医师量化考核择优晋升的方案设计与实践

目的：遵循公平、客观、透明的原则,探讨医师量化考核择优晋升的方案,为其晋升提供参考依据,并促进医师自身全面发展。方法：在广泛征求管理者和临床譬家的基础上,设立基本素质、工作作风、工作业绩、业务水平4个一级评价指标,通过基础分和附加分对医师实行综合评价。结果：医师评价坚持以医疗为中心,注重工作业绩和业务水平。结论：通过综合评价和量化排序,实现择优晋升,效果显著,并对医师发展起到引导和激励的作用。     

血液净化专业护士核心能力培训的实践与效果

目的：探讨血液净化专业护士核心能力培训的模式及培训效果。方法：成立专业护士核心能力评估与培训小组,对血液净化中心22名护士进行专业能力分级,按照血液净化专业护士核心能力培训模块,从专科基础知识和技能、专科专业知识和技能、临床思维能力、教育和培训能力、管理与应急能力5个方面制定相应的培训计划,分层级地实施一对一导师培训法、临床定点轮转培训法和以问题为导向的针对性训练,并实行护士分层使用和管理。结果：经系统的护士核心能力培训、考核与分层级使用2年后,护士的专科理论知识掌握、技术操作能力及综合能力,以及护理技术质量与服务质量前后比较均有明显的提高（P〈0．01）。结论：实行护士分层级核心能力培训,有助于发展护士的专业能力和综合素质的提高,明显提高护理工作中的技术质量和服务质量。     

关键业绩指标在手术室绩效中的应用

目的应用关键业绩指标法制定手术室护士绩效考核项目,选取一些关键的且与手术室护理管理目标实现关系紧密的工作内容作为考核项目,为护理工作指明方向,发挥手术室绩效管理的作用。方法制定KPI考核方法对手术室护理人员进行考核,包括综合考核指标、日常工作考核指标和考核周期等。结果关键业绩指标的应用有利于手术室护士业务素质、护理质量的提高;KPI目标必须具体可测量,KPI评价指标应清晰具体有特异性。结论在手术室绩效中应用关键业绩指标制定相关考核目标,能客观公正地评价护士,可激励护理人员持续改进工作,同时得到应得的绩效奖金。     

手术室专科护士核心能力评价指标体系的构建

目的：探讨手术室专科护士核心能力评价指标体系的构建。方法运用德尔菲法,并且对50名专家进行函询,并对手术室专科护士核心能力评价指标体系下的各级指标以及权重进行确定。结果经过函询分析后,构建的评价指标体系包括一级指标6个、二级指标27个,总共73条评价标准。结论在权威专家的积极配合下,本次研究构建手术室专科护士核心能力评价指标体系具有较好的协调性,在手术室专科护士核心能力考核、评级以及培养上发挥着重要的基础性作用。     

神经外科护士核心能力培训实施及效果分析

目的:探讨神经外科护士核心能力培训的实施效果。方法:对我院神经外科在职的42名护士实行分层级核心能力培训并评价培训效果。结果:培训后护士的各项考核指标评分均显著高于培训前(P<0.05),各层级护士专业能力和工作效率显著提高。结论:神经外科护士核心能力培训效果确切,可显著提高护理质量。     

能岗匹配低年资护士核心能力培养体系的构建与研究

目的：探索一套有效提高低年资护士临床综合能力的培训管理模式。方法：针对青年护士成长特点,将护士培养与实习生教育有效衔接,通过健全教育培训管理体系和优化培训方法,建立了青年护士分层级培养以及基于信息化继续教育管理平台的综合考核的规范化培养体系。结果：以能岗匹配为原则对低年资护士核心能力培养体系的有效构建能促进护士的快速成长,确实提高了她们临床发现问题、解决问题的能力,确保了临床护理工作安全及质量。     

牧区基层综合医院病区护士工作绩效综合评价方法初探

目的：探讨护士工作绩效综合评价体系的建立与实施。方法：体现护士专业技术能力、职业道德、工作态度、患者评议、临床实践能力及不良事件主动报告等因素进行评价,变封闭式考核改为开方式考核。结果：使护士工作绩效考评充分量化,便于操作,使评价结果更趋客观、公正,使劳务分配尽量体现无偏重与倾斜。结论：明确了护理工作的行为、责任与利益主体,建立了争创优良业绩为主的绩效意识,形成了良好的管理导向。     

应用Delphi法构建ICU专科护士核心能力评价指标体系

目的:依据我国ICU的现况,构建一套客观、科学的ICU专科护士核心能力评价指标体系.方法:采用Delphi对17名专家进行两轮问卷咨询.结果:建立由5个一级指标、16个二级指标、50个三级指标组成ICU专科护士核心能力评价指标体系,并计算出专家咨询的权威系数为0.85,判断系数0.82,熟悉系数0.88;一、二级指标的协调系数分别为0.342、0.586.结论:ICU专科护士核心能力评价各级指标的条目可信度高,对ICU专科护士的临床任用、考核提供借鉴.     

骨科专科护士核心能力评价指标体系的构建

目的：建立骨科专科护士核心能力评价指标体系。方法采用德尔菲法对我国重庆、北京、江苏等地21所三级甲等综合性医院35名专家进行3轮函询,确定骨科专科护士核心能力评价指标体系的各级指标和权重。结果最终确立的骨科专科护士核心能力评价指标包括4个一级指标、14个二级指标、72个三级指标。专家咨询的权威系数为0．833,熟悉程度系数为0．794,判断依据系数为0．872。一级、二级、三级指标的协调系数分别为0．390、0．324、0．308,差异有统计学意义（P＜0．05）。结论骨科专科护士核心能力各级评价指标专家意见集中,研究结果客观、科学,为骨科专科护士的培养、考核和评价提供了可量化的依据。     

浅谈绩效考核指标在急诊科层级管理中的应用效果

目的：探讨在分层级护士管理中不同级别护士绩效考核指标体系的应用效果。方法：相应的岗位系数需要根据各个层次的护理岗位、护理工作量、护理质量、护理安全的不同,结合绩效考核制度,设置相应的构建不同层级护士的绩效考核指标,对护理平台护士进行考核。结果：绩效考核指标在分层级护士中的应用为护士奖惩、评优、晋升等提供了依据,提高了各层级护士的工作热情,确保了护理安全。结论：将绩效考核指标与分层级管理护士制度相结合,将绩效考核应用于不同级别的护士,充分提高了护理人员的工作热情及工作态度,达到了持续改进护理质量的目的。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.