卫生保健护理学

041634部分临床护士发生针刺伤情况的调查/毛秀英-…//中华护理杂志.-2003,38(6).一422～425 为了解临床护士针刺伤的发生率、刺伤原因、环节、有关防护的概念及安全操作行为等问题。采用便利抽1 S2样对1 075名临床护士进行回顾性问卷调查。结果:80.6%的护士发生过针刺伤;74.5%的护士被污染针头所刺伤,年人均刺伤3.5次;36.0%的护士在整理用物特别在处理使用过的针头时被刺伤;7.7%的护士在取静脉血及抽液时戴手套;仅10.2%的护士在刺伤发生后向上级做了汇报。提示:临床护士防护意识淡漠,针刺伤发生率高。加强“全面性防护”概念的教育、建立…     

临床护士针刺伤的原因分析与防护

目的通过调查了解临床护士针刺伤的发生率和刺伤原因、环节,有关防护的概念及安全操作行为等问题。方法对本院护士发生针刺伤进行自制问卷调查：结果被调查482名护士中369人曾发生过针刺伤,发生率为76．6％;共发生针刺伤1638次,被调查者年人均被刺伤3．4次;369人中有289人被污染针头剌伤,发生率为78．3％。结论临床护士防护意识淡薄,针刺伤发生率高。因此,加强“全面性防护”概念的教育、建立并执行全面性防护措施是当前职业防护面临的紧迫课题。     

自制锐器盒的应用

近年来,世界各地报道医务人员工作中受医疗锐器伤害的事故逐年增加.据我国护理专家毛秀英采用便利抽样对参加全国护理学术会议及北京7家医院部分临床护士共1 075名护士进行回顾性问卷调查表明,被调查护士中866人发生过针刺伤,发生率80.6%;被调查者年人均刺伤3.5次,其中74.5%被污染针头所刺伤;操作后整理用物特别在处理使用过的针头时刺伤率高达36.0%;回套针帽率高达57.0%[1].     

自制锐器盒的应用

近年来,世界各地报道医务人员工作中受医疗锐器伤害的事故逐年增加。据我国护理专家毛秀英采用便利抽样对参加全国护理学术会议及北京7家医院部分临床护士共1075名护士进行回顾性问卷调查表明,被调查护士中866人发生过针刺伤,发生率80.6%;被调查者年人均刺伤3.5次,其中74.5%被污染针头所刺伤;操作后整理用物特别在处理使用过的针头时刺伤率高达36.0%;回套针帽率高达57.0%[1]。我国乙肝病毒携带者的数量快速增长,一次偶然的针头刺伤,刀片划伤有可能把乙肝、丙肝、HIV病毒传播到护士体内。因此,潜在的危险使医务人员对工作安全化的要求日益…     

实习护生护理操作中发生针刺伤情况的调查分析及对策

目的:了解实习护生在临床护理操作中发生针刺伤的发生率,刺伤原因及针刺伤后的处理方法;探讨防护措施施.方法:对实习的47名护生,8个月实习期间发生针刺伤的情况进行回顾性调查.结果:发生针刺伤37人,发生率为78.7%,其中28人被污染针头刺伤占75.6%.发生针刺伤不同环节的刺伤率分别是穿刺前占29.4%,穿刺中占7.3%,穿刺后占63.2%.结论:实习护生防护意识淡漠,技术操作欠规范,针刺伤发生率高.因此,加强岗前职业安全教育、增强防护意识、强化规范操作行为,降低针刺伤发生率.     

实习护生发生针刺伤的现状调查

目的 :为了解实习护生发生针刺伤的刺伤率、刺伤原因及环节 ,探讨防范措施。方法 :对北京 9所护士学校的 434名实习护生在 6个月实习期间发生针刺伤的情况进行前瞻性调查。结果 :发生针刺伤 160人次 ,发生率为36.9% ,其中 61.9%被污染针头刺伤 ,仅有 2人在刺伤后进行了血液学检测 ;71.9%的刺伤发生在病房 ,85 .6%发生在白班。发生针刺伤不同环节的刺伤率分别是 :操作前占2 5 .6% ,操作中占2 0 .0 % ,操作后占5 4.4%。结论 :建立全面防护及岗前职业安全教育、增强防护意识、加强安全操作技能训练、规范操作行为可降低针刺伤发生率     

临床护士针刺伤的调查

目的了解临床护士在诊疗工作中发生针刺伤频率及报告情况,探讨职业安全管理模式。方法采用随机抽样方法对200名临床护士进行针刺伤经历及相关问题进行回顾性问卷调查。结果被调查的200名临床护士在工作期间针刺伤发生率为98%;有13.2%被针刺伤人员每年刺伤均大于1次。针刺伤涉及到的操作主要有处理医疗废物、处置针头或注射器、准备注射的过程中等。有33.7%护士发生针刺伤时会上报,能及时报告的占15.8%,从来不报告的占19.8%。结论临床护士针刺伤发生频率高,报告率低,防护意识淡漠,职业安全制度不健全。     

护理人员针刺伤的调查分析

目的 了解临床护士针刺伤的发生率、刺伤原因、环节，有关安全防护理概念等问题。方法 对某医院部分临床护士进行回顾性问卷调查。结果 被调查的120名护士中，114人曾发生过针刺伤，发生率95％，发生在操作后针刺伤占58．9％，尤其是针头或注射器使用后处置不当；约78．1％的人从未主动报告针刺事件；86．7％的人愿意参加有关针刺伤的职业安全培训。结论 护理人员自我防护意识淡漠，缺乏有关针刺伤知识，针刺伤发生率高。因此，加强护理人员的职业安全教育和针刺伤防护管理，建立针刺伤报告制度是当前职业防护的重要课题。     

输液室护士针刺伤危险因素与防护的研究进展

针刺伤是护士在工作中最常见的一种职业性损害,临床护士针刺伤率高达80.6%[1]。针刺伤的危害包括身体、心理、经济及社会的危害[2]。输液室护士每天要完成大量的注射、采血、输液等操作,被注射针头刺伤的发生率更高。虽然近年来,针刺     

临床护士发生针刺伤的调查研究

[目的]了解临床护士针刺伤情况.[方法]采用问卷调查法,对全院241名临床一线护士进行回顾性调查.[结果]241名护士中最近6个月发生过针刺伤的185人,占76.8%,主要为注射或抽血后处理注射器的过程中(28.2%)和浸泡前取下针头时(29.6%);操作时不戴手套的124人(51.5%);针刺伤后没有向上级汇报的21 0人,占87.1%;针刺伤后表现为无可奈何的125人(51.9%),感到害怕的96人(39.8%);护士认为领导对针刺伤不重视的169人,占70.1%;伤后能采取较正确的方法处理伤口的仅占44.0%.[结论]护理人员防护意识淡薄,针刺伤发生率高,刺伤后大多数护士出现不良的情绪反应,缺乏必要的支持系统.     

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.     

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.     

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.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.