护理安全管理的思路与方法探讨

目的：为了降低护理风险的发生率,为患者提供、安全、优质、有效的护理服务。方法：护理管理者要转变风险管理的思维模式和方法,寻求护理风险的防范措施。结果：增强护理安全的风险意识,完善工作制度优化工作流程,持续改进和提高护理质量。结论：通过改变护理安全管理思路和方法,最终降低了护理风险的发生率。     

加强护理风险管理的思路与方法

目的为了有效地回避护理风险,降低护理风险的发生率,为病人提供安全的、有序的优质护理.方法制定护理风险管理计划,明确护理风险管理职责,加强护理业务质量建设,规范关键护理过程的管理,协调好护理工作与相关科室部门的工作,建立多途径、多视角的护理质量监控系统,培训护士风险防范的意识和能力,持续质量改进.效果住院病人满意率保持在98%以上,护理差错发生率由0.15%下降至0.05%.结论实施有效的护理风险管理,对预防护理安全隐患的发生,减少护理纠纷起到了重要的作用.     

实施护理风险管理提高护理质量

目的降低护理风险的发生率,为患者提供安全优质的护理服务。方法建立完善的风险管理制度,制定风险防范措施,加强护理业务工作管理,培训护士风险防范的意识和能力,持续质量改进。结果风险管理前后比较经卡方检验,有显著性差异(P<0.05),患者的满意度由2004年95.7%上升到2005年98.1%。结论实施护理风险管理,能有效提高护理人员的风险防御能力,护理行为逐步规范,减少护理差错及纠纷的发生,提高患者满意度,使护理质量得到提高。     

急诊科实施护理风险管理的效果评价

目的:为强化急诊护理风险管理,降低护理风险的发生率,为病人提供优质、安全的护理。方法:健全完善护理风险管理制度,强化安全和护士素质教育,提高护理安全认识,加强业务素质培训,提高护理工作质量,规范仪器设施的应用和管理。结果:实施风险管理前后护理缺陷发生率、护理投诉率、病人及家属满意率、急救物品完好率、护理质量分比较均有统计学意义(P<0.05,P<0.01)。结论:实施急诊护理风险管理对预防护理安全隐患,提高护理质量起到了积极重要作用。     

头脑风暴法在护理风险管理中的运用

[目的]为了规避风险,降低护理缺陷发生率,提高护理质量.[方法]在科室护理风险管理中充分发挥团队精神和激发人的创造性思维,恰当应用头脑风暴法识别护理工作中存在的风险,分析原因,制定并执行各项防范护理风险措施,加大风险监控.[结果]护理质量、病人满意度及护士对工作满意度均明显提高,护理差错减少(P＜0.01).[结论]在科室护理风险管理中善用头脑风暴法,能提高每位护士防范风险的意识和能力,有效地预防和减少了护理风险的发生,为病人提供更加安全、有序、优质的护理.     

护理风险管理探讨

目的有效地回避护理风险,加强风险防范,降低护理风险的发生率,为患者提供安全、有序的优质护理。方法护理风险回避或取消,熟悉医疗法律法规,加强护理记录管理,风险教育。结果住院患者满意率由95%上升到98%。结论实施有效的护理风险管理,为患者提供优质的服务,对预防护理风险的发生,减少护理纠纷起到了重要的作用。     

实施护理风险管理提高护理质量

目的 降低护理风险的发生率,为患者提供安全优质的护理服务.方法 建立完善的风险管理制度,制定风险防范措施,加强护理业务工作管理,培训护士风险防范的意识和能力,持续质量改进.结果 风险管理前后比较经卡方检验,有显著性差异(P＜0.05),患者的满意度由2004年95.7%上升到2005年98.1%.结论 实施护理风险管理,能有效提高护理人员的风险防御能力,护理行为逐步规范,减少护理差错及纠纷的发生,提高患者满意度,使护理质量得到提高.     

实施护理风险管理 提高护理质量

目的降低护理风险的发生率,为患者提供安全优质的护理服务。方法建立完善的风险管理制度,制定风险防范措施,加强护理业务工作管理,培训护士风险防范的意识和能力,持续质量改进。结果风险管理前后比较经卡方检验,有显著性差异（P〈0.05）,患者的满意度由2004年95.7%上升到2005年98.1%。结论实施护理风险管理,能有效提高护理人员的风险防御能力,护理行为逐步规范,减少护理差错及纠纷的发生,提高患者满意度,使护理质量得到提高。     

风险管理在血液透析护理管理中的应用

目的:探讨血液透析护理风险管理模式及其应用价值。方法:对风险管理前与执行风险管理后的血液透析质量进行比较,评估血液透析工作加强风险管理的价值。结果:血液透析综合评分由94.8%上升至98.8%,病人满意度由94%上升至98.5%,一般差错由3起降至0起,无护理投诉发生。结论:在血液透析中实施风险管理,能有效预防和减少透析风险的发生,为病人提供更加安全、有序、优质的透析服务。     

护理风险管理在急诊科护理管理中的应用

目的:探讨急诊科风险管理的实施方法与效果。方法:评估急诊护理工作中存在的风险因素,制定应对措施,完善和修订工作制度,加强培训,强化护理人员的风险意识,成立风险管理小组,加强风险监控等。结果:病人满意度及全院护理质量检查合格率均有所提高。结论:在急诊科应用风险管理能有效预防和减少护理风险的发生,提高病人满意度和护理质量,为病人提供更加安全、优质的服务。     

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.