新生儿病房护理中断事件的干预性管理效果研究

目的探讨新生儿病房护理中断事件的干预性管理效果,为护理管理者提供依据。方法观察西安市某大学附属医院新生儿病房2018年3月至5月20名护理人员高峰工作时间段临床工作过程中护理中断事件的发生情况,并对护理中断事件进行干预性管理。结果干预性管理后新生儿病房护理中断事件发生次数明显减少,护理中断事件持续时间明显缩短,积极型结局明显增加,消极型事件显著减少,差异均有统计学意义(P0.01或P0.05)。结论干预性管理可以降低新生儿病房护理中断事件的发生率,减少护理不良事件的发生,在临床工作中应该提倡和推广对护理中断事件的干预和管理。     

感染科病房护理中断事件的干预性管理效果

[目的]探讨感染科病房护理中断事件的干预性管理效果,为护理管理工作提供依据。[方法]观察西安某大学附属医院感染科病房的16名护士高峰工作时间段临床工作中护理中断事件的发生情况,并对护理中断事件进行优化工作环境、对病人及家属开展护理知识讲座并制定健康指导卡、建立健全科室各项规章制度、护士自身应变能力培养等干预性管理,比较干预前后护理中断事件的发生频率、持续时间及结局。[结果]干预后,感染科病房护理中断事件发生率明显减少,护理中断事件断持续时间明显缩短,干预后积极型结局明显增加,消极型事件显著减少,差异均有统计学意义(P0. 05)。[结论]在感染科病房中给予适当的干预性管理,可以降低护理中断事件的发生频率,缩短护理中断持续时间,减少护理消极事件的发生。     

基于智慧病房护理管理系统的多角度干预在护理中断事件观察中的应用效果

目的探讨基于智慧病房护理管理系统对护理中断事件实施多角度干预的管理效果,为护理管理工作提供依据。方法2019年6月首都医科大学附属北京天坛医院普外科成立护理中断事件管理小组,观察病区护理中断事件的发生情况,实施“5S”物品管理,优化工作流程,利用智慧化系统开发新功能,开展专题讲座和情景模拟等策略进行多角度干预管理。比较干预前(2019年5月6—19日)和干预后(2019年9月2—15日)护理中断事件的发生频率、持续时间及结局,以及患者对护士处理护理中断事件的满意度。结果干预前共观察护理班6名护士360 h,发生护理中断事件1734次;干预后共观察护理班6名护士360 h,发生护理中断事件次数为1006次。护理中断事件持续时间从干预前的(4.53±1.07)min缩短至干预后的(2.16±0.48)min,差异有统计学意义(t=66.475,P<0.01);干预后积极型结局增加,消极型事件减少;患者对护士处理护理中断事件的满意度得分从(96.55±3.41)分提高至(99.05±1.36)分,差异有统计学意义(t=3.046,P<0.05)。结论基于智慧病房护理管理系统对护理中断事件进行多角度干预管理,可减少中断事件的发生频次,缩短持续中断时间,提高患者对护士处理护理中断事件的满意度。     

门诊护理管理在糖尿病合并动脉粥样硬化性心血管疾病防治中的应用效果

目的探讨门诊护理管理在糖尿病合并动脉粥样硬化性心血管疾病患者中的应用效果。方法选取该院糖尿病合并动脉粥样硬化性心血管患者120例,按随机数字表法分为观察组和对照组各60例。观察组采用门诊护理管理,对照组采用常规护理模式。比较两组患者的超声心动图以及干预前后营养状况、生化指标,并随访1年记录发生心脏事件情况。结果通过干预观察组营养状况评分低于对照组,差异有统计学意义(P<0.05);观察组HbA1c、BMI、血脂指标明显低于对照组,差异有统计学意义(P<0.05);通过干预观察组LVEF无明显下降,对照组明显下降,差异有统计学意义(P<0.05);随访1年观察组不良心血管事件发生率低于对照组,两组比较差异有统计学意义(P<0.05)。结论门诊护理管理有利于改善患者的各类生化指标,促进糖尿病合并动脉粥样硬化性心血管患者的康复,提高患者的营养状况及心功能。     

干预性管理在护理中断事件中的应用效果分析

目的研究干预性管理在护理中断事件中的应用效果和时间有效性。方法采取本院普外科2018年3月—5月8名护士作为研究对象,对护理中断事件进行干预性管理,详细记录干预前、干预后2周、干预后4周三个时间段护理中断事件发生情况,并从造成护理中断事件的环境、管理、患者、同事、自身五个因素方面评估干预性管理效果的时间有效性。结果干预性管理后护理中断事件随着时间迁移明显减少,但干预后4周护理中断事件总体水平逐渐恢复至干预前。在造成护理中断事件发生五个因素方面,除管理因素外,其他因素均不能长期维持干预性管理的效果。结论单次干预性管理护理中断事件,短期内可以降低护理中断事件的发生率,但不能长期维持。     

