耳鼻咽喉头颈外科门诊患者对护理人员素质需求的探讨

目的探讨耳鼻咽喉头颈外科门诊患者对护理人员素质的需求,以便按其所需提高专科门诊护理服务质量.方法对耳鼻咽喉头颈外科门诊就诊患者需求进行问卷调查.结果 612例患者中有62.6%患者希望护士技术操作技巧好;有68.3%的患者希望护士有非常好的服务态度;有73.8%患者希望护士有大专以上文化程度;有82.0%患者希望护士在与患者的沟通中使用大众语言;有85.0%患者希望护士在工作中不断掌握新知识.结论了解门诊就诊患者的需求并根据需求不断提高自身素质是门诊护士提高护理质量的根本所在.     

内科门诊患者就诊需求调查与分析

目的　探索内科门诊就诊的患者需求 ,以期提高医疗服务质量。方法　对内科门诊就诊患者的就医需求进行分类问卷调查。结果　 1130例患者中 6 6 .2 % (74 8/ 1130 )是辗转当地数家医院后来到我院就诊的 ,6 5 .8% (74 4 / 1130 )为自费就诊者。 6 3.1%患者 (712 / 1130 )要求选择专家为接诊医生 ,70 .5 % (797/ 1130 )的患者希望自己的诊治医生为主任级医师 ;患者对护士的需求主要是为其提供咨询和帮助。结论　门诊患者对高质量医疗的需求越来越多 ,高学历、高级职称的专家更受患者的垂青 ,护士在门诊的分诊作用非常重要     

门诊老年患者护理服务需求状况调查及对策

目的了解门诊老年患者护理服务需求现状,为今后能够提供更好的护理服务,提高老年患者对医院的满意度提供理论依据。方法采用自行设计的门诊老年患者需求调查表,采取随机抽样的方式,对2016年3~6月62名门诊就诊的老年患者进行调查。结果需求最多的是诊前咨询(93.5%)、用药指导(93.5%)、结账收费(93.5%)、病历建档(90.32%)。结论改善老年门诊患者护理服务内容,满足老年患者门诊就诊的护理需求,从而提高患者满意度。     

内科门诊患者就诊需求调查与分析

目的探索内科门诊就诊的患者需求,以期提高医疗服务质量.方法对内科门诊就诊患者的就医需求进行分类问卷调查.结果1 130例患者中66.2%(748/1 130)是辗转当地数家医院后来到我院就诊的,65.8%(744/1 130)为自费就诊者.63.1%患者(712/1 130)要求选择专家为接诊医生,70.5%(797/1 130)的患者希望自己的诊治医生为主任级医师;患者对护士的需求主要是为其提供咨询和帮助.结论门诊患者对高质量医疗的需求越来越多,高学历、高级职称的专家更受患者的垂青,护士在门诊的分诊作用非常重要.     

无缝隙延伸护理服务模式在口腔门诊的构建与实践

目的探索"无缝隙"延伸护理服务模式在口腔门诊的实践效果。方法广州市某三甲口腔专科医院于2015年9月~2016年9月针对口腔门诊患者在就诊前、就诊中、就诊后这3个时间段内的需求特点,探索并实践了一系列全程、优质、无缝隙的延伸护理服务模式。结果实施"无缝隙"延伸护理服务后,护士服务患者的时间增加了(18.5±1.3)min;医护比由原来的1∶1.06提高至1∶1.3;椅护比由原来的1∶1提高至1∶1.2;患者失约率由33.3%降至8.3%;患者对护理工作的满意度由93.3%提高到99.4%;患者对诊位责任护士的知晓率由61.1%提高到96.7%。结论 "无缝隙"延伸护理服务模式把患者就诊前、就诊中、就诊后的护理服务进行有机的衔接,充分满足了口腔门诊患者的护理需求,体现了护理的专业价值和社会服务功能。     

