产科实施护理组长负责制层级管理的效果评价

[目的]探讨护理组长负责制在产科层级管理中的作用,调动各级护理人员的工作积极性,提高护理质量。[方法]实施APN连续排班,实行护士长一护理组长一责任护士一助理护士的层级管理模式,比较护理组长负责制模式下住院病人对护理工作的满意度、医生对护理工作的满意度、病区不良事件发生率情况。[结果]实施护理组长负责制后病人、医生对护理服务满意度均较实施前提高,护理不良事件发生率下降40％。[结论]护理组长负责制层级管理的实施能充分发挥护理骨干的核心作用,更加合理地安排护理人力资源,提高工作效率,保证护理安全。     

产科实施护理组长负责制层级管理的效果评价

[目的]探讨护理组长负责制在产科层级管理中的作用,调动各级护理人员的工作积极性,提高护理质量。[方法]实施APN连续排班,实行护士长-护理组长-责任护士-助理护士的层级管理模式,比较护理组长负责制模式下住院病人对护理工作的满意度、医生对护理工作的满意度、病区不良事件发生率情况。[结果]实施护理组长负责制后病人、医生对护理服务满意度均较实施前提高,护理不良事件发生率下降40%。[结论]护理组长负责制层级管理的实施能充分发挥护理骨干的核心作用,更加合理地安排护理人力资源,提高工作效率,保证护理安全。     

ICU护理绩效考核模式的构建与成效

[目的]构建客观、简单、实用的ICU护理绩效考核模式,评价实施后的效果。[方法]依据ICU护理工作特点,建立定性评价与定量评估考核量表,对ICU护士进行综合考评,将考核结果应用于绩效分配。比较实施绩效考核前后护士满意度及病人(家属)对护理服务满意度及护理质量。[结果]实施绩效考核后护士满意度、病人(家属)对护理服务满意度及护理质量均高于实施前,差异有统计学意义(P0.05或P0.01)。[结论]以定性评价与定量评估相结合为基础的ICU护理绩效考核模式,为ICU全面实施有效的绩效管理提供了科学依据,对提高护士和病人满意度、推动护理质量的持续改进有积极作用。     

护士站前移工作模式在神经内科病区中的应用

[目的]探讨护士站前移工作模式在神经内科病区中的应用效果。[方法]在护士长指导下设立护理组长及辅助护士,配备流动的护士站的工作车,护理组长落实人车合一工作制,辅助护士负责后勤输送工作,落实责任包干,实行分组负责、包干到人、护士站前移工作模式。[结果]提升了专科护理内涵,提高了护理工作满意度,确保了护理安全。[结论]护士站前移工作模式的实施使护士分工更加明确,护患、医护关系更加融洽,减轻了护士工作量、提高了护士工作质量和效率、提高了健康教育效果及病人满意度、提升了护士的整体素质。     

医护合作一体化模式在综合性ICU病房中的应用

目的:探讨医护合作一体化模式在综合性ICU病房中的应用及实施效果。方法:2013年1~12月在综合性ICU病房中未实施医护合作一体化模式,2014年1~12月实施医护合作一体化模式,比较实施前后护理质量、三管感染率、医护患满意度及临床护士工作能力。结果:实施后护理质量评分、医护患满意度及临床护士工作能力均高于实施前(P0.05),实施后三管监测千日感染率低于实施前(P0.05)。结论:在综合性ICU病房中运用医护合作一体化模式,促进了专科特色护理服务工作的开展,提高了ICU科室综合护理质量、临床护士工作能力及医护患满意度,保障患者安全。     

责任组长在提高护理绩效中的作用

[目的]探讨优质护理中责任组长在护理绩效考核中的作用。[方法]根据医院对责任组长的要求选拔护理责任组长,让责任组长对本组护士的工作进行绩效考核。[结果]提高了病人的满意度,激发了护士的工作积极性,静脉输注、基础护理等各项护理质量均提高,护士专科理论成绩、护士绩效成绩也有明显提高。[结论]在优质护理服务中责任组长对本组护士进行绩效考核,能够激发护士潜力,责任组长的实行在护理工作中不仅起到帮带作用,也促使责任组长要不断进行新业务的学习,有利于科室护理工作的开展,也有利于护士长的管理。     

新型组长负责制培训模式在ICU的实施与效果

目的:探讨我院ICU组长负责制分层管理模式下新型护理培训模式的实施及效果。方法:通过对ICU护理人员架构调整,制订培训计划,建立组长负责制分组分层的新型培训方式,实施合理的培训考核形式,评估培训人员经新型培训方式后的效果。结果:经过3个月的培训,护理人员ICU专科理论知识、单项专科操作、综合护理能力及带教能力等方面与新型护理培训模式实施前比较,差异有统计学意义(P0.01)。结论:新型组长负责制分组分层培训模式可提高ICU护士各方面的能力。     

责任护士负责制对提高晨间护理质量的影响

目的实行责任护士负责制进行晨间护理工作,以提高晨间护理质量。方法实施责任护士分管晨间护理床位,制定晨间护理质量标准,随机抽样对实施前后晨间护理合格率及患者、家属满意度进行比较。结果实施责任护士负责制后晨间护理合格率及患者、家属满意度较实施前提高（P〈0．05）。结论责任护士负责制可解决晨间护理落实不到位的问题,提高晨间护理质量,增强护士的管理能力和自我价值感,在整体护理中有积极的意义。     

新型急救护理培训模式在急诊科的实施与效果

[目的]探讨我院急诊科组长负责制分层管理模式下新型护理培训模式的实施及效果。[方法]通过对急诊护理人员架构调整,制订培训计划,建立组长负责制分组分层的新型培训方式,实施合理的培训考核形式,评估培训人员经新型培训方式后的效果。[结果]经过3个月的培训,护理人员参与急救准备时间由以前的5min缩短至现在的1min。急诊专科理论知识、单项急救操作、整体合作综合抢救能力及医生、病人满意率等方面与新型护理培训模式实施前比较,差异有统计学意义（P〈0．01）。[结论]新型组长负责制分组分层培训模式可提高急诊护士各方面的能力。     

医护一体化培训模式对提高护理人员核心能力的效果研究

目的探讨医护一体化培训模式对提高护理人员核心能力的效果。方法采取医护一体化培训模式对400名护士进行培训,包括医护共同查房,加强理论知识培训,护士参加术前讨论、疑难病例讨论及多学科会诊、医护配合进行应急能力培训等。在实施前后,测评护士的核心能力、护士对医护一体化培训的满意度、医生对护理工作的满意度以及患者满意度。结果实施医护一体化培训模式后,护士核心能力总分及评判性思维/科研能力、临床能力、教育/咨询能力、专业发展能力提高(P<0.01);医生和患者对护理工作的满意度提高(P<0.01)。结论医护一体化培训模式能有效提高护士的专业能力,有效促进医护合作,提高医生和患者的满意度。     

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.