理质量重要程度的认同差异性研究

[目的]了解医院病人、护士和医生对护理质量重要程度认同的差异性，以便于改进护理质量评价标准，使之适应以病人为中心的护理质量管理。[方法]根据质量评价标准和现代护理涉及的内容从7个方面设计23个研究项目，每个项目分为5个等级．以问卷调查形式了解病人、护士和医生对每个项目重要程度的认同状况。[结果]医院病人、护士和医生对评价护理质量内容重要程度总体认同存在差异，表现出不同的护理质量观，有的项目各类人群也存在认同差异（P〈0．05）。[结论]医院病人、护士和医生对护理质量重要程度认同的差异的确存在，应从病人的需求改进护理质量评价标准的内容和权重。     

不同职级临床护理人员从事工作项目及其比重的调查

目的调查不同护理项目及其比重在不同年资、学历、职称护理人员中的分布。方法采用文献检索和专家会议法自行设计临床护理人员工作项目及其比重情况调查表，随机抽取3所三级甲等综合性医院450名临床护理人员实施问卷调查。结果调查表的内部一致性信度Cronbach＇s α系数为0．783，因子分析累计贡献率为60．91％；不同年资、学历、职称护理人员均从事所有护理项目，其中以大专学历、护士职称所占比例最高；中专及大专学历、护士职称均侧重执行治疗、等级护理和生活照护，本科学历、护师以上职称侧重危重病患者护理、健康教育、临床教学，不同学历、不同职称护理人员所从事的护理项目有统计学差异（P均〈0．01）；工作项目比重从大到小依次为等级护理、执行治疗、生活照护、健康教育、危重病患者护理、病区管理、临床教学、临床科研。结论护理人力资源不足和服务利用低效率现象并存，提示护理管理者应加大对临床护理研究工作的组织与管理，重视临床型科研人才的持续培养，推进护理科研水平的不断提高；并根据不同岗位的专业技术要求配备相应能力的护理人员，实现人力资源的优化管理。     

本科学历护士与大专科学历护士组织承诺的对比研究

目的:了解本科学历护士与大专学历护士组织承诺的现状,探讨影响其组织承诺的相关因素。方法:以5所三级甲等医院306名本科学历护士与大专学历为研究对象进行问卷调查。结果:本科学历护士在组织承诺、感情承诺、规范承诺、经济承诺得分明显低于大专学历护士(P<0.01)。结论:医院在进行护理人力资源管理时,要充分考虑本科学历护士与大专学历护士组织承诺的差异性,结合其特点,适当变革管理方式,以提高管理有效性。     

临床护士护理能力及影响因素的调查研究

目的了解临床护士的护理能力现状及其影响因素,为护理人力资源管理提供参考依据。方法采用护理能力量表对某市8所二甲及其以上综合医院1042名临床注册护士进行横断面调查。结果护理能力得分为73.99±9.81分;影响临床护士护理能力的因素从大到小分别为专业兴趣、工作年限、职位、学历、医院等级、参与教学活动和婚姻。结论临床护士在维护和促进病患健康方面具备基本的护理能力,但尚待进一步提升其护理能力水平;管理者应针对不同个性特征护士的能力水平进行人力资源管理。     

医院护理人力资源培训需求调查

为了了解医院护理人力资源培训需求的现状 ,对上海市部分医院的护士进行了问卷调查。调查结果显示 :①不同学历、工龄的护士 ,希望得到培训的项目有显著性差异 (P <0 .0 1 ) ,职称不同无显著性差异 (P >0 .0 5) ;②不同学历、工龄的护士 ,希望达到的学历有显著性差异 (P <0 .0 1 ) ,职称不同无显著性差异 (P >0 .0 5) ;③不同学历、工龄、职称的护士 ,希望提高学历的方式有显著性差异 (P <0 .0 5) ;④不同工龄、职称的护士 ,认为影响继续教育的因素有显著性差异 (P <0 .0 1 ) ,学历不同无显著性差异 (P >0 .0 5) ;⑤护士最希望的继续教育方式是短期培训。根据调查结果探索护理人力资源培训的有效途径和方式。     

护士分层管理模式在普外科病房的使用

随着科学技术的迅速发展和医学模式的转变，护理专业的内涵和外延都发生了较大变化。护理人力资源的合理配备和科学管理，直接关系到医院的工作质量，更直接影响到护理质量，护理人力资源的合理配置与使用是护理管理改革的一项重要内容，越来越受到医院管理部门的重视。但是在护士的使用中，不同职称、不同学历的护士工作内容与职责差异不大，责权利未达到一致，     

我院管辖社区卫生服务中的护理现状与思考

目的了解西乡社区护士的现状、社区护理人力资源配置情况,为社区护士培训提供依据。方法对所管辖的29个社区健康中心的108名护士进行问卷调查。结果社区护士普遍存在学历、职称较低,社区护理经验不足,掌握的知识不能满足社区护理各项工作需要,影响社区护理项目的开展。结论对社区护士学历较低、社区护理经验不足应引起足够的认识,并加强社区护理人力资源的调配和继续教育工作,探索适合社区护理发展模式是社区护理管理者今后的工作重点之一。     

分层管理模式在护理工作管理中的应用研究

正护士分层管理是指将护士按照工作年限、职称、学历等不同分层使用,并规定岗位工作职责、技术要求,充分发挥不同层次护士的作用。护士分层管理是一种现代化的管理模式,是护理专业发展的必然趋势,对于合理利用人力资源,发挥科室的管理力度,实现护理质量的持续改进具有积极意义[1]。护士分层管理是护理管理探索的新特点,要求护理人员逐级对应,根据能力分管患者。本院对护士实施分层管理以来,有效提高了护理质量和护士工作积极性,现报告如下。     

护理人员按技术职称分层次设岗的实践

目的:使护理人力资源利用更趋科学合理化,降低护理成本。方法:根据护士学历、资历、职称、专业能力,按工作职责和临床角色分层次设岗,定期审核及考核。结果:明确了等级划分,科学界定了护士的工作职责,实现人员与岗位的最佳组合。结论:有效地培养和培训了在职护士,达到了护士专业能力进级,促进护理梯队建设,提高患者的满意度。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.