护士护理不良事件报告认知与态度的调查研究

[目的]探讨护理不良事件报告认知与态度在任职方式方面的差异性,为护理不良事件的管理提供参考。[方法]运用不良事件报告认知与态度调查问卷对791名护理人员报告认知与态度进行调查。[结果]不同任职方式护士不良事件报告认知与态度差异有统计学意义(P0.01);在报告认知、执行意向、管理期望维度上差异也有统计学意义(P0.05);正式护士的报告认知与态度随学历的增高呈低—高—高的发展趋势,各学历间差异无统计学意义(P0.05);合同制护士的报告认知与态度随学历的增高也呈低—高—高的发展趋势,不同学历间差异有统计学意义(P0.01)。[结论]不同任职方式护理人员不良事件报告认知与态度不同;护理管理部门要给予合同制护士尤其低学历者更多的关注。     

肿瘤专科医院护士护理不良事件报告认知、报告意向与报告障碍的关系研究

目的探讨肿瘤专科医院护士护理不良事件报告认知、报告意向、报告障碍状况及三者的关系,了解护理认知与行为之间的相互作用,为减少报告障碍,提升肿瘤专科医院护士护理不良事件上报意向提供参考依据。方法应用护理不良事件报告认知问卷、报告意向问卷及报告障碍问卷对某肿瘤医院623名护士进行调查,应用线性回归分析、路径分析探索变量间的关系。结果肿瘤专科医院护士护理不良事件报告认知、报告意向、报告障碍得分分别为(3.31±0.38)分、(3.02±0.75)分、(3.57±0.50)分。路径分析结果显示,报告认知、报告意向对报告障碍有直接影响(P0.05)。结论护理不良事件报告认知越好的肿瘤专科医院护士,报告意向越积极,上报的积极性高,报告障碍越低。医院管理者应有针对性地对护士不良事件的报告认知和报告意向等方面进行培训,以提升医院护理安全文化氛围,保障护理质量安全。     

重症监护室护士护理不良事件上报认知及态度影响因素分析

[目的]探讨重症监护室(ICU)护士护理不良事件上报认知及态度的影响因素,为护理不良事件的管理提供参考。[方法]应用不良事件报告认知与态度问卷对170名ICU护士进行调查。[结果]ICU护士护理不良事件上报制度认知及态度总分为108.29分±11.42分。5个维度得分由高到低依次为报告认知(4.59分±0.56分)、报告意愿(3.99分±0.71分)、科室文化(3.78分±0.53分)、管理期望(3.60分±0.77分)、惩罚环境(3.51分±0.95分)。不良事件经历与护龄是ICU护士不良事件报告认知及态度的影响因素(P0.05)。[结论]ICU护士护理不良事件上报制度认知及态度处于中等水平,有待于进一步提高。     

护士护理不良事件报告认知与态度的调查研究

[目的]探讨护理不良事件报告认知与态度在任职方式方面的差异性,为护理不良事件的管理提供参考。[方法]运用不良事件报告认知与态度调查问卷对791名护理人员报告认知与态度进行调查。[结果]不同任职方式护士不良事件报告认知与态度差异有统计学意义（P〈0.01）;在报告认知、执行意向、管理期望维度上差异也有统计学意义（P〈0.05）;正式护士的报告认知与态度随学历的增高呈低-高-高的发展趋势,各学历间差异无统计学意义（P〉0.05）;合同制护士的报告认知与态度随学历的增高也呈低-高-高的发展趋势,不同学历间差异有统计学意义（P〈0.01）。[结论]不同任职方式护理人员不良事件报告认知与态度不同;护理管理部门要给予合同制护士尤其低学历者更多的关注。     

精神科护士患者安全文化态度现状及其影响因素分析

目的 了解精神科护士患者安全文化态度的现状,探讨精神科护士患者安全文化态度的影响因素,为提高精神科护士患者安全文化态度水平,保障患者安全提供参考。方法 采用医院护理人员患者安全文化态度调查问卷及护理不良事件报告障碍问卷对广东省精神病专科医院434名护士进行调查。结果 精神科护士患者安全文化态度总分(86.78±14.53)分,护理不良事件报告障碍总分为(54.38±12.0)分,单因素分析显示,不同性别、职称、职务、每月夜班数的护士,患者安全文化态度得分比较,差异有统计学意义(P＜0.05)。不良事件报告障碍得分与患者安全文化态度得分呈显著的负相关(r=-0.537,P＜0.001)。多元线性回归分析显示,不良事件报告障碍为患者安全文化态度的独立影响因素(R²=0.295,_△R²=0.287,F=35.876,P＜0.001)。结论 精神科护士患者安全文化态度水平有待提高,医院管理者应该重视影响精神科护士患者安全文化态度的因素,深入探索精神科安全文化的建设,提高安全文化水平,增强安全防范意识,保障患者的安全。     

