社区医院医护合作现状的调查与影响因素分析

[目的]了解社区医院医护合作的现状,对比医生和护士医护合作的差异,分析影响医护合作的因素,为提高社区医院医护合作水平提供参考依据。[方法]采用中文版的医护合作量表和医护合作态度量表对5所社区医院175名护士和80名医生进行问卷调查,对各种因素进行方差分析,筛选出医护合作情况的影响因素。[结果]社区医院医生医护合作得分78.59分±9.12分,护士医护合作得分73.12分±10.69分,社区医院医生医护合作得分高于护士,合作态度、工作年限是影响医生评价医护合作的因素。学历、合同类型是影响护士评价医护合作的因素。[结论]社区医院医护合作情况较好,但仍需进一步提高。可以从医生、护士两方面着手,提高社区医院医护合作的水平,构建和谐的医护合作氛围。     

急诊科医护合作不良的影响因素调查研究

[目的]了解急诊科医护合作不良主要影响因素,比较医生和护士对医护合作不良影响因素的看法.[方法]采用自制问卷调查北京市4所三级甲等医院134名急诊科医护人员对急诊科医护合作不良的影响因素的看法.[结果] 急诊科医护合作不良的主要影响因素,包括急诊护士工作压力大(95.5%),病人多的时候医生相对不足(93.3%),急诊护士数量少(85.0%),医生工作压力大(83.6%),急诊科环境差(83.6%);医护人员对医护合作不良的影响因素的看法在人员方面,医生得分4.04分±0.87分,护士得分4.51分±0.67分;在社会方面,医生得分3.47分±0.59分,护士得分4.18分±0.57分.[结论]明确急诊科医护合作不良的主要因素,对提出急诊科医护合作不良的对策有重要意义.     

慢性心力衰竭患者营养支持中的医护合作现状及影响因素分析

目的调查心内科(包括心内科病房和CCU)慢性心衰患者营养支持中的医护合作现状及影响因素,为实施干预性营养支持措施,降低心衰患者营养不良发生率提供依据。方法采用医生和护士合作量表(NPCS)对洛阳市10家医院心内科病房及CCU的64名医生和168名护士展开调查。结果心内科医护人员NPCS总分为(86.95±14.42)分,其中,医生NPCS总分为(87.42±15.73)分,护士NPCS总分为(80.97±13.80)分;心内科病房的医生NPCS各维度得分高于护士(P<0.05)。结论心内科医生在慢性心衰患者营养支持中的医护合作状况感知优于护士,且心内科病房的医护合作状况优于CCU,但两者的医护合作状况均有待加强。在患者营养支持中应重视医护合作,通过规范化的流程管理、沟通技巧和积极的团队合作来提高患者营养支持质量。     

医生和护士对医护合作所持态度的现状分析

目的调查和比较我院保健医疗部医生和护士对医护合作所持有的态度,找寻影响医护合作的主要因素。方法通过对北京协和医院保健医疗部的内科、外科、ICU等7个病区的医生36名、护理人员62名为研究对象,利用Jefferson医护合作态度量表进行问卷调查,对所得结果进行分析。结果我院保健医疗部医生和护士医护合作态度得分均较高,医生和护士合作态度总得分比较差异无统计学意义(P0.05);不同职称的医生和护士总分及各维度得分比较差异无统计学意义(P0.05)。结论我院保健医疗部医生和护士对医护合作都持有非常积极的态度,不存在各职称间的得分差异。     

