掌上电脑在临床护理中的应用调查

目的 了解护士在临床中应用掌上电脑(PDA)的情况,为进一步推广使用提供依据.方法 采用自制的调查问卷,对应用PDA科室的41名护士进行问卷调查.结果 80.5%护士喜欢应用PDA,认为操作简单,能提高工作效率、节约成本、减少护理差错和计费差错;41.5%护士认为PDA应用中存在一些问题;92.7%护士认为PDA会很快在临床普及使用等.结论 绝大多数护士对应用PDA持赞成态度,但目前PDA的临床应用较为局限,其功能有待于进一步开发和完善.     

柏拉图在分析差错隐患中的应用

收集获奖护士杜绝差错事故的件次，用柏拉图对其分布情况进行分析。结果所杜绝的差错事故共计104件次，其中与医嘱有关的错误45件次，占43．3％；与护士工作粗疏有关的错误35件次，占33．6％；药品质量问题l7件次．占16．4％；与药剂科、检验科工作粗疏有关的错误7件次，占6．7％。提示护士认真执行“三查七对”制度，在杜绝差错事故的发生、保证医疗安全方能面发挥重要的作用。     

临床护士发生护理差错后的真实体验

目的深入了解和探索临床护士发生护理差错后的真实体验．为护理差错管理体系相关研究提供依据。方法运用质性研究方法，与8名曾发生护理差错的临床在职护士进行深入访谈，现场录音和笔录，并运用Colaizzi的分析程序进行分析：结果临床护士发生护理差错后承受着担心、不安、惊慌、恐惧、委屈与无奈等一系列情绪变化；认为在差错事件中缺乏同事的支持，发生差错后的处理缺乏人性与宽容。结论转变护理管理理念，强调以改善系统和程序作为减少差错之策略，建立一种非惩罚性且能保证患者安全的管理理念已迫在眉睫。     

中医护理诊断应用现状的调查分析

目的了解中医护理诊断在中医医院的应用现状。方法采用自制问卷对全国14所三级甲等中医医院465名护士进行调查。结果85．2％的护士认为有必要应用中医护理诊断，88．2％的护士所在医院在使用中医护理诊断，其中28．1％的护士参考依据是冯运华等主编的《中医护理诊断手册》，21．2％的护士将中医护理诊断应用到临床护理实践中，26．9％的护士认为影响中医护理诊断应用的最主要原因是缺乏中医护理诊断标准体系的指导，42．8％的护士认为在中医医院应该使用能融合中医和北美两种诊断的护理诊断体系，18．9％的护理人员认为中医护理诊断体系应该根据脏腑理论来分类。结论中医护理诊断在我国应用广泛，但缺乏标准体系。有必要构建中医护理诊断体系。     

实习护生流失的原因分析及对策

目的调查临床实习期间护生流失的原因，并提出针对性的措施。方法采用自制实习护生流失原因调查问卷对保定市146名实习护生进行调查。结果认为自己动手能力差，对未来工作没信心和自觉自身的基础较差，实习期间的压力较大的护生分别占71．2％和68．5％；对护士工作产生失望感、倦怠感，认为护士工作缺乏成就感的分别占64．4％与55．5％；实习期间动手机会少，影响学习积极性的占75．3％；认为带教老师把自己当作劳动力使用，传授知识较少的占82．2％；认为在校期间所学理论知识与临床实践脱节的护生占82．2％。结论护生流失的原因既有其主观方面的因素，又有实习环境等客观方面的因素。学校及实习单位对此应给予重视，帮助护生顺利完成临床实习。     

护理人员对护理查房评价的调查

目的 了解临床护理人员对护理查房形式、作用、质量等的认识程度。方法 随机抽取临床在职护士120名，采用自行设计的问卷调查。结果 96．7％护理人员认为有必要进行护理查房，他们认为临床业务性护理查房最有益处．教学指导性护理查房应成为最常用的形式；88．3％护理人员认为护理查房可以提高交接班的正确性和全面性，53．3％认为护理查房可以减少患者的恐惧感和紧张心理，50．0％认为护理查房可以提高护理质量．58．3％认为护理查房与成本核算无关，61．7％认为护理查房可以提升护士在医疗过程中的作用；65．0％护理人员认为专业知识水平是影响护理查房质量的主要因素，95．0％认为最合适的护理查房频次为每月1次。结论 应进一步提高护理人员的专业知识水平，了解临床护士对护理查房的要求和需求，从而指导护理管理人员组织和开展护理查房．提高查房质量和效率。     

