解放军援非医疗队对塞拉利昂医务人员实施埃博拉防护技能培训的效果

目的：探讨解放军援非医疗队对塞拉利昂医务人员实施埃博拉防护技能培训的方法及效果。方法由医疗队成员对塞方47名护理人员及40名保洁人员分别实施埃博拉防护技能培训,培训分两批次进行,历时10d。培训内容包括讲解埃博拉相关知识、心理疏导及防护知识与技能培训、集中考核。培训前采用自行设计的调查问卷调查塞方医务人员的防护知识现状。结果培训前,塞方医务人员74.71%缺乏埃博拉相关知识,85.06%缺乏传染病防护知识,88.50%未参加过防护技能培训。塞方87名医务人员全部参加培训及考核,其中护理人员考核得分为(94.93±4.69)分,保洁人员考核得分为(91.18±5.37)分,考核未合格3人经再培训,补考后全部合格。结论在建立良好沟通的基础上,通过多种方法对当地医务人员实施埃博拉防护技能培训并取得了良好效果,为其他援非医疗队提供了一定借鉴。     

执行援外抗埃任务中护理工作建议与思考

随着国际和平日益发展的今天,外援医疗任务越来越多,护理是不可或缺的一部分。笔者于2014年11月跟随医疗队前往利比里亚执行抗击“埃博拉”病毒(Ebola virus,EBOV)任务,为期2个月。埃博拉病毒病是由纤丝病毒科(filoviridae)的埃博拉病毒所引起的一种急性出血性传染病。主要通过病人的血液和排泄物传播,医护人员是感染的高危人群。现结合本人在执行抗击埃博拉病毒任务中的一些护理经验与做法总结几点建议,现汇报如下。     

中国援助利比里亚埃博拉出血热治疗中心留观病区护理管理模式分享

目的总结第二批援助利比里亚医疗队留观病区2个月临床抗击埃博拉出血热(Ebola hemorrhagic fever,EHF)护理管理经验,为跨国烈性传染病救治积累经验。方法主要创新三方面管理,即中方和利比里亚籍(简称利方)医护人员的科学管理、护理工作内容和流程的合理安排、病区物资的实时管理和集中领取。结果确保了中利双方医护人员的人身安全,实现了EHF留观病区的安全管理,物资请领科学高效。结论该模式为第三批援利医疗队抗击EHF工作和日后传染病防治积累了宝贵的经验。     

援利比里亚埃博拉诊治中心门诊区感染控制护士工作实践

目的:探讨埃博拉诊疗中心门诊区感染控制护士的日常工作开展及在感染预防和控制中的作用。方法:援利比里亚抗埃医疗队门诊区护士由军队各家医院优秀护士抽调形成,规定其工作职责和任务,包括门诊区感染监测、监管、利比里亚工作人员的教育培训等,门诊区每周召开感染控制护士例会,反馈数据,讨论面临问题,分享感染控制信息和实施培训。结果:感染知识培训后,利比里亚医务人员对感染控制知识掌握合格率、手卫生依从率明显高于培训前,培训前后比较差异有统计学意义(P0.05)。结论:门诊区感染控制护士带领和指导利比里亚工作人员正确贯彻感染控制制度、落实感染控制措施,提高了门诊区感染监测、监管的及时性和有效性。     

埃博拉病毒感染5例患者的隔离防护与护理

总结5例埃博拉病毒感染患者的隔离防护和护理。隔离防护措施:做好人员和物品及污物进出病区管理,注意环境和物体消毒,加强防护教育和培训,做好一般个人防护及尸体料理防护,严格医疗废弃物管理。护理重点是做好患者心理护理及健康教育,加强饮食护理、药物治疗护理,密切监测生命体征,做好出血的观察与预防。3例患者痊愈出院,2例医治无效死亡。医疗队员工作期间和回国隔离21d没有发生任何感染。     

