护理人员对移动护士工作站认知情况的分析

[目的]了解护理人员对移动护士工作站的认知情况,以提高认知更好地指导移动护士工作站的临床应用。[方法]采用自行设计的《护理人员对移动护士工作站的认知情况调查问卷》,对新疆某三级甲等医院1 068名护理人员进行现场调查。[结果]护理人员对移动护士工作站的认知总得分为3分~20分(16.12±2.64)分,正确率排前5位的多为实用性较强的项目,排后5位的为系统理论知识;单因素分析显示,不同年龄、性别、科室、民族、职务、职称、岗位、工作年限、每天分管病人数、个人使用移动手持计算机设备(PDA)时间的护理人员认知得分差异有统计学意义(P0.05);多元逐步回归分析影响因素为:年龄、科室、性别、岗位、民族和PDA培训频次。[结论]应注重移动护士工作站的系统知识与其实用性相结合,并根据临床护理人员对移动护士工作站的认知规律有针对性地进行培训。     

少数民族地区护士对移动护士工作站使用意愿的相关分析

[目的]了解少数民族地区护士对移动护士工作站使用意愿的相关因素。[方法]采用自行设计的移动护士工作站应用现状调查问卷,现场对新疆维吾尔自治区某三级甲等医院1 068名临床护理人员进行调查。[结果]护理人员对移动护士工作站的使用意愿总得分为16分~80分(65.86分±9.21分),处于中等偏上水平;护理人员对移动护士工作站的认知、接受程度、使用频次、出现问题频次、顺利程度、对护理工作影响程度及支持系统满意程度均与移动护士工作站的使用意愿相关(P0.05)。[结论]护理人员更愿意使用移动护士工作站优势明显的功能版块;护理人员对移动护士工作站的认知越好、接受程度越高、使用频次越高、使用越顺利、出现问题频次越低,护理人员的使用意愿越高,而移动护士工作站的整体应用现状才会步步提升。     

新疆地区护士对移动护士工作站的使用意愿及其影响因素分析

目的 ：了解新疆地区护士移动护士工作站的使用意愿,并提出相应对策。方法 ：采用自行设计的移动护士工作站使用现状调查问卷,对新疆某三级甲等医院的1068名护士进行调查并分析。结果 ：护士对移动护士工作站的使用意愿总得分为16-80（65.86±9.21）分,处于中等偏上水平;单因素分析显示,不同年龄、性别、科室、职务、职称、岗位性质、工作年限、每天分管患者数、培训频次的护士使用意愿不同,差异有统计学意义（P〈0.05）;回归分析中,进入回归方程的因素为：性别、科室。结论 ：护士更愿意使用移动护士工作站优势明显的功能版块;护理管理人员应根据新疆少数民族地区特色,采取针对性措施提高新疆地区护士移动护士工作站的使用意愿。     

护士对移动工作站的认知现状及影响因素分析

目的:调查某三级甲等医院护士对移动护士工作站在临床护理工作中的应用情况,为优化临床护理工作模式提供理论依据。方法:采用自行设计的《医院开展移动护士工作站认知情况调查表》,内容包括一般资料、移动护士工作站使用和接受情况,对天津市某三级甲等医院202名临床护理人员进行现场调查。结果:接受调查的202名护士对移动护士工作站的实施效果总分值为(64.12±7.22)分,分值分布范围为32~80分。不同学历、职称、能级、工作年限、分管病人、使用时间、培训次数护士认知得分比较差别均具有统计学意义(P值均小于0.05)。多因素分析结果显示学历、能级、工作年限、分管病人数数量、使用时间和培训次数(P值均小于0.05)为独立影响认知情况的因素。结论:护士对使用移动护士工作站的接受程度总分值为(64.12±7.22)分,今后会根据临床护士对其的认知规律有针对性地进行培训。     

护士心理资本对职业倦怠、离职意愿的影响研究

[目的]调查护士心理资本、职业倦怠及离职意愿现状,并分析三者之间的关系。[方法]采用心理资本、职业倦怠和离职意愿问卷对805名护理人员进行调查。[结果]护士心理资本总均分为(4.60±0.67)分,职业倦怠得分为(12.25±8.68)分,离职意愿总均分为(2.43±1.45)分;不同年龄、婚姻状况、学历、民族的护士心理资本评分比较差异具有统计学意义(P0.05);心理资本得分与职业倦怠、离职意愿得分呈负相关,职业倦怠得分与离职意愿得分呈正相关。[结论]应提高护士尤其年轻护士心理资本水平。针对不同特征的护士进行相应的指导和培训,以降低护士职业倦怠和离职意愿,维持护理队伍稳定。     

