临床护理路径在消化性溃疡出血患者中的应用

目的:探讨优质护理服务试点病房在消化性溃疡出血患者中应用临床护理路径(CNP)的效果.方法:选择将开展优质护理服务试点病房前2010年1～4月住院的49例胃十二指肠溃疡出血患者设为对照组,采用常规的方法进行整体护理;选择开展优质护理服务试点病房后2010年5～12月住院的52例设为实验组,在包床到护基础上应用CNP进行计划护理.观察、比较两组患者住院天数、住院费用、健康知识掌握程度及满意度.结果:实验组住院天数、住院费用均低于对照组(P＜0.05),而患者健康知识掌握程度、满意度均高于对照组(P＜0.01).结论:在优质护理服务试点病房应用CNP对消化性溃疡出血患者实施计划护理,可缩短住院天数,降低医疗费用,提高患者满意度、健康教育效果及护理工作质量,故试点病房护士责任分工模式是落实临床护理路径的保障.     

针对住院患者人文护理需求实施全程人文关怀护理服务模式的效果评价

目的 调查全程人文关怀护理服务模式病房中住院患者的人文护理需求状况,为持续改进护理服务质量提供科学依据.方法 选择我院2个全程人文关怀模式病房入院患者408例,发放自制患者人文需求量表了解患者的人文护理需求,针对患者的需求开展全程人文关怀护理.并采用我院自行研制的患者对护理服务满意度调查表,于患者出院前进行关怀护理满意度调查,并对结果进行分析.结果 在开展全程人文关怀护理模式后,住院患者对关怀护理服务总体满意度和满意率较高,分别为98.2％、97.5％.结论 优质护理服务的开展与提升人文关怀理念相互促进,在全程人文关怀护理模式病房中进行住院患者人文护理需求调查,将人文关怀措施融入临床护理中的各个方面,是优质护理服务的关键,也是临床护士需要认真面对的新课题.     

边远山区医院开展优质护理服务对患者护理满意度的影响

目的探讨在边远山区开展优质护理服务对提高住院患者护理满意度的效果。方法对住院治疗的1634例患者进行护理满意度调查,比较开展优质护理服务病房患者（观察组）和未开展优质护理服务病房患者（对照组）的满意度。结果观察组住院患者护理服务满意度为90.75%,对照组满意度为79.87%,观察组比对照组高10.88%,两组差异有统计学意义（P<0.05）。结论开展优质护理服务能有效改善护患关系,提高护理质量,显著提升住院患者满意度。     

基于主成分分析法的天津市某三级甲等医院CCU患者满意度分析

目的：采用主成分分析法分析影响住院患者满意度的主要因素指标权重,为进一步提高医疗护理服务质量,提升患者就医感受提供理论依据。方法：采用自行设计的住院患者满意度调查问卷,对天津市某三级甲等医院CCU的100名住院患者进行调查。指标权重采用主成分分析,各指标评价采用象限图法。结果：指标权重分析结果显示,对患者满意度影响较大的指标分别为医院提供的心理辅导、家属的关心、健康教育、医生沟通能力、病房探视制度、就医费用、病房软件环境（隔音、温湿度、气味等）、医院提供的饮食。象限图显示非常重要但是满意度相对不高的指标依次为医院提供的饮食、医院提供的心理辅导、就医费用、病房软件环境、病房探视制度、健康教育。结论：医院应优先改进医院提供的饮食、心理辅导、就医费用、病房软件环境、病房探视制度及健康教育这6个方面,以提高医疗护理服务质量,提升患者就医感受。     

优质护理服务对普通外科住院患者满意度的影响

目的:探讨优质护理服务对普通外科住院患者满意度的影响.方法:随机选取普通外科住院一周或以上时间的患者共230例作为调查对象,对比优质护理服务前(2009年8月至2010年6月,115例,对照组)和服务后(2010年6月至2011年4月,115例,试验组)普通外科住院患者的满意度,采用本院患者满意度调查表进行问卷调查,进而分析探讨.结果:经过优质护理服务前后的10个月对比,发现在活动开展期间,从患者满意度在90％～ 93％之间,提升达到96％～99％,经过统计学处理,整体满意度有明显提高(P＜0.05).结论:优质护理的开展有效强化了护理人员的优质护理服务意识,并且提升了外科患者住院的满意度.     

优质护理服务对患者满意度的影响

目的 探讨开展优质护理服务前后住院患者对护理工作满意度的影响.方法 采用医院统一设计的患者满意问卷调查表,对开展优质护理服务前后两组住院患者均为100例在出院前随机进行满意度调查.结果 通过开展优质护理服务,患者满意度由实施前的90％上升到97％ (P＜0.05).结论 开展优质护理服务可提升住院患者的满意度,提高护理质量,和谐护患关系,值得推广.     

临床路径在护理管理中的应用

目的 探讨临床路径在护理管理中的应用价值.方法 选择2010年12月实施临床路径前后的住院患者各300例,比较实施临床路径前后患者满意度、住院时间、医疗费用等情况.结果 在护理管理中实施临床路径后,患者对于责任护士总满意度评分显著增高,住院天数及医疗费用显著降低.结论 护理管理工作中实施临床路径,可有效提高患者对护理工作的总体满意度,减少住院时间、降低医疗费用.     

运用追踪方法学调查优质护理对A类与C类示范病房患者满意度的影响

目的:运用追踪方法学调查优质护理对A类与C类示范病房患者满意度的影响。方法:对2012年优质护理A类示范病房心血管科和C类示范病房呼吸科出院患者运用追踪方法学进行调查,了解优质护理A类与C类病房出院患者对护理服务的满意度。结果:A类病房出院患者满意度明显高于C类病房出院患者(P0.05)。结论:开展优质护理能强化护士服务意识,改善服务态度,提高护理质量,保障医疗安全,为患者提供安全、优质、满意的护理服务,对提高患者满意度有重要意义。     

患者满意度调查在优质护理工作中的作用

目的 通过对患者在住院2周及出院时分别进行护理工作满意度调查,探讨其对提高优质护理工作的作用.方法 采用问卷调查的方法,采用本院自制的护理满意度调查表,对患者在住院期间及出院时分别进行满意度调查.结果 对比2010年8月～12月患者满意度均有明显提高,且患者出院时的满意度提高幅度更大,但患者在出院时的满意度仍低于住院期间的满意度,而两者之间满意度的差距在缩短.结论 在患者出院日行护理满意度调查,能真实反映护理服务中存在的问题,有针对性地改进护理工作,有效促进优质护理工作开展.     

开展优质护理服务对患者满意度的影响

目的：探讨开展优质护理服务对患者满意度的影响。方法：2011年16月～2012年6月在我院采用随机数字表法选取病情稳定、能接受访谈的288例住院患者为研究对象,在优质护理示范病房选择患者144例,对其实施优质护理服务措施;在未实施优质护理服务的普通痫房选择患者144例,采用自制患者满意度调查表对不同病房患者的满意度进行调查。结果：优质护理示范病房患者对护理工作的满意度明显高于普通病房患者（P〈0．05）。结论：对患者实施优质护理服务有利于提升患者对护理工作的满意度。     

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.     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.