肿瘤科护士护理不良事件报告意向及影响因素的调查

目的:调查肿瘤科护士护理不良事件报告意向,探讨肿瘤科护士护理不良事件报告意向的影响因素。方法:选取396名在岗的肿瘤科临床护士。采用护理不良事件报告意向问卷和报告障碍问卷调查临床护士不良事件上报的意向及其他影响因素。结果:肿瘤科护士报告意向问卷的得分范围为3~15,报告障碍问卷的得分范围为25~80,护理不良事件报告意向与年龄、工作年限及报告障碍中的惩罚文化和报告意义有关(P0.05)。结论:护理不良事件报告意向随着护理不良事件的严重程度的加重而增高,护士更倾向于采取上报上级主管的报告方式。年龄较高和工作年限较长的护士护理不良事件的报告意向相对较高,同时医院的惩罚文化和护士感受的报告意义均会影响护士护理不良事件报告意向。医院应尽快深化非惩罚文化理念,明确报告意义,提高护士的报告意向。     

医护人员对临床异常事件报告认知程度的调查

[目的]调查述医护人员对临床异常事件报告的认知程度,比较医生和护士对临床异常事件认知的差异,识别影响医护人员对临床异常事件报告认知程度的因素.[方法]方便抽样422名医护人员,采用改良的<临床异常事件报告认知问卷>进行调查.[结果]医护人员对临床异常事件报告的认知正确率为78.06%,其中报告类别的正确率为92.50%,报告重要性的正确率为95.67%,报告流程的正确率33.17%.医生和护理人员对临床异常事件报告的认知差异无统计学意义,在报告流程方面,护士得分显著高于医生得分.影响医护人员对临床异常事件报告认知的因素包括职业、年龄、工龄、职称和受教育程度.[结论]医护人员对临床异常事件的报告流程知识缺乏,必须对医护人员进行有关临床异常事件报告流程的培训,以提高上报率.     

护理人员循证护理技能的调查研究

[目的]了解护理人员循证护理技能现况.[方法]自行设计问卷,对我院100名护士循证护理技能进行调查.[结果] 护士循证护理技能得分(70.51±5.40)分,其中>80分5人,60分～80分90人,<60分5人;不同学历、职称、职务护理人员循证护理技能得分差异具有统计学意义,而不同工作年限护理人员得分差异无统计学意义;多元线性回归分析显示,学历是护理人员循证技能重要影响因素.[结论]护士具备一定的循证护理技能,学历是影响护理人员循证护理技能的重要因素,不同职称、职务护理人员基本体现出相应循证护理技能.     

婚姻状态对护理不良事件报告认知与态度的影响

[目的]探讨护理不良事件报告认知与态度在婚姻状态方面的差异性,为护理不良事件的管理提供参考。[方法]运用《不良事件报告认知与态度调查问卷》对791名护理人员进行调查。[结果]不同婚姻状态护士不良事件报告认知与态度比较差异有统计学意义(P0.05);在执行意向、管理期望维度上差异也有统计学意义(P0.05)。[结论]不同婚姻状态护理人员不良事件报告认知与态度不同,护理管理部门要给予未婚护士更多的关注。     

儿科护士对尿布皮炎认知及态度的调查分析

目的调查儿科护士对尿布皮炎相关知识的掌握程度及护理态度现状。方法采用自行设计的调查问卷对贵州省9所综合医院362名儿科护士进行调查。结果儿科护士尿布皮炎知识得分为(8.24±1.51)分,尿布皮炎护理态度得分为(20.93±3.22)分;科室、最高学历、本科室工作年限、职务是影响儿科护士尿布皮炎知识和态度的重要因素(P0.01)。结论儿科护士尿布皮炎态度属于偏积极水平,但尿布皮炎认知现状不容乐观,建议开展规范化培训,逐步建立尿布皮炎标准化护理流程及风险评估工具,充分发挥儿科护士在尿布皮炎预防管理中的作用。     

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.