提高院前急救成功率探讨

目的探讨如何提高院前急救成功率。方法回顾性分析我院2004-01／12院前急救的3674例患者的临床资料．总结其成功的经验。结果总抢救成功率98．3％，其中心肺复苏（CPR）成功率48．5％，危重症抢救成功率93．3％。结论提高院前急救成功率的关键；①良好齐全的院前急救设备；②高素质急救人员；③铁的纪律．规范化的急救措施。     

系统的护理措施在院前急救中的应用体会

目的探讨系统的护理措施在院前急救中的作用。方法统计共救治的3856例患者的抢救成功率及心肺复苏的成功率。结果3856例患者中抢救成功率为96％，心肺复苏的成功率提高7．25％。结论系统的护理措施可以提高院前急救的成功率。     

危重症患者院前急救护理体会

目的 探讨掌握危重症患者院前急救中现场抢救和转运途中的护理措施.方法 回顾性分析1040例病例的出车情况、病情及护理措施,总结出危重症患者院前急救的护理要点.结果 1040例患者经积极的抢救处理,安全送达医院946例,抢救成功率达91%.81例患者现场抢救无效死亡,13例患者由于病情重及院前条件所限,转运途中死亡.结论 采取及时有效的急救措施,能最大限度地减少患者的痛苦,降低伤残率,减少死亡率,提高抢救成功率.     

预见性护理在院前急救中的应用

目的 探讨预见性护理在院前急救中的应用.方法 将我科2011年9 12月200例院前急救患者随机分成对照组和观察组,对照组实施院前急救护理常规,观察组实行预见性护理,比较二组患者的有效抢救时间及抢救的成功率.结果 对照组的抢救时间及抢救成功率为(21.38±3.84) min和83.0％,观察组为(14.91±3.26)min和92.0％,二组比较差异均有统计学意义(P均＜0.05).结论 对院前急救患者实行准确、恰当的预见性护理,可以缩短抢救时间,提高了抢救成功率.     

预见性护理在院前急救急危重症病人转运中的应用

目的探讨预见性护理在院前急救危重症病人转运中的应用效果。方法在2014年1月至2016年1月期间,选取我院收治的140例急救危重症患者,随机分为对照组(70例)与实验组(70例),对照组采用常规转运护理,实验组采用预见性护理转运,对两组患者的护理效果进行对比分析。结果实验组患者对护理满意度率92.9%,对照组患者对护理满意率为77.1%,对比差异显著(P0.05),具有统计学意义。结论在院前急救危重症患者转运中采用预见性护理,可以显著提高患者的转运效率与安全性,为入院后的抢救提供良好的条件,促进患者抢救成功率的提高。     

院前急救护理之隐患及对策

目的：分析院前急救护理中的隐患，寻求最佳应对措施，减少医疗护理纠纷，提高抢救成功率。方法：总结分析1677例院前急救病例资料，探讨院前急救护理中存在的问题及采取的有效应对措施和效果。结果：本组病例经及时抢救护理．尤其是及时消除院前急救护理巾的隐患，为院内急救赢得了时间，纠纷发生率为0，患者满意率达99．5％。结论：及时发现院前急救护理中的诸多隐患，并采取有效的应对措施，可为院内急救赢得时间，大大提高抢救成功率，减少或社绝医疗护理纠纷和差错事故。     

多发伤患者院前急救护理和安全转运的临床价值

目的探讨多发伤患者院前急救护理及安全转运的临床价值。方法选取2017年03月至2018年06月本院收治72例多发伤患者,随机分为对照组、研究组均36例。对照组按常规急救流程对患者实施救护,研究组实施院前急救护理及安全转运,分析比较两组救护车到达时间、有效抢救时间与急救成功率。结果两组患者救护车到达时间、有效抢救时间比较差异均具有统计学意义,P0.05;研究组急救成功率显著高于对照组,两组急救成功率分别为97.22%、88.89%,P0.05。结论院前急救护理和安全转运的实施对多发伤患者具有重要临床价值,保障急救工作有序进行,进一步提高急救成功率,提高急救护理水平,值得临床推广应用。     

全程护理在急诊危重患者抢救中的应用效果探讨

目的:总结全程护理干预在急诊危重症患者抢救治疗中的实施效果,为急诊护理工作提供参考.方法:选择急诊抢救的200例患者,分为常规护理组以及全程护理组两组,组间例数一致.对比两组急诊危重症患者的抢救成功率以及护理满意度.结果:全程护理组患者护理满意度以及抢救成功率均明显高于常规护理组(P＜0.05).结论:全程护理干预的实施可以提高急诊危重症患者的抢救成功率以及患者的护理满意度,整体上提高患者的生活质量,建议实施推广.     

严重多发伤的院前和急诊科抢救效果分析

目的探讨提高严重多发伤抢救成功率的方法。方法43例多发伤病人按受伤后采取的急救措施分为院前急救组23倒。非院前急救组20倒,比较两组抢救效果。结果严重多发伤病情严重,院前急救组病死率为8．7％;非院前急救组的病死率为35．0％,非院前急救组病死率高于院前急救组（P〈0．05）,院前急救组死亡患者存活时间为（5．12±1．6）h,非院前急救组为（2．3±0．97）h,两组比较差异有统计学意义（P〈0．05）。结论严重多发伤早期病死率高,院前急救能延缓伤员死亡时间,降低病死率。加强创伤“黄金时间”的抢救,是提高严重多发伤抢救成功率的关键。     

预见性护理在急性心肌梗死院前急救中的应用

目的：比较预见性护理与常规护理在AMI患者院前急救中的应用,探讨AMI患者更好的院前急救方法。方法：将2010年12月-2012年12月79例患者作为实验组,在常规急救护理基础上实施预见性护理干预。以2008年11月-2010年11月的79例患者作为对照组,按常规急救护理。比较患者急救反应时间、抢救成功率和并发症发生率。结果：两组患者的急救反应时间、抢救成功率、并发症发生率比较差异均有统计学意义（P<0.05）。结论：急性心肌梗死患者实施院前预见性护理干预不仅可以缩短院前急救反应时间,而且可以提高抢救成功率和减少并发症的发生率,保障患者的安全。     

Guidelines for a palliative approach for aged care in the community setting: A suite of resources

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.     

