专家型护士培养和管理模式在低年资护士专科能力培养中的应用

目的:探讨循环科低年资护士专科能力有效提升的途径,以期为提升护士业务能力,提高护理质量提供理论参考。方法:选择2011年1月~2014年1月我院循环科40名新分配的护士给予专科能力评估,采用专家型护士培养和管理的方法实施岗位规范化培训。结果:经培训干预,40名低年资护士在基础知识与技能、专科知识与技能、应急与沟通能力、护理程序实施能力、管理教育科研能力等方面均得到明显提高,与培训前比较,差异均有统计学意义(P0.05)。结论:对循环科低年资护士实施专家型护士培养和管理,可以明显提高护士的综合素质以及业务能力,更加符合专科化的发展需要,值得推广与应用。     

PDCA循环在NICU低年资护士专科培训中的应用

目的探讨计划-实施-检查-处理(Plan-Do-Check-Action,PDCA)循环管理模式在NICU低年资护士专科培训中的应用效果。方法将NICU工作的低年资护士32人随机分为对照组(常规培训模式)和实验组(PDCA循环模式),比较在两种不同培训模式下,低年资护士相关知识能力提升水平,科室护理质量情况及护理不良事件发生率。结果实验组护士的相关知识能力提升较对照组明显提高,实验组的护理质量明显高于对照组,实验组的护理不良事件发生率为1.11%,明显低于对照组,以上指标的差异均具有统计学意义(P0.05)。结论采用PDCA循环进行低年资护士专科培训,能有效提升低年资护士的护理能力,提高临床护理质量,降低护理不良事件发生率。     

行动研究法在低年资护士床边交接班培训中的应用研究

目的分析外科低年资护士床边交接班存在的问题,提升低年资护士床边交接班质量。方法选取外科系统50名低年资护士为研究对象,运用行动研究法"计划—行动—观察—反思"的2个螺旋循环过程,基于交接班评价量表测评和访谈质性分析的基础上,确定床边交接班存在的问题,制定改进措施,进行情景演练和床边交接班内容分割培训,观察实践效果。结果 2次行动后低年资护士床边交接班质量各项评分及总分都较行动前提高,差异有统计学意义(P0.01),第2次行动提升提高了床边交接班效率,差异有统计学意义(P0.01)。结论运用行动研究法在低年资护士床旁交接班培训中,提高了床边交接班质量,在临床护理培训工作具有一定的使用价值和可行性。     

低年资护士专科技能培训效果分析

目的 培训低年资护士的专业技能和专科理论知识，提高整体素质。方法 2004年8月-2005年8月对32位低年资护士进行操作技能、仪器知识及处理、专科理论和并发症的观察等系统的培训。结果 培训前后护士的操作技能、专科理论知识、仪器的使用和并发症的观察能力有显著性差异（P〈0．05）。结论 培训低年资护士的专科技能有利于提高护士的整体素质和潜力的发挥。     

普外科低年资护士的规范化培训

总结普外科开展低年资护士规范化培训的经验，主要包括强化职业道德教育，加强专科知识培训，培养语言沟通技巧，认为规范化培训有助于提高低年资护士的道德修养和专科技能，避免护患矛盾，减少差错事故的发生。     

低年资护士专科技能培训效果分析

目的培训低年资护士的专业技能和专科理论知识,提高整体素质.方法 2004年8月～2005年8月对32位低年资护士进行操作技能、仪器知识及处理、专科理论和并发症的观察等系统的培训.结果培训前后护士的操作技能、专科理论知识、仪器的使用和并发症的观察能力有显著性差异(P＜0.05).结论培训低年资护士的专科技能有利于提高护士的整体素质和潜力的发挥.     

标准化沟通方式在低年资护士与医生沟通中的应用

目的总结标准化沟通方式在低年资护士与医生沟通中的应用体会。方法建立"现状-背景-评估-建议"标准化沟通报告模型,对57名低年资护士进行培训,在6个内科病区低年资护士应用标准化沟通方式向医生汇报病情。结果通过1年多的实践,标准化沟通落实率91.43%,医生对低年资护士工作的满意率从82.6%提升到96.4%,患者满意度从95.6%提升到99.5%。结论标准化沟通方式提高了低年资护士的沟通能力及医生、患者的满意度。     

提高产科低年资护士应急能力的有效途径

目的：探讨提高产科病房低年资护士的应急能力。方法：结合我院产科病房实际，对低年资护士的应急能力进行分析，在此基础上，优务人员结构，合理分工，统筹安排护理工作，有计划、有针对性地对低年资护士进行专科理论知识和急救技能的培训。结果：明显提高了低年资护士的应急能力和专科护理水平，完成了各项临床护理工作。结论：有计划地进行专科知识及技能的强化培训，并对专科流程管理工作常抓不懈，才能提高低年资护士的整体业务素质。     

低年资护士健康教育技能考评结果分析

目的 通过对低年资护士健康教育技能考评,了解存在的薄弱环节,为制定培训计划提供依据.方法 采用自制健康教育技能考核评分标准,现场考评52名工作与年内规范化培训护士在临床护理工作中健康教育技能的实际应用情况.结果 该层次护士在沟通意识、沟通技巧、形体语言、健康教育内容、语言表达等方面较为薄弱,使整体健康教育效果受到影响.结论 低年资护士在健康教育技能方面较欠缺,应强化薄弱部分的健康教育技能培训,建议今后应将健康教育技能培训作为低年资护士继续教育培训的重要内容.     

产科病房低年资护士应急能力培养的实施

目的 探讨提高产科病房低年资护士的应急能力.方法 对31名低年资护士的应急能力进行分析,在此基础上进行专科知识、应急技能培训,从而提高综合素质.结果 培训后低年资护士理论操作考试成绩及综合素质测评成绩明显优于培训前.结论 低年资护士应急能力欠缺,对此医院管理层要重视提高低年资护士的应急能力培养.     

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.