内科门诊患者就医围诊的不良影响及相应对策的效果评价

目的：探讨医院内科门诊患者就医时围诊现象造成的不良影响,为改进内科门诊就医流程、缩短候诊时间及最大限度满足患者就诊需求提供科学依据。方法随机抽取2014年3~7月在我院内科门诊就诊的患者1600例,由门诊分诊护士指导填写自行设计的调查问卷,内容包括患者就诊时能够接受的等候时间、超时等候的心理反应、围诊现象带来的不良影响、门诊医护人员服务态度、门诊就医环境、就诊时最需求的服务、患者候诊时不满意事项以及需要改进的内容等。结果98%的患者认为就诊等候时间应在40 min内,2%的患者认为等候时间可在60 min内。调查显示,就医围诊现象的发生主要就是觉得等待时间太长和最不满意不按顺序就诊或而随意带患者插队加塞的现象。结论门诊护理管理人员应及时制定和采取合理的门诊患者就诊程序和措施,分诊护士主动安排患者按顺序就诊,最大限度缩短就诊时间,杜绝医院内部医护人员带熟悉患者插队就诊的问题,从而减少内科门诊患者就医时围诊现象的发生。     

开展门诊健康科普大课堂的护理管理实践

目的 :提高门诊就诊患者的健康保健知识水平,调动门诊护士的学习和工作热情,构建和谐护患关系。方法 :制定和发放门诊患者健康教育需求调查问卷,结合就诊患者的特点和需求拟定授课内容,利用中午休息时间开展门诊大课堂活动,根据评价结果和患者需求不断改进活动质量。结果 :护士熟练掌握了护理知识和技能,提升了科普授课能力;患者及家属的疾病防治意识得到了增强,患者满意率为96.4%,门诊就诊秩序相应得到了改善。结论:在门诊开展健康大课堂活动可密切护患关系,是优质护理服务的拓展,是民众科学素养提高的好时机,是提高社会效益和经济效益的有效途径。     

胸外科术后专科护士门诊的建立与实践

目的探讨胸外科术后患者出院后的专科护士门诊建立与实践效果。方法选择2015年1月—2016年5月我科护士坐诊胸外护士门诊就诊的食管和肺术后患者872例,对就诊患者术后不同时间点的不同需求进行各种处置、对就诊患者伤口疼痛进行评估、对就诊资料收集、整理分析。结果患者在护士门诊主动重点咨询的内容为康复锻炼、伤口管理、抗炎治疗、饮食管理、用药管理、生活问题、后续治疗;专科护士门诊综合处置内容为:伤口护理、心理护理、健康教育、开具复查检查单;不同术后时间节点疼痛评分均为轻度疼痛;患者就诊时间为(20.15±7.28)min;患者就诊满意度为100%。结论胸外科术后专科护士门诊主要对出院后患者所遇到的各种问题进行及时咨询和处置,对不同术后时间节点患者在医生门诊复查做好前期准备工作,是一项利患举措,能提高患者满意度。     

319例糖尿病专科护理门诊就诊案例回顾性分析

[目的]调查糖尿病专科护理门诊式教育模式的效能,并提出对策。[方法]采用糖尿病专科护理门诊就诊病人个案调查表和糖尿病病人受门诊式教育的影响程度调查表对319例在糖尿病专科护理门诊就诊的糖尿病病人进行调查。[结果]就诊病人均得到健康问题筛选、咨询及糖尿病知识宣教服务,并表示满意;大多数病人对护理门诊了解不多,就诊主要源于医护人员的介绍,37.93%能按时复诊。病人对教育内容信任程度:55.80%完全信任,44.20%部分信任;教育后遵嘱改变行为程度:18.81%完全改变,76.81%部分改变,4.38%没有改变。[结论]糖尿病护理专科门诊可满足病人和社会的需求,提高满意度;多种模式拓展糖尿病专科护理服务覆盖面,完善糖尿病门诊,提高专科护士公信度;教育应医院-家庭-社区一体化,同伴支持互助,提高教育效能。     

莆田市三甲医院门诊护理服务质量现状调查

目的了解目前莆田市三甲医院门诊护理服务质量的现状。方法采用门诊护理服务质量评价表,对1256例门诊就诊患者进行调查,让对目前门诊护士的服务质量进行评价。结果65％-79％患者对门诊就诊的整体评价为非常好或特别好。护理人员的服务心态、隐私的保护和护理人员的礼貌态度得分排列前3位;护理人员的专业能力、预先告知就诊的时间长短、在适当的时间接待得分排列后3位。结论门诊护理人员应该保持良好服务态度和意识的同时,提高和改善专业能力及其他影响因素,不断完善和提高门诊护理服务质量,满足不同患者的健康需求。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."