细节管理在EICU急救车管理中的应用

目的:探讨细节管理对急救车管理质量的影响。方法:对我科病区急救车的整体布局、空间利用、药品及物品质量、管理制度等进行全方位的细节管理,抽样检查管理前(2013年,对照组)和管理后(2014年,研究组)急救车使用中存在的问题,不定期记录急救车每班检查所需时间,抽查护士1次盲取同种同等数量药品、物品时间。结果:与对照组比较,研究组的急救车专项质量检查基数不符、药品物品混放、破损或过期均明显减少(P0.05);护士每班检查急救车所需时间及护士1次盲取药品、物品时间均明显缩短(P0.05)。结论:细节管理可保证急救车使用的有效性和安全性,提高急救护理工作质量,并减少管理时间成本。     

急救车药品一体化管理效果分析

目的:探讨急救车药品一体化管理的效果。方法:对全院急救药品采用一体化管理模式,护理部每个月抽查急救车药品管理情况及考核临床护士在应急演练中对急救药品的掌握情况。结果:采取一体化管理半年后,急救车药品管理质量评分均有提高(P0.05),护士对急救药品理论和操作考核成绩均高于实施前,差异具有统计学意义(P0.05)。结论:急救车药品一体化管理可提高管理质量和药品实际使用水平,从而保证急救时用药的及时和准确,提高抢救成功率。     

集束化管理在灾难应急救援队培训中的应用

【】目的：探讨集束化管理在灾难应急救援队培训中的应用。 方法：2014年至2016年对灾难应急救援队的16名护士进行集束化管理培训,比较集束化管理培训前后护士在体能、专业急救技能、应急救援时间和配合能力、灾难护理能力等方面的差异。结果：集束化管理培训后护士的体能测试和专业急救技能水平均有明显提高。应急救援时间和配合能力、护士灾害护理能力均有显著提高(P＜0.05),差异具有统计学意义。结论：集束化管理能够增强救援队护士的体能,提高其专业急救技能水平和灾害护理能力。     

产房急救车单箱封条式管理的尝试

目的观察急救车单箱纸封条式管理的效果。方法随机抽查（问卷和现场查看）采用开放式管理法的病区护士和采用单箱纸封条式管理法的产房护士各1059个值班次的急救药品、物品检查情况。对比两组急救药、物品的完好率。结果单箱纸封条式管理组的药、物品完好率高于开放式管理组,两组比较差异有极显著意义（P〈0．01）。结论急救车单箱纸封条式管理不仅提高了急救车的管理质量,而且大大提高了护士的工作效率。     

持续质量改进在病区急救车管理中的应用

目的探讨病区急救车规范科学管理的方法。方法收集本院病区急救车管理存在的问题,主要有:账物不符;性能不完好,处于紧急备用状态;过期失效。制定持续质量改进目标及实施方法:成立持续质量控制专项小组;增强护理人员急救物品管理意识;建立三级监控加强急救物品管理,学习急救物品管理制度和维护知识,急救车定位放置;严格急救车的性能管理。全院护士参与,实施6个月后评价持续质量改进效果。结果持续质量改进后6个月后,急救物品账物不符、性能不完好、过期失效明显较实施前减少,差异均有统计学意义(P0.05)。结论遵循护理持续质量改进原则,可有效提高病区急救车管理质量,防范医疗护理风险,保证患者安全。     

PDCA循环在急救车专项质量规范管理中的应用

目的探讨病区急救车规范管理的方法。方法结合三级综合医院评审标准要求,应用PDCA循环管理模式,对病区急救车药品保存、物品存放、封条使用、钥匙存放、接物本交接5个方面出现的问题进行分析,制定整改措施并实施。结果 5个方面PDCA实施前后,除钥匙存放比较差异无统计学意义(P=0.21)外,其他4项比较差异均有统计学意义(P=0.00)。结论 PDCA循环管理是降低急救车项目缺陷率,提高急救车质量管理的有效方法。     