护士对护理差错事故认识和态度的调查分析

对100名护士进行护理差错事故认识和态度的调查，结果100％的护士能在护理差错事故发生后及时通知本病区护士长，并能积极采取合理的补救措施，97％的护士能实事求是地书写护理记录，95％的护士认为公开差错事故记录利于从中吸取经验教训。     

临床护理人员对骨髓腔输液通路的认知调查

目的 了解临床护理人员对骨髓腔输液通路的认知情况，分析存在的问题，为临床骨髓腔输液相关培训提供参考。方法 采用自行编制的问卷对1 067名护士进行调查，调查内容包括骨髓腔输液了解及使用意愿；骨髓腔输液专业知识，如使用指征、适用人群、穿刺部位、禁忌证、并发症等。结果 51.45%护士表示没有听说过骨髓腔输液技术；17.63%护士认为外周静脉穿刺困难情况下首选骨髓腔输液通路输液； 20.34%～32.15%护士知晓骨髓腔输液使用指征；关于骨髓腔输液穿刺适用人群，25.12%护士认为成人儿童均可；8.72%护士认为首选部位是胫骨近端；29.80%～30.93%护士知晓骨髓腔输液相关禁忌证； 15.84%～33.83%护士知晓骨髓腔输液相关并发症；92.78%护士认为有必要进行骨髓腔输液的培训；96.63%护士愿意掌握骨髓腔输液技术。结论 临床护理人员对骨髓腔输液通路的知晓率低，学习意愿高；对骨髓腔输液通路认知水平参差不齐，应开展系统培训，进一步规范临床实践，使骨髓腔输液在临床规范应用。     

耳鼻喉科住院患者用药知识需求调查

目的了解耳鼻喉科患者的用药知识需求，为更好地为耳鼻喉科患者开展健康教育提供依据。方法根据临床所遇问题自行设计住院患者用药知识需求调查问卷，对300例耳鼻喉科患者进行调查。结果愿意了解药品情况占89．3％；认为医护人员有必要进行药品情况介绍占86．3％；希望由医生介绍用药知识62．3％，护士介绍33．7％，自己看说明书4．0％；希望通过语言讲解占36．3％，书面介绍22．0％，两者结合41．7％；希望了解所用药品的作用。43．7％、价格27．0％、不良反应18．3％、用法6．0％、名称5．0％、疗效5．0％；关心能否报销13．7％；认为了解所用药品情况是自己应有的权利占72．0％，对今后的用药有指导20．3％，监督医护人员工作7．7％；认为医护人员介绍所用药品情况是尊重患者的权利占57．0％，避免差错事故发生29．0％，履行公事14．0％；认为医护人员能认真介绍药品情况占88．3％，应付差事11．7％；认为通过用药知识指导对自己非常有帮助占73．3％，对今后用药有指导20．7％，没有帮助6．0％。结论耳鼻喉科住院患者用药知识教育需求较高，应在合适的场合、合适的时间，以合适的方式，传授合适的内容，以得到最佳的健康教育效果。     

护士参加远程教育学习情况调查分析

目的 了解护士参加远程教育学习的情况，以便进一步利用远程教育资源的优势，达到良好的继续教育效果。方法 自行设计护士参加远程教育学习情况调查问卷。对北京某三级甲等医院的215名护士进行问卷调查。结果 83．3％护士在2005年度参加了远程教育学习；其中78．8％自己独立完成，16．8％在他人的帮助下完成，4．4％由他人代替完成；74．4％护士选择远程教育学习的原因主要认为其不受时间和地点限制。仅21．4％认为远程教育学习效果好；远程教育学习与我院开展的区级继续教育讲课项目学习效果的认可程度比较，差异有显著性意义（P〈0．05）。结论 远程教育学习不受时间和地点的限制，学习内容可以根据自己的兴趣进行选择，已经为广大的护士所认可和接受，但远程教育学习的学习效果还有待进一步提高。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.