因素型儿科病人分类系统的建立

目的:建立因素型儿科病人分类量表,确立病人分类的时间分割点。方法:根据病人需要建立儿科病人分类工具,并作内容效度测定。根据科室和护士的工作年限进行分层抽样,采用自我记录法及观察员记录法完成168项护理活动工时测定。8个病区中的140位护士参与工作取样研究,记录其当班所发生的护理活动及频率,共收集得1762份记录。结果:儿科病人分类量表中共纳入80项护理活动,该系统以"2h、4h、10h"为分割点形成4个病人类别。结论:病人分类系统可提供真实动态的护理人力需要,有助于护理管理者进行合理的护理人力配置。     

患者分类量表在外科重症监护室护理人员配置中的应用

目的探讨修订版患者分类量表（RMT—PCS量表）在ICU护理工作量测量的应用,计算实际需要和动态需要护理人力,为科学合理的配备护理人员提供依据。方法于2010年4—7月在外科重症监护室（SICU）病区用随机抽签法抽取了20d的全部住院患者,共29位,151人次,用单盲法应用修订版患者分类量表进行记录,记录每位患者24h的护理需求量（护理活动项目及发生频数）,每人次为一份完整的记录表,并用SPSS11．0统计软件单因素方差分析。结果用患者分类量表测算护理工作量配备护理人力与用床护比配备护理人力差异有统计学意义（x^2=6．096,P〈0．05）;同一病区总床位不变而不同时间段其护理时数不同,所需护士数也不同。结论按修订版患者分类量表测算护理工作量实时配备护理人员较按照床护比规律循环配备人力科学,并为护理管理者提供科学的护理管理依据,避免人力资源浪费,把有限护理人力用于患者需要上,为患者提供优质高效的服务。     

病人分类系统在优质护理服务病区护理人力资源配置中的应用

[目的]应用病人分类系统探索专科医院优质护理服务病区护理人力资源配置,为专科医院优质护理服务病区护理人力资源配置提供科学依据。[方法]2013年9月选择我院开展优质护理服务的肝病内科、肝胆外科、肝病产科、感染病科、肿瘤科5个病区的住院病人护理需求量及各班次护理人员每日护理时数作为研究对象。采用改良的罗斯麦迪可斯量表(RMT-PCS)调查,辅以工作参与法,计算出各病区病人24h的平均工作量指数、各病区病人疾病平均严重度,按照改良RMT-PCS量表护理人力分配比率计算出各病区所需护理人员数量。[结果]各病区由于病种不同,病人类别所占比例不同,病人严重度、每日平均工作量指数、每日所需护理时间均有不同。[结论]运用改良RMT-PCS量表对病人分类,建立专科医院的病人分类系统,为专科医院优质护理服务病区的护理人员配置提供科学依据,更加有利于护理管理,有利于为病人提供优质护理服务。     

某医院不同科室护理工时测量及分类研究

目的:通过测定综合医院不同专科的护理工作量,探讨护理人力合理配置方法。方法:对全院37个病区进行护理工时测量,计算各病区护理工作量、每位患者每日所需平均护理时数及护士配比,并根据每位患者每日所需平均护理时数对临床科室进行系统聚类。结果:经护理工作量显著性差异比较,合并相似病区,得到33个临床科室,进而根据工作量大小将33个科室聚类为6个水平,其每位患者平均每日护理时数分别为258.63min、200.36min、174.35min、143.46min、116.91min、91.87min。结论:不同专科护理工作量存在较大差异,应根据专科性质合理配置护理人力。     

因素型病人分类系统在骨科护理人力资源配置中的应用分析

[目的]构建因素型骨科病人分类系统,探讨其在骨科护理人力资源配置方面可行性及作用。[方法]依据RMT-PCS原始量表与郑州大学附属第一医院骨科实际护理诉求相结合,构建因素型骨科病人分类量表,此量表四部分为中心制定67个护理及相关项目,运用整数时数分割法将骨科病人分为4种类型病人进行分析。[结果]一类与二类病人比例为44.88%、49.77%,足踝病区一类病人比例为49.48%,关节外科病区比例为46.75%,二类病人在脊柱外科病区和骨病骨肿瘤病区比例依次为50.87%、48.63%;创伤绿色通道病区和脊柱外科病区病人以三类、四类为主。5个病区四类病人平均护理时数依次为(1.76±0.67)h、(2.79±0.53)h、(5.97±1.05)h、(12.14±1.34)h。护士配备系数依次为0.34、0.51、1.16、2.18。[结论]因素型骨科病人分类系统的护理配备系数为科学化的护理管理提供可靠依据,对医院护理人力配比指明方向。     

