儿童外周静脉留置针输液渗出预防的最佳证据应用

目的将儿童外周静脉留置针输液渗出预防的最佳证据应用于临床实践。方法组建循证项目小组,确定循证问题,通过文献的系统检索和质量评价总结8条外周静脉留置针输液渗出预防相关的最佳证据,遵循澳大利亚JBI循证卫生保健中心的临床证据实践应用系统的标准程序制定了11条质量审查指标并开展证据应用。证据应用前后各纳入外周静脉留置针输液的患儿、家长及病区护士作为研究对象,比较护士对质量审查指标的执行率及患儿外周静脉留置针输液渗出发生率。结果证据应用后,4条审查指标的执行率比审查前有了显著改善;儿童外周静脉留置针输液渗出发生率从5.4%下降至2.4%。结论儿童外周静脉留置针输液渗出预防最佳证据的临床应用可降低静脉输液渗出的发生率,提高家长静脉输液渗出的防范意识和早期识别能力。     

儿科外周静脉导管建立的循证证据应用在质量评价中的研究

目的将基于循证的儿科外周静脉导管建立的最佳证据应用于临床实践,规范儿科护士外周静脉导管穿刺的护理行为,提升静脉治疗专科临床护理质量。方法确定循证问题,通过文献检索、文献评价等进行证据总结及质量审查指标的制订。遵循JBI循证护理中心的临床证据实践应用系统的标准程序开展证据应用项目,即基线审查、实践变革和证据应用后变革效果的再审查。同时,比较最佳证据应用前后最佳证据的执行率、一次穿刺成功率、外周静脉导管留置时间、护士静脉导管置入的相关知识及患儿家长满意度。结果在最佳证据的执行率中,最佳证据应用后指标1、指标3、指标4、指标6、指标8、指标9、指标10、指标11及指标12的执行率高于应用前,经比较,差异有统计学意义;最佳证据应用后一次穿刺成功率、外周静脉导管留置时间、护士静脉导管置入的相关知识得分及患儿家长满意度高于应用前,经比较,差异有统计学意义。结论在临床护理中应用基于循证的儿科外周静脉导管建立的最佳证据,可规范护士外周静脉导管建立的护理行为,提高患儿家长的满意度和儿科静脉治疗专科临床护理质量。     

思维导图在降低住院患者静脉血标本不合格率中的应用

目的探讨思维导图在降低住院患者静脉血标本不合格率中的应用效果。 方法通过对宿迁市第一人民医院2016年7月至2017年6月静脉血标本不合格信息进行收集统计,讨论分析降低静脉血标本不合格率关键节点,制定静脉血标本采集思维导图,比较采用思维导图改进前后6个月血标本采集执行流程的不合格问题与改进前后静脉血标本合格率情况。 结果应用思维导图后血标本采集执行流程中关键环节的不合格问题低于改进前(P<005),静脉血标本不合格率也低于改进前,差异均有统计学意义(P<005)。 结论应用思维导图能够规范静脉血标本采集流程与送检流程,降低静脉血标本不合格率。     

儿科门诊留置针置入与维护的循证实践

目的:采用循证方法寻找儿科门诊输液患儿留置针的维护方法,以减少儿科门诊患儿外周留置针相关并发症的发生。方法:遵循霍普金斯临床证据系统的标准程序,采用现场观察法、问卷法收集证据。证据应用前后将20名护士和儿科门诊应用外周静脉留置针的患儿及家属为研究对象,分析每条证据应用存在的障碍因素及可解决措施,评价护士对每条证据执行的依从性、应用前后门诊患儿留置针相关并发症发生率。结果:证据应用后的审查标准依从性达标率高于证据应用前(P0.05),门诊患儿留置针并发症发生率由证据应用前的41.6%降至应用后的18.6%,差异有统计学意义(P0.05),护士对并发症的处理能力明显提高(P0.05)。结论:儿科门诊留置针维护最佳证据应用于临床,可规范儿科门诊护士外周留置针置入与维护的护理行为,降低儿科门诊输液患儿外周留置针并发症发生率。     

自封式塑料袋打包采血管在住院患者静脉血标本采集过程中的应用

目的 探讨应用自封式塑料袋打包采血管防止住院患者静脉血标本采集过程中,发生采血差错和临界差错、采血管遗漏等问题的效果.方法 记录分析患者静脉血标本采集过程中出现问题的原因,从患者单剂量配发药品中受到启发,应用此模式理念,将同一患者单次静脉血标本采集的多个采血管,装在大小合适的自封式塑料袋内打包,从粘贴检验标签开始到静脉血标本采集结束,整个过程始终保持同一患者的多个采血管在自封袋内.结果 应用自封式塑料袋打包采血管方法采血后,患者静脉血标本采血差错、采血管遗漏人次均为零.结论 自封式塑料袋打包采血管应用于住院患者静脉血标本采集的整个过程,避免了差错发生.     

