强化知识培训 提高护士对结直肠癌患者疼痛管理能力

目的:探讨强化知识培训对普外科护士管理结直肠癌患者疼痛能力的影响。方法:选择2011年9～12月在我院普外科工作的25名护理人员进行强化癌性疼痛知识培训,采用疼痛管理知识和态度问卷(KASRP)和随机病历抽查的方式调查普外科护士对结直肠癌患者疼痛管理能力的效果。结果:普外科护理人员进行培训后KASRP平均分和KASRP合格率高于培训前,差异有统计学意义(P<0.05)。结论:癌性疼痛知识强化培训能够规范护理人员的护理行为,提高护理人员疼痛管理能力。     

临床护士疼痛管理知识与态度的调查研究

目的了解护士疼痛管理知识与态度现状。方法采用护理人员疼痛管理知识与态度问卷(Knowledge and Attitudes Survey Regarding Pain,KASRP)和自设一般情况问卷对福建省11所三级甲等医院440名临床护士进行调查研究。结果护士KASRP问卷其总体正确率为48.35%,疼痛评估维度正确率最高,为58.58%,疼痛干预维度正确率最低,仅为26.55%;能通过阅读学术期刊获得疼痛知识的临床护士KASRP得分高于其他护士(P<0.05);工作后接受过疼痛继续教育的临床护士KASRP得分高于未接受继续教育的护士(P<0.05)。结论临床护士疼痛知识和态度水平较低,通过自主学习和继续教育,能有效提升护士的疼痛管理能力,提高疼痛护理整体水平。     

术后急性疼痛管理的持续质量改进

目的探讨持续质量改进程序在术后急性疼痛管理中的作用和效果评价。方法运用持续质量程序分析急性疼痛管理中的各个环节,查找导致术后患者疼痛管理质量差和镇痛满意度低的原因并制订改进措施:加强与外科护士的沟通协作并对外科护士进行疼痛知识培训和操作演练、规范疼痛管理流程和职责制度,实施程序前后分别对192名护士和300例患者进行问卷调查,分析评价实施后的效果。结果术后患者疼痛最严重的程度得分由(7.23±1.04)分下降到(5.03±1.03)分(P<0.01);实施后患者对术后镇痛效果满意度及认为医院提供的疼痛信息充分程度均较实施前提高(P<0.01);护士对患者进行有效疼痛记录的次数从(1.78±0.70)次提升到(11.02±2.45)次,(P<0.01);护士的疼痛知识和态度调查问卷平均得分由(40.2±12.4)分提高到(59.8±11.6)分(P<0.01)。结论 FOCUS-PDCA程序用于急性疼痛管理不仅可以提升护士的疼痛知识水平和疼痛管理水平,而且可以提高患者的镇痛满意度和舒适度,从而显著提高医院的疼痛管理质量。     

外科临床护士疼痛知识认知调查分析

目的了解外科临床护士对疼痛管理知识掌握的程度和态度,为创建外科无痛病房,开展疼痛知识培训提供依据和方向,加强术后疼痛管理,促进康复。方法应用KASRP(2008)中文版问卷对外科病区护士随机调查200名护士。结果外科护士对疼痛知识认知较低,问卷答对率45.69%,平均得分(18.11±3.91)分。结论创建外科无痛病房要对外科护士进行疼痛相关知识培训,重点关注护士疼痛评估能力的提高、镇痛药知识的完善及综合判断能力提升。     

护理人员疼痛知识培训效果分析

目的 探讨疼痛知识培训对护理人员疼痛管理知识和态度的影响.方法 选取某三级综合性教学医院的临床一线护理人员127人,采用自身前后对照的研究设计,使用“护理人员疼痛知识和态度(2008)中文版问卷(KASRP)”评价疼痛知识培训对护理人员疼痛管理知识和态度的影响.结果 接受疼痛知识培训后,“护理人员疼痛知识和态度(2008)中文版问卷”的平均得分从培训前的(15.94±3.13)分增加为(23.99±4.90)分,护理人员培训后的问卷所得总分和每个纬度的得分与培训前相比差异均有显著意义(P＜0.01).结论 疼痛知识培训能显著提高护理人员的疼痛知识水平,改善对疼痛管理的认识,是促进疼痛管理的有效措施之一.     