双人搭配互换法参与急救车管理 提高低年资护士急救能力

目的:通过让低年资护士参与急救车管理,保证急救物品完好率,使其熟悉急救车内物品药品,熟练掌握急救器材的使用,增长急救知识,提高其急救能力。方法:安排14名低年资护士每2人1组管理急救车1个月,1人负责急救药品的管理,1人负责急救器材的管理,半个月后再2人对换管理。结果:低年资护士参与急救车管理后,加强了责任心,急救物品完好率达到了100%,药品效期管理、急救相关理论知识、急救时物品盲取速度、急救器材使用的熟练度均高于参与管理前(P<0.05)。结论:低年资护士参与急救车管理,能保障急救物品完好率,保证急救时能熟练、安全、有效地使用急救物品及药品,提高急救能力。     

Excel表格预警提醒设置功能在产科急救药品物品有效期管理中的应用

目的:探讨Excel表格预警提醒设置功能在产科急救药品、物品有效期管理中的应用方法及效果。方法:在Microsoft office Excel软件平台下,建立急救物品、药品管理等工作簿,用表格内的定时提醒设置功能对产科物品、药品失效期限进行有效预警管理。结果:Excel表格预警提醒实施前后分别检查20次,实施前急救车药品、物品完好率为96%,实施后为100%。Excel表格预警提醒实施前后清点抢救车药品、物品时间比较差异有统计学意义(P0.05)。结论:Excel表格预警提醒设置功能在产科急救药品、物品有效期管理中的应用效果较好,值得推广应用。     

急救车管理方法的改进及效果

目的为提高急救车使用的有效性和安全性,提高危重病人的抢救成功率,对急救车的管理方法进行探讨。方法抽取20个护理单元随机分为实验组和对照组,对实验组的急救车采用改进的方法管理,对照组仍沿用以前的方法管理。分别评估两组护士平均每人进行1次盲取急救药品的时问及平均每周用于核对急救车内药品、物品的时间,每月评估1次,连续评估1年。结果实验组平均每人进行1次盲取急救药品所用的时间为（2．t8±0．89）min,对照组用（5．05±1．14）min;实验组平均每周用于核对急救车内药品、物品的时间为（82．11±3．17）min,而对照组用（90．82±2．93）min,差异均有统计学意义（P〈0.05）。结论急救车采用改进的方法管理后,使急救车内药品、物品完好率始终为100％,急救车的使用更方便、快捷,明显提高急救护理工作质量,有利于提高危重病人的抢救成功率。     

基于问题解决型的急救药品物品检查方式的应用效果

[目的]探讨以解决问题为主导的急救药品物品检查方式的应用效果。[方法]对全院55个临床医技科室91台急救车内的急救药品物品,分别按照急救药品物品布局图、标识指引正确符合率、急救车封条粘贴的准确率、急救药品物品品种数量与目录符合率、急救药品物品完好率,每季度进行检查找出问题挖掘亮点、汇总分析,将存在问题及改进措施提交护理部审批,在每季度护理质量与安全会议上重点反馈存在主要问题培训整改措施,追踪成效。[结果]实施后急救药品物品布局图、标识指引正确符合率、急救车封条粘贴准确率、急救药品物品品种数量与目录符合率分别由76.92%、89.01%、97.80%均提高至100.00%,急救药品物品完好率由97.74%提高至99.99%,实施前后比较差异有统计学意义(P0.05)。[结论]以解决问题为主导的急救药品物品检查方式的应用,在检查标准、人员不变的情况下,通过以"查问题"向"改措施"转变检查方式由"要我改"向"我要改"转变管理理念;项目质量与检查组捆绑,护理质量控制管理的重心由护理部下沉至检查组,检查、整改、追踪有效衔接,达到了通过检查促进护理质量的持续改进和提升,且此检查方式简便易掌握,实用性强。     

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.     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.