开展星级服务的实践与体会

目的为深化护理体制改革,探讨优质高效的以病人为中心、以质量为核心的护理服务模式。方法结合各科室不同工作特点制定相应的量化考评标准,根据护理部、科室及病人三方面的阶段性综合测评结果,确定三种星级护士。结果各科护理综合质量总分从90．14±3．12提高到94．32±2．16;病人对护理工作满意度总分从92．10±2．14提高到98．50±1．32,护士操作技术评分从85．50±5．40提高到90．32±4．13;“三基”理论考试从90．32±4．18提高到94．16±5．23。p值均小于0．01。结论推行星级护理规范了护士行为。     

实行聘用护士量化绩效考核的效果与分析

目的　探讨切实可行的聘用护士量化绩效考核模式。方法　通过护理部、科室双重考核评分的方法,确定考核结果(优秀、称职、基本称职、不称职),同时进行奖惩,优胜劣汰。结果　实施量化绩效考核后科室护理综合质量总分由实施前(91.56±3.36)提高到(95.67±2.12)(P <0.01),病人对护理工作满意度总分由实施前(90.16±3.25)提高到(95.55±1.92)(P <0.01),全国护士执业考试通过率由实施前75%提高到98.3%(P <0.01)。结论　护理管理工作中实行量化绩效考核,能促进护理质量和护理人员综合素质的全面提高。     

实行聘用护士量化绩效考核的效果与分析

目的探讨切实可行的聘用护士量化绩效考核模式.方法通过护理部、科室双重考核评分的方法,确定考核结果(优秀、称职、基本称职、不称职),同时进行奖惩,优胜劣汰.结果实施量化绩效考核后科室护理综合质量总分由实施前(91.56±3.36)提高到(95.67±2.12)(P<0.01),病人对护理工作满意度总分由实施前(90.16±3.25)提高到(95.55±1.92)(P<0.01),全国护士执业考试通过率由实施前75%提高到98.3%(P<0.01).结论护理管理工作中实行量化绩效考核,能促进护理质量和护理人员综合素质的全面提高.     

星级服务在护理管理中的应用

[目的]探讨星级服务在护理管理中的应用.[方法]根据护理部、护士长、医生及病人的动态阶段性综合考评确定星级护士,实施星级服务,比较实施前后的效果.[结果]星级服务实施前病人对护理服务的满意度为91.6%,实施后为96.6%;星级服务实施后护士的操作技术和"三基"理论考核成绩均优于实施前(P均＜0.05).、[结论]实施星级护理服务,规范了护士的行为,保障了病人的安全,促进了护理业务技术和服务水平的提高,提高了病人对护理服务的满意度.     

癌症化疗患者舒适护理的探讨

目的　探讨舒适护理在癌症患者化疗过程中的作用。方法　对 5 0例患者进行“化疗前疏导、化疗中护理、化疗后观察与随访”的舒适护理与未经舒适护理的 5 0例患者的资料进行分析 ,比较两组患者化疗后的生活质量。结果　舒适护理组生活质量得分 (x±s) 47.64± 9.0 1,对照组得分 3 8.18± 11.0 2 ,P <0 .0 0 1。结论　舒适护理在癌症化疗中的运用提高了护理质量 ,充实了“以人为本”的整体护理内涵     

志愿者咨询服务在妇科护理中的实践

目的：探讨实施志愿者护理咨询服务在妇科优质护理服务中的作用。方法：根据妇科护理人员的结构及工作情况,针对科室开展＂优质护理服务示范工程活动＂存在的问题,组建科室护理志愿者咨询团队,制定团队工作目标、职责、任务,有计划、有组织地实施志愿者护理服务方案。比较实施志愿者护理咨询服务前、后,优质护理服务示范病房的临床护理管理质量和临床护理服务质量、住院病人遵医行为依从性及服务满意度、医护人员服务满意度等。结果：志愿者咨询护理服务实施后,临床护理管理质量和临床护理服务质量均明显高于实施前,差异有统计学意义（P〈0.01）;病人总满意度（满意＋基本满意）由实施前的80.3%,提高到实施后的97.8%（P〈0.01）,病人的遵医行为中服药依从性由实施前的81.1%,提高到实施后的99.5%（P〈0.01）。结论：实施志愿者护理咨询服务后,护士有了专门的时间与病人沟通及提供心理护理和健康教育,加之相关制度的实施及运作,增强了护士主动服务的意识、工作的积极性及责任心,提高了护理质量和病人满意度,促进了病区医、护、患关系的和谐发展,在病区优质护理服务中起到了积极有效的作用。     