山东省综合性三级医院临床护士疼痛管理知识、态度现状及影响因素分析

目的:调查山东省综合性三级医院临床护士疼痛管理知识和态度现状,为后续开展相关培训提供依据。方法:采用疼痛管理知识和态度调查问卷(KASRP)2014中文版问卷,对山东省30所综合性三级医院的766名临床护士进行调查,了解临床护士疼痛管理知识和态度的现状及存在的问题,并采用多元线性回归分析其影响因素。结果:临床护士KASRP评分为(21.12±4.64)分,平均得分率为51.51%;不同科室、职称、疼痛继续教育程度的临床护士疼痛管理知识与态度不同(P<0.05)。结论:临床护士疼痛管理知识有所欠缺,应注意提高低职称、非疼痛/肿瘤科室临床护士的知识水平和学习主动性,加强疼痛管理的继续教育和培训。     

血液内科护理人员疼痛管理知识和态度的调查分析

[目的]了解血液内科护理人员疼痛管理知识水平和态度现状,探讨疼痛管理知识水平和态度的影响因素。[方法]运用便利抽样法选取某三级甲等医院348名血液内科护理人员进行问卷调查,使用自制的一般情况问卷、(2008)中文版疼痛管理知识和态度问卷(KASRP)进行调查。[结果]KASRP(2008)中文版问卷答对率为(44.5±9.7)%;不同学历、岗位、是否为专科护士对KASRP(2008)中文版问卷答对率比较差异有统计学意义(P0.05)。[结论]血液内科护理人员疼痛管理知识水平有待提高,需通过针对性的继续教育等多种培训形式提高护理人员的知识水平。     

新生儿重症监护病房护理人员疼痛知识培训的效果分析

目的探讨疼痛知识培训对新生儿重症监护病房(neonatal intensive care unit,NICU)护理人员疼痛管理知识和态度的影响。方法便利抽样选取某三级综合性教学医院的临床NICU护理人员42人,采用自身前后对照的研究设计,使用护理人员疼痛知识和态度(2008)中文版问卷(knowledge and attitudes survey regarding pain,KASRP)评价疼痛知识培训对护理人员疼痛管理知识和态度的影响。结果接受疼痛知识培训后,护理人员KASRP的平均得分从培训前的(16.88±3.05)分增加到(34.68±5.74)分,应用疼痛评估工具的频率显著增加,与培训前比较差异均有统计学意义(均P0.05)。结论疼痛知识培训能显著提高NICU护理人员的疼痛知识水平,改善对疼痛管理的认识,促进其对新生儿疼痛的管理,对及时评估、预防和降低新生儿疼痛具有积极的意义。     

疼痛管理知识和态度调查问卷在我国的应用现状

对疼痛管理知识和态度调查问卷(KASRP)在我国的应用情况进行分析,认为该问卷是我国应用最广泛的护士疼痛管理知识和态度的调查工具及疼痛护理培训项目效果的衡量工具,建议我国学者应及时更新KASRP问卷,注意应用的局限性。     

新生儿重症监护室护士的早产儿睡眠管理调查研究

目的了解新生儿重症监护室(neonatal intensive care unit,NICU)护士的早产儿睡眠管理现状。方法选取3所三级甲等儿童专科医院NICU护士177名,采用自设的一般资料问卷和NICU护士的早产儿睡眠管理调查问卷,以微信的形式发放和收集问卷。结果 NICU护士的早产儿睡眠管理标准分为(67.60±7.44)分,其中,知识维度标准分为(53.11±13.47)分,行为维度标准分为(73.58±15.14)分。是否接受睡眠知识培训(t=2.953,P=0.003)、不同睡眠知识获取途径(F=3.106,P=0.001)、不同NICU工作年限(F=4.182,P=0.024)、不同日平均管床数(F=3.022,P=0.016)的护士的早产儿睡眠管理得分差异有统计学意义。结论 NICU护士的早产儿睡眠管理现状亟待改善,护士缺乏相关技能和知识,应加强培训。     

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.     

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.     

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.     

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.