临床护理工作中履行告知义务的实践及效果

目的保证护理安全,降低护理纠纷及投诉的发生率.方法在临床护理工作中,培养护士的法律意识,建立护士告知、患者知情同意的管理制度,建立良好的护患关系;护士在护理活动中告知护理计划、医院环境与制度、医疗风险、患者的疾病信息及自我护理方法.采用问卷调查和随机访谈的形式评价患者对护理工作的满意度、护患纠纷的发生情况.结果患者对护理工作的满意率由2003年的92.3%上升到2005年的97.8%(P＜0.01),护理纠纷和投诉由2003年的12起减少到2005年的2起.结论履行告知义务,尊重患者知情同意权可减少护理纠纷的发生.     

护理告知及知情同意书对防范血透中心护患纠纷的作用

目的落实血透中心患者护理告知、知情同意书制度,降低护理纠纷及投诉发生率。方法按时间顺序将590例血透住院患者分为观察组（300例）和对照组（290例）。对照组按常规方式宣教;观察组采用口头护理告知,并自行设计包括5个系列28个务目的告知与知情同意项目书。采取书面告知、图文宣传告知及多媒体讲座告知等形式,对患者进行宣教。结果两组除环境设施与制度所致的护患纠纷外,因安全防护措施、护理操作、治疗不良反应及相关费用所致的护患纠纷发生率比较,差异有统计学意义（P〈0．05,P〈0．01）。结论履行护理告知义务、尊重患者知情同意权可减少护患冲突和护患纠纷。     

护患纠纷后护理人员心理状况调查分析

目的 提高护理服务质量，减少护患纠纷。方法 采用问卷调查方式调查发生护患纠纷后38名护士的心理变化。结果 发生护患纠纷后仅4名护士表现为正性心态（10．5％）；34名（89．5％）表现为负性心态。其中高年资（护龄≥10年）护士心态显著优于低年资（护龄〈10年）护士（P〈0．01）。负性心态中低年资护士以愤怒和悲观为主（82．1％、75．0％），高年资护士以迁就为主（50．0％）。结论 发生护患纠纷后，护士以负性心态为主，尤其是低年资护士。应重点加强低年资护士护理安全教育，强化其优质服务意识，尽早公平解决纠纷，以使护士尽快恢复正常心态。     

护理告知及知情同意书对防范血透中心护患纠纷的作用

目的落实血透中心患者护理告知、知情同意书制度,降低护理纠纷及投诉发生率。方法按时间顺序将590例血透住院患者分为观察组(300例)和对照组(290例)。对照组按常规方式宣教;观察组采用口头护理告知,并自行设计包括5个系列28个条目的告知与知情同意项目书。采取书面告知、图文宣传告知及多媒体讲座告知等形式,对患者进行宣教。结果两组除环境设施与制度所致的护患纠纷外,因安全防护措施、护理操作、治疗不良反应及相关费用所致的护患纠纷发生率比较,差异有统计学意义(P0.05,P0.01)。结论履行护理告知义务、尊重患者知情同意权可减少护患冲突和护患纠纷。     

层级制护理小组为单位排班模式在急诊科的实践

目的探讨急诊科实施以层级制护理小组为单位排班模式对提高护理人员素质和护理质量的效果。方法根据在岗护理人员的的职称、年资、学历、实际工作能力、经验和责任心进行新老、强弱合理搭配,组建层级制护理小组,以小组为单位进行排班。连续2年后从患者投诉、护理差错及护患纠纷发生率、患者满意度4个方面进行评价。结果实施层级制小组排班后患者投诉、护理差错及护患纠纷由13例次、2起、2起减少至4例次和0,患者满意度由93．1％升至98．1％。结论以层级制护理小组为单位排班模式有利于护理人员相互学习。取长补短,提升综合素质．从而提升护理质量和患者的满意度。     

应用护理营销策略提高急诊患者满意度

目的探讨应用营销策略提高急诊患者满意度的方法和效果。方法将内部营销、外部营销及互动营销的营销理论，结合急诊工作特点，应用于急诊科护理管理。结果患者满意率由实施前90．42％提升至实施后96．61％，差异有显著性意义（P〈0．01）；护患纠纷与投诉由实施前3例次将为零。结论采用护理营销策略能提高护理服务质量和患者满意率，减少护患纠纷。     

卡式高压蒸汽灭菌器用于连台腹腔镜手术器械快速灭菌的效果观察

根据破伤风抗毒素脱敏注射的特点自行设计破伤风抗毒素脱敏注射知情同意书并应用于临床，即护士脱敏注射前充分口头告知，将知情同意书交给患者及其代理人阅读，双方签名后妥善保存。知情同意书的应用，加强了护患沟通，增强了护理人员的责任感，减少了护患纠纷。     

论患者的知情同意权与护士的告知义务

对患者的知情同意权和护士的告知义务进行概述。认为护士履行告知义务有利于建立和维护和谐的护患关系,有利于护士的自我保护。同时,护士在履行告知义务中应注意明确告知主体即知情同意权的主体,掌握告知时间,并取得履行告知义务的证据。     

护士情绪工作管理效果评价

目的 探讨护士情绪工作管理的方法及效果.方法 对手外科31名护士情绪工作加强管理,内容包括情绪评估,合理排班,组织培训,开发情绪智力,建立支持系统,建立激励机制等.结果 情绪工作管理实施1年后,护士情绪稳定,护理工作有序、顺利;护患纠纷发生率及患者对护理服务态度的满意度比较,差异有统计学意义(均P＜0.01).结论 对护士情绪工作进行有效管理,可促进护士合理调控情绪,减少护患纠纷,提高护理服务满意度.     

论患者的知情同意权与护士的告知义务

对患者的知情同意权和护士的告知义务进行概述。认为护士履行告知义务有利于建立和维护和谐的护惠关系，有利于护士的自我保护。同时，护士在履行告知义务中应注意明确告知主体即知情同意权的主体，掌握告知时间，并取得履行告知义务的证据。     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.