太原市三级甲等医院ICU护士术后谵妄管理知信行现状及知识需求的调查研究

目的:探索太原市三级甲等医院重症监护室(ICU)护士的术后谵妄管理知信行现状及知识需求,为制订ICU术后谵妄管理培训方案提供依据。方法:采用非概率抽样法及自行设计的问卷,通过问卷星的方式对太原市5所三级甲等医院的332名ICU护士进行调查。结果:332名ICU护士术后谵妄管理知信行问卷总得分为(135.72±11.99)分,得分率为84.83%,知识得分为(51.98±5.31)分,态度得分为(43.00±4.39)分,行为得分为(40.73±4.86)分;多元线性回归结果显示,有术后谵妄管理培训方案、术后谵妄评估时间是ICU护士术后谵妄知信行得分的影响因素;88.6%的ICU护士认为学习术后谵妄的知识主要通过科室集中培训;89.5%的ICU护士认为临床实践中缺乏术后的镇痛、镇静管理来预防术后谵妄的相关知识;亟待学习术后谵妄的诊断标准、谵妄评估量表的准确使用及术后谵妄的预防及处理。结论:ICU护士术后谵妄知识水平较高,态度积极,但实践行为能力较弱。管理者应建立术后谵妄知识培训体系、制订规范化的术后谵妄管理培训方案与流程以促进临床实践。     

河南省三级甲等医院ICU护士亚谵妄综合征知识、态度和行为现状

目的:调查河南省三级甲等医院ICU护士亚谵妄综合征知识、态度和行为现状。方法:使用“综合性医院ICU护士亚谵妄综合征知信行量表”通过网络问卷对河南省17个城市20所三级甲等医院的ICU护士进行问卷调查。结果:研究最终纳入733份问卷,ICU护士亚谵妄综合征知信行总分为(101.24±15.32)分。65.3%的护士处于中等水平(≥96分),2.9%的护士处于优秀水平(≥128分)。知识维度得分为(49.64±14.96)分,表明护士知识水平一般;态度维度得分为(15.23±4.57)分,表明护士态度消极;行为维度得分为(36.36±7.92)分,47.9%的护士处于中等水平(≥30分),35.9%的护士处于优秀水平(≥40分),表明多数护士能够按照要求进行临床实践。ICU护士的技术职称、ICU工作年限、学历、婚姻状况和ICU类别是影响护士亚谵妄综合征知信行得分的因素。结论:河南省三级甲等医院ICU护士对亚谵妄知识掌握程度及临床实践水平一般,且存在态度消极的问题,管理者应制定合理的培训策略,并正确引导护士积极看待亚谵妄综合征的评估和管理工作。     

ICU护士对ICU谵妄认知的调查分析

目的 了解重庆市主城区5所三级甲等综合医院ICU护士ICU谵妄认知、知识需求及知识来源.方法 采用自行设计的问卷对186名ICU护士进行调查.结果对 ICU谵妄综合知识“十分清楚”的护士占6.5％,53.2％的护士认为“在校学习”是其获得ICU谵妄知识的主要来源,26.9％的护士接受过入职后相关岗位能力需求培训,7.3％的护士经常主动学习ICU谵妄知识.100％的调查对象认为曾在校学习的知识远远不能满足临床需要.结论 重庆市主城区5所三级甲等综合医院ICU护士ICU谵妄知识水平较低,不能满足临床需要.可能与护理人员的ICU谵妄知识主要来源于学校教育有关,建议在学校课程设置和后续培训中增加ICU谵妄知识的内容,提高工作能力、专业水平,以提高ICU患者的安全管理质量.     

ICU护士对亚谵妄综合征认知、态度与护理行为的现状及影响因素

目的调查ICU(重症监护室)护士对亚谵妄综合征认知、态度与护理行为现状并分析其影响因素。方法采用ICU护士一般资料调查问卷与ICU护士亚谵妄综合征知信行现况调查量表,于2019年1月—8月对衡阳市6所三级医院181名ICU护士进行调查。结果 181名ICU护士亚谵妄综合征知信行现况调查量表总平均分为(81.67±15.78),其中知识维度得分为(34.50±5.80)、态度维度得分为(19.32±6.02),护理行为维度得分为(25.44±3.82)。logistic回归分析显示:学历、工作年限、是否参加相关培训、是否有规范管理流程与体系是影响ICU护士对亚谵妄综合征认知、态度与护理行为水平的主要因素。结论 ICU护士对亚谵妄综合征认知、态度与护理行为水平偏低,受学历、工作年限、是否参加相关培训、是否有规范管理流程与体系因素的影响。管理者应特别关注学历低、工作年限短、未参加过相关培训、未建立规范管理流程与体系医院的护士,根据影响因素制定有效的改进措施,提高ICU护士对亚谵妄综合征认知、态度与护理行为水平。     

