耳鼻咽喉头颈外科门诊患者对护理人员素质需求的探讨

目的探讨耳鼻咽喉头颈外科门诊患者对护理人员素质的需求,以便按其所需提高专科门诊护理服务质量.方法对耳鼻咽喉头颈外科门诊就诊患者需求进行问卷调查.结果 612例患者中有62.6%患者希望护士技术操作技巧好;有68.3%的患者希望护士有非常好的服务态度;有73.8%患者希望护士有大专以上文化程度;有82.0%患者希望护士在与患者的沟通中使用大众语言;有85.0%患者希望护士在工作中不断掌握新知识.结论了解门诊就诊患者的需求并根据需求不断提高自身素质是门诊护士提高护理质量的根本所在.     

内科门诊患者就诊需求调查与分析

目的　探索内科门诊就诊的患者需求 ,以期提高医疗服务质量。方法　对内科门诊就诊患者的就医需求进行分类问卷调查。结果　 1130例患者中 6 6 .2 % (74 8/ 1130 )是辗转当地数家医院后来到我院就诊的 ,6 5 .8% (74 4 / 1130 )为自费就诊者。 6 3.1%患者 (712 / 1130 )要求选择专家为接诊医生 ,70 .5 % (797/ 1130 )的患者希望自己的诊治医生为主任级医师 ;患者对护士的需求主要是为其提供咨询和帮助。结论　门诊患者对高质量医疗的需求越来越多 ,高学历、高级职称的专家更受患者的垂青 ,护士在门诊的分诊作用非常重要     

门诊老年患者护理服务需求状况调查及对策

目的了解门诊老年患者护理服务需求现状,为今后能够提供更好的护理服务,提高老年患者对医院的满意度提供理论依据。方法采用自行设计的门诊老年患者需求调查表,采取随机抽样的方式,对2016年3~6月62名门诊就诊的老年患者进行调查。结果需求最多的是诊前咨询(93.5%)、用药指导(93.5%)、结账收费(93.5%)、病历建档(90.32%)。结论改善老年门诊患者护理服务内容,满足老年患者门诊就诊的护理需求,从而提高患者满意度。     

内科门诊患者就诊需求调查与分析

目的探索内科门诊就诊的患者需求,以期提高医疗服务质量.方法对内科门诊就诊患者的就医需求进行分类问卷调查.结果1 130例患者中66.2%(748/1 130)是辗转当地数家医院后来到我院就诊的,65.8%(744/1 130)为自费就诊者.63.1%患者(712/1 130)要求选择专家为接诊医生,70.5%(797/1 130)的患者希望自己的诊治医生为主任级医师;患者对护士的需求主要是为其提供咨询和帮助.结论门诊患者对高质量医疗的需求越来越多,高学历、高级职称的专家更受患者的垂青,护士在门诊的分诊作用非常重要.     

无缝隙延伸护理服务模式在口腔门诊的构建与实践

目的探索"无缝隙"延伸护理服务模式在口腔门诊的实践效果。方法广州市某三甲口腔专科医院于2015年9月~2016年9月针对口腔门诊患者在就诊前、就诊中、就诊后这3个时间段内的需求特点,探索并实践了一系列全程、优质、无缝隙的延伸护理服务模式。结果实施"无缝隙"延伸护理服务后,护士服务患者的时间增加了(18.5±1.3)min;医护比由原来的1∶1.06提高至1∶1.3;椅护比由原来的1∶1提高至1∶1.2;患者失约率由33.3%降至8.3%;患者对护理工作的满意度由93.3%提高到99.4%;患者对诊位责任护士的知晓率由61.1%提高到96.7%。结论 "无缝隙"延伸护理服务模式把患者就诊前、就诊中、就诊后的护理服务进行有机的衔接,充分满足了口腔门诊患者的护理需求,体现了护理的专业价值和社会服务功能。     