运用病人分类合理配置外科病房护理人员的研究

目的探索外科病区护理人员的配置问题，建立适合临床实际的病人分类系统，为外科病区的护理人员配置提供科学依据。方法以2006年5月某院外科8个病区的住院病人护理需求量及各班次的护理人员每日护理时数作为研究对象。采用改良罗斯麦迪可斯量表——病人分类系统（RMT-PCS），用调查统计辅以工作参与法进行，计算出各病区每位病人24h的平均护理时数、需要的护理人数及各病区病人疾病平均严重度。结果各病区住院病人由于病种不同，病人类别所占比例明显不同，各类病人24h所需要的护理时数也不相同，第1类病人平均护理时数1．71h，第2类病人平均护理时数2．75h，第3类病人平均护理时数4．96h，第4类病人平均护理时数10．0h；各病房24h所需护理总时数为（第1类病人数×1.71）＋（第2类病人数×2.75）＋（第3类病人数×4.96）＋（第4类病人数×10．0）。按照RMT—PCS量表护理人力分配比率计算出各病区所需护理人员数量符合工作量和病人平均严重度的要求，避免了按床护比分配人员的缺陷。结论改良的RMT-PCS量表更符合国情，运用改良RMT-PCS量表对病人分类并建立病人分类操作系统，科学地配置护理人力，既有利于科学的护理管理，又有利于为病人提供优质高效的服务。     

应用因素型骨科病人分类系统进行护理人力资源配置的研究

目的 :建立因素型骨科病人分类系统,指导骨科护理人力资源科学配置。方法 :根据因素型骨科病人分类量表,对病人进行因素型分类,通过公式计算每类病人的护士配备系数,根据各病区病人分类情况,计算病区需要的护士人数。结果 :因素型骨科病人分类量表根据人均每日所需护理时间采用整数时数分割法将6个病区病人分为四类,护士配备系数分别为0.30、0.48、1.04、2.01,每个病区每日需配备的护士人数=(一类病人人数×0.30)+(二类病人人数×0.48)+(三类病人人数×1.04)+(四类病人人数×2.01);临床实际配备护士人数远远小于所需人数。结论 :因素型骨科病人分类系统的建立为病人客观归类提供了量化指标,可科学指导护理人力资源配置。     

因素型患者分类系统在眼科护理人力资源配置中的应用

目的 探讨因素型患者分类系统在眼科护理人力资源配置中的应用。方法 采用方便抽样法,选取2018年2月—2019年3月收治于本院眼科5个病区的住院患者,每个病区选取5例患者的护理服务项目时间取平均值作为护理服务项目标准时间。根据RMT-PCS原始量表与哈尔滨医科大学第一临床医学院眼科实际护理诉求结合,构建因素型眼科患者分类量表,此量表以四部分为中心制订了53个护理相关项目,运用整数时数分割法将眼科患者分为4种类型患者进行分析。结果 一类、二类患者占比较大,分别为44.88%、49.77%,一类患者在出院病区占49.48%,手术病区占46.75%,二类患者在眼底病病区占50.87%,术后病区占48.63%;三类与四类患者集中在创伤绿色通道病区和眼底病病区。眼科5个病区的一类、二类、三类和四类患者每日平均护理时数依次为(1.76±0.67) h、(2.79±0.53) h、(5.97±1.05)h和(12.14±1.34) h。护士配备系数依次为0.34、0.51、1.16和2.18。结论 因素型眼科患者分类系统为不同患者归类提供量化指标依据,护理配备系数应用为护理管理操作带来科学化依据,对护理人力资源的分配起到了指导作用,值得临床推广应用。     

护理管理与人才配置的调查分析

目的：为医院及病房护士人力配置提供依据。方法：对我院两个病区进行调查，采用观察法统计各病区每天护理工作总量，计算出每位病人每天所需的直接护理时间和间接护理时间。再根据护士配置公式，测算出不同病区床护比，并对数据进行统计分析。结果：两个病区直接护理时间比较差异有统计学意义，P〈0．05；间接护理时间比较差异无统计学意义。病床与护士比内科为1：0．55，外科为：1：0．45。结论：不同病区所需护士人数应根据护理工作量、床位使用率、实际床位数、床护比等综合因素来配置。     

因素型患者分类系统在眼科护理人力资源配置中的应用

目的 构建因素型眼科患者分类系统，探讨其在眼科护理人力资源配置方面可行性及作用。方法 本文依据RMT-PCS原始量表与哈尔滨医科大学第一临床医学院眼科实际护理诉求相结合，构建因素型眼科患者分类量表，此量表的四部分为中心制定67个护理及相关项目，运用整数时数分割法将眼科患者分为四种类型患者进行分析。结果 一类与二类患者占比数量较大，依次为44.88%、49.77%，一类患者在出院病区占比49.48%，手术病区占比46.75%，二类患者在眼底病病区占比50.87%，术后病区，占比48.63%；三类与四类患者集中在创伤绿色通道病区和眼底病病区。眼科5个病区的一类、二类、三类及四类患者每日平均护理时数依次为（1.76±0.67）h、（2.79±0.53）h、（5.97±1.05）h、（12.14±1.34）h。护士配备系数依次为0.34、0.51、1.16、2.18。 结论 因素型眼科患者分类系统为不同患者归类提供量化指标依据，护理配备系数应用对护理管理操作带来科学化依据，对护理人力资源的分配起到指导作用，值得广泛推广。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.