护士月排班表的设计与应用

目的探讨护士排班表的改进方法,科学合理地安排护理人力资源。方法改革传统的周排班方式为月排班方式,重新设计格式,使用Excel办公软件打印排班表。结果月排班表利于增强护士长与护士之间的理解和支持,调动护士的工作积极性,减轻护士长的工作压力,保证护理工作的连续性。结论在班次相对固定、护士相对稳定的科室,月排班方式可以推广应用。     

护士排班需求表在人性化护理管理中的应用

目的使用护士排班需求表,合理安排护理班次,提高护士工作效率,减少安全隐患。方法护士在护士长排班前3天填写需求表,写明休班原因及具体时间,护士长根据个人实际情况给予酌情安排班次。结果护士长排班效率提高,护士调班及临时请假次数均明显减少。结论使用护士排班需求表,实行人性化护理管理,护士掌控时间的主动性增强,可以合理解决工作与生活中的矛盾,既满足了护士的个人需要,又调动了护士工作的积极性,提高了工作效率和护理工作质量,保证各项护理工作的顺利完成。     

妇产科护理人员排班方式的探讨

介绍根据妇产科护理工作的特点,进行合理的工作班次微调及弹性排班来确定排班方案,以便于护士长管理,调动护士的积极性。     

妇产科护理人员排班方式的探讨

介绍根据妇产科护理工作的特点，进行合理的工作班次微调及弹性排班来确定排班方案，以便于护士长管理，调动护士的积极性。     

护士月排班表的设计与使用

正护士排班是护士长的工作职责之一,科学合理的排班能激励护士的工作积极性,提升护士满意度,确保护理工作顺利有序开展。目前,最常用的护士工作周排班表模式已运行多年,具有简单、随机的优点,但需要护士长每周调配班次,存在效率低下、计划性差、与责任制整体护理模式脱节等不足。我科自2015年1月起取消护士周排班表,参考国外护理排班经验[1],使用自行设计的月排班表,护士长能够根据科室工作及护士休     

Excel在制作护士排班表中的应用

目的 探讨护士排班新方法,使护士长排班高效省时,同时科学合理地安排护理人力资源;使护士查看排班表时一目了然.方法 采用Excel办公软件工具,在传统的护士排班项目基础上,增加层级护理标示符、职称、工龄项;利用Excel的多功能性使本周时数、本周结余、上周累计结余、本周累计结余等结果自动生成.结果 护士长花在排班表上的时间大大缩短,护士认可度达95%.结论 利用Excel设计的护士排班表,大大节约了护士长排班时间,减少了护士复核工时的时间,使护理人力资源安排更加科学合理.     

急诊科护士长的排班技巧与职能作用

根据急诊科护理工作繁重、病人病情复杂、随机性强、流动性大的特点 ,护士长在排班上既要考虑人力的均衡 ,又要考虑到工作的连续性和可持续性。如果不能科学地安排护士班次 ,则容易陷入具体纷乱的琐事中丧失整体指挥作用 ,而护士的职能性得不到充分发挥 ,从而影响护理质量。因此 ,急诊科护士长如何科学地安排护士班次 ,发挥其指挥职能 ,提高急诊科护理质量 ,是急诊科护理管理工作的一个重要课题。我科从实践中不断改进总结了一套职能化、层次化管理的护士排班方法 ,使急诊抢救成功率由过去的 90 %提高到现在的 98% ,连续 10年无护理差错事故…     

弹性排班对护理工作质量影响的Meta分析

正护理工作是医院工作中必不可少的一部分,但面对护理人员不足的问题,如何合理排班达到最大限度地利用现有的人力资源,既可以推行整体护理又能保证护理质量是值得护理管理者探讨的课题。护理弹性排班,是指护士长根据患者数量及工作量的多少灵活调动工作人员,根据护士工作能力的不同,安排不同的班次[1]。本研究通过选取已在国内公开发表的关于弹性排班对护理质量影响的相关文献进行Meta分析,以评估弹性排班的效果,为提高护理管理质量提供循证     

利用蒙特卡罗方法实现护士排班的程序化

护士排班工作是医院护理管理的一项重要内容[1].目前国内医院护士排班主要由护理管理人员依据经验进行手动排班,往往忽略了护士对不同班次意愿程度的考虑.为了解决护理管理人员在护士排班工作上耗费大量时间的问题以及不同护士对不同班次的偏好问题,本工作在劳动法条件和客观条件的约束下建立排班模型;同时根据护士对不同班次的意愿度调查,利用蒙特卡罗方法进行随机抽样、判别,进而得到一定周期内的护士排班表.该方法利用计算机程序实现,从而有效地节约了护理管理人员的排班时间,提高了工作效率;利用随机抽样与意愿度相符的方法,从而有效地结合了护士在排班过程中的意愿度,现报道如下.     

实施阶梯式全程排班 稳定护理人才队伍

目的:探讨阶梯式全程排班管理对稳定护理人才作用的效果。方法:采用阶梯式全程排班,结合满足病人需要的弹性排班,调整班次,实行按职称上岗,因人施用,发挥主观能动性,发挥年龄优势,稳定护理人才队伍。结果:改变排班模式后,减轻了轮班、夜班对老护士的心理压力,调动了护士的积极性,护士的价值得到了提升,护理人才队伍稳定,有效的保障了医疗护理安全,提高了病人对护理工作的满意度。结论:阶梯式全程排班方法提高了人力资源的管理水平,使护理人员的工作积极性得到了最大的发挥,起到了稳定护理人才队伍的作用。     

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.     

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.