内科门诊患者就医围诊的不良影响及相应对策的效果评价

目的：探讨医院内科门诊患者就医时围诊现象造成的不良影响,为改进内科门诊就医流程、缩短候诊时间及最大限度满足患者就诊需求提供科学依据。方法随机抽取2014年3~7月在我院内科门诊就诊的患者1600例,由门诊分诊护士指导填写自行设计的调查问卷,内容包括患者就诊时能够接受的等候时间、超时等候的心理反应、围诊现象带来的不良影响、门诊医护人员服务态度、门诊就医环境、就诊时最需求的服务、患者候诊时不满意事项以及需要改进的内容等。结果98%的患者认为就诊等候时间应在40 min内,2%的患者认为等候时间可在60 min内。调查显示,就医围诊现象的发生主要就是觉得等待时间太长和最不满意不按顺序就诊或而随意带患者插队加塞的现象。结论门诊护理管理人员应及时制定和采取合理的门诊患者就诊程序和措施,分诊护士主动安排患者按顺序就诊,最大限度缩短就诊时间,杜绝医院内部医护人员带熟悉患者插队就诊的问题,从而减少内科门诊患者就医时围诊现象的发生。     

胸外科术后专科护士门诊的建立与实践

目的探讨胸外科术后患者出院后的专科护士门诊建立与实践效果。方法选择2015年1月—2016年5月我科护士坐诊胸外护士门诊就诊的食管和肺术后患者872例,对就诊患者术后不同时间点的不同需求进行各种处置、对就诊患者伤口疼痛进行评估、对就诊资料收集、整理分析。结果患者在护士门诊主动重点咨询的内容为康复锻炼、伤口管理、抗炎治疗、饮食管理、用药管理、生活问题、后续治疗;专科护士门诊综合处置内容为:伤口护理、心理护理、健康教育、开具复查检查单;不同术后时间节点疼痛评分均为轻度疼痛;患者就诊时间为(20.15±7.28)min;患者就诊满意度为100%。结论胸外科术后专科护士门诊主要对出院后患者所遇到的各种问题进行及时咨询和处置,对不同术后时间节点患者在医生门诊复查做好前期准备工作,是一项利患举措,能提高患者满意度。     

开展门诊健康科普大课堂的护理管理实践

目的 :提高门诊就诊患者的健康保健知识水平,调动门诊护士的学习和工作热情,构建和谐护患关系。方法 :制定和发放门诊患者健康教育需求调查问卷,结合就诊患者的特点和需求拟定授课内容,利用中午休息时间开展门诊大课堂活动,根据评价结果和患者需求不断改进活动质量。结果 :护士熟练掌握了护理知识和技能,提升了科普授课能力;患者及家属的疾病防治意识得到了增强,患者满意率为96.4%,门诊就诊秩序相应得到了改善。结论:在门诊开展健康大课堂活动可密切护患关系,是优质护理服务的拓展,是民众科学素养提高的好时机,是提高社会效益和经济效益的有效途径。     

319例糖尿病专科护理门诊就诊案例回顾性分析

[目的]调查糖尿病专科护理门诊式教育模式的效能,并提出对策。[方法]采用糖尿病专科护理门诊就诊病人个案调查表和糖尿病病人受门诊式教育的影响程度调查表对319例在糖尿病专科护理门诊就诊的糖尿病病人进行调查。[结果]就诊病人均得到健康问题筛选、咨询及糖尿病知识宣教服务,并表示满意;大多数病人对护理门诊了解不多,就诊主要源于医护人员的介绍,37.93%能按时复诊。病人对教育内容信任程度:55.80%完全信任,44.20%部分信任;教育后遵嘱改变行为程度:18.81%完全改变,76.81%部分改变,4.38%没有改变。[结论]糖尿病护理专科门诊可满足病人和社会的需求,提高满意度;多种模式拓展糖尿病专科护理服务覆盖面,完善糖尿病门诊,提高专科护士公信度;教育应医院-家庭-社区一体化,同伴支持互助,提高教育效能。     

莆田市三甲医院门诊护理服务质量现状调查

目的了解目前莆田市三甲医院门诊护理服务质量的现状。方法采用门诊护理服务质量评价表,对1256例门诊就诊患者进行调查,让对目前门诊护士的服务质量进行评价。结果65％-79％患者对门诊就诊的整体评价为非常好或特别好。护理人员的服务心态、隐私的保护和护理人员的礼貌态度得分排列前3位;护理人员的专业能力、预先告知就诊的时间长短、在适当的时间接待得分排列后3位。结论门诊护理人员应该保持良好服务态度和意识的同时,提高和改善专业能力及其他影响因素,不断完善和提高门诊护理服务质量,满足不同患者的健康需求。     

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.     

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.     

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.     

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.