基层医院护理工作环境现状调查及分析

目的:调查基层医院护理工作环境现状,为护理管理者创建健康的护理工作环境提供相关的科学依据。方法:采用自行设计的问卷和中文版护理工作环境量表,对东莞市4家二级综合医院的400名护士进行问卷调查。结果:高质量护理服务的基础(3.09±0.11)分、护理管理者的能力及领导能力(3.01±0.15)分、医护合作(2.92±0.09)分、护士参与医院事务(2.85±0.32)分、充足的人力与物力(2.36±0.10)分。结论:人力和物力资源的缺乏是基层医院护理工作环境存在的主要问题,护士参与医院事务决策的机会较少、需引起相关管理者的重视。     

护理工作环境与护士职业获益感的相关性研究

[目的]调查护士护理工作环境及护士职业获益感现状,并分析护理工作环境对护士职业获益感的影响。[方法]采用自行设计的一般资料调查表、护理工作环境量表和护士职业获益感问卷对某医院230名护理人员进行调查。[结果]护理工作环境总分为(89.94±12.90)分,各维度得分由高到低依次为:高质量护理服务的基础(29.91分±4.01分)、护士参与医院事务(22.26分±3.97分)、护理管理者的能力及领导方式(14.84分±2.37分)、充足的人力和物力(10.86分±2.40分)、医护合作(9.20分±1.31分);护士职业获益感总分为(131.60±19.29)分,各维度得分由高到低依次为:自身的成长(32.47分±4.93分)、正向职业感知(26.54分±4.68分)、良好的护患关系(24.46分±3.90分)、团队归属感(24.13分±3.63分)、亲友认同(23.98分±3.77分)。护理工作环境与护士职业获益感总分和各维度呈正相关(P0.01)。[结论]护理工作环境对护士职业获益感有影响,良好的护理工作环境可提高护士的职业获益感。     

工作环境对临床护士工作投入的影响研究

目的调查临床工作环境对护士工作投入的影响。方法应用护士工作环境量表和护士工作投入量表对600名临床护士进行调查。结果临床一线护士工作环境评分为(3.30±0.65)分;工作投入评分为(3.71±0.69)分;护士工作环境中高质量护理服务基础和参与医院事务两个维度为工作投入的主要影响因素(R~2=0.311)。结论医院护理管理者应重视对良好工作环境的创造,提高临床护士工作投入水平,提高护理服务质量。     

护理工作环境与护士离职倾向之间的关系

目的了解北京市某三级甲等医院护理工作环境、护士离职倾向现状,并分析两者间的关系。方法采用一般资料问卷、护理工作环境量表(PES)和离职倾向问卷对657名护士进行调查。结果护理工作环境总均分为(2.97±0.57)分,各维度得分由高到低依次是"高质量护理服务的基础""医护合作""护理管理者的能力及其领导方式""充足的人力和物力""护士参与医院事务";离职倾向总均分为(2.72±1.00)分,有30.4%的护士的离职倾向水平较高(3分)。分层回归分析结果显示,控制一般资料后,护理工作环境对离职倾向的独立解释量达到18.5%。结论三级医院护士认可所处工作环境,近1/3护士有离职倾向,两者呈负相关。护理管理者应采取针对性的管理措施,稳定护理队伍。     

医院内科、外科和ICU病区护士特征分布以及护理工作环境分析

目的:探讨我国医院不同病区的护士特征分布以及护理工作环境情况。方法:该研究为描述性研究,采用一般资料调查表和护理工作环境量表(PES-NWI量表)对181家医院共9698名护士进行调查,在病区层面上描述内科、外科和ICU病区护士特征的分布情况,比较不同病区护理工作环境的差别。结果:ICU的护士较内科、外科护士年轻,工作年限短,男护士及合同制护士比例大、学历高。各类病区得分最高的均是"医护合作关系"维度,得分最低的是"充足的人力和物力"维度,其次是"护士参与医院事务"维度。ICU护士的PES-NWI量表总分以及各维度均分较内科、外科均低,外科"人力和物力的充足性"维度得分高于内科(P<0.001)。结论:ICU的护理工作环境较内科和外科差;外科在"人力物力充足性"方面好于内科。     

