护理工作程序化管理在麻醉恢复室中的应用

目的：探索麻醉恢复室护理工作程序管理化管理模式。方法：自行设计护理工作程序化管理方案（包括入科交接程序、监测护理程序、出科护理程序和管理评价机制）观察麻醉恢复成功率。结果：通过程序的应用,麻醉恢复成功率达100%,及时发现并发症。结论：程序化管理可以保证患者尽早接受专科系统的治疗和护理,提高护士观察病情能力和护理水平,管理评价机制使护理质量得到持续改进,管理更加有序。     

程序化管理对提高急诊护理质量的效果评价

目的 探讨护理质量程序化管理在急诊护理管理中的应用效果.方法 选择近2年急诊科实施护理质量程序化管理后接诊的861例患者作为研究对象,与实施护理质量程序化管理前的850例患者作对比,观察实施护理质量程序化管理前后的护理质量.结果 实施护理质量程序化管理后护理人员的接诊时间、出车时间、输液差错次数及护患纠纷次数较实施前显著减少;而专科考核得分、抢救成功率及患者对护理工作的满意度较实施前显著提高.结论 在急诊护理管理中应用护理质量程序化管理,可有效提高护理质量及工作效率.     

质量管理常用方法与工具在护理质量管理中的应用

<正>护理质量管理应从传统的经验管理模式向科学管理模式转变,护理质量问题的产生需要分析其构成因素各因素之间的影响机制,从中析出影响质量的贡献因子,为质量改进提供科学决策,从而提高护理质量管理活动的效率。护理质量结局的评价需要应用科学的护理质量检验工具,将繁杂的信息经过系统化整理和程序化的处理,客观而准确地监测其质量水平。质量管理学者在长期的实践中的提炼总结成功的质量管理方法和通用的质量工具。     

手术标本的程序化管理

目的探讨手术标本程序化管理模式。方法制定手术标本程序化管理方案，包括手术标本保管、处置、送检程序和管理评价机制。结果通过程序化管理，消除了手术标本管理中的安全隐患，无1例差错事故的发生。结论程序化管理规范了医务人员的行为，使手术标本管理规范化，使质量得到持续改进，管理更加有序。     

儿科临床护理教学中的程序化管理

目的在临床护理教学中采用程序化管理教学方法,以提高实习护士的护理核心能力。方法将73名护生按时间顺序分为观察组35名和对照组38名,观察组采取程序化管理的教学方式,以培养护生的护理核心能力为目标,对护生进行过程评价。对照组采用传统的教学方法,对护生进行终末评价。比较2组护生的教学效果。结果观察组临床教学效果显著好于对照组,P〈0.01,差异有统计学意义。结论程序化管理教学方式具有互动性和协作性的特点,是一个循环的、动态的过程。在临床教学中采用程序化管理教学能有效提高护生的护理核心能力。     

儿科临床护理教学中的程序化管理

目的 在临床护理教学中采用程序化管理教学方法,以提高实习护士的护理核心能力.方法 将73名护生按时间顺序分为观察组35名和对照组38名,观察组采取程序化管理的教学方式,以培养护生的护理核心能力为目标,对护生进行过程评价.对照组采用传统的教学方法,对护生进行终末评价.比较2组护生的教学效果.结果 观察组临床教学效果显著好于对照组,P＜0.01,差异有统计学意义.结论 程序化管理教学方式具有互动性和协作性的特点,是一个循环的、动态的过程.在临床教学中采用程序化管理教学能有效提高护生的护理核心能力.     

护理操作行为及其程序化管理在护理不良事件中的应用与效果

目的探讨程序化护理操作管理在预防护理不良事件中的应用效果,规范护理操作行为及其程序化管理。方法建立护理操作程序及其归类,设计程序化护理操作行为评价表,并确定评分因素、评分系数及评分因素分值。采用程序化护理操作行为评价表比较实施程序化护理操作管理模式前、后护理操作不良事件的发生率。结果通过运用程序化护理操作管理模式,有效降低了护理操作不良事件的发生(P0.01)。结论程序化护理操作管理模式能科学指导护理操作行为,为护理操作管理提供了新的思路和方法,为护理操作提供了安全保障。     

孕产妇急救护理程序化管理在基层保健院的应用

目的探讨护理程序化管理在基层保健院急救接诊孕产妇工作中的应用。方法将实施护理程序化管理前、后急救接诊孕产妇的护理质量进行分析对比。结果实施护理程序化管理后,医生、病人对急救接诊护理工作满意率提高了17.8%。结论基层保健院运用护理程序化管理急救接诊孕产妇,能提高护士整体素质及护理质量。     

ICU机械通气患者实施护理程序化管理的效果观察

目的:探讨程序化管理护理干预措施在ICU机械通气患者中的应用效果,以提高护理质量和患者满意度。方法:ICU机械通气患者根据护理方式不同分为观察组和对照组,观察组103例行护理程序化管理,对照组83例行常规护理,比较两组机械通气时间、ICU监护时间及院内感染、呼吸机相关性肺炎发生情况,并对护理服务满意度进行评价。结果:观察组机械通气时间和ICU监护时间分别为(5.54±1.31)d和(6.07±1.82)d,其院内感染、呼吸机相关肺炎及死亡病例的发生率分别为12.62%,5.83%,1.94%,与对照组比较均有统计学意义;观察组患者对护理质量的满意度明显提高,两组比较差异有统计学意义。结论:程序化管理护理干预措施应用于ICU机械通气患者效果明显。     

在临床带教过程中实施人性化管理的做法

介绍了在临床带教过程中实施人性化管理的做法，即：①教学方式的人性化：包括正确的人性化意识、带教计划程序化、采用多媒体教学方式和赏识教育法。②评价机制的人性化：包括双向反馈和双向考核。③学习环境的人性化：包括融入护理团队、强调护士长参与带教、合理的护理实践和信息共享等。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.