温馨服务承诺的实施与评价

目的探讨对患者实施温馨优质服务的方法，以提高护理质量及患者满意度。方法制定“温馨服务承诺”活动条例，下发到每位护理人员．同时进行相关培训及督促检查．在活动开展前及开展3个月后分别用自编的“患者对病区护理服务质量评价表”和“患者对病区责任护士满意度评价表”对70例住院患者进行问卷调查。结果“温馨服务承诺”活动实施后患者对护理服务质量及责任护士的满意度显著高于活动前（P〈0．05，P〈0．01）。结论护士在“温馨服务承诺”活动中重视对患者进行人性化服务，既加强了自身素质又有利于提高护理质量和患者满意度。     

扁平化排班责任包干制在优质护理实践中的成效

目的 探讨在“优质护理服务示范工程活动”中实施扁平化排班模式结合责任护士包干制护理患者的成效.方法 对骨科病区30名护士按扁平化排班模式优化排班、责任包干制护理患者,分别于实施前后对患者、护士、医生进行满意度调查.结果 实施后患者对责任护士满意度、护士对自身工作满意度、医生对护士满意度显著高于实施前(P＜0.05,P＜...     

外科优质护理服务试点病区开展责任制护理初探

目的在优质护理服务试点病区开展责任制护理,提高"患医护"满意度。方法学习领会"优质护理服务示范工程"精神实质,改革护士分工排班模式,落实责任制护理,责任护士提供全程、连续、无缝隙的护理,注重人文关怀、创建温馨病区等举措。结果患者、护士、医生针对开展责任制护理提出合理化意见或建议40余条;外科试点病区护士对"优质护理服务示范工程"知晓率为100%;患者知晓率100%;6个病区环境改善,并增加了相关设施;顺利推行护理排班模式改革及责任制护理,提供全程优质的护理服务,无一例发生护患纠纷,患者满意度97.1%,护士满意度93.1%,医生满意度为97.5%。结论在外科优质护理服务试点病区实施责任制护理,有利于提高护理质量和患医护满意度。     

Application of bedside work rating scale to charge nurse responsibility system

目的 探讨管床评分表在责任制护理实施中的应用效果.方法 在开展优质护理服务示范病房活动中实施管床责任制护理,应用自制的管床评分表对责任护士进行评分并纳入绩效考核.结果 应用管床评分表后患者对护理服务满意率、医生满意率、护士对患者十知道掌握情况较应用前显著提高(均P＜0.01).结论 管床评分表具有导向作用,有助于指导责任护士开展责任制护理,同时纳入绩效管理,增强了护士责任心和积极性,从而提高护理质量和患者满意度.     

实施护理品牌服务营造和谐病区环境

目的 探讨实施护理品牌服务对营造和谐病区环境的作用.方法 于2005年7月至2006年7月在病区实施护理品牌服务并比较实施前、后患者对护理服务的满意情况.结果 实施后患者对各项护理服务满意率均有所提高,其中对护理服务态度满意、护士能圆满解决问题等6项的满意率与实施前比较,差异有显著性意义(P＜0.05,P＜0.01).结论 实施护理品牌服务,能提高患者对护理服务的满意度,有助于营造和谐病区环境.     

Application of stratified placement of nurses and network-based management in the high-quality care demonstration project

目的 探讨护士分层使用与网络化管理模式在优质护理服务中的应用与效果.方法 选择外科4个专科8个病区为试点病房实施护士分层使用与网络化管理模式,包括病区护士层级设置与岗位职责制定,建立立体通信网络,对人员及护理质量进行网络化管理.结果 实施1年后,试点病房患者满意度及护士对工作的自我评价(对薪酬的评价除外)显著提升(均P＜0.01).结论 护士分层使用与网络化管理模式合理利用和优化配置人力资源,提高了护理服务质量,在开展优质护理服务示范工程活动中发挥了积极有效的作用.     

优质护理服务示范病区护士长五查房对护理质量持续改进的影响研究

目的:研究优质护理服务示范病区护士长每日五次护理查房对护理质量持续改进影响.方法:护士长每日五次重点高危时间段护理查房.通过满意度调查方法,对优质护理服务示范病区护士长开展五查房前后病人满意度情况及护理质量持续改进情况进行比较.结果:优质护理服务示范病区护士长开展五查房后病人满意度高于开展前,护理质量持续改进较开展前明显提高.(均P＜0.05).结论:优质护理服务示范病区通过护士长开展五查房,可以提高护理人员综合素质、护士长管理能力及患者满意度,减少护理并发症及不良事件发生.     

聘高年资护士为病区总责任护士的临床实践

目的利用高年资护士良好的交流沟通能力、娴熟的操作技能,提高护理服务满意度和护理质量。方法在18个病区聘高年资护士为总责任护士,护理部定期评价考核其胜任能力,比较实施前后患者满意度、护士工作满意度及病区护理缺陷、差错事故发生情况。结果聘高年资护士为病区总责任护士后病区患者满意度从92.00%提高到98.50%(P0.01),年护理差错事故从21起降至9起,临床护士工作满意度在护士之间关系、医护之间关系等5个方面显著提高(均P0.01)。结论聘高年资护士为病区总责任护士能充分利用资深护士的资源优势,是创建良好的医患关系,造就和谐医疗环境,提高患者满意度和护理质量的有效途径。     

老年专科护理的实践模式探讨

目的 探讨老年专科护理的实践模式,为更好地开展专科护理提供依据.方法 对1 660例老年住院患者开展老年专科护理实践,如建立老年护理专业架构,成立老年专科护理小组,规范专科护理程序,实行专科护理会诊、查房以及引进相关评估工具等.结果 实施老年专科护理后老年患者不良护理事件(如压疮、肺炎)的发生率显著低于实施前(P＜0.05,P＜0.01),患者满意度显著提高(P＜0.05).病区护士老年专科护理知识和技能考核优良率显著高于培训前(均P＜0.01).结论 建立老年专科护理实践模式,可提高老年护理质量及老年患者对护理质量的满意度,显著提高护士的学习热情和业务能力.     

护士分层管理模式下母婴床旁护理的实践

目的 探讨产科病区在护士分层管理模式下开展母婴床旁护理的方法,评价实施效果.方法 将产科病区护士分3层,即责任组长—高级责任护士—初级责任护士,实施责任组长负责的小组包干制整体护理.责任护士针对孕产妇不同住院阶段在床旁实行一对一、有重点的健康教育,对产妇及家属进行新生儿护理技能一对一的讲解和操作演示.结果 实施前后纯母乳喂养率、母乳喂养方法正确率(除抱奶体位外)及孕产妇对护理工作满意度比较,差异有统计学意义(P＜0.05,P＜0.01).结论 在护士分层管理模式的基础上实施母婴床旁护理能提高纯母乳喂养率,提高孕产妇对护理工作的满意度.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.