基层医院肿瘤科护理人员工作压力调查分析及对策

护士培训是护理人力资源管理的重要组成部分，而新护士培训对于护理队伍的建设和护理人才的培养起着举足轻重的作用。自2003年7月以来，我们通过对新护士进行为期两年的系统化综合性培训，取得满意效果。现报告如下。1资料与方法1．1研究资料将2003年、2004年毕业来我院工作的新护士设为实验组，2001年、2002年毕业的新护士设为对照组。实验组32人，女性，年龄18～23岁、平均20．7岁；其中中专毕业生24人，大专毕业生8人。对照组29人，女性，年龄19～22岁、平均20．5岁；其中中专毕业生23人，大专毕业生6人。     

基层医院绩效工资改革在护理人员中的作用

目的探讨基层医院护士绩效工资分配改革在护理人员中的作用。方法自2003年以来，全院护理人员试行绩效工资分配改革，即实行二级分配制：全院护士绩效工资首先由总护士长按护士人均教统一发放到各科室，再由科室护士长根据护士工作量量化的分值、护理质量考核分值、护士职称系数按比例综合核算出每个护士的绩效工资。结果4年来护士考试综合成绩逐年上升（p〈0．05）；病陪人对护士工作满意度逐年升高（p〈0．05）；护理工作质量考核综合得分逐年升高（p〈0．05）；差错发生率由15％下降至3．25％、结论绩效工资的分配改革激发了护理人员的工作和学习热情，提高了护理质量及病陪人的满意度，减少了差错事故的发生.     

广东省医院护理人力及教育现状研究

目的：描述广东省医院护理人力及教育现状。分析存在的问题并提出建议。方法：采用自行设计的调查表,对广东省166家二级、三级医院进行调查。结果：①三级、二级医院平均医护比分别为1：1．29、l：1.14,500张床位以上的医院平均床护比为1：0．52,低于卫生部颁布标准（P〈0．0）.②护理人员起始学历中。研究生、本科、大专、中专和无专业学历者所占比例分别是：0．01％、1．94％、8．07％、88．52％、1.46％;相应的耳前学历分别是：0．10％、4。66％、29．96％。64.30％、0．98％。结论：①广东省医院临床一线护理人力不足。⑦护理人员学历有所提高。但仍以中专学历为主。建议5年内三级医院护理人员的学历结构逐步达到：中专占30％、大专及以上占70％,二级医院逐步达到：中专占50％、大专及以上占50％。     

我国护理职业教育改革的实践与探索

职业教育是护理教育的重要组成部分。据卫生部2004年对126所二级以上综合医院的调查，具有中专或职高学历的人员占57．65％，具有大专学历的护理人员占36．72％。2005年卫生部颁布的《中国护理事业发展规划纲要（2005-2010年）》要求，到2010年，各层次护理教育的招生数量比例应达到中专占50％，大专占30％，本科及以上占20％的目标。     

刍议整体护理中护士按职上岗

整体护理是以现代护理为指导，以护理程序为框架，将护理临床业务和护理管理的各个环节系统化的一种模式。多年来由于护理模式陈旧，初、中、高级职称护理人员不能量职使用，大大挫伤了护理人员的工作积极性，限制了护理事业的发展。笔者通过探讨在整体护理实践中，护主控职上岗，旨在规范各级护理人员的岗位职责，促进此项工作顺利进行。1初级护理人员中专毕业十五年内．大专毕业七年内，大学毕业五年内。1．1素质行为评价富有朝气，精力充沛，理论知识扎实，接受新事物快，出勤率较高。但心理素质不稳定，有相当一部分认为，护理工作没有…     

不同学历护士对患者静脉穿刺技术比较

目的:对不同学历背景的护理人员的临床工作能力进行研究比较。方法:纳入毕业后已进入临床工作1年的中专学历护理人员20名,大专及其以上学历的护理人员25名,在相同条件下比较静脉穿刺技术掌握程度和患者对其工作的满意程度。结果:大专以上学历护理人员静脉穿刺成功率为64.0%,患者满意度为76.0%,明显高于中专学历护理人员。结论:同等条件下,学历较高的护理人员在临床护理工作中比学历较低的护理人员工作能力更好,对患者有责任感。     

融并医院护理人员观念转变的方法探讨

目的探讨融并医院护理人员观念转变的方法。方法融并后对本院区护理人员进行观念的转变，内容包括：融并目的教育、护士的人生观和价值观教育、护士晋升制度教育、护理文化建设教育等。结果融并后病人满意度从融并前89．5％上升至97．8％，教学层次上由带教中专学生提高到大专学生及本科学生，教学满意度达94．9％。融并后护理人员撰写论文数从2篇上升至103篇。发表护理论文从0上升至7篇。结论稳步推进融并是护理人员观念转变的基础，持续不断的服务理念教育是护理人员观念转变的有效措施。     

医院门诊病人对护理工作满意度评价

目的：了解门诊病人对医院护理工作的满意度，为制定护理服务对策提供依据。方法：两阶段分层整群抽样方法确定调查对象，采用问卷调查，调查员追踪询问门诊病人，共调查1914人。结果：调查对象应答率99．3％。门诊病人对护理工作总体评价较高，满意率高于95．0％。但对就诊环境、护理设备、候诊秩序及候诊时间的满意度低于对护理服务态度、护理技术操作的满意度。对护理工作中尚不满意的问题主要是设备条件差、就诊环境差与候诊等待时间较长。结论：坚持“以病人为中心，以顾客满意为目标”的服务宗旨，继续强化质量第一和优质服务观念；重视护理设备建设；合理配备护理人员，提高护理人员素质。     

医院办好护理函授站的做法和体会

为提高护士的学历层次及知识结构，我们于1994年开始先后与第一、第二和第三军医大学联合在医院成立护理大专及护理本科函授站。经过十多年的努力，共培养护理大专生9批260名、护理本科生7批120名，为护士在职学习开辟一块天地。使我院护士大专率由原来10％上升为58％；本科率由原来1．6％上升为33％，护理队伍的整体素质得到进一步提高，有力地保障各项护理工作的完成，     

中专护理教育后继续高等教育的调查

对南京２０所医院中专护理人员继续高等（大专）教育后在护理技术操作、护士长任职人数、护理教学、护理科研及论文撰写４方面能力进行调查，同时与护理中专、护理大专、护理本科进行对照比较。结果表明：在调查期间护理中专后继续大专教育组在护理技术操作、护士长任职人数、护理科研方面明显优于护理本科组（Ｐ＜０．０１），在护理技术操作、护理科研方面明显优于护理大专组（Ｐ＜０．０１）。中专护理教育后继续大专教育仅是目前我国高等护理教育的形式之一，该教育形式为我国护理质量的提高、护理事业的发展发挥了极其重要的作用，是快速培养我国护理后备力量的一种切实途径。     

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.