基于评判性思维建立的护理培训在完全植入式输液港护理中的应用

目的探讨基于评判性思维建立的护理培训在完全植入式输液港护理中的应用。方法本院于2017年1～8月对普外科护士实施评判性思维能力培训,比较培训前后护士评判性思维能力、操作技能达标率及患者输液不良反应率和满意度情况。结果培训后护士评判性思维能力评分(包括寻找真相、分析能力、开发思想、系统能力、思维自信心、求知欲、认知成熟度及总评分)均高于培训前(P0.05);实施后护士输液港基本知识、并发症处理、植入输液港配合、输液港植入维护及出院指导等方面知晓率均高于实施前(P0.05);实施后患者并发症率发生率、意外风险发生率低于实施前(P0.05),而患者满意度高于实施前(P0.05)。结论基于评判性思维建立的护理培训能有效提高普外科护士评判性思维能力及完全植入式输液港护理操作技能,有助于降低患者并发症,提高患者满意度。     

浅静脉血管评级在手术室规范化培训护士静脉输液质量管理中的应用

[目的]通过对手术室规范化培训护士进行浅静脉血管评级的培训,提高静脉输液质量。[方法]2016年7月—2016年12月实施浅静脉血管评估及相关护理干预措施,将静脉评估、穿刺工具选择、首次穿刺成功、输液并发症及静脉穿刺技术满意度进行比较。[结果]规范化护士静脉评估能力、穿刺工具选择、首次静脉穿刺成功率、病人对静脉操作技术满意度明显提高。[结论]将浅静脉血管评级方法运用在手术病人静脉输液护理实践中,培养规范化护士在静脉输液过程中评估能力、解决问题能力,使规范化护士在静脉输液管理过程中能积极主动地采取干预措施,注重每一个操作环节,从而提高静脉输液护理质量。     

浅静脉血管评级在静脉输液穿刺管理中的应用

目的 进一步提高静脉输液穿刺成功率,为患者提供更人性化的护理服务.方法 观察组900 例浅静脉输液患者,在静脉输液前,采用浅静脉血管评级法,对其血管进行评估分级,确定穿刺难度系数,根据血管分级情况选择相应的穿刺者及护理干预措施.对照组900 例浅静脉输液患者,按常规静脉输液操作.比较两组静脉穿刺质量及患者对护士的服务和技术满意度.结果 观察组静脉穿刺工具选择合格率、静脉穿刺1 次成功率以及患者对护士静脉输液时服务态度、操作技术的满意度明显提高,静脉炎发生率也明显降低(P<0.05).结论 采用浅静脉血管评级与相关护理干预措施,可有效提高静脉穿刺成功率,减少静脉炎的发生,从而提升静脉治疗护理质量.     

评判性思维在预防小儿门诊输液用药风险事件中的效果观察

[目的]探讨评判性思维在预防小儿门诊输液用药风险事件中的应用效果。[方法]于2017年1月—2017年12月对门诊护士开始实施评判性思维培训,统计期间接收1 345例患儿输液期间用药风险事件发生率,并与2016年1月—2016年12月未实施评判性思维培训的临床指标进行对比,观察评判性思维培训的应用效果。[结果]培训后儿科输液穿刺一次穿刺成功率(87.66%)高于培训前(62.27%),静脉重注率(12.34%)低于培训前(37.73%),经比较差异有统计学意义(P0.05);培训后儿科输液缺陷及不良反应发生率(1.56%)低于培训前(7.83%),经比较差异有统计学意义(P0.05);培训前护理工作人员的评判性思维能力总分为(261.8±25.3)分,培训后总分为(311.4±29.2)分,经比较差异有统计学意义(P0.05)。[结论]评判性思维培训的实施有助于提高临床护理人员分析处理问题的能力,提高护理质量,有效减少输液用药风险事件,确保病人安全。     

基于评判性思维建立的护理培训在预防急诊输液用药风险事件中的应用效果

目的：探讨评判性思维在预防急诊输液用药风险事件中的效果。方法我院急诊科于2015年1月开始实施评判性思维培训,采用评判性思维能力测量表( CTDI-CV)评价培训效果,对比实施评判性思维培训前后的CTDI-CV评分、输液用药风险事件及护理满意度情况。结果采用评判性思维培训后,护士的评判性思维能力评分CTDI-CV总分为(311.4±29.2)分,明显高于培训前,差异有统计学意义(P<0.05)。培训后,输液用药不良反应仅2例,静脉炎1例,局部皮肤瘙痒1例,医生和患者对护理服务的满意度分别为91.6%和95.0%,均明显优于培训前,差异有统计学意义( P<0.05)。结论建立评判性思维模式有助于降低急诊输液用药风险,提高护理满意度,值得临床推广应用。     

