临床护理人员针刺伤及相关因素调查分析

目的了解临床护理人员发生针刺伤的状况，分析发生针刺伤的相关因素，并探讨预防对策。方法对某综合性医院全体临床护理人员323位进行问卷调查，了解其针刺伤的发生状况及相关因素，并对调查结果进行分析。结果本次接受调查的323名护理人员在12个月内被针刺伤率为41．80％。针刺时正进行的操作主要是配药、拔针、处理废弃物等；9：00～11：00为针刺伤发生的高发时段；多数护士发生针刺伤时无干扰因素；针刺伤发生与护士视力、工作环境光线的关联不显著；操作中采取防护针刺伤措施的护士的比例为10．07％；剌伤后向护士长报告的仅有16．32％。结论护士发生针刺伤率较高。应提高护理人员重视程度，并减轻临床护士的工作量，督导护士执行操作规程和职业暴露防护措施，以减少针刺伤的发生。     

护理人员针刺伤原因分析及对策

目的:分析护理人员发生针刺伤的原因,探讨相关防护对策。方法:采用问卷调查法对1 500名临床护士进行调查,统计针刺伤发生情况,分析原因,制定并实施防护对策。结果:本组93名发生针刺伤315次;实习护士针刺伤发生率高于其他职称护理人员(P0.01);儿科针刺伤发生率较高,占30.20%;更换针头再次穿刺时发生针刺伤比例较高,占17.14%。结论:缺乏防护教育、违反操作原则、工作强度大、管理及制度不完善是发生针刺伤的主要原因。     

护理人员职业暴露现状调查

目的了解某医院临床护理人员职业暴露状况及其防护措施。方法通过现场调查与分析,了解医院临床科室一线护理人员职业暴露情况,提出防护措施。结果该医院临床护理人员发生针刺伤占各类人员的61.78%,有53.39%针刺伤是明确被乙肝病毒表面抗原阳性病人用过的针头所伤。操作中针刺伤由操作者自己造成的占76.15%,最易发生的操作环节为回套针帽。职业损伤的发生与工作时间、学历职称以及工作负荷等因素有关。结论该医院临床护理人员职业暴露发生率较高,自身防护措施落实不到位,应当加强职业防护知识培训。     

护理人员在静脉输液操作中针刺伤的调查研究

目的 了解云南省护理人员在静脉输液操作中发生针刺伤的情况,并提出有效的防护对策.方法 利用组织护理学术活动机会,对云南地区15所医院的323名护士随机发放问卷调查表,对调查资料采用回顾性分析方法.结果 323名护士针刺伤发生率为92.26%;护龄短的护士针刺伤发生率明显高于护龄长的护士,两者比较有统计学意义(P＜0.01);静脉输液操作中以针头用后重新套入针帽、吸取药液配液体时、安装或取下注射器/输液器针帽时较其他环节更容易发生针刺伤.针刺伤前接种乙肝疫苗的护士仅占55.36%;针刺伤后能够采取正确处理方法的护士仅占52.34%;对针刺伤防护知识基本了解的护士仅占26.85%;针刺伤好发部位以手掌居多,占78%.结论 静脉输液操作中针刺伤已成为护士最常见的职业损伤,增强护士安全防护意识至关重要,应制定静脉输液中防止针刺伤的规范操作流程,建立静脉输液针刺伤报告及回访制度,提高静脉输液器材的安全性,最大限度地减少对护士造成的危害.     

护理人员在静脉输液操作中针刺伤的调查研究

目的：了解云南省护理人员在静脉输液操作中发生针刺伤的情况,并提出有效的防护对策。方法：利用组织护理学术活动机会,对云南地区15所医院的323名护士随机发放问卷调查表,对调查资料采用回顾性分析方法。结果：323名护士针刺伤发生率为92.26%;护龄短的护士针刺伤发生率明显高于护龄长的护士,两者比较有统计学意义（P〈0.01）;静脉输液操作中以针头用后重新套入针帽、吸取药液配液体时、安装或取下注射器/输液器针帽时较其他环节更容易发生针刺伤。针刺伤前接种乙肝疫苗的护士仅占55.36%;针刺伤后能够采取正确处理方法的护士仅占52.34%;对针刺伤防护知识基本了解的护士仅占26.85%;针刺伤好发部位以手掌居多,占78%。结论：静脉输液操作中针刺伤已成为护士最常见的职业损伤,增强护士安全防护意识至关重要,应制定静脉输液中防止针刺伤的规范操作流程,建立静脉输液针刺伤报告及回访制度,提高静脉输液器材的安全性,最大限度地减少对护士造成的危害。     

