某市ICU护士多重耐药菌感染防控知信行现状调查

目的调查ICU护士多重耐药菌感染防控知信行现状,旨在为管理者组织多重耐药菌(Multidrug-Resistant Organism,MDRO)防控培训,切实提高临床医务人员依从性提供依据。方法采用方便抽样法,应用自行设计的多重耐药菌感染防控知信行评估调查问卷,选择2019年11月—12月某市173名ICU在职护士进行调查,分析MORD防控知信行现状。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(20.40±1.62)分、(46.38±5.16)分、(117.47±13.27)分。护士多重耐药菌感染防控知信行的影响因素为:ICU工作年限、领导重视程度、MDRO知识培训次数及需求、是否设置隔离病房。结论护士多重耐药菌感染防控态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提高领导对多重耐药菌感染防控的重视程度,增加相应防护设施,加强低年资护士多重耐药菌感染知识培训,进而改善其防控行为。     

某市ICU护士多重耐药菌感染防控知信行现状调查

目的调查ICU护士多重耐药菌感染防控知信行现状,旨在为管理者组织多重耐药菌(Multidrug-Resistant Organism, MDRO)防控培训,切实提高临床医务人员依从性提供依据。方法采用方便抽样法,应用自行设计的多重耐药菌感染防控知信行评估调查问卷,选择2019年11月—12月某市173名ICU在职护士进行调查,分析MORD防控知信行现状。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(20.40±1.62)分、(46.38±5.16)分、(117.47±13.27)分。护士多重耐药菌感染防控知信行的影响因素为:ICU工作年限、领导重视程度、MDRO知识培训次数及需求、是否设置隔离病房。结论护士多重耐药菌感染防控态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提高领导对多重耐药菌感染防控的重视程度,增加相应防护设施,加强低年资护士多重耐药菌感染知识培训,进而改善其防控行为。     

ICU低年资护士多重耐药菌防控知识培训体会

目的:通过对ICU低年资护士多重耐药菌的防控知识培训,增强低年资护士对多重耐药菌患者的感染预防与控制意识,确保低年资护士掌握正确、有效的多重耐药菌感染预防和控制措施。方法:对75名低年资护士进行相关知识培训后并进行考核。结果:经过培训,低年资护士多重耐药菌感染相关知识知晓率较培训前提高。结论:通过专职人员专业培训,对强化低年资ICU护士对多重耐药菌感染隔离、防控措施的认识,降低院内感染发生率,具有积极作用。     

ICU感染控制专职护士对多重耐药菌控制的效果评价

目的探讨ICU感染控制专职护士在多重耐药菌管理中的作用。方法设置ICU感染控制专职护士,通过加强培训、规范管理、及时通报多重耐药菌感染情况、加强感染控制措施落实。结果设立ICU感染控制专职护士前后新发MDROs菌株数分别为77株和50株,每千住院日新发多重耐药菌分离量下降(P0.05)。结论设立ICU感染控制专职护士,通过严格督导和培训,能有效落实多重耐药菌感染患者的隔离措施,减少ICU多重耐药菌的交叉感染。     

三级甲等医院护士多重耐药菌感染防控知信行的调查分析

目的了解三级甲等综合医院护士多重耐药菌感染防控知识、态度、行为现状。方法采用自设护士多重耐药菌感染防控知信行问卷对太原市4所三级甲等综合医院的370名护士进行调查。结果护士多重耐药菌感染防控知识、态度、行为得分分别为(23.79±2.27)分、(47.94±6.04)分、(137.35±16.49)分,且三者呈正相关(P0.01)。护士多重耐药菌感染防控知识的影响因素为:多重耐药菌知识培训需求、领导重视程度、有无设置隔离病房;态度的影响因素为:学历和领导重视程度;行为的影响因素为:领导重视程度和设置隔离病房。结论三级甲等综合医院护士多重耐药菌感染防控知识、态度、行为有待进一步提升。预防多重耐药菌感染的发生,需提升领导对多重耐药菌感染防控的重视程度,加强对护士多重耐药菌感染知识教育,端正护士态度,进而引导其防控行为。     

