手术室器械供应部辅助人员的岗位设置及其管理

目的探讨手术室器械供应部辅助人员的岗位设置、培训、使用方法及其效果。方法改革手术室器械供应部人员结构，新设器械清洗员、打包员、物品检查供应员等3种辅助人员工作岗位，经系统培训后完成清洗器械、打包和物品供应等工作。设计应用《辅助人员工作质量量化考核表》，客观评价辅助人员工作质量。结呆2004年与2002年比较，护士的直接护理时间增加17．9％，间接护理时间下降38．2％。外科医生对手术室护理工作的满意度评分由78．2分提高到92．3分（t=-7．937，P〈0．05）。2005年辅助人员工作量化考核平均成绩为（99．25±1．48）分。结论手术室器械供应部合理使用经过培训的辅助人员，提高了手术室的工作质量和效率，降低了用人成本。     

消毒供应中心与手术室合作的探讨

2004年11月,我院新的消毒供应中心正式启动运行,手术室器械的清洗、检查、保养、打包和敷料的打包工作均在消毒供应中心完成,与手术室的合作已一年,效果满意,现报道如下。合作条件1.建筑要求。消毒供应中心建筑必须靠近手术室。有2个特殊专用通道,一个是无菌物品运送通道,可保证无菌器械、敷料快速送达,一个是污染器械回输通道,保证手术器械使用后及时返回进行清洗,避免血液污物变干,造成清洗质量不彻底,影响灭菌效果。2个通道不得交叉,不得逆行。2.人员要求。工作人员必须熟练掌握清洗消毒设备的使用方法,各种清洗技术,手术器械的性能及构…     

消毒供应室与手术室一体化合作存在的问题及对策

医院的消毒供应中心主要开展消毒灭菌工作,它担负着医院重复使用的医疗、诊疗器械的清洗、消毒、灭菌和供应工作而在过去供应室与手术室各自为政,手术室的医疗器械及敷料打包的情况,都由手术室的护士独立完成,然后再送到供应室来完成消毒灭菌。由于手术室人员紧张,护士忙于日常的手术工作,护理工作,没有充分的时间来清洗器械,再加上她们不具备清洗的条件,所以很难保证手术器械的清洗质量。直至2012年9月,供应室与手术室开始合作,现将在合作过程中存在的问题及对策比较分析如下。     

手术室、供应室集中化管理手术器械的效果分析

[目的]通过实施手术室手术器械手术室供应室集中化管理提高手术室工作效率。[方法]手术室专人负责器械的保养、打包工作;供应室负责器械的清洗、灭菌工作;建立手术器械使用情况登记本;制作手术护士姓名卡片及耐高温手术器械明细卡片。[结果]保证了手术器械的及时供应,减少了器械的丢失情况,保证了器械清洗、灭菌质量,同时延长了器械的使用寿命。[结论]加强手术室、供应室手术器械集中化管理以及追溯管理,确保了手术器械的使用质量,有效控制了医院感染的发生率,使手术室护理工作得到了良性循环。     

中央集中型手术室供应部防止器械混乱和丢失措施

手术室供应部负责整个手术器械的供应,负责术后器械的清洗、上油、保存、准备、包装的全过程。器械准备的不充分,会直接影响到手术的进度,甚至造成手术的失败。我院手术室供应部实行中央集中型。即全院的灭菌物品(包括手术室的灭菌物品)由消毒供应中心集中供应。优点是节省人力、物资。缺点是路线长,中间环节多,器械在污染区分类送入自动器械清洗机,经过清洗后进入清洁区整理包装。这一过程需经过多人合作完成,每一环节的疏忽,都会造成器械的混乱和丢失。半年来通过手术室和消毒供应中心的相互配合,总结出一套切实可行的经验,现介绍如下。根…     

消毒供应中心与手术室相关护理风险隐患与对策

消毒供应中心是医院可重复性医疗用品清洗、消毒、灭菌集中供应的场所,尤其对手术后器械的处理和供应,其工作质量直接影响护理质量.手术使用消毒灭菌器械物品,施行各类手术与患者的手术治疗质量和安全息息相关.因此,消毒供应中心与手术室共同加强安全防范与管理确保医疗护理安全.加强护理人员消毒灭菌知识宣教,加强供应室新规范的学习,加强院感知识培训,对确保医疗护理安全有着重要的意义[1].现对消毒供应中心与手术室相关的护理风险隐患的原因进行分析,并提出相应的防范措施.     

手术室—供应室一体化管理模式的实施与效果

目的探讨手术室—供应室一体化管理模式的实施方法与效果。方法本院消毒供应室于2008年7月开始实施手术室—供应室一体化管理模式,内容包括供应室人员的培训,改造工作流程,工作人员合理搭配,协调合作。结果手术室器械清洗质量和灭菌质量达标率为100%。减少了手术室护士非护理性操作,使每台手术护士节省约1h的工作时间。结论手术室器械一体化管理的实施,不仅为手术器械的清洗质量提供保障,而且提高了手术室的工作效率。     

精细化管理在硬式内镜清洗质量控制中的应用

目的探讨精细化管理对提高硬式内镜清洗灭菌质量的效果,为确保患者安全提供保障。方法选取我院2016年6月-2017年6月硬式内镜器械共240套,分为对照组(手术室处理硬式内镜器械120套)和观察组(消毒供应中心)处理硬式内镜器械120套),比较两组精细化管理前后器械清洗合格率、考核合格率及手术科室满意度等。结果硬式内镜器械清洗质量合格率由78.27%提高到98.12%,残留血试验(OB试验)由65.16%提高到91.12%,人员的操作标准考核合格率40%提高到85%,手术科室人员对消毒供应中心工作的满意度由82%上升到94.5%。各项指标差异均有统计学意义(P0.05)。结论通过对硬式内镜器械实行精细化管理,使消毒供应中心工作人员处理硬式内镜器械的综合能力得到明显提高,工作质量得到有效保障。     

手术室器械管理方法的改进与效果

目的提高手术室器械管理效果。方法通过成立器械组、岗前培训、合理弹性排班、明确界定职责等措施改进手术室器械管理方法，实行手术器械术前常规供应、术中紧急供给、术后规范化处理。结果缩短了手术时间，提高了医护人员的满意度和器械清洗质量。结论器械管理方法改进能为各种手术提供及时、准确、优质的器械保证，是提高手术室护理工作质量的有效方法。     

篮筐打包标识在消毒供应中心质量追溯系统各分区的应用

总结篮筐打包标识在消毒供应中心质量追溯系统中的应用。消毒供应中心质量追溯系统,专为全方位的器械管理而开发,它可以记录每个无菌医疗器械包使用的全过程,包括回收、清洗消毒、准备、打包、灭菌、发放六个环节。我们在这些环节中建立篮筐分类打包标识,减少反复扫描操作的次数,优化了工作流程。不仅节省人力及时间,而且在实时掌握手术器械与物品状态的同时也提高了无菌物品的质量及工作效率。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。