责任包干制下护士能级对应与绩效管理的实践

目的 探讨责任包干制下护士能级对应与绩效管理在病房护理管理中的应用.方法 根据中国国情,结合医院实际情况,将病房护士按工作年资、学历、业务能力进行分层级使用和管理,建立护士能级与绩效考核指标.结果 能级与绩效管理实施后,护理质量较实施前有所提升;患者满意度、医生对护士的满意度及护士自身满意度较实施前显著提高.结论 能级对应与绩效管理提高了护理质量,增强了护士的职业成就感,提升管理效能.     

感染内科护理亚专业组管理模式的实践

目的探讨护理亚专业组管理模式在提升感染内科病区护理质量中的应用效果。方法根据科室收治病种特点,建立4个护理亚专业组,构建感染内科护理亚专业组管理模式。比较实施前后护士核心能力、科室护理质量基础指标及专业指标的差异。结果护理亚专业组管理模式实施后,护士核心能力、科室护理质量基础指标及专业指标评分显著高于实施前(P0.05,P0.01)。结论对感染内科实施护理亚专业组管理模式,有利于护士核心能力的提升,以及感染内科护理质量的提高。     

基于ICU亚专科岗位管理模式的护理服务绩效评价

目的探讨基于ICU亚专科岗位管理模式的护理服务绩效评价的实践效果。方法以35名ICU护士为研究对象,建立亚专科工作组,实施基于ICU亚专科岗位管理模式的护理服务绩效模式。结果实施1年后,护理各项综合指标成绩和护士岗位管理绩效管理满意度显著提升(均P0.01)。结论 ICU亚专科岗位管理有助于提高ICU护理综合质量和护士满意度。     

医护同组排班在优质护理服务示范工程试点病房的实施

目的探讨医护同组排班在优质护理服务示范工程试点病房中的实施效果。方法在神经内科病房实行医护同组排班:将科室21名护士分为总务团队3人和3个责任组各6人,实施组长负责制。每组每日在岗4人(包括护理组长或副组长1人、白班责任护士1人,连班责任护士1人,6～8班责任护士1人),组长仅上白班(7:45～12:00,14:30～17:30),6～8班(17:30～8:00)代替传统中夜班。各责任组护士每日跟随同组医生查房。结果实施医护同组排班后,患者满意度由92%提升至99%,护士满意度由94%提升至98%;护理质量(基础护理、一级护理、文件书写及消毒隔离)评分由85.80～87.11提高至91.01～99.38;医护矛盾、护患矛盾均从2起降至0,表扬信件从12封上升至52封;晨间采血、测量体温时间推迟1.0～1.5h,患者夜间连续休息时间延长4h。结论医护同组排班使护士分管患者人数减少,保证了护理工作的连续性,为患者提供了更人性化的护理服务,且利于护士的身心健康。     

管床评分表在责任制护理实施中的应用

目的探讨管床评分表在责任制护理实施中的应用效果。方法在开展优质护理服务示范病房活动中实施管床责任制护理,应用自制的管床评分表对责任护士进行评分并纳入绩效考核。结果应用管床评分表后患者对护理服务满意率、医生满意率、护士对患者十知道掌握情况较应用前显著提高(均P<0.01)。结论管床评分表具有导向作用,有助于指导责任护士开展责任制护理,同时纳入绩效管理,增强了护士责任心和积极性,从而提高护理质量和患者满意度。     

Application of bedside work rating scale to charge nurse responsibility system

目的 探讨管床评分表在责任制护理实施中的应用效果.方法 在开展优质护理服务示范病房活动中实施管床责任制护理,应用自制的管床评分表对责任护士进行评分并纳入绩效考核.结果 应用管床评分表后患者对护理服务满意率、医生满意率、护士对患者十知道掌握情况较应用前显著提高(均P＜0.01).结论 管床评分表具有导向作用,有助于指导责任护士开展责任制护理,同时纳入绩效管理,增强了护士责任心和积极性,从而提高护理质量和患者满意度.     

应用6S管理模式提高临床护理管理质量

目的探讨6S管理模式对提高临床护理管理质量的作用。方法成立6S管理小组,采用6S管理模式对病区进行现场管理,包括整理、整顿、清扫、清洁、素养、安全。结果实施6S管理模式后,病房护理质量各项评分、患者满意度与实施前相比均显著性提高(均P0.01)。结论 6S管理模式的实施,改善了工作环境、护理服务质量,患者满意度得到了明显提升。     

医院质量与安全评价指导下的血液专科病房护理岗位安全管理

目的探讨在医院质量与安全评价指导下血液专科病房护理岗位安全管理的实施效果。方法在对医院质量与安全评价标准充分解读及指导下,血液专科病房着重护理岗位安全管理,重点落实岗位设置、培训及管理各项措施。结果实施1年后,患者满意度、护士满意度及一级护理评分较实施前显著提高(均P0.05)。结论通过医院质量与安全评价活动的开展,指导血液专科构建护理安全文化,促进内涵建设,保障了患者护理安全,提升了专科护理质量。     

高级责任护士负责制分层管理在“优质护理服务示范工程”中的应用体会

目的:探讨高级责任护士负责制护理分层管理在优质护理服务中的应用效果。方法:示范病房实施高级责任护士负责制分层管理模式,并与绩效工资挂钩,比较活动开展前后各项护理工作质量,护理服务满意度。结果:各项护理工作质量明显提高,P<0.01;患者对护士、医生对护士的满意度明显提高,P<0.01。结论:高级责任护士负责制护理分层管理模式是保证护理质量、提高护理服务的有效方式。     

能级对应护理人力资源管理模式下的绩效考核方案探讨

目的探索能级对应的护理人力资源管理模式下的绩效考核方案实施效果。方法建立能级对应的人力资源管理模式。将护理人员按照学历、年资、能力分为高、中、初、新护士4个能级层次,根据性格特点及能力水平匹配主班、责任护理组长、责任护士3种护理岗位;选取相应人员承担科室质控组长、临床带教组长以及科研组长等;将绩效考核划分为岗位绩效、工作绩效及奖罚绩效三部分。评价实施前后护士职业满意度及患者满意度。结果绩效考核方案实施后护士职业满意度及患者满意度评分显著高于实施前(均P0.01)。结论与能级对应的绩效考核方案有利于提高护理人员的职业满意度,从而有效提高患者满意度。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.