ICU多重耐药菌感染风险识别及防控的研究进展

重症监护室(ICU)是多重耐药菌感染的高发科室,多重耐药菌感染与多种因素有关,早期进行风险识别、严格落实各环节是做好多重耐药菌感染防控工作的关键。该文介绍了ICU患者多重耐药菌感染的危险因素,综述了多重耐药菌感染的管理方法和防控技术。其中,管理方法包括多学科协作管理、危急值信息追踪管理和PDCA循环法管理,防控技术包括严管手卫生、规范诊疗、严格消毒隔离、合理应用抗菌药物和提高管理层的重视度,旨在为ICU患者多重耐药菌感染的防控提供参考。     

心脏术后多重耐药菌感染的护理对策

总结了预防心脏外科ICU多重耐药菌发生的方法,主要包括加强培训及管理、加强手卫生、气道管理、体位管理、合理使用抗生素等,认为落实防控制度,提高感染控制措施的执行力,能有效预防和控制多重耐药菌的传播,保障患者安全。     

手术室护士多重耐药菌防控知信行现状调查研究

目的 了解上海市医疗机构手术室护士多重耐药菌防控知信行现状,针对性开展多重耐药菌防控专项培训,为进一步加强医疗机构多重耐药菌防控管理提供参考依据。方法 选择2021年12月21日至2022月1月27日上海市多家医疗机构在岗手术室护士129名作为研究对象。采用根据国家卫生健康委员会办公厅发布的《多重耐药菌感染预防与控制技术指南(试行)》结合医护人员职业特点自行编制调查问卷进行多重耐药菌防控知信行调查。结果 129名手术室护士平均多重耐药菌防控知识总分为(27.76±1.857)分;平均多重耐药菌防控态度总分为(46.36±8.977)分,平均多重耐药菌防控行为总分为(161.94±16.965)分。不同性别、护龄的手术室护士多重耐药菌防控知识得分比较,差异均有统计学意义(P<0.05)。结论 医疗机构手术室护士多重耐药菌防控知信行能力尚有待提升。     

应用知信行模式提高ICU护士对多重耐药菌感染防控的效果

目的观察应用知信行模式提高ICU护士对多重耐药菌感染防控的效果。方法成立防控小组,组织学习多重耐药菌感染相关知识,建立防控制度并逐一实施。结果实施后护士知信行问卷得分较实施前提高,多重耐药菌防控知识能力专项测评成绩也高于实施前,手卫生依从性由实施前59.8%提高到91.3%。结论知信行模式可提高ICU护士对多重耐药菌感染防控的效果。     

重症监护病房多重耐药菌感染临床分析及护理干预

[目的]通过调查重症监护病房(ICU)多重耐药菌感染的临床分布情况,探讨降低多重耐药菌感染的护理防控措施。[方法]收集2014年1月—2015年12月ICU病人中有多重耐药菌感染的资料,分析多重耐药菌的种类、分布情况及与医院感染的关系。[结果]2014年1月—2015年12月ICU住院病人2547例,临床细菌培养标本中共培养出致病菌605株,其中多重耐药菌感染病人329株,占54.38%;发生医院感染病人135例,其中多重耐药菌医院感染79例,医院感染病例中多重耐药感染占58.52%。ICU多重耐药菌株中以鲍曼不动杆菌最多251株,占76.29%;ICU多重耐药菌感染主要感染部位为下呼吸道,占85.41%。[结论]多重耐药菌是ICU感染的主要致病菌,同时也是ICU医院内感染的主要致病菌;多重耐药菌病人感染部位以呼吸道为首位,临床实践显示,通过护理干预措施,可有效地预防与控制多重耐药菌在ICU的传播,降低医院感染率。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.