ICU护士对疼痛、躁动和谵妄管理的知信行调查

目的:调查ICU护士疼痛、躁动和谵妄管理的知信行现状,分析其影响因素,为相关实践培训提供参考。方法:采用便利抽样方法,对252名ICU护士进行调查,调查工具为自行设计的一般资料调查表,ICU护士疼痛、躁动和谵妄知识问卷、态度问卷和行为问卷。结果:ICU护士疼痛、躁动和谵妄管理的知识得分为(28.67±8.00)分,态度得分为(40.10±5.59)分,行为得分为(27.15±9.22)分。多重线性回归分析得出,影响ICU护士实践行为的因素有:知识得分、医院级别和是否接受相关培训,可解释总体变异的14.6%。结论 :ICU护士疼痛、躁动和谵妄管理知识相对不足,态度较为积极,实践行为亟待加强,提示管理者需要加强ICU护士相关培训,尤其是谵妄评估、每日唤醒实践、减少保护性约束和维持正常昼夜节律等方面,以提高其对疼痛、躁动和谵妄的管理水平。     

骨科护士对患者术后谵妄管理知信行现状及学习需求的调查研究

目的 了解骨科护士对患者术后谵妄管理的知信行现状及学习需求情况,为相关培训提供参考.方法 采用自行编制的问卷对四川省11所三级医院的骨科护士进行网络问卷调查.结果 共回收有效问卷444份,骨科护士对患者术后谵妄管理知信行总得分率为72.67％,其中知识、态度、行为得分率分别为57.68％、80.85％、82.48％.单...     

重症监护室护士对经鼻高流量湿化氧疗的知信行现状调查

目的：了解重症监护室(ICU)护士对经鼻高流量湿化氧疗知信行现状,分析其影响因素。方法：2021年10月25日—2021年11月25日采用一般资料调查表、ICU护士HFNC知信行调查问卷对绍兴市10所三级医院及4所二级医院的190名ICU护士进行问卷调查。结果：共收回问卷201份,其中有效问卷190份,有效回收率为94...     

ICU谵妄知识水平调查问卷的编制及信度效度检验

目的 :编制问卷客观评估重症监护病房护士对ICU谵妄相关知识的掌握情况,并对问卷的信度和效度进行检验。方法 :通过明确研究目的及框架、建立题项库、题目筛选和修改、预试验和题目再筛选形成ICU谵妄知识水平调查问卷;采用方便抽样法选取北京市3家三级甲等医院的222例ICU护士,应用ICU谵妄知识水平调查问卷对护士进行测试,评价问卷的信度和效度。结果 :ICU谵妄知识水平调查问卷题项水平的内容效度指数为0.83～1.00,问卷水平的内容效度指数为0.96;问卷的Cronbach’sα系数为0.82,难度指数在0.17～0.80之间;平均区分度指数为0.46。结论 :ICU谵妄知识水平调查问卷具有良好的信度、效度,难度和区分度适宜,可作为我国医护人员ICU谵妄相关知识水平的测量工具。     

护士对ICU谵妄知识、态度和行为的认知调查

[目的]了解护士对重症监护病房(ICU)谵妄的相关知识、态度和行为的认知情况。[方法]应用方便抽样法,应用自行设计的问卷对上海市两所三级综合医院的ICU注册护士进行调查。[结果]ICU注册护士知识得分(50.43±3.48)分,态度得分为(61.61±4.75分),行为得分为(44.76±2.77分);学历、职称及是否接受过相关内容培训是ICU护士对谵妄知识认知的影响因素(P<0.05)。[结论]管理者应认识到护士在早期发现ICU谵妄中的重要作用,对护士进行预防ICU谵妄的培训,将对ICU谵妄的预防措施纳入管理系统,以保证病人的安全,提高护理质量。     

云南澜沧地区护士对ICU谵妄认知及知识需求的调查分析

目的了解边疆医院护士对ICU谵妄的认知及相关知识的需求情况,寻求谵妄管理中的薄弱环节,为管理者制订专业化培训计划提供参考。方法采用自行设计的问卷对云南澜沧2所二级甲等医院的82名ICU注册护士进行调查,以了解其对谵妄的认知及相关知识的需求。结果护士对ICU谵妄的相关知识掌握中,谵妄的基本概念得分最高(3.44±0.76),谵妄的预防措施得分最低(2.15±1.19);在谵妄知识需求排序中,预防措施的需求排于首位(6.42±0.39);不同级别护士对谵妄知识掌握程度存在差异,而对谵妄知识的需求差异无统计学意义(P0.05)。结论护理管理者应重视护士在预防ICU谵妄中的重要作用,针对护士在谵妄认知中的薄弱环节进行针对性的专题培训,提高护士对谵妄认知度及干预能力,以确保患者安全。     

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.