三级甲等医院护士工作环境感知与满意度相关性研究

目的调查银川市三级甲等医院护士工作环境状况,分析工作环境感知与满意度相关性,为护理管理者改善护士执业环境提供依据。方法采用问卷调查法对宁夏银川市4所三级甲等医院520名护士进行护理工作环境、满意度调查,并对结果进行分析。结果银川市三级甲等医院工作环境总得分(73.43±8.71)分,护士感知的工作环境各维度中充足的人力和物力、高质量护理服务的基础得分较高,护理管理者的能力及领导方式得分处于中等,护士参与医院事务、医护合作得分较低;工作满意度总得分为(116.05±11.33)分,其中晋升机会、管理者、工作性质均与工作环境各维度及总分显著相关。结论银川市三级甲等医院护士对工作环境的感知度处于高水平,其工作满意度整体处于一般水平;护理工作环境、高质量的护理服务基础及工作年限是护士工作满意度的重要影响因素,应通过改善护理工作环境,提高护士工作满意度水平。     

ICU护士工作环境与工作满意度相关性分析

目的:分析ICU护士工作环境与工作满意度的关系,为提高护理人员工作满意度提供策略指导。方法:采用一般资料调查表、护理工作环境量表及护士工作满意度评定量表对济南市4所三级甲等综合性医院的300名ICU护士进行调查。结果:护理工作环境各维度得分及总分和护士工作满意度各维度得分及总分之间呈显著正相关,护士参与医院事务维度、高质量护理服务的基础维度、充足的人力和物力维度对护士工作满意度有正向影响。结论:济南市三级甲等医院ICU护理工作环境对护士工作满意度有显著影响,管理者应改进管理策略,为护士创建一个健康的护理工作环境,从而有效提高护理服务质量,提高护士工作满意度。     

ICU护理工作环境现状及其对离职意愿的影响

目的 :调查ICU护士的工作环境、离职意愿现状,分析工作环境对离职意愿的影响。方法 :采用一般资料问卷、护理工作环境量表(PES-NWI)和离职意愿量表,对北京市6家三级甲等医院294名ICU护士进行调查,采用分层回归分析工作环境对离职意愿的影响。结果 :ICU护理工作环境量表总均分为(3.53±0.58)分,其中5个维度得分由高到低依次为高质量护理服务的基础、医护合作、护理管理者的能力和领导方式、护士参加医院事务、充足的人力和物力;离职意愿总均分为(2.73±0.57)分。根据分层回归分析结果,每月夜班数、婚姻状况(已婚无子女)、护理工作环境对离职意愿有影响(P0.01)。结论 :护理管理者应根据ICU护士现状,改善ICU护士的工作环境,提高护士对工作环境的认可度,从而降低离职率。     

河北省综合医院护理工作环境现状及与护理质量安全的相关性研究

目的调查河北省综合医院护理工作环境的现状,并分析其与护理质量安全的相关性。方法采用护士工作环境量表和护理质量安全问卷对河北省20所二级、三级综合医院的1023名护士进行问卷调查。结果护理工作环境得分为（3．45±0．55）分,得分最高的维度为医护合作,最低的维度为充足的人力和物力。良好的医护合作可使护士对病区护理质量和出院后患者自我护理有正性影响;鼓励护士参与医院事务、重视高质量护理服务的基础工作,对护士的患者安全评价有正性影响。结论河北省综合医院护理工作环境总体较好,良好的护理工作环境有利于护理质量和患者安全的保障,医疗主管部门和护理管理者应当继续优化护理工作环境的各要素,以进一步提升护理质量和患者安全。     

临床护士对医院科室护理工作环境的评价

目的调查临床护士对医院科室护理工作环境的评价。方法以中文版护理工作环境量表(practice environment scale,PES)为调查工具,采取分层随机抽样,对乌鲁木齐市驻地军队医院600名护士进行问卷调查。结果临床护士对医院科室护理工作环境评价良好,PES各维度得分均大于2.5分临界值,五类科室在"护士参与医院事务"维度上比较差异无统计学意义(P0.05),其余4个维度及总分比较差异均有统计学意义(均P0.05)。结论护理管理者需要在人力物资及护士参与医院事务方面加大力度,着重关注儿科和急重症科室护理工作环境的改善,以进一步优化医院护理环境。     

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.     

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.     

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.     

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.     

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.