护理专案在降低神经外科手术患者术中医疗器材相关压力性损伤发生率中的应用

目的：探讨护理专案在降低神经外科手术患者术中医疗器材相关压力性损伤发生率的应用效果。方法：成立护理专案小组,对153例神经外科手术患者进行现况分析和要因分析,确定“降低神经外科手术患者术中医疗器材相关压力性损伤发生率”为护理专案改善主题,制定术中医疗器材相关压力性损伤发生率＜4%的专案改善目标,制定并督导专案改善措施的落实。结果：神经外科手术患者术中医疗器材相关压力性损伤发生率由9.80%下降到2.42%（P＜0.05）,达到了专案改善目标。结论：针对神经外科手术患者术中医疗器材相关压力性损伤的护理专案改善活动,有效降低了术中医疗器材相关压力性损伤的发生率。     

移动医疗在脑卒中患者延续护理中的应用现状

介绍移动医疗在脑卒中患者延续护理中的必要性,总结移动医疗在脑卒中患者延续护理中用药、监测、康复知识、康复指导等方面的应用,提高脑卒中患者的康复效果。同时分析并指出了移动医疗目前存在的问题和其在脑卒中患者延续护理中应用的发展,以期为脑卒中患者开展延续护理提供更多参考。     

手术麻醉信息管理系统中风险预警的构建及应用

目的 探讨手术室护理信息管理系统中风险预警的构建以及其对手术室护理安全的重要影响。方法 构建手术室护理信息管理系统中的手术患者安全核查、手术器械追溯、手术耗材管理和收费、术中输血和用药管理、病理标本管理、术中压力性损伤防护等6个风险预警提示模块,并评估其在手术室护理安全管理中的作用。结果 患者安全核查执行率、器械追溯执行率、标本信息准确率、手术压力性损伤上报率、医护人员和患者满意度明显上升;过期物品使用率、手术收费漏费和差错率、手术压力性损伤发生率明显降低。结论 手术室护理信息管理系统中的各种风险预警提示,可强化手术室护士的风险意识,提高其风险识别和管理能力,实现手术全程安全监管和无缝对接,保障手术患者的医疗安全。     

双轨制管理模式在压力性损伤管理中的应用

目的探讨双轨制管理模式在压力性损伤管理中的应用及成效。方法采取便利抽样法,选取我院2017年1-12月的患者为对照组,采用传统的三级管理模式。选取2018年1-12月的患者为观察组,采取双轨制管理模式。比较两组患者压力性损伤预防情况与压力性损伤发生率。结果观察组在压力性损伤风险评估准确率、高危标识正确率、预防措施正确率等方面均高于对照组,差异均有统计学意义(P0.05),观察组患者院内压力性损伤发生率低于对照组,差异均有统计学意义(P0.05)。结论双轨制压力性损伤管理模式可有效提高压力性损伤风险评估准确率、高危标识正确率、预防措施正确率、降低院内压力性损伤发生率。     

伤口造口小组在压力性损伤高危患者皮肤护理中的应用及对不良反应发生的影响

目的探讨伤口造口小组在压力性损伤高危患者皮肤护理中的应用及对不良反应发生的影响。方法选择2017年3月至2018年3月华中科技大学同济医学院附属同济医院收治的压力性损伤高危患者86例,随机分为两组。对照组给予常规护理,研究组给予伤口造口皮肤护理。比较两组患者压力性损伤治愈时间、压力性损伤发生率、护理满意度评分、疼痛评分及不良反应等。结果研究组患者压力性损伤治愈时间及发生率指标均优于对照组,患者满意度评分高于对照组,疼痛评分低于对照组,皮肤破损、水疱、红斑、乏力等情况少于对照组,差异均有统计学意义(均P<0.05)。结论压力性损伤高危患者皮肤护理中加入伤口造口护理,护理质量得到提升,患者压力性损伤治愈时间显著缩短,减少压力性损伤和不良反应的发生。     

重症监护室患儿压力性损伤发生特征及影响因素分析

目的 了解儿童重症监护室（pediatric intensive care unit,PICU）患儿压力性损伤发生特征并分析其影响因素,为临床PICU患儿压力性损伤防治提供依据。方法 2016年12月—2017年4月横断面调查上海、广东、浙江5所三级甲等医院儿童重症医学科的302例患儿,收集相关人口学资料、病情、压力性损伤评估及发生特征等,并对相关因素进行分析。结果 PICU患儿压力性损伤发生率为16.23%,其中40.82%为医疗设备相关,损伤程度以1期为主（81.63%）;头面部（64.40%）为压力性损伤的高发部位,其次是骶尾部（10.17%）、足跟部（8.47%）、足踝部（8.47%）。不同病种间压力性损伤发生率不同,压力性损伤患儿多有病情严重、意识障碍、机械通气、接受手术治疗、医疗设备使用数量多、低Braden Q评分等特征。结论 PICU患儿是发生压力性损伤的高危人群,损伤部位多集中于头面部,医疗设备相关压力性损伤发生率较高,临床护理过程应早期识别压力性损伤的危险因素,及时干预,预防PICU患儿发生压力性损伤。     

