ICU床边核查单的优化设计及应用效果

目的探讨自制ICU床边核查单在交接班过程中的应用效果。方法将使用核查单前后护理质量情况(包括管道问题发生例数、护士院感相关知识、特殊护理知晓情况)进行对比。结果使用核查单后,患者管道安全问题明显减少(P0.01),护士对患者病情、相关院感知识知晓率、特殊注意事项知晓率明显提升(P0.01)。结论自制床边核查单能规范交接班流程,提高护理质量,保障患者安全。     

基于SBAR沟通模式的ICU床边交接班核查单的设计与应用

摘要:目的 探究基于SBAR沟通模式的ICU床边交接班核查单在老年ICU床边交接班中的应用效果。方法 采用方便抽样法,选取2020年3月至2021年2月在江苏省人民医院老年ICU住院的危重患者100例为研究对象,根据患者入住老年ICU的先后顺序分为对照组(n=50)和实验组(n=50)。对照组采用传统床边交接班模式进行交接班,实验组采用基于SBAR沟通模式的ICU床边交接班核查单进行床边交接班,并通过患者信息传达遗漏或错误发生率、接班护士对患者病情的掌握情况、交接班质量、床边护理质量合格率来评价床边交接班的效果。结果 与对照组相比,实验组患者信息传达遗漏或错误发生率更低,护士对患者病情的掌握更全面,护理交接班质量更高,患者床边护理质量检查合格率更高,差异有统计学意义（P＜0.05）。结论 基于SBAR沟通模式的ICU床边交接班核查单的设计与应用,规范了护士交接班流程,有助于护士快速掌握护理工作重点,降低了患者重要信息传达发生遗漏和错误,提高了护理交接班质量和床边护理质量,值得应用推广。     

ECMO操作规程核查单的设计与应用

为规范ECMO操作,设计ECMO操作规程核查单,主要包括操作前评估、操作前准备、操作过程及操作后处理4部分。比较使用该核查单前后护理操作情况。核查单使用后护士物品准备时间、管路预冲时间、上机前总用时均较核查单使用前缩短,操作质量评分较核查单使用前提高。     

改良床单元消毒法在多重耐药菌污染床单元消毒中的应用

〖HT5"H〗摘要 目的 比较改良床单元消毒法与传统消毒法对多重耐药菌污染床单元的消毒效果。方法 选择2018年6月—2019年4月某三甲医院重症医学科需终末处理的多重耐药菌污染床单元60张，随机分为试验组和对照组，各30张。试验组采用75%乙醇喷洒联合季胺盐消毒湿巾进行消毒，对照组采用1 000 mg/L含氯消毒液进行消毒，比较2组消毒合格率、消毒时间和操作人员满意度。结果 试验组消毒合格率为96.67%，对照组消毒合格率为90.00%，差异无统计学意义|试验组消毒时间显著短于对照组(P＜0.01)|试验组操作人员满意度明显高于对照组(P＜0.01)。结论 2种床单元消毒法合格率均可达90%以上，但改良床单元消毒法能缩短消毒时间，减少操作人员身体危害，提高操作人员满意度，值得在临床应用推广。     

ICU连续性肾脏替代治疗护理核查单的设计和应用

目的设计ICU连续性肾脏替代治疗护理核查单并应用于临床。方法通过查阅指南和文献,设计ICU连续性肾脏替代治疗护理核查单,将核查单应用于ICU连续性肾脏替代治疗的患者中,对比该护理核查单使用前后的护理操作情况(包括操作时间、操作质量等)。结果 ICU连续性肾脏替代治疗护理核查单能规范了护士操作流程、缩短了护士操作时间、提高了护士操作质量。结论将ICU连续性肾脏替代治疗核查单应用于ICU连续性肾脏替代治疗的护理管理中,有助于规范连续性肾脏替代治疗上下机流程,提高工作效率和操作质量,保障患者的安全。     

