不同专科护士化疗防护现状及影响因素调查分析

目的了解综合性医院肿瘤科与非肿瘤科护士化疗防护现状及影响因素，为制订针对性干预措施提供依据。方法采用自行设计的问卷，对肿瘤科（32名）、非肿瘤科（40名）护士进行调查。结果非肿瘤专科未配备防护设施，75．0％护士未接受过系统的化疗防护知识培训，72．5％不了解化疗防护知识，50．0％不使用双层手套，仅25．0％护士配药方法正确，100％从未使用过防护设备，100％不会正确处理化疗废弃物；其主要影响因素为无防护设备（95．0％）、缺乏化疗防护知识（75．0％）及不了解化疗药物的潜在危害（70．0％）；前2项认同率显著高于肿瘤专科（均P〈0．01）；后1项与肿瘤专科相似（P〉0．05）。肿瘤专科防护设施配备齐全，护理人员防护基本知识和技能显著优于非肿瘤专科（均P〈0．01），但在使用防护设施及正确配药方面，与非肿瘤专科比较，除使用双层手套，一次性口罩、帽子外，其余差异无显著性意义（均P〉0．05）。结论化疗防护现状不容乐观，尤其是非肿瘤专科护理人员；医院相关领导和护理管理者应采取切实可行的措施改善化疗防护条件，提高护理人员的防护意识、知识和技能。     

输液胶贴回收现状调查分析

目的了解输液胶贴回收现状，提出对策，以期降低和消除医院感染隐患。方法自行设计问卷对本院30个病区的176名护理人员进行患者输液治疗及胶贴回收情况调查。结果被调查患者1785例，输液治疗1699例，占95．18％。拔针后护士按压161例（9．48％），患者或陪护按压1538例（90．52％）；按压后胶贴投入指定容器护士为90．68％，患者或陪护仅为0．98％。95．45％护士对胶贴规范性回收持肯定态度，但仅7．39％护士对患者或陪护进行了胶贴投入指定容器的指导。结论输液治疗量大，胶贴基本未按医院感染管理规定回收，相关管理者应引起高度重视，采取有效措施提高护理人员安全护理意识，对患者加强健康教育，提供胶贴回收专用设施，消除医院感染隐患。     

基层医院护理人员情报意识的调查研究

目的了解护理人员情报意识，为培养护理人员情报素养，提高护理队伍科研意识与科研水平提供依据。方法采用自制问卷，调查302名基层医院护理人员阅读护理期刊及其它专业期刊的情况。结果常阅读的护理期刊前3位为：护理学杂志45．0％，中华护理杂志19．2％，护理管理杂志10．9％；通过1种期刊获取信息者占50．0％，21．5％护理人员未阅读护理期刊；能结合本科专业阅读其它专业期刊者占13．2％。结论情报素养不高是护理队伍中的共性问题。从教育着手，改变知识结构，注重情报意识教育，普及情报检索知识是进行护理科研、推动护理队伍整体学术水平提高的基础环节。     

护生实验课中锐器刺伤情况调查分析

目的 了解护生在注射实验课中练习时的锐器刺伤情况，并探讨相应的防护对策。方法 采用自设问卷，对140名护生进行锐器刺伤频率、发生锐器刺伤后的处理、对锐器刺伤危害的认识等内容的调查，结果 140名护生中发生锐器刺伤58名（61人次），仅5人次在教师的指导下进行了正规的处理。45．71%护生排气时，手弹注射器而未固定针栓，42．14%生掰安瓿时未用纱布包裹。结论 护生自我防护意识淡漠，自我防护措施不到位，急需加强锐器刺伤防护教育，严格执行全面性防护措施，为临床实践打下坚实的基础。     

基层医院护理人员的学历结构调查分析

目的 了解基层医院在职护理人员学历结构及改变情况，以促进护理人员接受继续教育。方法 采用便利抽样法选取两所二级甲等医院护理人员169人，对其进行学历及继续教育方式的问卷调查。结果 基层医院护理人员起始学历：中专者占95．9％，其中79．6％接受继续教育；而起点大专者（4．1％）中仅28．6％接受继续教育。护理人员获得高层次学历的主要途径为自学考试；不同职称和护龄的护士接受继续教育情况比较，差异有显著性意义（均P〈0．01）。结论 基层医院护理人员学历结构改变明显，但低年资及初级职称以下护理人员学历结构普遍偏低，护理管理者应采取措施对低年资、低职称护理人员开展继续教育。     