评判性思维在采血晕针患者护理中的应用效果

目的探讨评判性思维在采血晕针患者护理中的应用效果。方法选取本院体检中心2015年10月～2016年10月在静脉采血过程中发生晕针的患者64例,将其随机分为对照组和试验组,对照组由未经评判性思维培训的护士护理;试验组由经正规评判性思维培训的护士护理。观察护士培训前后的评判性思维能力总分及各维度得分情况,比较2组患者晕针情况和对护理的满意度情况。结果护士培训前后的评判性思维能力总分及各维度得分均较前提高,试验组患者晕针情况低于对照组(P 0. 05),试验组患者的护理满意度高与对照组(P 0. 05)。结论在采血护理过程中,护理人员恰当地运用评判性思维降低了采血晕针情况的发生,提高了患者护理的满意度,为患者提供了高质量、高效果的晕针预防及护理对策,值得推广于临床。     

护士评判性思维培养对门急诊患者输液安全的影响

目的探讨护士评判性思维培养对门急诊患者输液安全的影响。方法对门急诊护士实施评判性思维能力的培训,比较培训前后输液缺陷及不良反应发生情况。结果评判性思维培训后,输液缺陷及不良反应总发生率为10.0%低于培训前的35.8%,培训前后比较,χ2=164.8,P<0.001,差异具有统计学意义。结论对门急诊护士实施评判性思维能力的培训,在提高护士评判性思维能力的同时,使护士能有预见性为患者提供有效的护理,从而减少和避免了输液缺陷及不良反应的发生,增加了输液的安全性。     

护理程序在输液病人静脉管理中的应用

目的 探讨如何保护静脉输液病人的血管,提高护士的穿刺成功率,减少病人的痛苦.方法 将护理程序应用到68例需输液治疗病人的静脉管理当中,先进行输液前评估,然后针对每一个病人的特点制定静脉穿刺计划,在计划实施的过程中收集护士及病人反馈的信息,从而不断改进输液穿刺方案.结果 68例静脉输液病人共进行静脉输液1 492人次,"一针见血"成功率为87.3%,病人对护士静脉输液满意率为98.5%.结论 护理程序应用到输液病人的静脉管理中,尽可能地保护病人的静脉,体现了以病人为核心.由于一针穿刺成功率高,增加病人的住院满意度,也能节约护士的操作时间,提高工作效率.     

肝病患者静脉输液的护理体会

目的 探讨肝病患者静脉输液的护理过程中的问题以及穿刺的要点.方法 选择最佳穿刺部位,做好穿刺后的护理,妥善固定并分析穿刺过程中常见难题的原因.结果 通过采取一系列的护理措施,肝病患者静脉穿刺取得了良好的效果,一针穿刺的成功率和家属对护士工作的满意度明显提高.结论 操作前做好患者及家属的心理护理,可减少负面影响,熟练操作,充分评估好血管,一针见血,妥善固定是提高穿刺成功率的关键.     

一对一培训＋小组式考核在低年资护士静脉输液技能培训中的应用

目的探讨提高低年资护士静脉输液护理技能的方法,减少因静脉穿刺给患者带来的痛苦,提高患者的满意度。方法对科内10名低年资护士静脉穿刺技能现状进行调查分析,找出穿刺技术差的原因,以小组为单位实施一对一的培训模式,建立高年资护师对低年资护士在科内外全程负责的帮教模式。将静脉穿刺技能纳入小组绩效考核。培训前后进行静脉输液考核和患者满意度问卷调查,评价护士的静脉输液水平和患者满意度。结果10名低年资护士培训后静脉穿刺考核成绩为（94．5±2．5）分,高于培训前的（84．5±9．3）分,差异有统计学意义（t=21．22,P〈0．01）;患者满意度培训后为96％,高于培训前的83％,差异有统计学意义（x2=8．99,P〈0．01）。结论一对一培训＋小组式考核能够提高低年资护士静脉输液护理技能,提高患者的满意度。     

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.     

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.     

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.