我院医务人员针刺伤现状与防护意识的调查分析

目的了解医务人员针刺伤的现状及防护意识,促进其树立职业防护观念。方法采用问卷调查法对我院577名临床医务人员进行有关针刺伤情况和防护知识调查。结果50.26%的医生、89.33%的护理人员有被针刺伤的经历;其中,66.67%的外科、妇产科医生发生过针刺伤,30.00%的感染病科医生发生过针刺伤。护理人员发生针刺伤最多的科室是急诊科和手术室,发生率分别为96.15%和93.33%。医护人员对于针刺伤相关知识了解程度存在较大差异,45.54%的医生、34.84%的护士不知道自身乙型肝炎和丙型肝炎的免疫状态;20.94%和42.70%的医生和护士不知道预防血源性感染疾病的措施。结论医务人员对于针刺伤的危害及相关预防知识不足,应加强对医务人员针刺伤相关知识的宣传与教育。     

某地区各级医院护理人员针刺伤情况的调查分析

目的了解本地区各级医院护理人员针刺伤的发生情况,并探讨相应的防护对策。方法采用自设的临床护理人员针刺伤害情况调查表对本地区5所不同等级医院工作满1年的护理人员过去1年内的针刺伤情况进行问卷调查。结果本地区护理人员1年内针刺伤发生率为38.89%;各级医院1年内针刺伤发生率以三级医院最低;针刺伤主要发生在处理针头、加药、注射等操作时,其中,处理针头时发生的针刺伤居首位,占49.76%;针刺伤发生后92%的护理人员能正确对伤口进行处理,但针刺伤后的上报率较低,仅占26.29%。本地区一、二级医院针刺伤发生率较高,针刺伤主要发生在处理使用后针头及给患者进行操作时。结论应完善侵入性操作安全防护措施,规范利器盒使用,加强职业防护培训,落实标准操作流程,严格操作过程监管,大力提倡安全操作,降低针刺伤风险。     

107名临床护士针刺伤认知行为的调查

目的了解临床护理人员对针刺伤相关防护知识的掌握情况,为提高自我防护提供参考。方法对107名临床护理人员进行对针刺伤相关知识的认知情况和对接受相关知识培训的态度的问卷调查,用SPSS11．0软件包进行统计学处理。结果护士针刺伤认知情况及格率为59．8％．临床护理人员对针刺伤的预防及针刺伤后的处理等知识比较欠缺,得分情况与工作年限相关,79．4％护理人员认为加强针刺伤相关知识培训十分必要。结论建议护理院校增设护士职业防护课程;对在职护士开展多形式的继续教育,弥补相关理论、知识和技能的欠缺;规范护理操作行为,以便切实做好自身防护工作．     

基层医疗机构临床护士针刺伤害现状及防护知识调查分析

目的对本院护理人员锐器伤现状进行调查,为提高临床护理人员的防护意识,规范操作行为以及制定职业防护措施提供指导。方法 2013年1月~2014年5月,采用整群抽样调查方法,对本院全体护理人员进行现场问卷调查及访谈。结果被调查的307名临床护士中,231人曾发生过针刺伤,发生率为75.2%,其发生针刺伤415次,发生密度1.27次/(人·年),不同工作年限和职称的护理人员针刺伤发生率差异均有统计学意义(均P0.05)。锐器伤职业暴露发生的环节主要是整理用过的针头及注射器(22.17%)、将使用过的针头重新套上针帽(17.83%)。锐器伤涉及的主要医疗器具是一次性注射器(42.89%),以普通病房为主(24.82%)。不同工作年限的护理人员对于防护知识的方方面面的掌握率差异均有统计学意义(均P0.05或P0.001),护理工作年限1年和10年的护理人员对做注射治疗需要带手套的相关知识相对缺乏,而对于血源性疾病针刺伤暴露后的预防措施,低年资护理人员具备较完备的知识,说明低年资护理人员的理论知识较高年资护理人员丰富。结论临床护士面临针刺伤职业危险,防护意识淡薄,应强化"标准预防"理念的教育、提高职业防护意识、加强相关知识培训、完善操作规程并规范操作行为,减少临床护士针刺伤害的发生。     

护理人员针刺伤的危险因素与防护研究进展

针刺伤是指护理人员在护理操作过程中由针头造成皮肤出血的意外伤害.现已证实大约20种病原体可经针刺伤接种传播[1].近年来,对针刺伤的研究仍然是临床研究的热点,大多数医疗单位和护理人员对针刺伤害的防护有了进一步的认识,但是在职一线护士针刺伤的发生率仍然处于职业损伤的较高水平.王祥英等[2,3]统计显示,1年间临床一线护士针刺伤发生率为68.12%～84.2%,污染针头刺伤率为77.67%,年人均针刺伤2.8次,治疗室和手术室的针刺伤发生率甚至达100%.为了使护理人员对针刺伤害的危险因素和防护措施有比较全面的了解,以增强职业防护意识,减少针刺伤的危害,现就护理人员针刺伤害的危险因素与防护研究进展综述如下.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."