细节护理对手术室护理质量及患者满意度的影响

目的探讨细节护理对手术室护理质量及患者满意度的影响。方法采用常规护理与细节护理两种模式对130例患者进行分别护理,以护理质量及满意度评分来评价细节护理对手术室护理质量及满意度的影响。结果与常规护理比较,细节护理在护理质量及患者满意度方面差异均有统计学意义（P〈0.01）。结论细节护理能明显提高手术室护理质量及患者的满意度,值得在临床进一步推广。     

甲状腺专科病区的术前及术后护理

总结了312例甲状腺手术患者的术前及术后护理要点,术前护理包括心理护理、体位护理、排尿护理、呼吸道护理及术前准备,术后护理包括体位护理、饮食护理、引流管护理、并发症的观察及护理,并做好出院指导.认为作为甲状腺专科护士,理解甲状腺疾病的特点及治疗过程,才能更好地进行护理工作.     

开放性颅脑损伤62例急救与护理

护理质量监控及督检是保证护理质量的前提，涉及护理管理工作的方方面面。现将护理安全管理、护理缺陷及护理风险管理、护理质量管理思维模式的监控及督检报告如下。     

《护理学报》“中医护理”栏目征稿

为了促进中医护理的发展,提高中医护理质量,规范中医护理特色疗法及中医护理新技术,探索和推广中医护理新方法,共同推进中医护理学的繁荣和发展。本刊“中医护理”栏目特向广大读者及护理同仁征稿,欢迎踊跃投稿。1征稿内容1.1中医护理特色疗法及中医护理新技术在临床护理中的应用;1.2中医干预解决临床护理问题的效果评价;1.3疑难、罕见病例的中医护理体会;1.4中医护理的循证护理、Meta分析或系统评价;1.5新入职护士中医基础知识、中医护理操作技能的规范化培训;1.6情志护理、药膳护理在临床中的应用及干预效果评价;1.7中医护理技术、中医护理评估流程及质量标准的构建;1.8中医康复特色护理;1.9中医体质辨证及护理1.10中医护理相关量表的编制及测评1.11中医操作器具的改良及研制1.12中医护理方案在临床中的实践及其效果评价1.13中医护理管理新举措及中医护理学科建设的思考与探索1.14新教学模式在中医护理教学中的应用及效果评价1.15“治未病”理论在中医护理中的运用2投稿要求论文按本刊规范化格式撰写,未公开发表,投稿请登录《护理学报》网站http://www.hlxb.com.cn点击“在线投稿”,论文审理结果在网站回复。     

《护理学报》“中医护理”栏目征稿

为了促进中医护理的发展,提高中医护理质量,规范中医护理特色疗法及中医护理新技术,探索和推广中医护理新方法,共同推进中医护理学的繁荣和发展。本刊“中医护理”栏目特向广大读者及护理同仁征稿,欢迎踊跃投稿。1征稿内容1.1中医护理特色疗法及中医护理新技术在临床护理中的应用.     

《护理学报》“中医护理”栏目征稿

为了促进中医护理的发展,提高中医护理质量,规范中医护理特色疗法及中医护理新技术,探索和推广中医护理新方法,共同推进中医护理学的繁荣和发展。本刊"中医护理"栏目特向广大读者及护理同仁征稿,欢迎踊跃投稿。1征稿内容1.1中医护理特色疗法及中医护理新技术在临床护理中的应用.     

信息系统促进护理精细化管理的效果探讨

为了全面提高护理管理水平和护理质量,采用医惠护理信息系统进行精细化管理,该系统具有移动护士工作站及护理信息管理两大功能。通过对应用前及应用后的护理质量信息数据进行比较,医惠护理信息系统的应用使护理质量及护理管理水平均比实施前提高。应用医院信息系统促进了护理管理精细化,有效地提高了护理质量及护理管理水平。     

肝硬化食管胃底静脉曲张破裂出血的预见性护理干预

目的探讨不同护理方法对肝硬化上消化道出血患者再出血率及病死率的影响。方法以回顾性研究方式分析了2003—2005年以食管胃底静脉曲张破裂出血人院患者的临床资料。按接受护理方法的不同分为3组：A组：抢救及护理＋饮食护理;B组：抢救及护理＋心理护理＋饮食护理;C组：抢救及护理＋心理护理＋饮食护理＋预见性护理等综合护理。比较各组再出血率及病死率。结果12组患者病死率及再出血率明显低于A、B两组（P〈0．05）。结论预见性护理辅以心理护理等综合护理措施能提高抢救成功率及临床治疗效果。并降低患者再出血率及病死率。     

优质护理服务对护理科研工作的推动作用

目的探讨优质护理服务对护理科研工作的引领及推动作用。方法将优质护理服务的理念和方法应用于临床实际及护理管理,成立护理科研及护理科技创新小组,强化科技管理,从关爱患者的角度开展护理研究及护理创新,解决患者的护理问题,收集2009～2010年各项科研指标并进行统计学分析。结果 2010年各项科研指标数量较2009年均有增长。结论优质护理服务活动的开展能很好地推动临床护理科研工作均衡发展,提升护理学科水平。     

纤维喉镜下声带疾病手术治疗的护理配合

总结了115例采用纤维喉镜下声带疾病病人手术治疗的护理配合,包括术前心理护理、用药、麻醉及一般护理,术中积极配合及护理,术后饮食护理及并发症等的观察及护理,认为积极主动细致认真的护理配合是采用纤维喉镜下声带疾病手术治疗成功的重要保障。     

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.