合并精神分裂症糖尿病患者实施护理干预探讨

目的探讨适合于合并精神分裂症的糖尿病患者的护理措施。方法 33例合并精神分裂症的糖尿病患者在常规降糖药物治疗的同时辅以综合护理干预措施 ,观察患者的配合治疗程度和血糖变化。结果 护理干预后病人治疗的依从性明显提高 ,血糖由 (9 5 0± 3 2 4)mmol/L下降至 (6 78± 2 61)mmol/L(P <0 0 5 )。 结论 合并精神分裂症的糖尿病患者进行综合护理干预是必要的     

临终关怀病人的心理护理

目的　探讨心理护理干预对临终关怀病人焦虑和抑郁情绪的作用。方法　对 60例临终关怀病人进行心理护理干预 ,干预前后采用焦虑自评量表 (SAS)和抑郁自评量表 (SDS)作测查 ,比较心理护理干预的效果。结果　SAS均分干预前为 65 .49± 7.85 ,干预后为 5 0 .81± 1 1 .5 9;SDS均分干预前为 66.1 0± 1 1 .45 ,干预后为 5 2 .45± 1 0 .0 4,干预前后两量表评分差异均有显著性意义 (P<0 .0 1 )。结论　对临终关怀病人进行心理护理干预能有效减轻病人焦虑和抑郁情绪 ,提高生命质量。     

浅谈心理护理在“一对一”全程陪伴分娩中的作用

目的　探讨心理护理在“一对一”全程陪伴分娩中的作用。方法　将 2 0 0 1年 7～ 1 2月在本院分娩的初产妇 50 0例 ,随机分为“一对一”全程陪伴分娩 32 0例作为观察组 ,导乐陪伴分娩 1 80例作为对照组 ,观察组实行“一对一”全程陪伴 ,进行三个产程的心理护理。结果　①两组分娩方式比较 ,自然分娩对照组与观察组分别为 70 .6 %与 79.7% (P <0 .0 1 ) ,阴道手术助产分别为 9.4%与 7.5 % (P <0 .0 5) ,剖宫产分别为 2 0 .0 %与 1 2 .8% (P <0 .0 1 ) ;②两组阴道分娩 (包括自然分娩与阴道手术助产分娩 )产程时间比较 ,第一产程对照组与观察组分别为 396± 1 0 2min、30 6± 78min (P <0 .0 5) ,第二产程分别是 62± 1 3min、45± 1 0min(P <0 .0 5) ,第三产程分别是 1 2± 4min、1 0± 2min (P >0 .0 5) ;③两组新生儿出生 1minApgar评分比较 ,对照组与观察组 8～ 1 0分分别是 94.4%、97.5 % (P <0 .0 5) ,4～ 7分分别是 4 .4%、2 .2 % (P <0 .0 1 ) ,1～ 3分分别是1 .1 %、0 .3 % (P <0 .0 5)。结论　“一对一”全程陪伴分娩中陪护人员根据产妇不同产程施以心理护理 ,能有效改善产妇心理状态 ,发挥其主观能动性 ,提高产科质量     

心区交感神经阻滞治疗酒精性心肌病心力衰竭的临床研究

目的　探讨高位硬膜外阻滞治疗酒精性心肌病、心力衰竭的疗效。方法　实施高位硬膜外阻滞 (胸椎 1～ 5 ) ,间隔 2～ 4h于管内注射 0 5 %利多卡因 3～ 5mL ,适当辅以药物治疗 ,4～ 8周为 1疗程 ,于治疗前后做超声心动图检查。结果　①治疗后症状、体征迅速改善、心功能提高 ,NYHA分级由 (3 7± 0 5 )至 (2 1± 0 6)级 ,P <0 0 5 ;②心腔缩小〔LV(72± 8)vs(69± 8)mm ,P <0 0 1;LA(4 4± 9)vs(4 0± 9)mm ,P <0 0 5〕 ,左室舒张末容积和收缩末容积缩小〔LVEDV(3 85± 12 0 )vs(3 5 2±112 )mL ,P <0 0 1;LVESV(2 72± 110 )vs(2 3 9± 10 9)mL ,P <0 0 1〕 ,射血分数提高〔LVEF(3 1± 9)vs(3 7± 9) % ,P <0 0 1〕 ,左室质量下降〔(4 12± 77)vs (3 85± 48)g ,P <0 0 5〕。结论　高位硬膜外阻滞治疗常用方法无效或疗效不满意的酒精性心肌病、心力衰竭患者改善心功能效果好 ,且能缩小心腔 ,逆转心肌重塑 ,是一种适合急救心衰的新方法     

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.