护生实验操作损伤及自我防护相关内容调查

目的了解护生在实验室练习时损伤发生情况和自我防护知识、意识、对血液传播疾病的认知，为在校护理防护教育提供依据。方法采用问卷法对179名大专护生进行调查。结果护生实验室操作实验损伤发生率为50．3％，其中单纯针刺伤占33．3％、单纯玻璃割伤占38．9％，同时发生2种损伤占27．8％；护生自我防护意识认知率为32．4％～44．7％，防护知识认知率20．1％、30．7％，对血源传播性疾病的认知率为25．7％～98．9％。结论护生实验操作时锐器损伤发生率高，自我防护意识薄弱、防护知识欠缺，护理院校应加强职业防护教育。     

公众对徒手心肺复苏认知度的调查

目的了解公众对徒手心肺复苏术（CPR）相关知识的认知度，为开展全民急救培训提供依据。方法采用自行设计的问卷对公民1072人进行CPR知晓程度、获取信息的途径、现场的处理、正确的CPR操作、接受培训的意愿等方面的调查。结果401人（37．4％）表示知道CPR，仅听说过者488人（45．5％），不知道者183人（17．1％）。仅79人（7．4％）直接从专业书籍或专业人士处获取信息。假设现场有人发生猝死时230人（21．5％）选择现场急救，其中仅17人（1．6％）表示可以正确实施CPR操作，但未通过任何形式的资格考试且未持有资格证书。结论公众对CPR的知晓率不高，急救技术普及率低。应在公众中开展广泛的CPR培训，强化公众的现场急救意识及急救技能。     

水媒射频切割闭合器在肝切除术中的应用配合

目的 探讨标准预防措施在手术室护理工作中的实施效果，以提高护理人员的自我安全防护意识。方法 设立医院感染管理委员会、感染管理小组、感染联络点三级监控管理体系，对手术室医护人员采用在职培训与考核、正确使用防护用具、严格执行手术室消毒隔离制度等标准化防护措施。结果 实施标准预防措施后，护理人员医院感染率由实施前（2003～2004年）5．6％下降至实施后（2005～2006年）。结论 标准预防措施可增强手术室护理人员的自我防护意识，提升护理质量。     

实习医护人员锐器伤的调查及预防措施

目的 探讨锐器伤的危害及相应预防措施。方法 对186名实习医护人员锐器伤采用自行设计的问卷进行回顾性调查。结果 被调查的实习医护人员中受伤人数占74．19％．受伤2次以上者占75．36%，186名实习生在实习过程中共受伤346次。结论 临床实习医护人员缺少锐器损伤相关知识的岗前培训，职业防护意识淡薄，操作不熟练．锐器伤发生率高，应加强全面性防护意识的教育．建立并执行全面性防护措施．以减少医护人员职业性、血源性疾病的传播。     

脾转移癌的诊断及临床病理特征

目的：探讨脾转移癌（MCS）的诊断及临床病理特征。方法：报告4例MCS的临床资料。结合文献进行临床病理分析。结果：4例MCS占1959－1999年间308例脾活检病例的1．3％。临床主要表现为左上腹疼痛和包块,癌灶位于脾上极1例,脾下极2例,脾下极＋脾门部1例,肉眼观均为结节型。组织学类型：来自胰腺腺泡细胞癌2例,肝细胞癌和横结肠腺癌各1例,临床诊断MCS1例,3例被误诊,综合国内文献资料。MCS具有以下临床病理特征：（1）30－60岁的患者占66．7％,平均年龄51．2岁;（2）76．3％有左上腹疼痛,63．2％伴脾肿大或包块;（3）肉眼观68．4％为结节型病变;（4）腺癌占94．2％。70．3％原发于结肠癌,肝细胞癌,卵巢癌和胰腺癌;（5）B超和（或）CT示脾占位性病变或肿块者占76．7％,提示MCS者占11．8％;（6）临床上被误诊者占73．7％,结论：MCS少见,临床误诊率高,影响学检查有助于临床诊断,临床医师和病理医师应相互协作,增强对MCS的诊断意识,以提高MCS的诊断水平和检出率。     

