儿科护理中存在的纠纷原因分析及对策

目的探讨儿科护理中存在的纠纷的常见原因及相应对策。方法人选2009年7月至2011年9月在我院住院治疗患儿276例，在患儿出院时对患儿及其家属进行问卷调查，综合分析护士、患儿及其家属的意见，探讨引起护患冲突的原因及其对策。结果引起护士和患儿及其家属冲突的主要原因包括以下几个方面，护士态度恶劣、没有掌握良好的沟通技巧、护士专业素质不高、护患双方缺乏法律意识、病房环境较差、护士的工作负荷较大和医院管理问题；其中最主要的问题是双方没有掌握良好的沟通技巧。结论改善护患之间的沟通，增强医院的各方面的管理，可以显著减少护患之间的沟通障碍，从而营造良好的医院氛围。     

小儿门诊输液室护患冲突原因分析及防范对策

小儿门诊输液室是医院的一个窗口,也是最易引起患儿及家属投诉的部门之一.减少护患冲突,使他们在平衡的心理状态下接受输液是治疗成功的关键.我们在长期的工作实践中,重视引起护患冲突的各种因素,及时采取各种防范措施,有效地减少了护患冲突的发生,提高了护理质量.现报告如下.     

循证护理在提高百日咳患儿家属感知护理支持程度中的应用

目的探讨循证护理在提高百日咳患儿家属感知护理支持程度中的作用。方法对382例百日咳患儿家属实施科学的健康教育,心理护理,满足家属的身心需要。结果家属与护士之间建立了良好的信任度,没有发生一例护患纠纷。结论运用循证思维有利于提高百日咳患儿家属情感和信息支持,对护理服务质量满意。     

照相机在NICU探视中的应用体会

由于新生儿特别是早产儿免疫系统不完善,具有易感性,所以NICU是无陪护的护理模式和限制探视的制度,但是100%入住监护室的患儿家属认为探视相当重要,大部分患儿家属不能或不能完全接受,我院将照相机应用在NICU探视中,取得良好效果,不仅缓解了患儿家属的负性情绪,也改善了护患关系,提高了患儿家属满意度和减少了护患纠纷。     

基层医院护患纠纷原因分析及防范对策

总结了基层医院护患纠纷发生的原因及防范对策,原因主要包括医院管理方面、护士方面和患者及家属方面;防范对策主要包括完善人员管理、强化护理安全意识及护士专业技能培训、加强法律教育及护患沟通等,认为患者、家属及全社会对护理工作的理解与支持也是减少护患纠纷的重要因素。     

给予患儿家属支持护理对家属心里感觉和护理满意度的效果分析

[目的]探讨护士给予患儿家属支持护理对家属的心里感觉、护理满意度的影响。[方法]将90例住院患儿家属分为观察组(45例)和对照组(45例),观察组运用人文关怀的原理给予家属护理支持,对照组采用常规的护理模式。观察比较两组患儿及家属的心里感觉、护理满意程度。[结果]给予护理支持的观察组消除了家属的负性情绪,提高了临床护理质量,观察组的满意度明显高于对照组,差异有统计学意义(P<0.01)。[结论]给予患儿家属护理支持有利于护士和患儿家属之间相互理解、相互尊重,从而提高护理满意度,给予护理服务对象提供高质量的服务。     

双休日护士负性心理分析与对策探讨

随着双休日的实施,临床第一线的护士随之产生一系列负性心理。如:攀比心理、失落心理、迁怒心理、应付心理等。这些负性心理的存在与护理差错的发生及护理质量皆具有相关性。因此,作为护士本身和护士的管理者应及时调整护士的负性心理,制定相应的措施,弱化负性情绪,变消极因素为积极因素,更好地为伤病员提供优质服务。     

有效沟通在儿科护理工作中的应用

儿科护理人员在从事护理工作时,不仅要为患儿进行技术护理,更要做好心理护理及对患儿家长的解释、咨询、安慰等工作,所以,护士与患儿及患儿家长的有效沟通能促进良好护患关系的建立,帮助患儿适应环境,从而解决患儿的健康问题。1沟通内容包括对病区环境、规章制度的宣传,对主管医生、护士、科主任、护士长的介绍。了解儿童患病后家长的忧虑和担心,及患儿、家长对治疗护理的特殊需要及愿望,与家长共同商量对个体护理所实施的护理措施,并取得家长的支持与合作。2影响沟通的因素2.1家长的心理反应特点如沟通者的表达能力、理解能力、文化程度、性格特征、心理素质等,这些内部因素直接关系到沟通的成功与失败。2.2情绪反应孩子生病后,家属容易产生焦虑、烦躁等情绪,对医院的期望值也过高。     

护患沟通在儿科病房中的应用

随着现代整体护理模式的转变，护士的职责范围日益扩大，对病人的帮助不仅仅单靠技术措施，而且更加注意心理、社会及情感因素在治疗护理中的作用。护士用自身良好的情绪去影响病人，帮助病人创造最佳的心理健康水平，从而具有战胜疾病的信心，并协同护士共同完成各种治疗和护理，使病人早日康复。护患沟通，主要是指护士与病人及其亲属，陪人之间的沟通，良好的护患沟通，对于提高护理质量，改善服务态度有着积极的影响。在儿科病房，护患沟通就显得尤为重要。如何才能与患儿及家属建立良好的沟通，     

心理干预对血液肿瘤患者护理满意度的影响

目的:探讨心理干预对血液肿瘤患者及家属满意度的影响,以期为临床护理工作提供依据。方法:将2010年4月～2011年10月住院的140例血液肿瘤患者按照数字表法随机分为干预组和对照组各70例,对照组患者按血液科护理常规进行护理,干预组患者除常规护理,加用以支持性心理治疗和改善患者的负性情绪为主的心理干预。于出院时分别进行我院自制的满意度问卷调查和护理服务质量评分,然后对所得数据进行统计学处理与相关分析。结果:干预组在患者满意度和各项护理质量方面均优于对照组(P<0.05)。结论:全面及有效的心理干预能提高患者对护理工作的满意度,利于构建和谐的护患关系,为提高临床护理质量和开展护理工作创造了便利条件。     

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.     

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.     

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.     

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.