目标管理在心胸外科患者术中压力性损伤预防中的应用

目的:探讨目标管理在心胸外科患者术中压力性损伤预防中的应用。方法:采用方便抽样法选取心胸外科收治的140例患者,将2016年6月～2017年6月70例患者作为对照组,采用预防压力性损伤常规护理措施;将2017年7月～2018年6月70例患者作为观察组,应用目标管理法预防压力性损伤。比较两组患者护理效果。结果:观察组患者压力性损伤发生率、压力性损伤高危患者发生率低于对照组(P0.05),且观察组压力性损伤分期主要为Ⅰ～Ⅱ期,对照组主要为Ⅲ～Ⅳ期;观察组Braden压力性损伤评分高于对照组(P0.05),而压力性损伤预警反应时间短于对照组(P0.05),观察组患者治疗满意度评分高于对照组(P0.05)。结论:目标管理能有效预防心胸外科患者压力性损伤发生风险,降低患者压力性损伤发生率,确保患者安全,提高患者治疗满意度。     

伤口适任护士主导链式压力性损伤护理团队在社区高危压力性损伤患者的管理实践

目的 探讨链式压力性损伤护理在社区存在压力性损伤风险患者中的应用效果。方法 选取2021年4－5月在上海市徐汇区龙华街道社区卫生服务中心4个站点代配药患者中的社区存在压力性损伤风险患者及照顾者作为研究对象,按整群分组的方法分为对照组（n=76）和观察组（n=77）。对照组给予常规健康随访;观察组由伤口适任护士主导链式护理团队实施队列研究,比较两组患者压力性损伤发生率及患者照顾者压力性损伤认知水平、照顾行为和负担情况。结果 3个月后,观察组患者压力性损伤发生率明显低于对照组（Ｐ＜0.05）;观察组患者照顾者压力性损伤认知水平、照顾行为和负担情况得分均优于对照组（Ｐ＜0.01）。结论 链式压力性损伤护理能明显改善社区存在压力性损伤风险患者和照顾者的认知,使照顾者的照顾能力得以提升,从而减轻照顾负担,降低压力性损伤的发生。     

FOCUS-PDCA模式在慢性心力衰竭伴水肿患者压力性损伤管理中的应用

目的：探讨持续质量改进模式(FOCUS-PDCA)在慢性心力衰竭伴水肿患者压力性损伤管理中的应用效果。方法：选择2017年7-12月慢性心力衰竭伴水肿患者压力性损伤高危者38例为对照组,选择2018年1-6月慢性心力衰竭伴水肿患者压力性损伤高危者36例为观察组。对照组采用压力性损伤高危常规护理,观察组应用FOCUS-PDCA模式,比较两组患者压力性损伤发生率和分期严重程度及其发生时间、压力性损伤有效防护措施落实率。结果：实施持续质量改进模式后,观察组压力性损伤发生率低于对照组、压力性损伤分期严重程度及其自入院至发生压力性损伤的时间均优于对照组、压力性损伤有效防护措施落实率高于对照组,除Ⅱ期PI发生例数外,差异均有统计学意义（P＜0.05）。结论：FOCUS-PDCA模式促进慢性心力衰竭伴水肿患者压力性损伤防护措施有效落实,提升护士对压力性损伤护理知识及技能的掌握,从而达到降低压力性损伤发生率的目的。     

基层医院住院患者压力性损伤现状及影响因素分析

目的:调查基层医院住院患者压力性损伤现状并分析其影响因素。方法:2020年11月1日～2021年1月1日,采用横断面调查法调查10所基层医院的80例压力性损伤患者,分析压力性损伤的现状,并采用多元线性回归分析住院患者压力性损伤的影响因素。结果:80例压力性损伤患者,压力性损伤来自家庭78.8%,养老院10.0%,外院8.7%,院内2.5%;发生在骶尾部34.9%,位于髋部16.1%,位于臀部15.0%;压力性损伤分期1期43.8%,2期35.0%;压力性损伤危险度极高危者41.2%,高危者36.3%。多元线性回归分析结果显示,糖尿病、给氧方式、住院期间手术、使用局部减压设备、大便失禁是患者压力性损伤的影响因素(P0.05,P0.01)。结论:基层医院住院患者的压力性损伤主要来自家庭,以骶尾部损伤、1期、2期损伤为主,糖尿病、鼻导管、气管切开或插管给氧、住院期间手术、大便失禁患者更容易发生压力性损伤。因此,要加强关注和预防,防止压力性损伤,提高患者生活质量,降低医疗费用负担。     

