老年医学科护士岗位胜任力与管理关怀性、护士长领导力的关系研究

目的 了解老年医学科护士岗位胜任力、管理关怀性和护士长领导力的现状,并探讨三者间的关系。方法 使用自行设计的一般资料问卷、护士老年护理岗位胜任力量表、管理关怀性评估量表、护士长领导力问卷对北京市23所三级甲等医院老年医学科的388名护士进行调查。结果 老年医学科护士岗位胜任力得分(207.25±8.48)分;管理关怀性得分(94.34±8.65)分;护士长领导力得分(166.37±8.58)分。老年医学科护士岗位胜任力与管理关怀性呈正相关(r=0.523,P<0.01),与护士长领导力呈正相关(r=0.604,P<0.01)。多因素分析显示,工作年限、职称、管理关怀性、护士长领导力是影响老年医学科护士岗位胜任力的主要因素。结论 老年医学科护士岗位胜任力处于中等水平,管理关怀性处于中等偏低水平,护士长领导力处于中等偏上水平。医院管理者可从管理关怀性、护士长领导力层面出发,进一步提高老年医学科护士岗位胜任力水平,助推老年护理事业发展。     

手术室新入职护士核心能力现状及影响因素研究

目的调查湖北省三级甲等医院手术室新入职护士核心能力的水平并探讨其影响因素。方法采用方便抽样法,应用中国注册护士核心能力测评量表对湖北省7所三级甲等医院172名手术室新入职护士进行调查。结果手术室新入职护士核心能力总分为(177.53±36.57)分,临床护理维度均分最高为(3.34±0.56)分,其次为法律/伦理实践维度为(3.22±0.52)分,得分最低的为评判性思维/科研维度(2.46±0.48)分。手术室新入职护士核心能力的主要影响因素为学历和手术室内培训时间(P0.01)。结论临床护理管理及教育者应结合手术室护士核心能力的影响因素,有针对地制订干预措施、建立合理有效的手术室新入职护士培养模式及评价体系,以促进临床护理人才培养和教学质量的提高。     

注册护士临床沟通能力现状及影响因素的多中心调查

目的了解注册护士临床沟通能力现状,并分析影响因素。方法选取新疆、甘肃、河北、湖北4个地区7所三级甲等医院2 068名注册护士作为研究对象,采用临床护士沟通能力量表和护士核心能力量表进行调查。采用多元线性回归分析其影响因素。结果注册护士的沟通能力、核心能力的总分分别为(80.83±11.91)分、(159.24±29.84)分。多元线性回归分析结果显示,核心能力、基础学历和培训频率是注册护士沟通能力的影响因素(P0.01)。结论本组注册护士的沟通能力水平较高,护士的核心能力、受教育程度及培训的频率是沟通能力的影响因素。医院和护理管理者可通过提高护士的核心能力及根据护士学历通过合理频次的培训来提高护士的沟通能力。     

广州市部分综合性三级甲等医院手术室护士胜任力分析

目的调查广州市某5所综合性三级甲等医院手术室护士胜任力现状并探讨其影响因素。方法应用手术室专科护士胜任力自评问卷对广州市某5所综合性三级甲等医院215名手术室护士的胜任力及其影响因素进行调查分析。结果广州市某5所综合性三级甲等医院手术室护士的胜任力权重均分(192.15±48.09)分,7个维度得分分别为:职业素养(4.16±0.80)分、团队合作能力(4.06±0.77)分、沟通协调能力(4.03±0.89)分、个性特征(3.91±0.73)分、专业态度(3.61±1.61)分、手术室临床教学培训能力(3.57±1.24)分、手术护理专业能力(3.15±1.06)分;性别、年龄、手术室工龄、学历、职称及聘用方式是胜任力的影响因素(P0.01)。结论广州市部分三甲医院手术室护士(尤为男性护士)胜任力存在提升空间,通过不断的手术护理实践、入职后层级培训、高学历教育及职业培训等方式可提高手术室护士胜任力。     

骨科护士的通用能力调查

[目的]了解北京市某三级甲等医院骨科注册护士通用能力现状,为制定护理人力资源配置方案提供依据。[方法]应用一般资料调查表和通用能力量表对北京市某三级甲等医院骨科191名护士进行问卷调查。[结果]护士通用能力总分为(53.922±8.993)分,均分为(2.996±0.499)分。设计和创新能力得分最低,与他人相处和工作配合能力得分最高。不同科室、年龄、工作年限护士的对通用能力有影响。[结论]北京市某三级甲等医院骨科护士通用能力处于中等偏上水平,需加强低年龄、低职称、工作时间短的护士的通用能力培训,以提高护理队伍的通用能力。     