上海市中心城区居家临终患者生活状况及护理指导需求调查

选择2011年1月至2013年12月本社区诊断明确的恶性肿瘤患者、诊断明确的慢性病晚期生活失能患者及照护者各150例,采用自制定量问卷进行面对面调查.112例（74.7％）的照护者认为相对医院而言,患者本人更希望在家里接受护理;95例（63.3％）的照护者护理技术认知水平欠缺,照护技术能力较弱;97例（64.7％）照护者表示希望得到临终患者护理技术指导.说明居家临终关怀可以满足患者的身心需求,但需要社区医疗服务和资源的支持,借助居委会平台集中培训,提供居家照护的技能指导或疾病管理的相关信息支持;需要建立临终关怀互助小组,尽早建立护理规范.     

护理团队在手术室护理质量管理中的应用效果

目的：探讨护理团队对提高手术护理管理质量的效果。方法：将2013年1月至2013年12月在本院实施护理团队管理的80例手术患者设为观察组,将2012年1月至2012年12月实施常规性护理管理的80例手术患者设为对照组,分别于护理团队实施前后采用自行设计的护理质量调查问卷及患者满意度问卷了解患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分及满意度,并记录两阶段护理错差率。结果：与未实施护理团队相比,实施后患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分显著提高,差异有统计学意义（P〈0.05）。与未实施前相比,实施后配错药、文书归档错误、遵错医嘱、术后压疮发生率显著下降,患者满意度显著提高,差异有统计学意义（P〈0.05）。结论：对手术室实施护理团队管理模式能有效提高护理人员护理质量,降低护理风险,提高患者满意度,有利于建立和谐的护患关系。     

Value Driven Outcomes (VDO): a pragmatic,modular, and extensible software framework for understanding and improving health care costs and outcomes

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.     

糖尿病的护理

随着生活水平的提高,糖尿病的发病率越来越高。然而,糖尿病患者心理压力大,缺乏糖尿病的基本知识,导致自我护理能力差。需要对糖尿病患者进行自我护理指导,帮助患者制定治疗和护理计划,做好终生护理工作;维持血糖的稳定,控制并发症,提高糖尿病患者的生活质量。     

安宁缓和医疗志愿者培训平台建设

为了让全社会的普通大众,不论性别、年龄、职业、受教育程度,都能够了解安宁缓和医疗的核心理念,并运用在自己的生活当中,甚至传播并服务给更多人,北京协和医院安宁缓和医疗组于2021年成立了面向全社会的专业安宁缓和医疗志愿者培训平台。本文对安宁缓和医疗志愿者培训平台的培训设计、内容、方式和结果进行回顾性的梳理和总结,发现平台的培训设计有理论依据,培训内容逻辑完整,培训方法适宜志愿者,培训结果优异。安宁缓和医疗志愿者培训平台建设具有极好的可行性,需要进一步深入探索培训平台的有效性并拓展长期发展策略。     

An overview of neurocritical care in China: a nationwide survey

Background Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units （NICUs） across China. Methods The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated. Results Seventy-six questionnaires were returned （a 68% response rate）. Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half （53%） and one-third （33%-37%） of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs. Conclusion In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well- staffed NICUs across the nation currently.     

美国医疗保健经济演变历程及对我国启示

美国作为以市场配置资源著称的发达国家,其医疗保健演化和变革的探索历程,为人类积累了经验和教训,为国内着力优化配置医疗资源相关制度体系的深化设计提供了有益的启发和可贵的警示。本文旨在借"他山之石",结合国内医疗保健经济发展的现实,提取出对"健康中国"国家战略下未来相关制度发展的有益借鉴。     

细节护理在儿科静脉穿刺中的应用

目的:探讨细节护理在儿科静脉穿刺中的应用效果。方法:将683例儿科住院患儿,按照治疗先后随机分为对照组和试验组。对照组给予常规护理,实验组实施细节护理,并对两组患儿输液结束后情况(静脉穿刺成功率、护理差错率及患者满意度等)进行比较分析。结果:试验组实施细节护理后,提高了护士静脉穿刺成功率和患者满意度,护理差错率明显降低,与对照组比较,差异有统计学意义(P<0.05)。结论:细节护理在儿科静脉穿刺中应用价值较高,可以提升患者满意度和护理质量,值得在临床中进一步推广与使用。     

人文关怀及心理护理在核磁共振检查中的应用

目的分析人文关怀及心理护理在核磁共振（MRJ）检查中的积极作用。方法选取2012年6月～2013年1月在东莞市太平人民医院接受MPJ检查的患者245例。对照组120例,给予常规护理;观察组125例,在此基础上辅以人文关怀及心理护理。对比2组SAg与SD9评分与护理效果。结果观察组SAS与SDS评分均显著低于对照组,差异有统计学意义（P〈0．05）;2组护理总有效率分别为96.80％、89．17％,观察组显著优于对照组,差异有统计学意义（P〈0.05）。结论在M刚检查中加强对患者的人文关怀与心理护理,可有效缓解患者负性情绪与提升护理效果,为MRJ检查顺利完成提供了可靠保证。