移动医疗在高血压患者延续护理中的应用进展

移动医疗具有节约人力、物力和财力,不受时间、空间限制等优点,在延续护理中的应用日趋广泛,本文对移动医疗在高血压患者延续护理中的应用形式以及效果进行综述,旨在为高血压患者延续护理实践和后续研究提供借鉴。     

A modified thumb spica splint for thumb injuries in the ED

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.     

Diving emergencies

Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. The four main pathologies in diving medicine include: barotrauma (sinus, otic, and pulmonary); decompression illness (DCI); pulmonary edema and pharmacological; and toxic effects of increased partial pressures of gases. The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.     

Dance medicine: current concepts

Dance medicine has grown exponentially over the past 10 to 15 years and continues to grow every year as more former professional dancers and students of dance enter into the field of medicine. Dance medicine is part of the field of performing arts medicine, which specializes in evaluating and treating performing artists such as musicians, dancers, actors/actresses, and vocalists. This article reviews the literature on dance medicine for various health-related medical issues, for the types of injuries commonly found, for the common surgical and rehabilitation interventions, and for injury prevention used in this unique group of patients.     

Future applications for emergency ultrasound

US has become an integral part of patient evaluation in emergency medicine. As discussed in this article, other potential uses for US are relatively early in their development. With the increased interest and study,however, there exists a real potential for US to be employed in an expanded clinical role in the evaluation of traumatically injured patients outside the standard FAST examination, for acute and chronic musculoskeletal injuries,and for triage of patients in disasters.     

Field airway management of a construction worker with an impaling rebar injury to the neck and brain

Abstract This article discusses a case of airway management by air ambulance emergency medical services (EMS) providers in a 22-year-old man impaled through the neck into the brain with 0.5-inch rebar. Penetrating neck injuries (PNIs) with impalement are extraordinarily rare. It is important for EMS providers and emergency medicine physicians to have an understanding of the initial management of an impaled patient with PNI, including having an organized approach to establishing a definitive airway and recognizing the airway complications that PNI may cause. This article discusses out-of-hospital management of impaled patients.     

Management and treatment of elbow and forearm injuries

Orthopedic injuries to the upper extremity are frequently seen in the emergency department (ED). The emergency medicine practitioner must be proficient in recognizing these injuries and their associated complications, and be able to provide appropriate orthopedic management. This article highlights the most frequent forearm and elbow injuries seen in the ED.     

Evaluation and management of acute cervical spine trauma

The evaluation and management of cervical spine injuries is a core component of the practice of emergency medicine. This article focuses on evaluation and management of blunt cervical spine trauma by the emergency physician. Pertinent anatomy of the cervical spine and specific cervical spine fractures are discussed, with an emphasis on unstable injuries and associated spinal cord pathology. The association of vertebral artery injury with cervical spine fracture is addressed, followed by a review of the most recent literature on prehospital care. Initial considerations in the emergency department, including cervical spine stabilization and airway management, are reviewed. The most current recommendations for cervical spine imaging with regard to indications and modalities are covered. Finally, emergency department management and disposition of patients with spinal cord injuries are reviewed.     

Prevention of neonatal pressure injuries

Pressure injuries in the neonatal unit can cause infection, unnecessary pain and have the potential for scarring. However there is a dearth of information available on this topic. Preventative strategies to address pressure injury development are essential when caring for vulnerable neonatal patients. This article highlights the issues regarding neonatal pressure injuries in clinical practice. In addition, it explores skin assessment and discusses the use of a neonatal skin risk assessment tool as a quality improvement intervention to improve clinical practice and patient outcomes.     

音乐疗法干预在减轻手外伤患者疼痛方面的作用

目的 探讨音乐疗法在减轻手外伤患者疼痛中的作用及临床价值. 方法 采用随机抽选方法,选取2012年1月至2013年1月来我院就诊的60例手外伤患者,随机将其分为对照组和实验组. 对照组患者在安静状态下休息30 min,实验组患者采用音乐疗法30 min. 比较两组患者在安静或音乐疗法前后的生理指标及心理反应变化情况. 结果 实验组患者心率、呼吸、收缩压、舒张压及疼痛得分均明显优于对照组( P<0. 05 ). 结论 音乐疗法应用于外科手外伤患者的护理过程中,可减轻患者的疼痛及平缓生理指标,从而减轻焦虑,值得临床推广应用.