高职护生基础护理操作技能评价体系的初步构建

[目的]构建高职护生基础护理操作技能评价内容及权重。[方法]研究小组2016年2月—2016年12月通过理论分析、文献回顾、专家访谈等多种方法了解现有的高职护生基础护理操作技能评价的方法及不足之处,构建高职护生基础护理操作技能评价的初稿。运用两轮专家咨询明确高职护生基础护理操作技能评价的维度、条目及指标,应用层次分析法计算评价体系的各条目的权重。[结果]经历两轮专家咨询,入选专家20名。两轮咨询中专家共提出建议40条。最终确立了高职护生基础护理操作技能评价体系的结构,包括基本素质、评估准备、技能操作和综合评价4个维度和17个条目。4个维度中技能操作维度最重要;条目层中应变能力等所占权重高。[结论]通过系统的研究方法进一步明确高职护生基础护理操作技能评价的内容和权重。     

手术室心理支持对经尿道膀胱肿瘤电切术患者的影响

目的探讨对采用经尿道膀胱肿瘤电切术治疗的患者实施手术室心理支持护理干预,对不良情绪、手术效果及并发症发生率的影响。方法选择本院采用经尿道膀胱肿瘤电切术治疗的患者64例,随机分成对照组和研究组,各32例。对照组采用常规护理,研究组采用常规护理配合手术室心理支持护理干预,观察2组不良情绪、手术效果、并发症发生率及生活质量等情况。结果护理后,研究组SAS、SDS、NIH-CPSI评分低于对照组,QOL评分高于对照组,差异有统计学意义(P0.05);研究组手术时间、膀胱冲洗时间、导尿管留置时间、住院时间均短于对照组,差异有统计学意义(P0.05);研究组术中出血量少于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论对采用经尿道膀胱肿瘤电切术治疗的患者实施手术室心理支持护理干预能缓解患者不良情绪,缩短手术时间,降低术中出血量,提高患者生活质量及预后效果。     

Mass casualty incidents with multiple burn victims: Rationale for a Swiss burn plan

Introduction

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

Methods

Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

Results

Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20–30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.

Conclusions

Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.     

The published research paper: is it an important indicator of successful operational research at programme level?

Is a published research paper an important indicator of successful operational research at programme level in low‐income countries? In academia, publishing in peer‐reviewed scientific journals is highly encouraged and strongly pursued for academic recognition and career progression. In contrast, for those who engage in operational research at programme level, there is often no necessity or reward for publishing the results of research studies; it may even be criticized as being an unnecessary detraction from programme‐related work. We present arguments to support publishing operational research from low‐income countries; we highlight some of the main reasons for failure of publication at programme level and suggest ways forward.     

Israeli hospital preparedness for terrorism-related multiple casualty incidents: Can the surge capacity and injury severity distribution be better predicted?

Background

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams.15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs.

Methods

A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as ≥10 casualties or ≥4 suffering from injuries with an ISS ≥ 16 arriving to a single hospital.

Results

The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8 ± 13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was ≤52. Based on severity scores and ED discharges 1022 (79.2%) casualties did not necessitate immediate medical treatment.

Conclusion

Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.     

Battlefield extremity injuries in Operation Iraqi Freedom

Objective

Extremity injuries account for the majority of wounds incurred during US armed conflicts. Information regarding the severity and short-term outcomes of patients with extremity wounds, however, is limited. The aim of the present study was to describe patients with battlefield extremity injuries in Operation Iraqi Freedom (OIF) and to compare characteristics of extremity injury patients with other combat wounded.

Patients and methods

Data were obtained from the United States Navy-Marine Corps Combat Trauma Registry (CTR) for patients who received treatment for combat wounds at Navy-Marine Corps facilities in Iraq between September 2004 and February 2005. Battlefield extremity injuries were classified according to type, location, and severity; patient demographic, injury-specific, and short-term outcome data were analysed. Upper and lower extremity injuries were also compared.

Results

A total of 935 combat wounded patients were identified; 665 (71%) sustained extremity injury. Overall, multiple wounding was common (an average of 3 wounds per patient), though more prevalent amongst patients with extremity injury than those with other injury (75% vs. 56%, P < .001). Amongst the 665 extremity injury patients, 261 (39%) sustained injury to the upper extremities, 223 (34%) to the lower extremities, and 181 (27%) to both the upper and lower extremities. Though the total number of patients with upper extremity injury was higher than lower extremity injury, the total number of extremity wounds (n = 1654) was evenly distributed amongst the upper and lower extremities (827 and 827 wounds, respectively). Further, lower extremity injuries were more likely than the upper extremity injuries to be coded as serious to fatal (AIS > 2, P < .001).

Conclusions

Extremity injuries continue to account for the majority of combat wounds. Compared with other conflicts, OIF has seen increased prevalence of patients with upper extremity injuries. Wounds to the lower extremities, however, are more serious. Further research on the risks and outcomes associated with extremity injury is necessary to enhance the planning and delivery of combat casualty medical care.     

Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams

OBJECTIVE: The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN: We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS: We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION: The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.     

完善公立医院经济运行的对策思考

公立医院经济运行存在如下问题:收支结构不合理,现行药品加成政策并没有节约药品支出,医疗收入增长依赖医疗服务价格政策;政府财政补偿缺位,医务人员劳动价值不能充分体现;医院发展迅速但呈粗放型增长,医疗费用增长迅速;不完善的医疗保险制度制约了医院经济运行? 完善公立医院经济运行机制的主要对策有:发挥政府主导作用,提高财政补偿和医疗服务补偿比重,完善医疗服务价格政策,引导医院收支趋于合理;完善医保部门与医院的协调机制;改革人事分配制度;加强成本核算,控制医疗费用增长速度;加强品牌建设,提升核心竞争力?     

Modelling of α1-adrenoceptor-mediated temporal dynamics of inotropic response in rat heart to assess ligand binding and signal transduction parameters

Background and purpose:

In order to use the transient response to an antagonist (prazosin) to evaluate properties of agonist interactions with the α₁-adrenoceptor system, an integrative mechanistic model of cardiac uptake of prazosin and its competitive interaction with phenylephrine at the receptor site was developed. Based on the operational model of agonism, the aim was to evaluate both the receptor binding and signal transduction process as determinants of the inotropic effect of phenylephrine.

Experimental approach:

In Langendorff-perfused rat hearts, prazosin outflow concentration and left ventricular developed pressure were measured, first in the presence of 12.3 µmol·L⁻¹ phenylephrine following a 1 min infusion of 1.27 nmol [³H]-prazosin, and second, when after 30 min the phenylephrine concentration in perfusate was reduced to 6.1 µmol·L⁻¹, the 1 min infusion of 1.27 nmol [³H]-prazosin was repeated.

Key results:

The kinetic model accounted for cardiac uptake and receptor binding kinetics of prazosin (dissociation constant, mean ± SD: 0.057 ± 0.012 nmol·L⁻¹), assuming that the competitive displacement of phenylephrine (dissociation constant: 101 ± 13 nmol·L⁻¹) reduced the receptor occupation by the agonist and, consequently, contractility. This competitive binding process appeared to be the rate-determining step in response generation. The relationship between receptor occupancy and inotropic response was described by an efficacy parameter (τ, ratio of receptor density and coupling efficiency) of 4.9.

Conclusions and implications:

Mechanistic pharmacodynamic modelling of the kinetics of antagonism by prazosin allows quantitative assessment of the α₁-adrenoceptor system both at the receptor and post-receptor levels.     

卫生管理运筹学课程教学探索

针对专业需求、课程特点,对卫生管理运筹学课程教学方面做了一些探索和总结。