60所医院聘用合同制护士现状调查

目的:了解该安徽省合同制护士现状,完善对合同制护士的管理。方法:发放问卷对该省60所质控网络医院的合同制护士进行现状调查。结果:合同制护士待遇普遍偏低,合同制护士离职率高,队伍欠稳定,直接影响病人安全。结论:各级管理部门应制定相关政策,采取有效措施,加强合同制护士的管理,保障病人安全,提高护理质量。     

情绪资本管理对合同制护士自我成就感的影响及相关因素调查

目的:探讨情绪资本管理对合同制护士自我成就感的影响,并对相关因素进行分析.方法:采用护士工作问卷、简易应对方式问卷、社会支持评定量表,对100名合同制护士实施情绪资本管理前后自我成就感、应对方式及社会支持状况进行调查,分析影响合同制护士自我成就感的因素.结果:实施情绪资本管理后,合同制护士较多采用积极应对方式,合同制护士自我成就感与积极应对、管理及人际关系的压力、支持利用度成正相关(P<0.05);与实施情绪资本管理前比较,实施后合同制护士自我成就感、工作自我实现愿望加大,工作业绩、综合成就感大幅提升,患者满意度明显增强(P＜0.05,P<0.01).结论:应用情绪资本管理是提高护理质量、稳定护士队伍的有效措施,可增强合同制护士自我成就感.     

合同制护士工作满意度调查分析及管理对策

目的：了解东莞市合同制护士工作满意度的整体状况,寻求并采取合理的合同制护士管理对策。方法：对东莞市合同制护士随机抽样进行问卷调查,问卷内容包括护士基本情况、工作满意度等。结果：不同学历、婚姻状况及职称的合同制护士工作满意度有差别,不同职称的合同制护士在收入、工作任务、职业地位方面满意度均数之间的差异都有统计学意义。结论：有效提高合同制护士的工作满意度、稳定合同制护士队伍是提高医院护理质量的关键。     

浅谈基层医院合同制护士的管理体会

目的:分析近十年招聘录用的合同制护士现状,探索一条规范的管理之道,提高护理质量。方法:通过源头把关、岗前培训、科室轮转、疏导沟通、提高待遇等方法,稳定合同制护士队伍,激发合同制护士的潜力,增强自信心和主人翁精神。结果:合同制护士队伍稳定,离职率下降,差错发生减少,表彰奖励和晋升机会增多。结论:公平公正的用人制度,机动灵活的人性化管理,是合同制护士安心工作的前提,更是提高护理质量的保证。     

建立长效奖惩机制稳定合同制护士队伍

目的:探讨建立长效奖惩机制,稳定合同制护士队伍的方法.方法:对我院2000年～2006年招聘的191名合同制护士建立了绩效考核档案、转聘、辞退等长效奖惩机制.结果:86.91%合同制护士继续在院工作(其中46.07%合同制护士转聘),7.85%合同制护士医院辞退,5.24%合同制护士辞职.结论:建立长效奖惩机制解除了合同制护士的后顾之忧,增强了其责任意识,调动了合同制护士的工作积极性,提高了合同制护士通过执业考试主动性,稳定了合同制护士队伍,提高了我院护理质量.     

运用人本原理 实施合同制护士管理

目的:通过人本管理原理的运用,稳定合同制护士队伍,提高综合素质,减少人员流失,节约人力资源成本。方法:建立健全合同制护士管理制度,强化管理,严把进人录用关、准入关、考核关,一视同仁,奖优罚劣,全面培养,综合提高。结果:190名合同制护士,解聘淘汰25人,辞职20人,留用率76.35%。大专学历人员由招聘时的24%,5年内上升到81%,其中晋升护师占23%,专科进修占9%。结论:运用人本原理,实施合同制护士管理,使合同制护士队伍稳定,综合素质提高,节约了人力资源成本。     

合同制护士心理健康状况调查分析及干预措施

目的:调查合同制护士心理状况,了解心理问题产生的原因,为制定干预措施提供理论依据.方法:采用心理测评量表用现场发放调查表的方法,对72名合同制护士进行心理健康状况调查.结果:有58.7%的合同制护士有不同程度的心理问题.结论:合同制护士在工作中心理压力较大,应引起医院管理者高度重视,必须采取有效措施进行改进和干预.     

持续质量改进在门诊输液室合同制护士管理中的应用

目的 探讨门诊输液室合同制护士的管理.方法 采用持续质量改进方法对门诊输液室合同制护士进行管理,每月对设立的目标进行评价.结果 实施持续质量改进方法后,合同制护士总体达标率明显高于实施前(P＜0.01).结论 通过持续质量改进方法的应用,合同制护士的综合素质显著提高.     

合同制护士规范化管理后的职业满意度分析

目的了解规范化管理对合同制护士职业满意度的影响。方法2008年1月开始,对合同制护士进行规范化管理,逐步实施了提高经济待遇和政治待遇、创建护士职业上升平台、提供公平竞聘护士长和选拔优秀机会、发挥社会支持系统等管理举措。采用护士职业满意度量表在2007年12月和2009年6月分别对合同制护士进行调查。结果规范化管理前后,合同制护士整体满意度分别为(143.04±35.21)分、(191.28±50.28)分,经比较,t=9.72,P0.05。结论规范化管理使合同制护士的职业满意度提高,从而稳定了护理队伍。     

医院合同制护士转事业编制的实施方法及效果观察

目的:探讨合同制护士转事业编制护士的实施方法和效果。方法:成立合同制护士转事业编制考核委员会,对符合申报转事业编制条件的合同制护士统一进行考核,择优转为事业编制。结果:稳定了护理队伍,调动了护士工作积极性,提高了护理质量。结论:医院通过合同制护士转事业编制此项措施,不仅调动了成功转事业编制护士的工作积极性,对于其他的合同制护士和编制内护士也有很好的激励与鞭策作用,能更好地稳定护理队伍,提高护理质量。     

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.