门诊输液室实施人性化护理服务的效果分析

目的探讨门诊输液室实施人性化护理服务的效果。方法选择4500例成年静脉输液患者作为实验组;4000例成年静脉输液患者作为对照组。实验组实施人性化护理服务;对照组实施传统护理服务,2组采用问卷调查并比较患者的满意度。结果实验组与对照组患者对护理的满意度分别为99.4%、83.3%;患者对健康教育覆盖率分别为100%、93.7%,知晓率分别为81.8%、72.3%;2组各项比较,差异均有显著性(P<0.01)。结论门诊输液室实施人性化护理服务可有效提高护理服务质量和患者的满意度,杜绝护理纠纷。     

人性化护理在门诊输液室护理中应用的效果评价

目的探讨人性化护理在门诊输液室护理中的应用效果。方法将2009年2月至2011年3月我院门诊接诊并实施人性化护理的52例输液患者设为干预组,将2004年2月至2006年3月我院门诊接诊并实施常规护理的52例输液患者设为对照组,回顾性分析2组患者的满意度。结果干预组患者满意度为88．5％;对照组患者满意度为51．9％,2组比较差异有统计学意义。结论针对门诊输液患者实施人性化护理,可显著提高护理质量,提升门诊输液患者的满意度,对门诊诊疗工作意义重大。     

优质护理服务在门诊儿童输液室中的应用效果

目的探讨优质护理服务在门诊儿童输液室中的应用效果。方法选取本院门诊儿童输液室治疗的84例患者作为研究对象,将2015年7月~12月42例患者作为观察组,将2016年1月~6月42例患者作为对照组。对照组采用常规护理法,观察组在对照组基础上采用优质护理服务方案,对2组患者的护理质量满意度、责任护士满意度、患者满意度、治疗依从率、健康教育知晓率情况进行比较,分析门诊儿童输液室优质护理服务实施效果。结果与对照组相比,观察组的护理质量满意度、责任护士满意度、患者满意度、治疗依从率及健康教育知晓率均有明显提高,差异比较具有统计学意义(P0.05)。结论在门诊儿童输液室输液过程中应用优质护理服务,可提高护士综合素质及护理质量,患儿在医院输液治疗期间可得到安全有效的输液护理服务,值得临床推广。     

细节化服务在门诊输液室中应用的效果分析

目的探讨门诊输液室实施细节化服务的必要性。方法将2012年6～12月来我院输液室输液的100例患者作为对照组，2013年1～6月的100例输液患者作为观察组。对照组按常规输液护理服务实施，观察组给予细节化护理服务措施，比较两组满意度和投诉情况。结果两组患者每组发放100份满意度调查表，对照组有效回收96份，观察组有效回收98份，观察组满意度和投诉率均好于对照组，两组比较差异有显著意义（P〈0．05）。结论细节化的护理服务理念应用于输液室工作中，从点滴做起，对构建和谐医患关系，改善医疗服务质量起到积极作用。     

人性化护理对门诊输液室患者护理满意度的影响

目的:探讨人性化护理对门诊输液室患者护理满意度的影响.方法:将200例门诊输液室患者随机分为对照组和观察组各100例,对照组采用常规护理,观察组在此基础上采用人性化护理干预措施,对两组护理满意度进行比较.结果:观察组护理满意度明显优于对照组(P<0.01).结论:对门诊输液室患者采用人性化护理干预措施可以满足患者生理和心理需求,提高护理满意度,值得基层医院进一步推广.     

人性化护理在妇科门诊输液患者中的作用

目的探讨人性化护理对妇科门诊输液患者满意度及静脉穿剌疼痛的影响。方法将152例妇科门诊输液患者按随机数字表法分为观察组和对照组,每组76例。对照组实行常规指导及穿刺护理;观察组实行人性化护理。输液结束后2组患者对护理工作的满意度、静脉穿剌疼痛程度进行比较。结果观察组实行人性化护理措施后总满意度明显高于对照组,静脉穿剌疼痛程度明显轻于对照组（均Р〈0.05）。结论对妇科门诊输液患者施行人性化护理,减轻了患者的疼痛度,提高了患者对护理工作满意度。     

个性化护理在门诊老年患者静脉输液中的应用

目的:探讨个性化护理对老年患者掌握静脉输液知识及护理满意度的影响。方法:选择2011年4～8月到我院门诊输液室输液的60岁以上老年患者240例为观察组,实施个性化护理服务;2010年4～8月于我院门诊输液的60岁以上老年患者309例为对照组,实施一般护理服务。比较两组患者的静脉输液知识掌握情况及对护理操作的满意度。结果:两组患者静脉输液知识及对护理操作满意度得分情况比较差异有统计学意义(P<0.01)。结论:对门诊静脉输液的老年患者采用个体化的护理,能够提高老年患者对静脉输液相关知识的了解,有效改善护患关系。     

评判性思维在社区卫生服务中心输液室输液护理中的应用

目的探讨评判性思维在社区卫生服务中心输液室输液护理中的应用效果。方法按时间段将1000例输液患者分为对照组和实验组各500例,对照组按照门诊输液室输液护理常规进行护理,实验组运用评判性思维方式对患者进行输液护理,观察比较两组患者对输液室护理工作的满意度和护理不良事件的发生情况。结果实验组患者对护理工作满意度高于对照组,护理不良事件发生率低于对照组,两组比较差异有统计学意义(P0.05)。结论评判性思维能提高社区卫生服务中心护理人员发现、分析和解决问题的能力,有利于减少护理不良事件的发生,提高患者对输液室护理工作的满意度。     

门诊输液室护理中采取人性化护理的价值研究

目的 研究人性化护理措施运用于门诊输液室护理的临床效果。方法 选取 2019 年 6 月至 2020 年 6 月我院门诊室输液治 疗的 100 例患者作为研究对象。通过随机数字法将患者分成实验组和参照组,每组 50 例。参照组予以常规护理干预,实验组 予以人性化护理。比较两组的护理满意度、负性心理和医患纠纷发生率和差错或者意外事件发生率。结果 实验组护理满意度 的评分均优于参照组（P<0.05）。实验组的医患纠纷的发生率和差错意外事件发生率均低于参照组（P<0.05）。实验组患者的 抑郁和焦虑评分指标均低于参照组（P<0.05）。结论 门诊输液室患者予以人性化护理,能减少医患纠纷,提高护理满意度和临 床护理质量。     

输液室开展优质护理服务的实践与成效

目的:探讨在输液室开展优质护理服务的实践与成效。方法:选取2011年2~12月和2012年1~10月门诊输液≥2 d的患者分别为对照组和实验组各80例,对照组给予输液室常规护理,实验组开展优质护理后实行路径管理,注重人文关怀,深化服务内涵,加强服务监管等措施,体现全程专业照护;比较两组对用药知识和疾病护理知识的知晓情况及患者满意度。结果:实验组用药知识知晓率、对疾病康复知识知晓率及对护士巡视、综合服务满意度均高于对照组(P0.05)。结论:输液室开展优质护理后提升了患者和家属满意度,提高了护理工作质量,值得临床推广。     

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.     

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.