人文关怀护理干预对门诊护理服务满意度的影响

目的 了解通过人文关怀护理干预后就诊者对门诊护士满意度影响.方法 护理服务质量满意度调查表共设置17条,每条项目有"满意"、"基本满意"、"不满意"3项选择或"是"与"否"2项选择."满意"、"基本满意"、"是"项列入优良项目数,"不满意"、"否"项列入不良项目数.对人文关怀护理干预及常规护理的就诊者各50例采用门诊现场问卷调查和集中填表相结合的方式进行满意度调查.结果 分别收到人文关怀护理干预组及常规护理组就诊者对门诊护理服务综合评价不良项目179条和21条,两者比较有统计学意义(P＜0.05).结论 对门诊就诊者进行人文关怀护理干预可提高门诊护理服务质量及就诊者的满意度.     

在门诊外科小手术室开展人文关怀护理干预的效果观察

目的：探讨人文关怀护理干预应用于门诊外科小手术室的临床疗效。方法2015年1月至2015年6月期间,我院120例门诊外科小手术患者,根据随机数字法,将其分为对照组(常规护理)和观察组(人文关怀护理干预),每组各60例,比较两组护理前后患者SAS、SDS评分,护理缺陷、护理投诉、护理差错发生率,以及患者对护理服务的满意度。结果与对照组相比,观察组SAS及SDS评分均明显降低,P<0.05;与对照组相比,观察组护理缺陷、护理投诉、护理差错发生率均明显降低,P<0.05;与对照组相比,观察组患者对护理服务满意度明显提升,P<0.05。结论人文关怀护理干预能够调整门诊外科小手术患者的负面情绪,提升护理质量及满意度。     

门诊护理服务满意度的调查与分析

目的 通过对2038名就诊者对门诊护理服务满意度的调查,旨在分析和找出影响门诊护理服务满意度的可能原因。方法 采用自制调查表,对就诊者采用门诊现场问卷调查和集中填表相结合的方式进行。结果 就诊者对门诊护理服务综合评价满意1057例(51．9％),基本满意898例(44．1％),不满意83例(4％),满意率95．9％;单项满意度中护理操作技能97．6％,仪表95．7％,语言90．3％,举止94．1％,工作态度93．6％,其他(如环境、卫生、设施等)91．6％。结论 就诊者对门诊护理服务总的评价是满意的,但基本满意率比例偏高,不满意的潜在性较大;单项护理服务中以护理人员操作技能的满意度最高,而护理礼仪方面包括语言、仪表、举止等均低于前者,以语言的满意度最低。应在护理人员中加强礼仪规范的学习,为患者提供全方位的优质服务,改善门诊护理服务质量和提高就诊者满意程度。     

人文关怀和心理护理在晚期肺癌诊治中的价值分析

目的探讨人文关怀和心理护理在晚期肺癌诊治中的价值。方法选择2017年1月~2017年12月住院治疗的80例肺癌晚期患者为研究对象,根据随机数字表法分为试验组和常规组各40例。对照组采取内科常规护理,试验组采用常规护理+人文关怀和心理护理,比较两组生活质量及对护理满意度。结果两组在不同护理方式干预后疼痛、焦虑、治疗依从性、护理满意度与干预前比较差异有统计学意义(P0.05),且试验组与常规组比较,差异有统计学意义(P0.05)。两组在不同护理方式干预后各项生活质量指标均较干预前明显改善,差异有统计学意义(P0.05),且试验组较对照组改善更明显(P0.05)。结论对晚期肺癌患者实施人文关怀和心理护理,能改善其焦虑抑郁等不良心态,提升其对治疗的依从性及护理的满意度,改善其生活质量,取得更好的治疗效果,在临床工作中有着重要价值,值得推广。     

人文关怀在骨外科门诊护理中的应用

目的：探讨人文关怀在骨外科门诊护理中的应用。方法从2012年1月至12月期间到本院骨外科门诊就诊的患者中抽取200名,随机分成观察组以及对照组,观察组采用人文关怀护理,对照组采用常规护理,患者就诊后进行问卷调查。将两组患者对护理服务的满意度进行比较、分析。结果观察组的患者对护理的满意度为97％,对照组进行常规护理后的满意度为76％,被人文关怀护理后患者的满意率与未被人文关怀护理患者的满意率比较差异有统计学意义（ P＜0．05）。结论人文关怀在骨外科门诊护理中既可以改善护患关系,还可以提高服务质量、提高患者对护理服务的满意度。     

