某市ICU护士多重耐药菌感染防控知信行现状调查

目的调查ICU护士多重耐药菌感染防控知信行现状,旨在为管理者组织多重耐药菌(Multidrug-Resistant Organism,MDRO)防控培训,切实提高临床医务人员依从性提供依据。方法采用方便抽样法,应用自行设计的多重耐药菌感染防控知信行评估调查问卷,选择2019年11月—12月某市173名ICU在职护士进行调查,分析MORD防控知信行现状。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(20.40±1.62)分、(46.38±5.16)分、(117.47±13.27)分。护士多重耐药菌感染防控知信行的影响因素为:ICU工作年限、领导重视程度、MDRO知识培训次数及需求、是否设置隔离病房。结论护士多重耐药菌感染防控态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提高领导对多重耐药菌感染防控的重视程度,增加相应防护设施,加强低年资护士多重耐药菌感染知识培训,进而改善其防控行为。     

某市ICU护士多重耐药菌感染防控知信行现状调查

目的调查ICU护士多重耐药菌感染防控知信行现状,旨在为管理者组织多重耐药菌(Multidrug-Resistant Organism, MDRO)防控培训,切实提高临床医务人员依从性提供依据。方法采用方便抽样法,应用自行设计的多重耐药菌感染防控知信行评估调查问卷,选择2019年11月—12月某市173名ICU在职护士进行调查,分析MORD防控知信行现状。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(20.40±1.62)分、(46.38±5.16)分、(117.47±13.27)分。护士多重耐药菌感染防控知信行的影响因素为:ICU工作年限、领导重视程度、MDRO知识培训次数及需求、是否设置隔离病房。结论护士多重耐药菌感染防控态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提高领导对多重耐药菌感染防控的重视程度,增加相应防护设施,加强低年资护士多重耐药菌感染知识培训,进而改善其防控行为。     

ICU低年资护士多重耐药菌防控知识培训体会

目的:通过对ICU低年资护士多重耐药菌的防控知识培训,增强低年资护士对多重耐药菌患者的感染预防与控制意识,确保低年资护士掌握正确、有效的多重耐药菌感染预防和控制措施。方法:对75名低年资护士进行相关知识培训后并进行考核。结果:经过培训,低年资护士多重耐药菌感染相关知识知晓率较培训前提高。结论:通过专职人员专业培训,对强化低年资ICU护士对多重耐药菌感染隔离、防控措施的认识,降低院内感染发生率,具有积极作用。     

ICU感染控制专职护士对多重耐药菌控制的效果评价

目的探讨ICU感染控制专职护士在多重耐药菌管理中的作用。方法设置ICU感染控制专职护士,通过加强培训、规范管理、及时通报多重耐药菌感染情况、加强感染控制措施落实。结果设立ICU感染控制专职护士前后新发MDROs菌株数分别为77株和50株,每千住院日新发多重耐药菌分离量下降(P0.05)。结论设立ICU感染控制专职护士,通过严格督导和培训,能有效落实多重耐药菌感染患者的隔离措施,减少ICU多重耐药菌的交叉感染。     

三级甲等医院护士多重耐药菌感染防控知信行的调查分析

目的了解三级甲等综合医院护士多重耐药菌感染防控知识、态度、行为现状。方法采用自设护士多重耐药菌感染防控知信行问卷对太原市4所三级甲等综合医院的370名护士进行调查。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(23.79±2.27)分、(47.94±6.04)分、(137.35±16.49)分,且三者呈正相关(P0.01)。护士多重耐药菌感染防控知识的影响因素为:多重耐药菌知识培训需求、领导重视程度、有无设置隔离病房;态度的影响因素为:学历和领导重视程度;行为的影响因素为:领导重视程度和设置隔离病房。结论三级甲等综合医院护士多重耐药菌感染防控知识、态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提升领导对多重耐药菌感染防控的重视程度,加强对护士多重耐药菌感染知识教育,端正护士态度,进而引导其防控行为。     

ICU多重耐药菌感染风险识别及防控的研究进展

重症监护室(ICU)是多重耐药菌感染的高发科室,多重耐药菌感染与多种因素有关,早期进行风险识别、严格落实各环节是做好多重耐药菌感染防控工作的关键。该文介绍了ICU患者多重耐药菌感染的危险因素,综述了多重耐药菌感染的管理方法和防控技术。其中,管理方法包括多学科协作管理、危急值信息追踪管理和PDCA循环法管理,防控技术包括严管手卫生、规范诊疗、严格消毒隔离、合理应用抗菌药物和提高管理层的重视度,旨在为ICU患者多重耐药菌感染的防控提供参考。     

心脏术后多重耐药菌感染的护理对策

总结了预防心脏外科ICU多重耐药菌发生的方法,主要包括加强培训及管理、加强手卫生、气道管理、体位管理、合理使用抗生素等,认为落实防控制度,提高感染控制措施的执行力,能有效预防和控制多重耐药菌的传播,保障患者安全。     

应用知信行模式提高ICU护士对多重耐药菌感染防控的效果

目的观察应用知信行模式提高ICU护士对多重耐药菌感染防控的效果。方法成立防控小组,组织学习多重耐药菌感染相关知识,建立防控制度并逐一实施。结果实施后护士知信行问卷得分较实施前提高,多重耐药菌防控知识能力专项测评成绩也高于实施前,手卫生依从性由实施前59.8%提高到91.3%。结论知信行模式可提高ICU护士对多重耐药菌感染防控的效果。     

重症监护病房多重耐药菌感染临床分析及护理干预

[目的]通过调查重症监护病房(ICU)多重耐药菌感染的临床分布情况,探讨降低多重耐药菌感染的护理防控措施。[方法]收集2014年1月—2015年12月ICU病人中有多重耐药菌感染的资料,分析多重耐药菌的种类、分布情况及与医院感染的关系。[结果]2014年1月—2015年12月ICU住院病人2547例,临床细菌培养标本中共培养出致病菌605株,其中多重耐药菌感染病人329株,占54.38%;发生医院感染病人135例,其中多重耐药菌医院感染79例,医院感染病例中多重耐药感染占58.52%。ICU多重耐药菌株中以鲍曼不动杆菌最多251株,占76.29%;ICU多重耐药菌感染主要感染部位为下呼吸道,占85.41%。[结论]多重耐药菌是ICU感染的主要致病菌,同时也是ICU医院内感染的主要致病菌;多重耐药菌病人感染部位以呼吸道为首位,临床实践显示,通过护理干预措施,可有效地预防与控制多重耐药菌在ICU的传播,降低医院感染率。     

基层医院多重耐药菌感染状况分析

[目的]了解基层医院多重耐药菌感染状况,明确不同部门、不同部位多重耐药菌感染的特点,为做好多重耐药菌医院感染管理工作提供依据。[方法]回顾性分析我院161例多重耐药菌感染病例的临床资料。[结果]多重耐药菌感染多发生在重症监护病房(ICU)、呼吸科、神经内科、神经外科、骨科、内分泌科等科室;感染部位以下呼吸道为主;患有循环系统疾病,接受侵入性诊疗操作、手术,使用抗生素是多重耐药的高危因素;病原菌以鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌(MRSA)为多见。[结论]基层医院多重耐药菌感染防控工作形势严峻,应加强多重耐药菌医院感染的管理,正确实施防控措施,预防多重耐药菌医院感染暴发。     

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.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.