护士长绩效考核在护理管理中的应用

目的:探讨护士长绩效考核在护理管理中的作用。方法:根据护士长工作职责,按德、能、勤、绩四个方面制定考核标准,进行定期、不定期的系统考核,并及时反馈考核成绩。结果:实施护士长绩效考核后护理质量、病人满意率、护理人员业务水平均有不同程度的提高。结论:护士长绩效考核提高了病人对护理工作的满意度;保障了护理安全,提高了护理质量;调动了护士长工作的积极性和主动性。     

县市级医院护士长竞聘上岗方法的效果

总结了基层医院在护士长竞聘上岗工作中的方法 和思路,包括根据基层医院护理人力资源现状,制定竞聘原则,在原来竞聘流程之外再增加:演讲答辩、民主测评、年终考核等程序.认为通过实施护士长竞聘上岗,客观公正地考核每一名竞聘者,优化人才队伍结构,使用人机制更具活力,同时保证了护理队伍的稳定性,护士长整体素质得到提高.     

市场化的医院 企业化的理念 人本化的管理

目的改革护理管理制度，借鉴企业管理理念，实施以人为本的护理管理模式，发挥护理人员的潜能。方法改革护士长管理办法，强化护理就业理念，更新服务观念，建立有效的沟通途径，正确处理患者的抱怨。结果护理管理达到了规范，病人的满意度调查达到99％以上，护理投诉率明显降低。结论增强了护士长的角色使命，提高了护理人员主人翁精神，建立了和谐的医患关系，实现了人性化护理服务。     

晨间护理质量与满意度调查

目的 了解临床护理人员对晨间护理质量的认识程度,提高护士长管理水平.方法 采取自行设计的问卷调查护士、医生、病人,了解我科晨间护理质量现状.结果 护理人员晨间护理质量自评与其他人员满意度存在差异,作为管理者护士长需要提高管理水平.结论 应进一步提高护理人员的职业素质,制定晨间护理标准,加强护士长护理质量控制的监督检查,做好医护配合,是提高护理质量的关键.     

基层医院护理质量持续改进中的细节管理

目的探讨细节管理在基层医院护理质量持续改进中应用效果。方法根据本院护理工作实际,成立由各科护士长、副护士长、专科护士组成的三级护理质控小组,对护理质量中的关键-环节质量进行培训督导考核,重点加强对影响患者安全的敏感因素进行评价。通过不断修订完善流程和质量标准,形成科学可行的质量控制体系,不断改善护理服务质量。结果通过细节管理模式的实施,护理质量体系不断完善,护士长管理能力不断提升,环节质量不断提高,患者安全得到保障。结论在基层医院护理质量持续改进中应用细节管理,能明显提升护理质量和护理人员风险意识,有利于和谐环境的发展和良性循环。     

按职上岗在外科重症监护室的应用及效果评价

目的探讨外科重症监护室（SICU）护理人员按职上岗的实施方法,以便更好地开展以病人为中心的整体护理,提高护理质量。方法对SICU护理人员实施按职上岗,包括建立合理组织架构,设立5个小组长分管病区工作;护理人员分为高级责任护士一责任护士一执行护士一辅助护士4个层次,制定和完善各级护理人员的工作职责,护士长对其工作情况给予量化考评。结果在SICU实施按职上岗有利于加强病区的有效管理,提高护理质量,调动护理人员的学习积极性,促进护理团队的精神文化建设,稳定护理队伍,促进护理学科的发展。结论在SICU实施按职上岗,使病区管理科学化、规范化,将使病人得到优质护理。     

浅谈责任制护理病房护士长的管理工作

责任制护理是临床护理工作的一大改革,是护理学向独立学科发展的必然产物。在计划与实施中,病房护士长是具体的组织者和领导者。下面谈谈我在实践中的粗浅体会。一.统一思想提高对责任制护理的认识我科共有病床四十五张,护理人员九名。在刚开始实行责任制护理时,有些护士认为,传染科病人多,护理人员少,工作量大,九名护理人员中,有三     

整体护理病房三级护理查房的体会

我院自1999年7月开始在整体护理模式病房中实施三级护理查房。1年多来,对800例危重病人进行了护理查房,查房的形式为责任护士每天查,主管护师或护士长每周查,副主任护师以上或科护士长每月抽查,护理部主任每季抽查。通过查房,明显提高了危重病人的护理质量,病人得到了更为优质的服务,护理服务满意率提高;对护理人员来说,提高了业务水平,锻炼了口头表达能力;对护理管理来说,及时了解护士对护理程序的应用情况,掌握危重病人的护理质量,对护理中存在的不足及时提出指导意见。     

护理人员“三基”培训“双轨制”管理模式的实践与体会

目的：促进护理人员扎实掌握护理基础理论,基本知识和基本技能。方法：制订培训计划,实施护理部督查和护士长培训,逐级负责的双轨制管理模式,全院定期统一考核。结果：提高了护士长的管理热情和团队建设能力,扩展了护理人员的知识广度。结论：增强了护理人员业务知识的综合运用能力和临床应急能力,＂双轨制＂培训管理模式在基层医院是有效可行的。     

运用护理程序开展晨间业务查房的体会

护理查房是护理部主任或科护士长、护士长通过查阅病历、查看病人以及询问病人和家属，系统地检验护理程序的实施，及时评价专业护士的工作情况和病历书写质量，提高各级护理人员的业务水平以及检验护理质量的重要手段。我科自2006年开展现代护理模式病房，为使护理业务查房适应护理模式的转变，不断改革护理业务查房的内容与形式，增加护理业务查房的内涵。一年多来，通过每周开展护士长晨间业务查房，提高了护理队伍的综合素质及护理服务质量，对整体护理工作的发展起到了积极的推进作用。现介绍如下。     

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.