实施规范化护理服务的做法与效果

目的树立医院护士形象,实施规范化护理服务,全面提升护理服务水平。方法研究制定护士形象标准及细则,对全体护理人员进行培训和考核,制订并下发病区规范化护理模式,建设和观摩示范病区,推广规范化护理服务。结果护理人员规范化护理服务意识增强,护士形象得到改善,护患关系更加融洽,护理整体水平得到提高,病人对护理服务的总体满意率达99.00%以上。结论树立护士形象,实施规范化护理服务是提高护理质量的有效措施。     

口腔修复专科护理操作规范化培训的实践

目的探讨口腔修复专科护理操作规范化培训的做法。方法建立一套规范化操作指导的培训管理模式,形成不同年资护理人员的培训体系,制订专科护理操作技术标准及考核标准,对全体护士进行培训。结果患者对护理操作技术的满意度及医生对护士配合的满意度均提高(P0.01)。结论规范口腔护理操作技术,形成口腔修复特色培训模式,提高护理质量。     

护士规范化培训与专业化发展一体化模式构建设想

分析和讨论我国护士规范培训现状,分别从我国护理人力资源编制、护士规范化培训的现状、护理人员职业生涯规划以及护士专业化发展体系等方面阐述了对我国护士规范化培训长效机制建立的思考。认为我国目前护理人才的间断式培养模式不利于护理人员的专业化发展,逐步建立和完善护士规范化培训与护士专业化发展综合教育培训体系是我国在职护理人才培养和队伍建设的关键。     

护士规范化培训与专业化发展一体化模式构建设想

分析和讨论我国护士规范培训现状,分别从我国护理人力资源编制、护士规范化培训的现状、护理人员职业生涯规划以及护士专业化发展体系等方面阐述了对我国护士规范化培训长效机制建立的思考.认为我国目前护理人才的间断式培养模式不利于护理人员的专业化发展,逐步建立和完善护士规范化培训与护士专业化发展综合教育培训体系是我国在职护理人才培养和队伍建设的关键.     

夜班护士准入的培训及效果评价

目的：增强夜班护士工作能力及理论技术水平,提高夜班护理质量。方法：制定夜班护士准入标准,对2007年符合独立值夜班的护士进行准入培训。结果：与2006年未接受夜班准入培训的护士比较,培训护士理论水平、操作技能及夜间护理质量明显提高（P〈0.05）。结论：要使夜班护理质量得到保证,就应该对夜班护士进行培训,并规范准入制度。     

新入职护士规范化培训临床教学基地师资准入标准研究

[目的]构建新入职护士规范化培训临床教学基地师资准入标准。[方法]在文献研究和专家访谈的基础上,初步构建新入职护士规范化培训临床教学基地师资准入标准体系,选取来自上海市15名专家进行两轮德尔菲咨询,确立评估指标体系。并在此基础上采用层次分析法建立评价指标递阶层次结构模型,确定各评价指标的权重系数。[结果]两轮专家咨询的积极系数均为100%,专家权威程度系数为0.868,两轮协调系数分别为0.244,0.179(P0.01)。初步建立了一套由职业素养、教学能力、临床护理工作能力3个一级指标和16个二级指标组成的新入职护士规范化培训临床教学基地师资准入标准体系。[结论]建立的新入职护士临床教学基地师资准入标准体系可信度高,可用于新入职规范化培训临床教学基地师资的遴选和规范化培训。     

病例讨论在ICU新护士规范化培训中的应用

目的保证ICU新护士规范化培训质量,提高护理人员的综合素质和专科护理能力。方法将病例讨论应用于ICU新护士规范化培训,组织床边护理查房、危重病例讨论、死亡病例讨论、典型病例示教等多种形式的教学活动。结果病例讨论教学能充分调动被培训者学习和工作的积极性,提高专科护理水平,有效地提升护理质量。结论将病例讨论引入ICU新护士规范化培训中,有利于专科护理能力的提高,规范护理行为,保障护理安全。     

护士继续教育的规范化管理

目的探索护理人员毕业后继续教育的规范化管理方法,提高护士继续教育管理水平。方法规范化管理方法包括：健全培训架构;系统管理培训;完善培训工具;建立激励机制。结果护士继续教育规范化管理后,全院护士继续教育达标率逐年提高（P〈0．001）,护士学历、职称结构实施规范化管理后显著优于实施前（P〈0．001）。结论规范化护理继续教育管理促进了护士成长,保障了护理安全,有利于专科护士培养,加强护理制度落实。     

病例讨论在ICU新护士规范化培训中的应用

目的 保证ICU新护士规范化培训质量,提高护理人员的综合素质和专科护理能力.方法 将病例讨论应用于ICU新护士规范化培训,组织床边护理查房、危重病例讨论、死亡病例讨论、典型病例示教等多种形式的教学活动.结果 病例讨论教学能充分调动被培训者学习和工作的积极性,提高专科护理水平,有效地提升护理质量.结论 将病例讨论引入ICU新护士规范化培训中,有利于专科护理能力的提高,规范护理行为,保障护理安全.     

护士规范化培训与专业化发展一体化模式构建设想

分析和讨论我国护士规范培训现状，分别从我国护理人力资源编制、护士规范化培训的现状、护理人员职业生涯规划以及护士专业化发展体系等方面阐述了对我国护士规范化培训长效机制建立的思考。认为我国目前护理人才的间断式培养模式不利于护理人员的专业化发展，逐步建立和完善护士规范化培训与护士专业化发展综合教育培训体系是我国在职护理人才培养和队伍建设的关键。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.