病人入院护理评估中的缺陷及干预措施

入院病人的评估直接影响着病人住院期间的整体护理质量。在病人入院护理评估单的检查中,发现在入院评估完成时间、评估资料完整性、阳性资料准确性、评估方法规范性和质量控制有效性等方面存在缺陷。通过加强教育提高认识、规范护理体检程序、加强环节质量监控等方法可以提高护理入院评估质量,促进整体护理质量的进一步提高。     

广东省18所医院护理入院评估的质量调查与分析

目的 :探讨提高护理入院评估质量的措施。方法 :以广东省 18所医院为调查对象 ,通过收集资料、实地考察、发放问卷和召开座谈会等方法 ,对各家医院现有的入院评估表设计、填写的完整性及与病人情况符合率、评估后护理诊断的分类比例和护士评估相关知识培训情况等进行调查与分析。结果 :5 5 %的医院在设计入院评估表时思路不明确 ;知识缺乏和焦虑占人文相关护理诊断的 82 .2 % ;98.96%护士缺乏系统的健康评估的知识和技能培训。结论 :要纠正入院评估表设计中存在的错误认识 ,系统科学地设计入院评估表 ;提高护士护理评估知识和技能是提高护理评估质量的关键     

入院评估资料采集的探讨

采集入院评估资料 ,是整体护理的基本功 ,体现出护士的素质和修养 ,护士对具体病人采集资料的态度、方法、能力、程度可影响整体护理的质量。目前 ,造成整体护理工作质量不高 ,工作皮软现象的原因 ,一是护士工作繁忙时 ,容易自觉不自觉地回到功能制的老路 ,容易简化和省略资料的采集。二是有的护士不知怎样采集入院评估资料 ,怎样与病人沟通。采集入院评估资料 ,是整体护理接触病人的第一步 ,也是病人接受整体护理 ,对责任护士形成第一印象的关键。做好入院评估 ,可为诊断、计划、实施、评价打下坚实的基础。为推动整体护理向纵深发展 ,我们…     

生存质量评估表在支气管哮喘患儿管理及生存质量评估中的应用

目的研究应用哮喘生存质量量表评估哮喘患儿管理的临床意义。方法回顾性分析2013年7月~2014年7月于本科治疗的75例支气管哮喘患儿的临床资料,所有患儿均实施护理管理,观察入院1 d、3 d、7 d,出院1 w、2 w患儿肺功能FEV1、PEF、FEF25、FEF50、FEF75改善情况,应用生存质量评估表评估各时点护理管理效果,并参考量表评分改进护理细节、优化护理管理。结果出院2 w时生存质量评估表评分中各项评分、患儿肺功能各项指标与入院1 d、3 d、7 d、出院1 w时对比,均明显改善(P0.05)。结论应用生存质量评估表评估、反馈、改进支气管哮喘患儿护理管理,可优化患儿生活质量,效果显著,值得临床推广应用。     

老年患者入院评估存在的护理风险及防范对策

目的探讨老年患者入院评估存在的护理风险,提高入院评估质量。方法随机抽查我院老年病房6个科室260份护理电子病历,并假以入院患者陪同(家属)身份随同观察98名护士做入院评估,分析存在的护理问题,并提出防范对策。结果入院评估中存在的护理问题包括护理人员对老年患者入院评估的重要性认识不足、护理入院评估表未得到充分利用、入院评估缺乏技巧、缺乏老年疾病专科信息的评估以及不重视医技检查的结果等。结论规范老年患者护理入院评估行为,提高入院评估质量,有助于降低护理风险。     

入院评估表的设计及应用

目的以"整体护理"为指导思想,贯彻"优质护理"的理念,改进并完善患者入院评估表。方法围绕生理-心理-社会模式,以排除护理安全隐患、提高患者满意度为目标,全方位收集入院患者资料,评估其存在的护理问题,依此制定护理计划。结果新完善的入院评估表能体现对患者实行责任制整体护理,为伤病员提供连续全程的专业护理服务的框架。结论改进的入院评估表具有良好的实用价值,值得临床推广应用。     

JCI标准下PDCA在护理入院评估表修订中的应用

目的 通过对入院评估表的修订及应用,提高对病人入院评估的质量。方法 通过PDCA循环管理方法对修改前护理入院评估表进行持续改进。结果 修改后入院评估表更能反映病人存在的护理问题,t=5.44(p=0.012＜0.05);护士对修改后入院评估表内容实用性、对病人病情的了解、对病人现存护理问题的判断、提高书写质量及费时情况5个方面评价均高于修改前入院评估表;使用修改后入院评估表后病人对入院健康教育的满意度评分从86.3分上升至93.7分。结论 运用PDCA管理方法修订的JCI标准入院评估表能够指导护士为病人提供国际化的优质服务。     

入院护理评估单在泌尿外科病人中的应用

护理评估是有计划、有目的、有系统地收集病人资料的过程。是护士对病人在入院时和入院前一段时间的身体状况、心理状态以及社会适应能力的评估,根据收集到的资料信息,对护理对象和相关事物作出大概推断,从而为护理活动提供基本依据。评估是整个护理程序的基础。同时也是护理程序中最为关     

病人入院护理服务现状调查

[目的]了解医院护理人员对病人入院护理服务的现状，分析其存在的问题，以提高病人入院护理服务质量。[方法]采用自行设计的问卷，对3所三级甲等医院和4所二级甲等医院从事临床护理工作的448名护士进行问卷调查。[结果]61．2％护理人员重视入院护理工作，31．0％护士把入院护理服务看成常规的工作内容来完成，7．8％的人不重视，不同护龄的护理人员对其重要性的认识差异有统计学意义（P〈0．01）；就目前的入院护理服务内容和方式，52．6％的护士认为不完善；护士常做入院护理评估的占62．6％；81．8％护士所在科室有自行设计的入院护理评估表，但很少应用；了解和收集心理状况资料的占57．9％。[结论]目前临床入院护理服务工作还处于相对滞后的状态，护理管理者应加强入院护理服务质量控制，入院护理服务的内容、形式应满足病人需要。     

入院患者护理评估书写存在问题及对策

入院患者护理评估是指护士对患者入院时基本护理信息收集后的记录。根据湖南省《护理文书书写规范及管理规定》，入院患者护理评估属于护理文书的一个部分。但因不属于《医疗事故处理条例》所规定的病历资料复印范围，不少护士思想上对其重视不够，加之缺乏收集信息的能力，入院患者护理评估书写存在问题较多，成了影响护理文书整体质量的瓶颈。随机抽查本院出院病历650份，就入院评估书写存在问题报告如下，并进行原因分析。     

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.