北京市某三级甲等医院护士通用能力调查

目的:调查北京市某三级甲等医院注册护士的通用能力现状,为制定护理人力资源配置方案提供依据。方法:应用一般资料调查表和通用能力量表,对北京市某三级甲等医院的448名护士进行问卷调查。结果:护士通用能力总分为(54.42±10.08)分,平均为(3.02±0.56)分。各维度中,运用设计和创造力方面的能力得分较低,管理和发展自我能力得分最高。不同科室、年龄、职称、婚姻状况、工作年限对于护士通用能力水平均产生影响,其中以职称的影响最为突出。结论:北京市某三级甲等医院护士的通用能力处于中等偏上水平,需加强对于年龄低、职称低、工作年限短的护士的通用能力培训,以提高护理队伍的整体通用能力。     

北京市28所医疗机构临床护士老年护理能力现状调查

目的 ：调查北京市医疗机构临床护士的老年护理能力,并分析其影响因素,为提高临床护士老年护理能力提供实证依据。方法 ：采用便利抽样法,于2022年4月—5月应用一般资料调查表和临床护士老年护理能力评价量表对北京市28所医疗机构的3 202名临床护士进行横断面调查。采用多元线性回归分析临床护士老年护理能力的影响因素。结果 ：临床护士老年护理能力总分为（119.85±36.60）分,条目总均分为（2.78±0.85）分,3个一级维度中专业素养维度得分最高,专业发展维度得分最低,10个二级维度中安全管理维度得分最高,其次为评判性思维维度,科研创新维度得分最低。多元线性回归分析结果显示,年龄、老年护理工作年限、是否为老年专科护士、对临床工作喜爱度、对临床工作满意度是临床护士老年护理能力的独立影响因素(P<0.05)。结论 ：临床护士老年护理各维度能力发展不均衡,处于中等水平,应重视专业发展能力,尤其是科研创新能力的培养,医院应开展老年护理相关培训,以提高临床护士老年护理能力。     

新入职护士核心能力的现状及影响因素研究

目的:了解新入职护士规范化培训后核心能力现状及影响因素,为完善新入职护士培训方案提供理论支持.方法:采用一般资料调查表、中国注册护士核心能力量表对南昌市属三级甲等医院161名新入职护士进行调查.采用单因素分析、两独立样本t检验、多元线性回归分析分析影响新入职护士核心能力的因素.结果:南昌市属三级甲等医院的161名新入职护士核心能力总分为(126.60±36.66)分,教育与咨询能力得分最高,为(2.41±0.65)分,领导能力得分最低为(2.21±0.71)分.不同婚姻状态护士临床护理维度得分比较差异有统计学意义(P<0.05);不同批次进行规范化培训护士核心能力总分及多个维度得分比较差异有统计学意义(P<0.05).单因素分析显示每月不同夜班数量、所在科室新入职护士核心能力总分及多维度得分比较差异有统计学意义(P<0.05),不同规范化培训时间新入职护士核心能力总分和各维度得分比较差异有统计学意义(P<0.05),进入了核心能力得分的回归方程,解释核心能力得分总变异量达到78.6％.结论:针对影响因素分层设计规范化培训方案和考核指标,进一步提升新入职护士核心能力.     

三级甲等医院临床护士叙事能力的影响因素

目的:调查三级甲等医院临床护士叙事能力的影响因素。方法:采取便利抽样法,采用一般资料调查表和叙事能力量表对214名三级甲等医院临床护士进行问卷调查。结果:临床护士叙事能力总分为(145.77±21.72)分;关注倾听、理解回应、反思再现3个维度得分分别为(49.33±7.51)分、(63.90±9.82)分、(32.50±5.78)分;关注倾听、理解回应、反思再现各条目均分为(5.48±0.83)分、(5.33±0.82)分、(5.42±0.96)分;多元线性回归分析结果表明,工作年限、叙事能力熟悉程度和同事关怀程度是影响护士叙事能力的主要因素。结论:临床护士叙事能力处于中等水平,提示护理教育者和管理者应加强叙事护理教育,强化叙事护理培训,提供多方位的社会支持,提高临床护士叙事能力。     

新疆北疆地区三级甲等医院产科护士核心能力现状调查及其影响因素研究

目的:调查新疆北疆地区三级甲等医院产科护士核心能力现状,探讨其影响因素。方法:采用护士一般资料调查表和适合产科专科护士使用的注册护士核心能力量表对新疆北疆地区三级甲等医院产科的注册护士进行问卷调查。结果:新疆北疆三级甲等医院245名产科专科护士总体核心能力总分为(82.09±22.49)分。各维度条目均分从高到低依次为职业道德及服务意识、产科护理风险处理及防范能力、产科护理技术操作能力、沟通及合作能力、产科护理理论知识、教育与咨询能力、个人专业发展和知识综合能力。产科专科护士核心能力影响因素为年龄、婚姻状况、工作年限、能级、职称、聘用形式。产科专科多元线性回归分析显示,婚姻状况、学历为护士核心能力独立影响因素。结论:新疆北疆地区三级甲等医院产科护士核心能力水平不高。建议针对产科护士特点开展不同层次更有针对性的教育和培训。     

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.     

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.     

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.     

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.