ICU专科护士院内培训存在的不足与对策

目的：本研究旨在分析ICU专科护士院内培训存在的问题,提出有效对策,为提高ICU专科护士培训成功率建言献策。方法：于泸州医学院附属医院内,对29名护理人员实施培训,并对整个培训过程进行监督,通过教学质量评价反馈调查和ICU专科护士培训满意度调查,分析存在问题与不足。结果：ICU专科护士院内培训在培养模式、培训内容、师资配备、师资水平、实践培训时间安排方面存在不足,针对问题,提出相应的解决方案与对策。结论：本研究为ICU专科护士培训走向科学、成熟奠定基础。     

Beyond-use date of extemporaneous morphine hydrochloride oral solution

Hospital pharmacists prepare morphine oral solution extemporaneously in Taiwan because of the unavailability of commercial products. According to the United States Pharmacopeia <795>, extemporaneous oral solution has an expiration of 14 days if there is no stability test data. However, outpatients usually need 4-week medications. The purpose of this study was to determine the beyond-use date of extemporaneous morphine hydrochloride (HCl) oral solution. Extemporaneous 0.1% morphine HCl oral solutions were prepared in an International Organization for Standardization (ISO) Class 8 compounding room, and bottled in 500-mL high-density polyethylene (HDPE) bottles with polypropylene caps. Twelve bottles were divided into 2 groups (sealed or opened daily) and stored under refrigeration or at room temperature to determine the chemical and microbial stabilities. Stability tests of the “sealed” group were performed after 4 weeks, while for the group in which the bottles were shaken and opened twice daily, stability tests were performed weekly. Chemical stability was determined by high performance liquid chromatography and pH, and microbial stability was determined by microbial limit tests according to pharmacopeias. In both groups, all the morphine HCl oral solutions retained more than 90% of the original concentration after 4 weeks, irrespective of whether they were stored at room temperature or in the refrigerator. The pH values were maintained at around 5 during the 4-week study period. All the refrigerated solutions passed the microbial limit tests within 4 weeks, regardless of whether they were sealed or opened twice daily. All the solutions stored at room temperature retained their microbial stability in the 1st week. However, mold and yeast counts exceeded the limits during the 2nd week in the “opened daily” group. Extemporaneous 0.1% morphine HCl oral solutions prepared in an ISO Class 8 clean room have a beyond-use date of 4 weeks in HDPE bottles when refrigerated. The beyond-use date decreased to 1 week when stored at room temperature. Extrapolation of this result may be limited by different compounding environments, containers or formulations.     

观察长期使用不同钙浓度透析液对维持性血液透析患者PTH和血压的影响

目的 观察长期使用不同钙浓度透析液对维持性血液透析(HD)患者PTH和血压的影响.方法 将36例慢性肾功能衰竭维持性血透(MHD)患者随机分为两组,A组18例患者使用钙浓度为1.5 mmol/L的透析液,B组18例患者使用钙浓度为1.75mmol/L的透析液,观察透析36个月后患者血清离子钙(iCa)、磷(P)、甲状旁腺激素(PTH)及平均动脉压(MAP)的水平和临床表现.结果 B组有3例患者因高血压不能耐受试验退出.长期治疗后A组患者血清离子钙(iCa)、MAP明显降低(P＜0.05),血P无明显变化(P＞0.05),血PTH明显升高(P＜0.05);B组患者血清iCa、MAP明显升高(P分别＜0.001和＜0.01),血P无明显变化(P＞0.05)、血PTH明显降低(P＜0.05).两组患者中骨痛发生率A组为55.56％,B组为20％,部位多见于脚后跟和脚底,其次为膝关节;心律失常发生率A组为11.11％,B组为46.67％,心率失常的类型以阵发性房性期前收缩多见,其次为阵发性心房纤颤以及室性期前收缩.结论 维持性血液透析患者长期使用1.5mmol/L钙浓度的透析液后血离子钙明显下降,出现低钙血症,血PTH明显增高,肾性骨痛发病率增加,患者MAP下降;长期使用1.75 mmol/L钙浓度的透析液后血PTH明显下降,血清离子钙和MAP明显升高,骨痛发生率下降,但心律失常的发生率增加.     

单人徒手心肺复苏术在专科护生教学中存在的问题及对策

目的：对某高校2012级专科护生单人徒手心肺复苏术教学过程中存在的问题进行剖析,有针对性地改进教学方式、内容,以期提高护生的操作水平、提高护理实验教学质量。方法：对2012级护理专科学生讲授《2010国际心肺复苏及心血管急救指南》中的心肺复苏术,随机选取本年级护生207人,分为9组,在讲授及逐一回视的过程中密切观察、反思、总结。结果：在单人徒手心肺复苏术课后回视中,颈总动脉定位方式、气道的打开、口对口人工呼吸错误率较高,错误包括操作步骤遗漏、时间观念不强、推理理念淡薄。结论：单人徒手心肺复苏过程中注意授课方式、时间的安排,训练过程中密切观察、及时纠正不正确的手法,训练结束后逐一回视,再次纠正。     

医院后勤服务社会化风险分析及应对策略

文章结合医院后勤服务社会化的具体实践,总结了当前医院后勤服务社会化过程中各种潜在的风险,简要分析了各种风险存在的原因,并提出了一些具体建议。     

新形势下军队医院职业道德存在问题的对策研究

新形势下，军队医院职业道德建设面临着许多新情况和问题，究其原因：一是市场经济发展中的消极影响反映到军队医院，使人们的传统职业道德观受到冲击二是国防卫生事业经费投入不足，使得医院在“确保”上难度加大，三是收治地方病人范围的不断扩大，使得有的医院任务过重，医患矛盾时有发生。四是“中心”工作五“首位”任务摆位不正，使得思想政治教育力量单薄。     

基于信息化系统的门诊流程再造实现和探讨

针对大型综合性医院“看病难”现象,结合某医院的自身特点和实际情况,探讨医院借助信息化系统优化门诊流程采取的具体方案。通过分析,认为门诊流程的优化,改变了医院传统的就诊模式,缩短了患者排队时间,充分体现了“以患者为中心”的服务理念,提高了医疗质量、就诊效率及患者满意度,促进了医院和谐发展。     

不同年龄阶段脱敏治疗依从性分析及护理对策

目的:了解不同年龄阶段脱敏治疗患者依从性差别以便针对性地给予护理干预。方法:将2003年3月～2010年4月在我科门诊脱敏治疗结束疗程的患者240例,按年龄分为少儿组、青年组、壮年组及老年组,依脱敏治疗坚持疗程情况进行分析。结果:少儿组及老年组依从性较高,壮年组及青年组依从性差。结论:脱敏治疗依从性受诸多因素的影响,不断为患者提供针对性的护理干预可望提高患者对治疗的依从性,巩固疗效。     

医院药品管理面临的问题及我院的对策

医药市场的改革，促进了药品生产经营部门的激烈竞争，也给医院药品管理带来了新问题。主要表现为药品购销中的回扣形式多样化，假，伪，劣药品生产仍甚，药费增高加重了患者的负担。以此反映出行现行药品管理体制和模式不适应医药市场的新形势。