Epidemiology of exposure to blood borne pathogens on a surgical service

BACKGROUND: The goal of this study was to analyze the type and mechanism of blood exposure injuries on the surgical service in order to develop appropriate preventative strategies. METHODS: A retrospective review of all exposure injuries affecting members of the operative care line at a single teaching institution between December 2002 and December 2005 was performed. RESULTS: Of 98 exposure injuries on the surgical service, only 17 (17%) were inflicted by hollow-bore needles. Seventy-four (76%) of these reported injuries occurred in the operating room (OR) and 24 (24%) occurred in other clinical areas. Sharps injuries accounted for 69 (93%) of OR injuries and were inflicted by suture needles (n = 37, 50%), hollow-bore needles (n = 7, 9%), and sharp instruments (n = 25, 34%). Mucocutaneous contamination accounted for 5 (7%) of the OR exposures. Professionals most frequently injured were residents (n = 43, 44%), followed by nurses (n = 28, 29%), students (n = 17, 17%) and other healthcare workers (n = 10, 10%). CONCLUSIONS: Blood exposure prevention strategies should be directed at safety within the surgical field and focused beyond hollow-bore needle stick injuries to include education, mentoring, and competency training.     

Epidemic of stab injuries: an Alice Springs dilemma

This study is unique in that it strives to unfold, perhaps for the first time, the problem of stab injuries and resultant significant mortality and morbidity within the Aboriginal population of Central Australia. Demographic features presented in the study are quite different from other published Australasian and overseas experiences. There were 1550 stab injury admissions to Alice Springs Hospital during a 7-year period (July 1998 to June 2005). Thirty-two patients were dead before arrival, and there were only three deaths in the hospital during the period of study. The most unique demographic feature was that 99.99% were Aborigines, 53% were women and the most common location of injury was in town camps and homes. The mean age of this population was 31 years, and the average length of stay in hospital was 3 days. The most common site of the stab injuries was the thigh with a total of 605 (38%). Stab injuries to the abdomen were significantly low with 68 (<1%). Twenty-one per cent (332) presented 24 h to 10 days after stabbing. Another 21% (335) absconded before the completion of treatment. Of the victims, 31% (481) were under the influence of alcohol. Twenty per cent (311) of the patients presented with repeat stabbings during the study period. Traditional punishment is still practised in Central Australia and thus explains the high number of thigh injuries. A particular pattern of traditional stab injuries was also noted; medial thigh to kill, posterior thigh to permanently disable and lateral thigh to punish. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were only five firearm traumas during this period, two were self-inflicted and three were accidental.     

Leg blood flow and long-term cardiovascular prognosis in men with typical and atypical intermittent claudication.

OBJECTIVES: To compare leg blood flow and the long-term cardiovascular prognosis in men with typical and atypical intermittent claudication (IC) according to Rose's questionnaire. METHODS: Leg blood flow during reactive hyperaemia was assessed at 55 years of age by calf plethysmography. Measurement of the systolic ankle-arm pressure index was used to assess the prevalence of peripheral arterial disease (PAD) at 68 years of age. Mortality and incidence of cardiac events is based on record linkage with regional and national registers. RESULTS: Twenty-one (3%) out of 700 men had typical IC at 55 years of age. Sixteen (76%) of these had normal plethysmography, with a mean peak flow (95% CI) of 24.6 (19.3-30.0) ml/min/100 ml. Peak flows were similar and normal in men with atypical IC (mean 22.5; 95% CI 21.3-23.6) and men having no pain (mean 23.8; 95% CI 23.1-24.4). Mortality rates were increased in men with typical IC but who had normal leg blood flow (49.5 deaths/1000 person years; p = 0.008), and men having atypical IC (35.3 deaths/1000 person years; p = 0.007) in comparison with men having no leg pain (27.4 deaths/1000 person years). This could not be accounted for by an increased cardiac event rate. The prevalence of PAD at 68 years of age was not increased in either of these two groups. CONCLUSIONS: Only 12% of subjects with exertional pain fulfilled all criteria for typical IC. Typical and atypical claudication in absence of objective evidence of PAD was associated with a reduced life expectancy, but not with an increased cardiovascular risk. To properly assess the prognosis, non-invasive assessment of PAD should be used in addition to questionnaires.     