护士慈心满意和共情疲劳状况及其与离职意愿的相关性研究

[目的]调查分析护理人员的慈心满意与共情疲劳状况,探讨其与离职意愿的相关性。[方法]采用中文版护士专业生活品质量表和离职意愿量表对489名护士进行问卷调查。[结果]护理人员慈心满意与共情疲劳症状得分为54.33分±16.12分,不同年龄、职称、性别护士存在差异(P0.05);离职意愿得分为16.27分±3.48分,与症状得分呈正相关(r=0.34,P0.01)。[结论]护士存在明显的慈心满意和共情疲劳症状,离职意愿增强。     

新疆某三级甲等医院少数民族护理人员对移动护士工作站接受程度的调查分析

目的了解少数民族护理人员对移动护士工作站的接受程度及影响因素,为提高少数民族护理人员接受程度,推进移动护士工作站的使用和发展提供理论依据。方法采用自行设计的护理人员对移动护士工作站接受程度的调查问卷,对新疆某三级甲等医院317名少数民族护理人员进行调查。结果少数民族护理人员对移动护士工作站的接受程度总得分为36~90(74.93±10.55)分,处于中等偏上水平;不同科室、每天分管患者数不同的少数民族护理人员对移动护士工作站的接受程度不同,差异有统计学意义(P0.05)。结论移动护士工作站在保证护理质量与安全的同时,应提升其细节,做到移动护理质量的持续改进;并加强与促进少数民族护理人员对移动护士工作站的认知,从而使移动护士工作站真正达到全护理人员的适用工具,提高信息化护理质量。     

新疆某三级甲等医院护理管理人员对移动护士工作站质控情况的调查分析

[目的]了解护理管理人员对移动护士工作站的质控情况,为探讨出适合我区特色、适合移动信息化护理建设的信息化质控标准提供依据和参考。[方法]采用自行设计的《移动护士工作站质控情况调查问卷》对新疆某三级甲等医院63名护理管理人员进行调查,分析护理管理人员对移动护士工作站的质控情况。[结果]不同年龄、学历、职称的护理管理人员对移动护士工作站质控情况不同;护理管理人员对移动护士工作站的质控情况(包括质控频次、内容等)参差不齐。[结论]根据不同特征护理管理人员分层次有重点地培训移动护士工作站的质控能力,护理管理者应逐步统一严格的信息化质控标准,以提高移动护士工作站的临床应用效果及质控水准,促进护理信息化建设。     

护理人员科研伦理认知现状及影响因素分析

[目的]调查护理人员科研伦理认知现状并分析其影响因素。[方法]采用护理人员科研伦理认知问卷对全国14所三级甲等医院的1 400名护理人员进行调查,并对结果进行分析。[结果]护理人员科研伦理认知得分为9.93分±3.04分,其中伦理规范知识得分为7.38分±2.34分,伦理委员会知识得分为2.54分±1.14分;单因素分析显示:护理人员科研伦理认知水平的影响因素为年龄、工作年限、学历、职称、科室、态度及培训经历;多重线性回归分析显示:护理人员科研伦理认知水平的影响因素依次为态度、培训经历、职称及科室。[结论]护理人员护理科研伦理认知水平有待提高,护理管理者应针对不同职称、科室等的护理人员开展相关培训。     

护理人员科研伦理认知现状及影响因素分析

[目的]调查护理人员科研伦理认知现状并分析其影响因素。[方法]采用护理人员科研伦理认知问卷对全国14所三级甲等医院的1 400名护理人员进行调查,并对结果进行分析。[结果]护理人员科研伦理认知得分为9.93分±3.04分,其中伦理规范知识得分为7.38分±2.34分,伦理委员会知识得分为2.54分±1.14分;单因素分析显示:护理人员科研伦理认知水平的影响因素为年龄、工作年限、学历、职称、科室、态度及培训经历;多重线性回归分析显示:护理人员科研伦理认知水平的影响因素依次为态度、培训经历、职称及科室。[结论]护理人员护理科研伦理认知水平有待提高,护理管理者应针对不同职称、科室等的护理人员开展相关培训。     

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.