老年住院患者安全风险管理及对策

目的:提高护理质量,降低护理风险系数,为老年住院患者提供安全、优质有效的护理服务。方法:通过识别与分析老年病房现存的和潜在的护理风险,结合老年患者的特点,提出有效的安全风险管理及对策,指导临床规避和化解护理风险。结果:护理人员提高了风险防范意识,促进病房护理管理质量,风险事件发生率降低。结论:老年病房实施护理风险管理十分必要;在实施过程中,健全管理机制和提高护理人员风险防范意识及对风险因素评估能力很重要。     

住院糖尿病患者安全风险管理

目的提高护理质量,降低护理风险系数,为住院糖尿病患者提供安全、优质、有效的护理服务。方法通过识别与分析住院糖尿病患者现存的和潜在的护理风险,结合糖尿病患者的特点,提出适合糖尿病专科的有效安全风险管理,指导临床规避和化解护理风险。结果护理人员提高了风险防范意识,促进病房护理管理质量,风险事件发生率降低。结论糖尿病患者实施护理风险管理十分必要;在实施过程中,健全管理机制和提高护理人员风险防范意识及对风险因素评估能力很重要。     

护理缺陷和经验分享制在急诊护理风险管理中的应用

目的改变以往管理者对缺陷的处理模式,增强护士的风险意识和提高护士识别防范护理风险的能力。方法根据急诊护理风险的特点制定护理缺陷和经验分享制度,落实于急诊护理风险管理的全过程。结果使科室护理人员防范和识别急诊护理风险的意识增强,识别和处理急诊护理风险的能力提高。急诊护理风险事件发生率大大降低。结论护理缺陷和经验分享制度降低急诊护理风险发生率,提高了急诊护理风险管理效率。     

风险管理在妇产科护理管理中的应用

目的:探讨风险管理在妇产科护理管理中的应用效果.方法:选取2009年1～12月收治的1 280例患者未实施护理风险管理,选取2010年1～12月收治的1 280例患者实施护理风险管理.结果:实施护理风险管理前患者对护理工作满意度为87.96%,实施护理风险管理患者对护理工作的满意度为96.02%,实施护理风险管理前后患者对护理工作满意度比较差异有统计学意义(P＜0.01).结论:实施护理风险管理可有效增强护理人员的风险防范意识,可提高妇产科护理质量,有效防范风险事件发生,提高患者满意度.     

风险管理在急诊护理管理中实施体会

目的:提高护理人员的风险意识和自我保护能力,减少医疗纠纷的发生。方法:对现有和潜在的护理风险进行识别和评价,实施护理风险管理程序。结果:护理人员的风险意识及责任意识增强,极大的减少了护理差错和护患纠纷的发生。结论:实施风险护理管理,提高了急诊护理质量,保证了护理安全。     

护理风险管理在急诊危重患者护送中的运用

目的探讨护理风险管理在急诊危重患者护送中的运用。方法成立风险管理小组；明确风险管理职责；制定护理风险管理预案；培训护理人员风险防范意识和抗风险能力；建立严格的护理质量监控系统。结果患者护送安全，无护理差错、事故发生。结论实施有效的护理风险管理，对预防患者护送中的安全隐患，减少纠纷具有重要作用。     

手术后麻醉恢复室护理风险分析及管理对策

目的:探讨手术后麻醉恢复室(PACU)存在的护理风险特点及针对性的风险管理对策.方法:以风险管理知识为指导,对2010 年我院手术后入PACU 的13 094 例患者(分上下半年)进行回顾分析,上半年6 612 例患者作为对照组,下半年6 482 例患者作为研究组.对照组仅行一般性临床护理,研究组针对护理风险实施针对性护理措施.对两组的护理质量进行比较.结果:实施风险管理后,护理人员的风险防范意识显著提高,护理风险事件频次减少,护理环境改善,研究组各项指标显著优于对照组.结论:风险管理有助于护士提高护理风险意识和应对能力,是减少护理风险事件的有效方法.     

急诊危重患者护理风险识别与管理

目的提高急诊科护理人员对急诊危重患者护理风险识别,加强护理风险管理,提高护理质量。方法对急诊危重患者护理风险进行分析和讨论,提出规避风险的管理策略。结果实施急诊危重患者的风险管理,使护理人员风险意识提高,增强了法制观念和工作责任心,加强了护理专业知识的学习和专业技术操作训练。结论建立健全规章制度,抓好护理人员的安全教育,提高护理人员的整体素质,规避护理风险是保障抢救成功的前提。     

风险管理在肾内科护理中应用的效果评价

目的分析肾内科护理风险的相关因素及探讨风险管理的策略。方法对我院肾内科的39名护士实施风险管理,对比实施护理风险管理前后护士的知信行（KAP）问卷得分情况,以及护理风险事件、投诉事件的发生率及患者满意度等情况。结果对护理人员实施护理风险管理后,护士的KAP问卷得分较实施前显著增高;护理风险事件、投诉事件的发生率显著降低;患者对护理的满意度显著增高。结论对护理人员实施肾内科护理风险管理,可有效提高护理质量,减少护理风险事件的发生率。     

风险管理在城镇医院普外科患者住院期间效果分析

目的 探讨城镇医院普外科患者围手术期存在的风险因素及针对性的风险管理措施..方法 在患者术前术后进行全程标识管理、细节管理、护理人员安全防范意识的培养等,评估实施风险管理前后护理不良事件发生率、护理人员护理流程的规范率及其法律安全认知度的差异.结果 风险管理运用于普外科,发生在患者身上的差错率较实施前降低38.5％,护理流程规范率提高21.3％,护理人员风险意识大幅度的提高.结论 运用风险管理可以有效避免护理差错事故的发生,有利于患者预后,提高护理质量.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.