传染病医院对陪护的管理对策

目的 了解传染病医院住院患者对陪护的需求现状,针对传染病医院的特殊性,提出管理对策.方法 对81例传染病医院的住院患者进行问卷调查,结合收集资料进行统计学分析.结果 66.7%的住院患者表示在住院期间需要陪护,其中87.7%希望家属做陪护.56.8%的患者认为传染病医院有必要限制陪护.同时,他们希望陪护人员具有相应的消毒隔离、饮食指导和疾病护理等相关知识.结论 传染病医院有其自身的特殊性,对陪护的质量控制是影响医院护理质量及防止疾病传播的重要因素,医院需要制定相应的管理对策.     

我国住院患者陪护现状分析与建议

近年来，医院的陪护率居高不下，有的医院陪护率甚至大于80．0％，远远超过了三甲医院对住院患者留陪率≤8．0％的管理要求，陪护问题已经成为医院管理的难题之一。做好医院的陪护管理工作，给患者提供优质的身心护理，是每所医院所面临的问题，也是提高护理管理质量的保证。本文从陪护现状、陪护存在的问题及陪护管理对策3个方面进行综述，让人们意识到陪护人员对患者的重要影响，并提出专职陪护发展的必要性及其存在的优势和需要解决的问题。     

151例无陪护住院老年患者围手术期的护理管理

对医院外科系统9个科室需要手术的151例无陪护住院老年患者实施了围手术期无陪护护理管理.包括护理安全评估、护理照顾分级、设定无陪护患者围手术期临床路经、建立护理小组、进行护理质量控制等.解决了无陪护住院老年患者围手术期的安全与舒适问题,提高了患者及其家属的满意度.     

住院患者对专职陪护满意度调查

目的 了解住院患者对专职陪护的满意度,探索整体护理模式下专职陪护的培训方法.方法 以问卷形式调查有专职陪护的50例患者对陪护的满意度.结果 68%的住院患者对专职陪护满意,32%基本满意,没有患者表示不满意.最满意专职陪护能进行简单按摩、正确翻身等简单操作,比较不满意的是专职陪护的爱心、同情心不够及文化程度太低.结论 由医院进行统一管理的专职陪护基本上得到患者的认可,调动了社会支持系统,提高了患者的生活质量,但需要加强专职陪护的专业知识培训及提高其文化程度.     

湖南省二级以上医院住院患者陪护需求的调查与分析

目的 调查并分析湖南省二级以上医院住院患者陪护需求的现状,为医疗机构向住院患者提供满意的陪护服务提供科学依据.方法 采用自制"住院患者对陪护需求及相关因素调查表",对湖南省60家二级以上医院1030名住院患者从陪护需求、对家属陪护和职业陪护的看法等方面进行问卷调查.结果 ①92%的住院患者希望有陪护;95%的患者有陪护.②住院患者需要家属陪护的原因排序依次是"看到家属心理踏实、有安全感"、"家属更能了解患者需求"、"需要家属安慰"、"家属照顾更周到"、"别人不能取代家属在患者心里的位置".③住院患者对职业陪护的看法各条目得分从高到低依次是"可以得到更精心、更专业的护理"、"家属太忙"、"可减轻家属的压力"、"增加经济负担"、"可减轻心理压力".72.3%的患者知道有职业陪护这个职业,76.8%的患者认为医院有必要提供职业陪护.④对家属陪护影响看法的条目得分最高的是"家属陪护有利于患者康复".结论 二级以上医院的陪护率高于卫生部制定标准及陪护需求,由此医疗机构应该适当考虑患者陪护需求,放宽陪护标准,采取家属陪护与职业陪护相结合的方式,以满足不同患者的需求.     