The injury potential and lethality of stab wounds: a Folsom Prison Study

The morbidity and mortality of stab wounds is unknown since much of the data is unobtainable. Folsom Prison, a closed system with respect to population at risk and medical care, represents a unique situation where all stab wounds and subsequent care are accounted for. A retrospective review of stabbing incidents at Folsom Prison identified 751 wounds in 270 prisoners. Overall mortality was 3%. Thirty-five per cent of the victims were hospitalized. The overall chance of serious injury, defined as an assault victim requiring more than cleansing and suturing of his wounds, was 25%. The most common procedures were tube thoracostomy (performed 36 times) and celiotomy (performed 31 times). We believe that this is the first study of its kind involving a closed population to accurately assess the overall morbidity and mortality of stab wounds. The 3% mortality and the 25% requiring a procedure beyond suturing reflects the low injury potential long clinically suspected in stab wounds.     

移植肾活组织检查191例的病理学研究

目的：研究供肾可能携带的病变及移植肾在术后出现合并症时间相应的病理组织学变化。方法对191例移植肾进行了活组织检查（以下简称“活检”,其中术中活检52例,术后活检139例,并进行病理学诊断与分类。结果（1）52例术中活检,40例（76．92％）正常,余12例（23．07％）供肾携带病变,其中细小动脉硬化3例（5．77％）、间质炎症4例（7．69％）、局部肾小管轻度萎缩3例（5．77％）、肾小管上皮细胞变性2例（3．84％）。（2）139例术后活检中明确诊断的134例（96．40％）,其中正常19例（13．66％）,超急性排斥反应（SAR）1例（0．71％）疑为急性排斥反应／临界性变化（S／B）15例（10．795）,急性排斥反应（AR）23例（16．54％、慢性移植肾肾病（CNA）37例（26．61％）、环孢素肾毒性损伤（CsA-NT)29例（20．80％）、急性肾小管坏死（ATN）8例（5．75％）、复发性肾炎（RN）2例（1．43％）、难以明确诊断的5例（3．59％）。（3）免疫细胞化学色显示AR时,侵入肾小管上皮内的Leu-7阳性细胞数增加,间质内CD68阳性细胞数明显增加。结论活检是诊断术后多种合并症的有效手段;CAN可在术后3个月发生;侵入肾小管上皮的Leu－7阳性细胞是协助诊断AR的有效指标。     

Gunshot wounds and stabbings: experience with 124 cases

A retrospective study was undertaken of 124 patients admitted with gunshot and stab wounds between January 1980 and the end of June 1985. The present series found an almost equal number of gunshot wounds (65) and stabbings (59), with an increasing incidence. The patients fell heavily into the categories of being male (88.7%), in their twenties (42%) and having consumed alcohol (52% when documented). There were 77 cases of assault, with 50 of these being caused by persons known to the victim, whilst violent crimes and prison riots accounted for the rest. The majority of injuries occurred outside normal working hours, with 62% arriving at the hospital between 8 pm and 8 am. There were 14 deaths (11.3%), usually within the first 4 h, with all but one occurring in the first 24 h. Gunshot wounds resulted in a higher mortality rate (16.9% cf. 5%) and longer hospital stay.     

Benzodiazepine Premedication: Can It Improve Outcome in Patients Undergoing Breast Biopsy Procedures?

Background: Women awaiting needle-guided breast biopsy procedures may experience high anxiety levels. A randomized, double-blind, placebo-controlled study was designed to evaluate the ability of midazolam and diazepam (in a lipid emulsion [Dizac]) to improve patient comfort during needle localization and breast biopsy procedures.