督查模式对做好重症监护病房床单元终末消毒的作用

目的 观察督查模式对搞好重症监护病房(ICU)床单元终末消毒的作用。方法 通过荧光标记和细菌定量培养方法,了解实施督察方式对做好医院床单位终末消毒的作用效果。结果 建立护理组长、责任护士和助理护士三级督查的干预措施,床单位终末消毒合格率由干预前的82.89%提高到97.44%;终末消毒完成时间由干预前的平均15 min缩短至10 min。实施督察干预后,医院感染发生率略有下降。结论 在医院实施三级督查模式,促进了病房床单位终末消毒效率的提高,有利于医院感染防控。     

精细管理在综合ICU病房接诊中的应用

目的：探讨精细管理在综合ICU病房接诊中的应用效果。方法统计综合ICU病房接诊实施精细管理前后6个月ICU病区接诊病人的物品准备时间、物品准备合格率以及患者入科至监护时间。结果精细化管理后平均物品准备时间、患者入科至监护时间均短于精细化管理前,物品准备合格率、同行满意度均高于精细化管理前( P<0.05)。结论对综合ICU病房接诊工作实施规范,系统的精细化管理可以确保监护单元急救物品、药品处于完好备用状态,人员职责分工明确,对保证患者接诊安全,提高患者监护救治成功率有着重要作用。     

ICU俯卧位通气安全护理核查单的设计与应用

设计ICU俯卧位通气安全护理核查单并应用于临床.ICU俯卧位通气安全护理核查单内容包括俯卧位前准备、俯卧位翻身、俯卧位过程、俯卧返至仰卧位、不良事件统计、应急事件处理.临床应用后,IC U俯卧位通气安全护理核查单能规范护士俯卧位通气操作流程、缩短护士俯卧位准备和操作时间,提高俯卧位通气的安全性.     

多媒体教材在心脏外科手术配合培训中的应用

目的探讨多媒体教材在手术室护士心脏外科手术配合培训中的应用。方法利用Photoshop图形处理软件对心脏外科手术步骤、专科器械等照片资料进行编辑,并制作成图片册和手术流程示意图,以此作为教材对手术室护士进行培训,进一步规范心脏外科手术配合。结果培训前后,洗手护士、巡回护士一般物品准备合格率从75.0%上升到96.4%(P0.05),专科仪器准备完好率从71.4%上升到96.4%(P0.05);手术医生对护士在工作主动性、灵敏性、器械传送准确率、手术基本物品准备情况、特殊物品及药品准备情况等方面的满意度均明显提高(P0.05)。结论多媒体教材的应用提高了手术室护士心脏外科手术物品、仪器等准备的准确率,提高了手术医生的满意度,规范了心脏外科的手术配合,提高了手术配合水平。     

优化ICU危重患者院内安全转运流程的实践探索

目的 :优化ICU危重患者院内转运流程,降低转运途中不良事件发生率,提高危重患者院内转运安全性。方法 :优化转运流程前医生和护士主要依据经验进行病情评估和物品准备;优化转运流程后应用"ICU转运决策核查单"进行病情评估和物品准备,第一部分为危重患者风险评估,第二部分为自行设计的转运前核查单,主要包括患者准备、物品准备、人员准备、相关科室确认和转运中病情观察记录单。结果 :优化ICU患者院内转运流程前,院内转运危重患者40例,共发生不良事件6例,发生率为15.0%,其中病情变化发生2例、跌倒1例、仪器设备故障1例、氧气瓶供氧不足1例、微量泵电量不足1例,转运急救物品携带齐全率93.0%;优化ICU危重患者院内转运流程后,院内转运危重患者45例,共发生不良事件3例,发生率为6.7%,其中病情变化发生1例、仪器设备故障1例、氧气瓶供氧不足1例;转运急救物品携带齐全率98.0%。结论 :ICU危重患者院内转运流程的优化可降低不良事件发生率,提高危重患者院内转运安全性。     

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.     

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.     

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.     

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.