护理专案小组在降低采集静脉血标本不合格发生率中的应用

目的:探讨护理专案小组在降低采集静脉血标本不合格发生率中的应用效果。方法:成立护理专案小组,以"降低采集静脉血标本不合格发生率"为活动主题,进行现状调查及要因分析,设定目标,制定对策并实施。比较实施护理专案小组前后静脉血标本不合格发生率。结果:实施后静脉血标本不合格发生率低于实施前(P0.01)。结论:针对静脉血标本不合格发生率高的现状,采取护理专案活动,可有效降低血标本不合格发生率,提升护理质量。     

防止血液流变标本凝血方法的改进与效果

目的 探讨防止血液流变标本凝血的最佳方法.方法 将577例体检者分为两组,常规组分次将标本摇匀;推动组使血液流变标本在操作台面上滚动,一次完成防凝血操作.比较两种方法进行防凝血操作护士手臂感觉评分、静脉血标本采集时间、血液标本凝血率.结果 推动方法手臂感觉评分、采血时间、凝血率均低于常规方法,差异具有统计学意义(P<0...     

不能自行如厕婴幼儿尿液标本非侵入性采集方法的循证实践

目的实施不能自行如厕婴幼儿尿液标本非侵入性采集方法的循证实践,并探索其对一次性采集成功率的影响。方法遵循Joanna Briggs Institute(JBI)临床证据实践应用模式,采用基于证据的持续质量改进模式的理论框架,于2019年4-11月,以证据获取、现状审查、证据引入和效果评价等4个阶段将循证实践方案应用于不能自行如厕的婴幼儿。比较循证实践方案应用前后非侵入性采集尿液标本行为的依从性、一次性采集成功率等指标的变化。结果循证实践项目应用了10条证据。与循证实践前相比,护士有关尿液标本非侵入性采集行为的依从性提高,一次性采集成功率提高,采集次数减少,标本污染率降低,差异均有统计学意义(均P<0.05)。结论通过循证护理对不能如厕婴幼儿进行尿液标本采集管理,可有效提高尿路感染诊断的及时性与准确性,为非侵入性采集婴幼儿尿液标本的临床实践提供实证参考。     

血液病患者外周静脉留置针最佳拔管策略的循证实践

目的制定血液病患者外周静脉留置针的最佳拔管策略并应用于国内一家三级甲等医院,以提高护士应用最佳证据拔除静脉留置针的依从性。方法遵循JBI的临床证据实践应用模式,包括证据应用前基线审查、证据临床应用及证据应用后再审查3个阶段。检索JBI图书馆、Cochrane图书馆、PubMed、英国卫生医疗质量标准署(National Institute for Health and Clinical Excellence, NICE)、美国国立指南库(National Guideline Clearinghouse,NGC)、中国生物医学文献数据库、万方数据库,获取静脉留置针拔除的最佳证据,利用JBI 2014版证据分级系统进行证据质量评价,并通过FAME结构讨论证据的可行性、适宜性、临床意义及有效性,采纳所有A级推荐的证据,并将证据转化为临床审查标准。通过现场审查、问卷法及查看护理记录单的方式收集资料。证据应用前后共纳入390例留置针患者及43名护士,进行2轮审查,分析证据应用的障碍因素并进行改进。结果共形成4条审查标准,证据应用后"护士每次交接班评估外周静脉留置针穿刺部位并记录"、"当外周静脉留置针无任何并发症时可持续使用"等4条标准的执行情况较证据应用前提高(P0.05);证据应用前后患者静脉炎、液体渗漏及导管堵塞的并发症发生率无统计学意义(P0.05),但留置时间由(5.18±2.42)d延长至(6.21±3.41)d,差异具有统计学意义(P0.05)。结论基于证据的外周静脉留置针最佳拔管策略在血液病患者中应用后,可规范护士行为,提高护士依从性,并延长留置针的留置时间,且不增加相关并发症发生率。     

儿童导尿管留置与拔除最佳证据的临床应用

目的:将儿童导尿管留置与拔除的最佳证据应用于临床实践,提高护士对实践证据应用的依从性,改善患儿结局,改进系统流程。方法:通过检索国内外数据库获取原始文献,纳入1篇证据总结和1篇指南;遵循澳大利亚JBI循证护理中心的临床证据实践应用模式,包括证据应用前的基线审查和证据应用后变革效果的再审查、分析证据应用过程中的障碍因素、应用可利用的资源及解决方案以及对比证据应用前后的各项指标变化。结果:构建了儿童重症监护室(PICU)留置导尿管的规范化流程。证据应用之后,7条审查指标中6条循证依从性较差的指标有提高,差异有统计学意义(均P0.01);导尿管插管率下降(62.83%vs71.07%),导尿管留置时间缩短[(6.38±2.08)天vs(8.42±5.26)天],儿童保留导尿管相关性尿路感染发生率下降(0vs7.23‰),差异有统计学意义(P0.05)。结论:将儿童导尿管留置与拔除的最佳证据应用于临床,制订了留置导尿管规范化流程,制作了提醒卡和操作视频,可规范护士行为,提高护士循证依从性,在系统流程、护士行为、患儿结局方面均得到改善。     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.