聘用护士非正式群体在护理管理中的作用

目的探讨聘用护士非正式群体在护理管理中的作用。方法在临床工作中正确引导和使用聘用护士非正式群体,使其与科室工作目标一致。结果聘用护士队伍稳定,护理质量稳步上升。结论加强聘用护士非正式群体的管理,能有效地提高护理工作效率,促进科室工作目标的实现。     

军队医院不同婚姻状况重症监护室聘用护士工作压力源的调查

[目的]调查分析军队医院ICU聘用护士工作压力源现状及其不同婚姻状况ICU聘用护士之间的差异。[方法]采用中国护士工作压力源量表对121名ICU聘用护士进行问卷调查。[结果]ICU聘用护士工作压力源5个维度得分中护理工作量及时间分配问题得分最高,其次是护理专业及工作方面的问题;在护士工作压力源条目排序中前5位依次是护士工作量大、经常倒班、上班的护士数量不够、担心工作中出现差错事故、护理病人病情过重;已婚ICU聘用护士工作压力显著高于未婚护士(P<0.05)。[结论]军队医院ICU聘用护士在工作量及时间分配问题方面压力最大,其工作压力源水平受婚姻状况影响。     

浅谈合同护士的管理

随着医疗体制改革的不断深入，以及年老护士退休离岗，医院原有在编护士数量不能满足临床工作需要。聘用护士已逐渐成为医院护理工作的主体，聘用护士的管理是目前护理管理中的一项比较突出的问题。如何对合同护士进行有效管理，以提高聘用护士在临床工作的稳定性及价值认同感，保持护理队伍稳定性，调动合司护士的积极性，挖掘其潜力，做到择优用人，发挥聘用护士在临床工作中的作用，对护理质量的提高，有一定的推动作用。     

快速提升新聘用护士综合素质的体会

目的 为了有效提升新聘用护士的综合素质,确保护理质量和护理安全。方法 护士长采取端正其工作态度、营造舒心环境、采用激励政策、保障待遇权益、严格临床带教、加强培训与监督管理等措施。 结果 新聘用护士重视业务学习与自身修养,确保了护理质量,提高了综合素质。 结论 对新聘用护士实施规范化培训与系统教育是提升新聘用护士综合素质的有效方法。     

军队医院中聘用护士管理浅谈

随着军队医院军人护士减少,聘用护士的增加,如何加强对聘用护士的管理,提高其自身素质修养和护理质量,适应军队护理管理的要求,就显得特别重要.作者提出了对军队医院中聘用护士管理应注意做好5个方面的工作.即:提高聘用护士素质,实行半军事化管理;稳定聘用护士思想,提高政治待遇;实行标准化管理,提高护理质量;加强系统培训,严格"三基"训练;建立聘用护士档案,掌握其综合素质.     

对优秀聘用护士的评选与管理

目的充分调动聘用护士的工作积极性和主动性,搭建聘用护士成长的平台。方法公示优秀聘用护士条件、广泛宣传、自愿报名,合格者参与评选。对评选出的优秀聘用护士,要求其认真履行职责,并进行适时评价、奖励等系统管理。结果提高了聘用护士的理论及操作成绩和患者满意度;患者投诉及护理缺陷发生率下降。结论实施优秀聘用护士的评选,可以提高其工作积极性。     

体检中心动态聘用计时护士的体会

目的探讨根据医院体检中心的工作量,动态聘用计时护士的应用效果。方法通过动态聘用本院护士,利用其休息时间在体检中心工作高峰期提供护理服务。结果计时护士不但节省了医院的人力成本支出,且能保证护理质量,提高患者满意度;护士综合能力得到了提升和发展。结论在体检中心聘用计时护士的方法是可行的,并值得在其他护理部门进行推广。     

提高手术室新聘用护士工作能力的探讨

手术室是集诊断、治疗、抢救和麻醉的场所，其护理特殊性有别于其他临床科室。随着科学技术突飞猛进的发展，各种高、精、尖技术应用于临床，使手术室护理工作的范围更加广泛，工作难度更大，这就要求手术室护士在土作中不断地学习，不断更新自已的知识来提高业务水平，对新聘用护士则提出了更高的要求。为了让聘用护士尽快适应手术室护理工作，近两年来我们通过对手术室聘用护士采取了岗前1周培训、一对一老师带教、晨间交班提问、科内业务学习、病例讨论、护理查房等形式教育，提高了聘用护士工作能力，使护理工作质量不断提高。     

规范聘用护士管理 提高军队护理队伍整体素质

十几年来,随着我军体制编制调整,军队护士队伍结构发生了很大变化,军人护士编制减少,护士转业量加大,护理骨干流失严重,聘用护士比例逐步增加。如何适应形势,提高护理队伍的整体素质,保证护理质量,成为军队护理工作的一项重要任务。为此,近年来我们主动适应新形势,转变观念,抓住机遇,通过规范管理和强化培训,狠抓聘用护士管理和聘用护士队伍建设,确保在护理队伍结构调整过程中,较好地完成了护理工作任务。1军队聘用护士队伍基本情况1.1比例逐年增高军队医院从20世纪80年代末期开始聘用护士,聘用护士在护理队伍中的比例逐渐增加。10年前聘用…     

激励制度在聘用护士管理中的作用

目前,聘用护士已成为护理队伍中不可缺少的重要力量[1].5年来,我院对聘用护士推出了多种激励政策,尤其人事代理制度,使聘用护士与在编护士同工同酬,同时给予继续教育及专业技术评聘和晋升等机会,从而稳定了护理队伍,提高了护理质量,使其在护理工作中发挥了积极的作用.     

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.     

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.