援利比里亚医疗队护理工作的组织与建立

<正>2014年10月,我校受命组建赴西非利比里亚抗击埃博拉出血热医疗队,此次抗击埃博拉出血热任务是习近平主席提出的第四轮援助西非国家抗击埃博拉出血热计划内容,其中包括为利比里亚援建一个治疗中心ETC(Ebola Treatment Center,ETC)。首批医疗队163人于10月下旬组建,完成集训后,于当地时间11月15日到达利比里亚蒙罗维亚,第一个成建制的中     

援塞抗击埃博拉出血热护理队伍的建设

目的探讨执行援塞抗击埃博拉出血热等应急援外任务时护理队伍的建设方案。方法通过分析解放军第302医院第二批援塞医疗队护理人员结构的合理性、出发前集中培训考核及效果评价、援塞完成任务情况,总结护理队伍建设的经验和取得的初步成效。结果援塞抗击埃博拉出血热医疗队护理队伍应选择年轻化、经验丰富、能力较全面的队员,使护理队伍结构更加合理,以便能够更出色地完成应急救援任务。结论针对援塞医疗队护理队伍的任务,建立一套完善的选拔、培训、考核及管理模式至关重要,同时要注重优化护理人才结构与强化应急保障能力的综合培训。     

抗击埃博拉出血热护理人员体力透支的原因与预防

目的探讨抗击埃博拉出血热(Ebola hemorrhagic fever,EHF)护理人员体力透支的原因,总结预防对策,以期为后期援助队员提供现实依据。方法 2014年11月至2015年1月,分析中国人民解放军援利医疗队首批队员在利比里亚中国埃博拉出血热治疗中心(Ebola Treatment Center,ETC)工作过程中发生体力透支的原因,并总结预防对策。结果援利期间护理队员发生疲倦乏力43例(63.2%)、头痛头晕31例(45.6%)、心慌胸闷14例(20.6%)、睡眠障碍10例(14.7%),其主要原因为气候及人文特殊性、防护工作特殊性、护理工作特殊性等。预防对策主要包括合理科学排班、科学安排工作、增强体能素质、加强自我保护、保持良好心态等。结论援利期间护理队员发生体力透支情况较多,管理者应积极分析原因,采取各项有效措施预防护理人员体力透支的发生。     

对护士应对突发性公共卫生事件培训的效果

目的总结四川汶川地震医学救援工作中护士培训的经验,探讨应对突发性公共卫生事件时护士培训的机制。方法在奔赴灾区开展医学救援的过程中,就地震可能引发的突发性公共卫生事件,对我医疗队的护士们开展了及时、高效的针对性培训,包括战前教育、急救护理技术培训、灾后疫情防控培训、心理学知识培训等。结果从2008年5月15日—7月5日,我院华益慰抗震救灾医疗队驻都江堰市向峨乡医疗分队共计接诊患者2200余例,各护士进入角色高效迅速,很好地完成了救援工作中的护理任务,并且做好了灾区的疫情控制和自我防护工作,确保了灾后无大疫及工作人员零伤亡。结论即使是在平实的工作学习中,也应加强护士在灾难护理学等方面的培训,以应对突发性公共卫生事件的发生。     

新型冠状病毒肺炎期间护理人员培训管理探索

目的 探索新型冠状病毒肺炎护理人员自我防护培训方案,总结培训实践体会,持续改进 方法 建立针对不同重点护理人员的自我防护培训方案,开展及时、高效、严格、针对性强的培训,包括理论知识培训和操作技能培训,采用线上与线下结合的方式,分批次、分重点、防护督导和培训的方式实施培训.结果 通过培训,护理人员自我防护技术及理论考核通过率100%;支援武汉一线、发热门诊、隔离病房及全院护理人员至今未发生感染。结论 在抗击新型冠状病毒肺炎的疫情期间,加强护理人员自我防护能力的培训,可以提高护理人员的自我防护 意识及自我防护技能,是确保医护人员“零感染”的重要保障.     

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.