基于人文关怀儿科护理对门诊患儿输液疼痛、家属心理状态及满意度的影响

目的探讨基于人文关怀儿科护理对门诊患儿输液疼痛、家属心理状态及满意度的影响。方法将500例门诊患儿根据随机数字表法分为常规组与干预组,各250例。常规组给予常规护理干预,干预组在常规护理干预基础上给予基于人文关怀儿科护理。比较两组的护理效果。结果干预后,干预组家属SAS、SDS评分低于常规组(P<0.05);干预组患儿输液疼痛评分低于常规组(P<0.05)。干预组患儿的完全依从率、依从率均高于常规组,输液重注率低于常规组(P<0.05)。干预组患儿家属各项护理满意度评分均高于对照组(P<0.05)。结论基于人文关怀儿科护理可有效改善患儿家属的心理状态,减轻患儿输液疼痛程度,提高患儿依从性,明显提升家属护理满意度。     

医保窗口护理服务质量调查与对策

为提高医保窗口服务质量,切实作好医保窗口护理工作,应分析医保患者的心理特点,找出影响医保门诊护理服务满意度的可能原因,采取相应改进措施,为患者提供优质高效的护理服务,成为医保门诊护理工作的主要内容。1资料与方法采用门诊现场问卷调查方式,对我院2019名就诊者对医保门诊护理满意度进行了调查,回收有效问卷2010份。自制问卷内容主要涉及患者对护理人员的综合性评价、业务技能、仪表、语言、举止、服务态度。2结果2038名患者对医保门诊护理服务的满意度分析,见表1。表12038名患者对医保门诊护理服务的满意度分析调查项目满意基本满意…     

急性心肌梗死患者的人文关怀护理

目的探讨人文关怀护理对急性心肌梗死(AMI)患者负性情绪以及睡眠质量的影响。方法选取心内科70例AMI住院患者,随机分为对照组和研究组各35例。所有患者均给予抗凝、止痛等常规药物治疗,对照组给予常规护理干预,研究组在对照组基础上开展人文关怀护理。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)观察干预前后负性情绪变化,采用匹兹堡睡眠质量指数量表(PSDI)评估睡眠质量,出院时自制住院护理服务满意度调查问卷进行调查。结果 2组干预前SAS、SDS、PSDI量表评分相较均无显著差异(P 0. 05),干预后研究组较对照组下降显著(P 0. 05);出院时研究组护理服务质量满意度优于对照组(P 0. 05)。结论人文关怀护理践行"以患者为本"护理理念,可较好改善AMI住院患者负性情绪和睡眠质量。     

人文关怀在雾化吸入患儿护理中的应用效果观察

目的探讨对门诊雾化吸入患儿实施人文关怀的护理效果。方法将2018年2月—5月来门诊雾化的患儿设为对照组(n=105),2018年6月—9月在门诊雾化吸入的患儿设为干预组(n=114),两组均按雾化先后顺序编号,抽取尾号为5的患儿为研究对象。对照组实施常规护理,干预组在常规护理基础上应用人文关怀护理。结果干预组患儿雾化吸入的依从性、家属护理满意度及雾化能力得分均高于对照组,差异有统计学意义(P0.05)。结论对门诊雾化患儿实施人文关怀护理的临床效果显著,值得临床参考和实践。     

人文关怀在手术室护理中的应用

目的:探讨人文关怀在手术室护理中的应用效果,为改进护理质量提供临床依据。方法:将140例择期手术患者随机分为对照组和实验组各70例。对照组进行常规手术室护理,实验组在对照组的基础上进行人文关怀护理措施。于出院前采用焦虑自评量表(SAS)和抑郁量表(SDS)对患者心理情况进行评定,通过调查问卷对手术室护理服务的满意度和护理质量进行评定。结果:实验组患者SAS、SDS评分明显低于对照组(P<0.05),患者对护理服务的满意度及护理质量评分均高于对照组(P<0.05)。结论:将人文关怀应用于手术室护理中,降低了患者不良心理反应,提高了护理质量和患者满意度,值得临床各科室推广应用。     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.