综合管理模式在手术室无菌物品管理中的应用效果

目的探讨综合管理模式在手术室无菌物品管理中的应用效果。方法选取2014年3月~2015年2月本院手术室无菌物品按照时间顺序分为对照组和实验组,各6个月时间。对照组的无菌物品应用现有常规管理方法管理手术室无菌物品;实验组的无菌物品应用综合管理模式管理手术室无菌物品。比较两组无菌物品过期数量、返消毒成本、一次性使用耗材成本及护理人员检查无菌物品所消耗的时间。结果实验组返消毒器械包、布类包数量,返消毒成本、护理人员检查无菌物品的时间均小于对照组,差异有统计学意义(P<0.01);实验组过期一次性使用耗材数量、一次性使用耗材成本、护理人员检查耗材的时间均小于对照组,差异有统计学意义(P<0.05)。结论联合"量身定制包装、量身定制数量、分层管理及目视管理、五常法的应用"4种管理方法形成综合管理模式对手术室无菌物品管理进行综合护理干预,可以有效地降低无菌物品返消毒的发生率、减少消毒成本、一次性使用耗材成本及护理人员的工作量,值得临床推广应用。     

“5S”活动规范手术室无菌物品间管理的效果评价

目的规范手术室无菌物品间的管理,提高手术室工作效率和护理质量。方法成立“5S”活动小组,制定实施计划,对无菌物品间物品进行“5S”管理。结果“5S”活动实施前后,无菌物品过期重消毒、环境整理和查过期物品时间及取放无菌物品时间比较有显著性差异（P〈0．001）。结论“5S”活动规范了手术室无菌物品间的管理,确保了病人安全,提高了护士的整体素质。     

五常法用于手术室规范化管理

目的 :提高手术室护理及管理的质量和效率。方法 :应用“五常法”原理 ,对人、物、环境进行规范改进 ,设计了流程图 ,规范了手术室护士言行、技术、手术物品准备与放置标准等。从形式化→行事化→习惯化推进 ,形成专科护理准则 (标准 )。结果 :器械准备完好率、物品准备完好率、贵重仪器使用管理完好率、手术科室及病人满意率五常组均高于常规组。结论 :五常法管理有效地提高了手术室质量     

“五常法”在无菌物品存放区管理中的应用

目的探讨＂五常法＂管理在消毒供应中心无菌物品存放区中的应用方法及效果。方法分析无菌物品存放区管理中存在的问题并开展＂五常法＂管理,制订相应的管理措施并定期进行检查、评估、不断改进。结果减少了错发无菌包,杜绝物品过期发放,提高了护士的工作效率。结论运用＂五常法＂实行消毒供应中心无菌物品存放区的规范化管理可提高护士的工作质量和效率。     

可移动式取物标牌在手术室无菌间管理中的应用

无菌物品间是手术室放置无菌手术器械、无菌敷料、一次性手术用物的场所,是手术室管理的一个重要组成部分[1],各类无菌物品应按手术专科摆放,布类包装、纸塑包装、一次性物品应分别放在相应的区域[2],按灭菌日期先后顺序摆放,并设有醒目标识,取用时按日期先后顺序取用.我院是一所三级甲等综合性医院,手术室有洁净手术间14间,无菌物品间1间,日均手术量35台次,设器械班护士管理无菌物品间,负责每日对无菌间内所有物品进行清理和检查,防止过期物品出现,在清理无菌间物品时,针对每件物品仔细查看,耗时过久,在上下左右移动物品时大量消耗体力,为减少检查时间和体力消耗,我科自制可移动取物标牌用于无菌物品的管理,效果良好.现介绍如下.     

五常法管理在骨科换药室无菌物品管理中的应用

[目的]探讨五常法管理在骨科换药室无菌物品管理中的应用效果及方法.[方法]分析骨科换药室无菌物品管理中存在的问题并开展"五常法"管理,制订了相应管理措施并定期进行检查评估与不断改进.[结果]减少了器械丢失,减少了与消毒供应中心的交涉,避免了无菌物品过期失效,提高了护士工作效率.[结论]运用五常法实行骨科换药室无菌物品科学规范管理可提高护士的工作质量和效率.     

手术室无菌物品间管理方法的改进与成效

[目的]探讨如何对手术室无菌物品间进行有效管理,从而使过期物品的数量和所需的人力消耗降到最低。[方法]通过分析物品过期,查找产生该现象的原因;对无菌物品间的管理继续应用5S管理法,同时根据科室具体情况实施相应的改进措施。[结果]无菌物品间的室内环境以及无菌物品包装松散、穿孔、空缺与改进前相比无变化;无菌物品过期量与改进前相比明显减少,清理过期物品耗时也明显缩短。[结论]采取切实有效的改进措施进行管理,可以提高工作质量和效率,同时减少人力物力的浪费,充分体现了护理管理的科学性。     

运用“五常法”加强手术室物品的管理

目的探讨“五常法”（Seiri，Seilon，Seiso，Seikelsu and Shilsuke，5S）在手术室物品管理中的应用效果。方法在手术室物品的管理中采用“五常法”管理，并比较实施“五常法”前后手术室物品管理的质量。结果实施“五常法”前后，手术器械和物品准备完好率、仪器使用管理完好率、医务人员及患者满意率等比较，均P〈0．05，差异有统计学意义。结论“五常法”具有简单、实用、高效的管理特点。它在手术室物品管理中的应用，有助于提高手术室物品管理的质量。     

柏拉图分析法在手术室一次性低值无菌物品质量管理中的应用

【目的】加强和完善手术室一次性低值无菌物品的管理。【方法】针对手术室低值无菌物品管理中存在的问题制作《提高手术室低值无菌物品管理质量征求意见表》,组织全体护士进行填写,然后利用柏拉图分析法对收集到的数据进行分析,找到问题发生的原因并制定出相应的措施,选取一个低值无菌物品间为整改对象,对整改前后的结果进行比较。【结果】在包装质量控制、减少过期包、提高取物时手卫生依从性方面,整改前后差异有显著性意义（P〈0．05）。【结论】柏拉图分析法能够有效地提高手术室一次性低值无菌物品的管理质量水平。     

9S管理法在手术室无菌间无菌物品管理中的应用

目的探讨9S管理法在手术室无菌间管理中的应用效果。方法将9S管理法应用于手术室无菌间空间和物品的日常管理中,根据9S管理要素实施的具体方法,制定明确的要求和相关措施,要求人人按规定办事,形成良好习惯。结果实施9S管理后手术室无菌间的室内环境以及无菌间内物品完好性、放置的规范性等均明显提高,无菌物品过期量与应用前相比明显减少,有效地降低了人力及物力成本。结论 9S管理法的运用有利于确保医疗无菌物品的安全性,提高医护人员的工作质量和效率。     

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.