医院随员存在的原因分析及其管理对策

介绍医院随员存在的现状：1）随员组成;2）全院临床科室几乎都有人数不等的随员存在,外科比内科多。3）儿科系统随员一直以来处于较高水平。4）床位数较少科室比床位数较多科室随员人数相对少。分析医院随员存在的原因：与患者自身及所患疾病种类有关;儿科系统随员在病房陪护和流动的人数处于较高水平;科室床位数有关;患者心理渴望家人陪护;与医院主、客观因素有关。提出减少随员的相应管理对策：加强对随员的宣教及人性化管理,建立专职专业的陪护队伍,统一培训、规范管理,注重患者生活护理。通过分析医院病房随员存在原因,提出减少随员的相应管理对策,促进患者身心健康的恢复,提高患者家属对护理服务的满意度,从92.3%上升至96.1%。     

医院随员存在的原因分析及其管理对策

介绍医院随员存在的现状：1）随员组成;2）全院临床科室几乎都有人数不等的随员存在,外科比内科多。3）儿科系统随员一直以来处于较高水平。4）床位数较少科室比床位数较多科室随员人数相对少。分析医院随员存在的原因：与患者自身及所患疾病种类有关;儿科系统随员在病房陪护和流动的人数处于较高水平;科室床位数有关;患者心理渴望家人陪护;与医院主、客观因素有关。提出减少随员的相应管理对策：加强对随员的宣教及人性化管理,建立专职专业的陪护队伍,统一培训、规范管理,注重患者生活护理。通过分析医院病房随员存在原因,提出减少随员的相应管理对策,促进患者身心健康的恢复,提高患者家属对护理服务的满意度,从92.3%上升至96.1%。     

心衰患者对开展无陪护病房意愿的调查研究

目的了解心衰患者对开展无陪护病房的意愿,分析其影响因素及制定护理改进措施。方法应用自行设计的心衰患者对开展无陪护病房意愿的调查问卷对某三甲医院的100名心衰患者生进行调查,内容包括患者的社会学特征、家庭年收入、住院频率、住院天数、心功能以及对开展无陪护病房的意愿及其原因,对调查结果进行相应的统计分析。结果 100名调查者中有68人(68%)不希望开展无陪护病房,与年龄、文化程度、家庭收入、住院次数、住院时间、心功能等有关,其中影响患者不愿意开展无陪护病房的原因有:患者更依赖家人、感觉不方便尤其是隐私部位的护理、考虑增加经济的负担、担忧护理质量、病情较重如有意外不能及时通知家属。结论由于多种因素影响,心衰患者对开展无陪护病房的支持度不高,应制定相应地护理改进措施,以便加快无陪护病房的开展,提高患者接受无陪护病房的意识。     

精神病患者家属对电休克治疗的态度及护理需求调查

目的了解精神病患者家属对电休克治疗的态度及护理需求,提出相应的护理对策。方法采用自编问卷,对于住院期间需要做电休克治疗的精神病患者,对家属进行关于电休克治疗态度和护理需求的调查。结果初诊患者家属对电休克治疗有心理准备的占35％,复诊患者家属对电休克治疗有心理准备的占94％;相比复诊患者家属,初诊患者家属对电休克治疗的目的认识更为不足,更希望能陪护患者;两组患者家属都希望得到护理人员的心理护理。结论精神病患者家属对电休克治疗的目的认识不足,有必要及时为患者家属提供相关知识,使他们认识到电休克治疗对精神病患者疾病治疗的重要性。     

重症监护室患者家属的探视需求与护理对策

目的：对重症监护室患者家属的探视需求进行调查分析,并探讨相应的护理对策。方法：对我院2009年5月～2010年2月ICU病房的180名患者家属进行问卷调查。结果：家属非常希望了解患者的饮食和精神状况,对患者的保暖情况重视程度稍低。家属大多希望能陪在患者身边,希望得到医院的辅导和宣教,并认为家属陪护对患者病情的缓解起到了积极作用。结论：应落实限制陪护制度,通过健康辅导和宣教加强患者家属对ICU制度的认识程度,确保护理质量,减少医患纠纷,使ICU护理工作顺利开展。     

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.