预见性护理联合人性化服务在预防手术室患者不良事件及护理质量中的应用

目的探讨预见性护理联合人性化服务在预防手术室患者不良事件及护理质量中的应用效果。方法选取2018年11月至2019年11月烟台市烟台山医院接受手术治疗患者248例。采用手术编号奇偶数字排列法分为观察组和对照组, 各124例。对照组患者给予常规手术室护理干预, 观察组患者在此基础上给予基于预见性护理联合人性化服务干预, 观察并比较两组患者干预后的不良事件、护理质量以及护理满意度。结果实施预见性护理联合人性化服务后, 观察组患者的不良事件发生率明显低于对照组, 差异有统计学意义(P<0.05);观察组患者的护理质量评分、护理满意度总满意率均明显高于对照组, 差异均有统计学意义(P<0.05)。结论预见性护理联合人性化服务干预可显著降低手术室护理安全中的不良事件发生率, 有效提高护理质量和患者护理满意度, 对手术室护理安全管理具有重要意义, 值得临床推广和应用。     

老年综合评估护理对老年冠心病患者自我效能及不良事件发生情况的影响

目的:探讨在治疗老年冠心病中实施老年综合评估护理干预对其自我效能及不良事件发生情况的影响。方法:选择2015年3月-2017年8月期间在商丘市第二人民医院治疗的50例老年冠心病患者作为研究对象,随机分成两组,各25例。对照组行常规护理,观察组采取老年综合评估护理,比较两组护理干预前后自我效能及不良事件发生率。结果:观察组组干预前自我效能评分为(17.41±5.59)分与对照组(17.38±5.62)分相比,差异无统计学意义(P0.05);观察组干预后自我效能评分(32.26±6.73)分高于对照组(22.63±6.17)分,差异有统计学意义(P0.05);观察组不良事件发生率为8.00%低于对照组36.00%,差异有统计学意义(P0.05)。结论:老年冠心病患者采取老年综合评估护理,可有效提高患者的自我效能与依从性,减少疾病复发,降低不良事件的发生率。     

基于风险因素控制的无缝护理模式在新生儿输注高危药物管理中的应用价值分析

目的研究基于风险因素控制的无缝护理模式在新生儿输注高危药物管理中的应用价值。方法采用随机数表法将2019年1月至2021年12月我院收治的且均行高危药物注射治疗的86例新生儿分为对照组和观察组各43例。对照组行常规护理管理,观察组行基于风险因素控制的无缝护理模式。比较两组高危药物使用情况、临床护理质量、不良事件发生情况及家属满意度。结果观察组患儿高危药物总合理使用率为95.35%,明显高于对照组的79.07%,差异有统计学意义(P<0.05);观察组新生儿体征监护、药物输注管理、血管评估及皮肤护理评分均高于对照组,差异有统计学意义(P<0.05);观察组不良事件总发生率明显低于对照组,差异有统计学意义(P<0.05);观察组患儿家属总满意度为93.02%,明显高于对照组的76.74%,差异有统计学意义(P<0.05)。结论基于风险因素控制的无缝护理模式能有效管理新生儿输注高危药物,提高临床护理治疗和患儿家属满意度,减少不良事件发生。     

纠错法在护理安全管理中的应用和效果

目的探讨纠错法在护理安全管理中的应用效果。方法成立管理小组,制作纠错案例教育资料,组织护士进行纠错分析;设立纠错信箱,鼓励护士主动上报实际工作中的安全隐患,征集"安全金点子";修订和再造制度、流程,提高执行力。比较实施纠错法管理前后护理不良事件发生数、护理隐患主动上报数、护理综合质量得分,并问卷调查护士对纠错法管理的认同度。结果实施纠错法管理后,护理不良事件的发生数明显下降,与实施前比较差异有统计学意义(P<0.05);护理隐患主动上报数、护理综合质量得分明显提高,与实施前比较差异有统计学意义(P<0.01);200名护士对纠错法管理的认同率高达82.0%～97.5%。结论纠错法管理激发了护士参与安全管理的兴趣,提高了护理人员的抗风险能力,有利于减少护理不良事件的发生,保障了患者安全。     

护理用药过程中中断事件现状调查

目的:调查护士给药过程中护理中断事件的现况,为制定中断事件的预防策略提供依据。方法:将护士给药过程按照临床实践的时间分为医嘱处理、药物配置、给药执行3个环节,观察2018年9月至2019年2月心内科护士3个环节中断事件发生频率、来源、类型及结局,平均中断时间以及因中断导致的用药错误,分析中断的原因。结果:共观察270 h,发生3424次护理中断事件,平均12.68次/h;3个环节事件类型、结局分布均有统计学差异(P<0.001);平均中断时间(28.01±10.99)s,共中断护士的给药工作26.65 h,占总观察时间的9.87%,3个环节平均中断时间无统计学差异(P=0.209);观察期间在中断事件发生时共出现39次用药错误隐患事件,发生率为11.39‰;中断事件来源按照发生次数从高到低分别是:患者家属、环境、医生、患者、护士同事、护士自身、其他,其中低优先级事件共有2340件,占68.34%。结论:护士用药过程护理中断事件发生频率高、来源多、原因复杂、消极性结局常见、低优先级事件占比高,能够反映患者需求;中断也有时间成本,且会直接导致用药错误,为患者提供预见性服务,避免或减少护理用药过程中不必要的中断,对满足患者需求、减少时间浪费、保障给药安全有积极的意义。     

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.