Methods: Ninety women received two consecutive doses of a study medication, one before the mammographic needle localization and a second before entering the operating room. Patients were assigned randomly to receive saline, 2.0 ml intravenously, at the two time points; midazolam, 1.0 mg intravenously and 2.0 mg intravenously; or diazepam emulsion, 2.0 mg intravenously and 5.0 mg intravenously, respectively. Patients assessed their anxiety levels before the needle localization, before entering the operating room, and on arrival in the operating room. Patients completed a questionnaire evaluating their perioperative experience at the time of discharge.

Results: Patient satisfaction during needle localization was significantly improved in both benzodiazepine treatment groups (vs. saline). The incidence of moderate-to-severe discomfort during needle localization was lower in the midazolam (20%) and diazepam emulsion (6%) groups compared with the saline group (70%) (P < 0.05). The preoperative visual analogue scale anxiety scores were similar in all three groups. In the operating room, however, anxiety scores were 55% and 68% lower after midazolam (21 +/- 19) and diazepam emulsion (15 +/- 14) compared with saline (46 +/- 28). Finally, there was no difference in the time to achieve home-readiness or actual discharge time among the three groups.     

Benzodiazepine premedication: can it improve outcome in patients undergoing breast biopsy procedures?

BACKGROUND: Women awaiting needle-guided breast biopsy procedures may experience high anxiety levels. A randomized, double-blind, placebo-controlled study was designed to evaluate the ability of midazolam and diazepam (in a lipid emulsion [Dizac]) to improve patient comfort during needle localization and breast biopsy procedures. METHODS: Ninety women received two consecutive doses of a study medication, one before the mammographic needle localization and a second before entering the operating room. Patients were assigned randomly to receive saline, 2.0 ml intravenously, at the two time points; midazolam, 1.0 mg intravenously and 2.0 mg intravenously; or diazepam emulsion, 2.0 mg intravenously and 5.0 mg intravenously, respectively. Patients assessed their anxiety levels before the needle localization, before entering the operating room, and on arrival in the operating room. Patients completed a questionnaire evaluating their perioperative experience at the time of discharge. RESULTS: Patient satisfaction during needle localization was significantly improved in both benzodiazepine treatment groups (vs. saline). The incidence of moderate-to-severe discomfort during needle localization was lower in the midazolam (20%) and diazepam emulsion (6%) groups compared with the saline group (70%) (P<0.05). The preoperative visual analogue scale anxiety scores were similar in all three groups. In the operating room, however, anxiety scores were 55% and 68% lower after midazolam (21+/-19) and diazepam emulsion (15+/-14) compared with saline (46+/-28). Finally, there was no difference in the time to achieve home-readiness or actual discharge time among the three groups. CONCLUSIONS: Premedication with midazolam or diazepam emulsion improved patients' comfort during needle localization procedures and significantly reduced intraoperative anxiety levels before breast biopsy procedures without prolonging discharge times. Use of diazepam emulsion may be an effective alternative to midazolam in this population.     

When is it safe to discharge asymptomatic patients with abdominal stab wounds?

BACKGROUND: This study sought to determine the time from hospital presentation to surgical intervention for hemodynamically stable patients with abdominal stab wounds. The objective was to identify the optimal time for observation of these asymptomatic patients before safe hospital discharge. METHODS: The authors reviewed a prospectively collected trauma database at their level 1 trauma center. The time from admission to surgery was noted in their patient population. All stab wound patients who underwent either peritoneal lavage or immediate surgery were excluded from the study. RESULTS: During a 7-year period, 650 asymptomatic patients with abdominal stab wounds were admitted for serial examination. The study showed that 567 of these patients had no abdominal surgical intervention, whereas 68 underwent abdominal surgery (15 left the center against medical advice). No patients were identified as requiring surgery more than 12 hours after presentation. CONCLUSION: It appears that asymptomatic patients with abdominal stab wounds may be discharged from the hospital after 12 hours of observation with little likelihood of missed injury.