浅谈病区责任护士应具备的整体素质

病区是医院最基本和最重要的单位，而病区的责任护士是病区参与护理管理的重要一员，她们能力的高低将直接影响到病区的护理质量水平。护士长是病区护理管理的灵魂，作为护士长左膀右臂的责任护士，必须具备良好的整体素质，因为责任护士不仅要对患者的机体进行护理，还要对患者的心理、社会关系和家庭生活状况等进行全面的了解，给予全方位的最佳护理。为了提高病区责任护士的综合能力，本文就病区责任护士应具备的整体素质进行浅谈，希望本文能对责任护士提高自身整体素质有一些帮助和启发，成为优秀的责任护士，为患者提供高品质的服务。     

ICU的责任组长护理体会

ICU(重症监护病房)护理责任组长是护士长的助手，在科主任、护士长的统一领导下展开工作，依据护理工作安排，组织护士完成护理工作任务。工作中，协助护士长合理调整及使用人才资源、保证工作落实、提出合理化建议，为护士长作决策提供依据。护士长外出时，临时代替护士长履行职责及时征求病人对护理工作的意见及要求。并反馈给护士长和责任护士。进一步改进工作方法，调整护理内容，增强工作的针对性和主动性、参与对病人、病区护士及护理员的管理，建立并保持良好的工作治疗秩序。经过近四年来任ICU护理责任组长的切身体会，认真总结及分析临床护理工作中点点滴滴，笔者认为ICU的护理责任组长必须做到如下几点：     

护士长的管理意识及其培养

护士长工作在临床第一线，既是医院指挥系统及护理分系统的管理者，也是临床护理业务和病区管理工作的具体执行者。护士长所承担的责任，对于护理工作在医院管理中的地位和作用举足轻重，护士长管理的水平将直接反映第一线护士护理工作的质量，也直接影响医院的综合管理水平和医疗业务的水平和质量。因此，护士长只有具备高水准的管理能力，才能适应现代的管理工作。     

护士长在“夯实基础护理,改善护理服务”中的作为

医院基础护理工作应引起各方面足够的重视,护士长在病区基础护理管理中担负着重要的角色,本文作者就结合我专科医院的实际,谈谈护士长如何夯实我外科基础护理,提高目标质量管理水平。本文作者认为,护士长在夯实基础护理工作中应有如下作为（：1）做好病区护士对基础护理认识的调查工作（;2）建立基础护理质量管理长效监督机制（;3）组织讨论基础护理工作中出现的问题和定期进行护理业务培训;（4）尊重和关爱基础护理的主体-护士。     

层级责任制护理模式在儿科中的应用

目的探讨层级责任制护理模式在儿科临床工作中的应用。方法将儿科病区13名护士进行分层级管理责任于人进行管床,设立护士长一高位责任护士一初级责任护士,按岗位分管床位,全面负责患儿的病情观察、治疗、护理、病区安全及家属沟通,使患儿得到及时、最适合的治疗和护理措施。结果基础知识技能、专业技能、急救技能、综合能力、病区安全管理、护理质量、护理文书等项目,实施层级责任制后显著优先实施前（P〈0．05）。患者对护理服务满意度差异有统计学意义（P〈0．05）;护士压力感降低。结论护理人员分层级管理,充分调动护士工作积极性,加强工作责任感,护士的综合素质和护理质量得到提升,充分利用现有护理人力资源,能提高工作质量和效率,使患儿得到更好更全面的照料,患者满意度提高,进一步提高了儿科优质护理服务的内涵。     

应用护理程序进行护理病例查房

目的适应新的护理模式转变和形势发展要求,提高病区病例查房质量。方法挑选高年资护士负责病例查房主讲,收集资料,汇报病史,提出护理问题及制定护理措施;参加查房人员对主讲责任护士提出的护理问题及措施提出意见并进行补充;病区护士长提出问题让护士回答,鼓励护士积极思考,热烈发言,最后护士长补充总结。结果病例查房质量不断提高,服务意识增强,护理措施落实到位。结论运用护理程序进行护理病例查房促进护士护理知识的积累和更新,提高服务质量和病历书写质量,真正体现了以病人为中心的整体护理。     

护士长授权在护理质量管理中的应用体会

目的探讨护士长授权在病区护理质量管理中的效果。方法以“质量控制,人人参与”为原则,科室成员参与护理质量管理,设立专人专项质量检查。结果护士长授权可以减轻护士长的工作压力,同时护士们更有主人翁意识,充分调动了各级护理人员的积极性。结论护士长授权科室护士共同进行护理质量管理是全面提升护理质量的有效管理方法。     

护理工作分工责任图在科室质量自控的应用

目的护理工作分工责任图在科室护理质量管理中的应用,提高护理的服务质量。方法将整个病区所有的护理工作分为8个组,护士长在充分了解每个护士的性格特征和能力后作出合理安排,护士长负责督促落实。结论通过应用护理工作分工责任图,把护理部管一个患者交一个朋友的护理理念和“五心”服务、全程服务的人性化护理落实到位,树立了医院良好的品牌形象。     

军队医院护理单元设置助理护士长做法与成效

目的 建立并形成责权分明的医院病区管理新模式,加强护理人才的分层次使用和管理工作,科学使用护理人力资源,充分发挥护理管理效能,降低护理人才成本,提高病区管理质量。方法 全院设置26名助理护士长,履行病区护士长工作职责,完成病区管理工作,参与护理教学活动,负责科室间护理工作协调。结果 护理单元设置助理护士长,增加了护理管理人员,壮大了骨干队伍,加强了护理单元的管理和质量控制力度,对护理骨干队伍的开发和管理提供了新方法,为促进护士成长搭建了平台,使护理单元的管理更为科学规范。结论 设置助理护士长是目前军队医院加强护理骨干层力量,培养和选拔护理管理骨干的新途径,是推动科室护理工作发展的有效举措。     

新加坡陈笃生医院护理管理见闻与体会

1. 护理管理系统组织结构 护理管理系统在医院管理体系中是一个相对独立的组织系统,由资深护理总监、科护士长、病区护士长三级组成,共同负责医院护理管理工作.她(他)们中大多数均获得护理管理硕士或博士学位,熟悉护理业务和管理.各级护理人员都有明确的工作职责、权辖范围、上下级关系和汇报沟通的渠道.护理总监直接向院长汇报工作;科护士长负责本专科病区,经常在本专科病区走动,了解病区护士长和护士的工作情况,及时反馈给护理总监;病区护士长工作重点在于管理病房,实行24小时负责制,每天巡视病房,了解病人病情及病人需要,及时解决各种问题,督促护士工作,定期评价每位护士的工作业绩,并与医生及其它部门工作人员进行沟通与交流,负责病区物资请领与财政预算工作,以便尽可能在节约人力、物力的基础上,取得最好的社会及经济效益.在人事制度上,护理部实行层层聘用,并每半年进行一次个人评价,由上一级管理者评价下一级管理者,并完全有权决定下属的级别、工资、晋升、纪律处分等.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.