急诊护士直面患者死亡的创伤后成长体验

目的了解急诊护士直面患者死亡创伤后成长的心路历程。方法采用现象学研究法,选取6名面对患者死亡致创伤后应激障碍的急诊护士,对其进行半结构式深入访谈,以诠释现象学分析法分析资料,提炼主题。结果提炼出5个主题:加强个人业务能力,创伤事件体验后的自我调适,对于生命的哲学思考,积极应对自己的心理障碍,对于创伤后成长的感知。结论急诊护士能正视创伤后应激障碍,有意识地进行自我调适,从而提高急诊护士的心理健康水平和护理工作质量。     

急诊与院前急救护理衔接的现状与对策

通过对建立急诊绿色通道后的急诊与院前急救护理衔接现状的分析,提出了加大急救护理信息传输的力度、加强急诊护理交接的管理力度、做好急诊与院前急救护理的衔接、急诊与院前护士经常进行交流的解决对策。     

回访护理对院前急救护理工作质量的影响分析

目的分析回访护理对提高院前急救护理工作质量的效果。方法选取2015年5月～2016年5月我院院前急救收治的患者100例,住院科室的护士100名作为对照组,未实施回访护理。选取2016年6月～2017年6月我院院前急救收治的患者100例,住院科室的护士100名作为观察组,行回访护理。比较两组护理工作质量。结果观察组患者或家属对及时性、急救技能、服务态度满意度高于对照组,差异有统计学意义(P<0.05)。观察组病房护士对急诊护士服务态度、沟通能力、护理质量、交接班执行满意度高于对照组,差异有统计学意义(P<0.05)。观察组护士急救意识、急救技能、沟通能力、专科知识、护理文书书写综合素质合格率高于对照组,差异有统计学意义(P<0.05)。结论回访护理可通过收集患者以及患者家属对院前急救护理工作的意见使改进措施更具针对性,对提高护理人员综合素质以及患者、接收科室护士的满意度有利。     

老年医疗机构护士对老年人态度及照顾体验的质性研究

[目的]探讨老年医疗机构护士对老年人的态度及照顾体验。[方法]选取上海市3所老年医疗机构的19名护士进行3次小组焦点访谈,深入了解护士对老年人的态度及照顾体验。[结果]使用类属分析法,共提炼出刻板印象、理解与尊重、照护与关怀、积极体验、护理挑战5个主题。前3个主题为老年医疗机构护士对老年人的态度特点,后2个主题为影响态度形成的护士的工作体验。[结论]护理管理者应重视护士对老年人的态度及照顾体验,在护理管理过程中可鼓励经验丰富的护士分享自身的积极体验,提高护士的沟通能力。     

急诊科护士对工作场所互惠行为的认知及体验

目的 ：探讨急诊科护士工作场所互惠行为的真实体验,以期对急诊护理团队合作文化进行梳理,为急诊科护士工作场所互惠行为开展和改进,以及急诊护理管理改进提供参考依据。方法 ：采用现象学研究方法,对13名急诊科护士进行半结构式访谈,运用内容分析法对资料进行分析整理。结果 ：通过整理和分析资料,提炼出4个主题：工作场所互惠行为广泛存在且符合急诊护理工作特点;工作场所互惠行为的形式和时机多样;不同工作年限护士之间的互动;急诊护理管者鼓励并支持工作场所互惠行为。结论 ：工作场所互惠行为对急诊科护士具有重要影响。提高工作场所互惠水平可以建立更安全、更方便、更高效的工作氛围。应结合急诊护理工作文化特点及不同年资护士互惠行为特点,梳理急诊已有的互惠行为,总结开展形式及时机,从管理层面鼓励互惠行为,以促进急诊护理团队合作,改善工作环境及氛围。     

基于优势视角理论下急诊科护士抗逆体验的质性研究

目的 探讨基于优势视角理论下急诊科护士抗逆体验的真实感受,为提升急诊护士抗逆力及应对急救工作挑战提供理论依据。方法 采用最大差异抽样法,采用现象学研究方法,对12名急诊科护士进行半结构式访谈,采用Colaizzi分析法进行资料分析。结果 提炼了急诊科护士抗逆力的5个主题：逆境掌控感、自我重塑、击穿惯性、具备反脆弱力和内心驱动力。结论 多种因素与急诊科护士抗逆体验的发生发展过程存在着相关性,医院及护理管理者应针对急诊科护士的抗逆体验,提供多维度的支持策略,强化急诊团队变革型领导关系,提升急诊护士抗逆力,从而稳定急诊护理队伍。     

急诊护理专业小组管理模式的应用效果

目的通过成立急诊护理专业小组促进急诊护士专业知识和技能水平的发展,从而提高急诊专科护理质量。方法设立院前急救、预检分诊、急救技能、重症监护、护理安全、药品仪器6个护理专业小组,明确小组职责,解决本专业临床问题。结果各小组积极开展活动有所作为,护理质量明显提高,患者满意度、护士工作满意度提高。结论通过小组活动,调动了护士参与科室管理的积极性,在科内营造了良好的学习和竞争氛围。     

提高急诊护士抢救能力的做法与体会

目的　提高急诊护士应急抢救能力。方法　护理部在护理人力资源与急救管理上加大管理力度。通过不断优化人员结构,实施合理的区域划分与分工;有针对性、有计划地对急诊护士进行专科知识和急救技能的培训;狠抓急救管理。结果　明显提高了护士的应急抢救能力,急救技能考核合格率均达10 0 % ,出色完成院前急救任务。结论　急诊应有计划地进行专科知识及技能的强化训练,并对急救管理工作常抓不懈,才能提高护士整体业务素质,提高应急抢救能力,提高危重病人抢救成功率     

模拟出车现场对提高急诊护士院前急救能力的效果观察

探讨模拟出车现场对提高急诊护士院前急救能力的应用效果.通过成立院前急救能力培训小组,对急诊护士进行理论授课、急救技能示教、模拟出车现场操作培训,结合临床制订院前急救操作流程,采用模拟出车现场进行操作培训,急诊护士的急救知识、急救技能操作、院前急救能力和医生的配合满意度明显提高.     

急诊护理风险分析及防范措施探讨

目的统计分析急诊科护理工作中常见风险安全隐患并提出针对性防范措施。方法以本院2015年6月~2016年6月急诊科院前急救80例危重患者为研究对象,应用统计学方法对本院急诊护理工作中常见的护理风险进行分析归纳,并制定针对性的防范措施,对方案实施前后护士技能培训状况、护理质量评分、患者院前急救依从性、患者满意度等进行比较分析。结果实施后护士技能培训状况、护理质量评分、患者院前急救依从性、患者满意度均明显改善,与实施前对比差异有统计学意义(P0.05)。结论急诊科是高风险科室,加强风险意识,实施防范对策迫在眉睫。对急诊护理风险进行积极的防范,能够使急诊护理工作质量得到有效提升,将高风险因素降到最低程度,对提高护理质量起到了积极重要作用。     

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.