护士感知的三级医院科室医护合作现状和影响因素分析

目的:了解护士感知的三级医院科室医护合作状况,并从护士的视角分析影响医护合作现状的因素。方法:对三级医院971名护士进行问卷调查,并对结果进行分析。结果:护士感知的科室医护合作得分为(3.93±0.68)分,其中医护合作的3个维度分别为信息共享(4.06±0.68)、相互关心和协作(3.94±0.75)、共同参与患者治疗和护理决策(3.83±0.77)。医护人际交换得分为(4.13±0.68)分,其4个维度得分分别为尊重(4.12±0.71)、信任(4.26±0.64)、合作意愿(4.50±0.59)、有效沟通(4.03±0.68)。护士感知的医护合作水平的影响因素是科室、职称和医护人际交换的4个维度。结论:护士感知的医护合作状况处于中等偏上水平,提示医院管理者应针对科室、职称和医护人际交换等影响因素采取措施,以增进医护合作。     

对二级医院医生、护士医护合作态度的现状调查

[目的]调查二级医院临床一线医生及护士对医护合作的态度,寻找影响医护合作的主要因素.[方法]以北京市区医疗中心二级医院的内科、外科、妇科、儿科等18个病区的医生74人、护理人员166人为研究对象,利用Jefferson医护合作态度量表进行问卷调查,对所得结果进行分析.[结果]二级医院临床医生和护士医护合作态度得分较高,医生和护士医护合作态度总得分比较,差异无统计学意义 (P＞0.05);不同职称的医生和护士总分及各维度得分比较差异无统计学意义(P＞0.05).[结论]二级医院临床一线医生及护士对医护合作都持非常积极的态度,各职称间无差异.     

三级乙等综合医院不同层级护士执业环境测评分析

目的了解三级乙等综合医院不同层级护士对执业环境不同维度的评价情况。方法采用分层抽样调查法,抽查四川省不同地区的3家三级乙等综合医院的护士,共338名,其中N1级82名,N2级191名,N3级54名,N4级11名,进行执业环境的测评。结果护士执业环境6个维度得分差异有统计学意义(P0.05),其中医护合作得分最低(76.70±27.22)分,其次为薪酬待遇和社会地位得分(79.42±35.67)分,得分最高为优质护理服务的基础(84.97±24.60)分;不同层级护士对执业环境总体评价得分差异有统计学意义(P0.05),N4级最高(86.24±21.35)分,N2级最低(80.03±27.57)分;同一维度中不同层级护士评分比较,优质护理服务的基础,护理管理者的能力、领导力及支持,医护合作,薪酬待遇和社会地位4个维度评分差异有统计学意义(P0.05),其余差异有统计学意义(P0.05)。结论三级乙等综合医院应建立良好的医护合作环境,改善护理人员的薪酬待遇,护理管理者应重视N2级护士的培养与职业规划,从而营造良好的护士执业环境。     

医护合作文化的现状调查及改善策略

目的了解医院医护合作文化的现状,提出相应的改进措施,提高医疗护理质量。方法采用自行设计的医护合作文化现状调查问卷,对某三级甲等综合性医院当Et在班的121名护士和48名医生进行调查,了解医护合作的现状,评价医生、护士对于合作现状的满意度。结果总体合作情况不尽理想,护士对于医护合作总体满意度为（6．37±1．97）分,医护合作与预期满意度差距为（5．08±2．22）分,医生对于医护合作总体满意度为（8．31±1．29）分,医护合作与预期满意度差距为（7．79±2．26）分,差异有统计学意义（t值分别为-6．497,-5．887;P〈0．01）。护士参与一合作模式满意度得分为（2．62±1．02）分,高于医生;经常讨论和核对医嘱为（2．71±1．12）分,医护人员待遇方面为（2．38±1．18）分,低于医生;差异均有统计学意义（t值分别为-2．378,-2．794,-2．245;P〈0．05）。结论护理人员对于医护合作更不满意,但更加积极,期待改进;多项措施可以促进医护合作文化的构建,对于提升优质护理的质量具有重要意义。     

医护合作关系对护士工作投入影响的研究

目的 :调查护理人员医护合作关系和护士工作投入的现状,并分析医护合作关系对护士工作投入的影响。方法 :采用便利抽样法,于2015年2-5月采用一般资料调查表、医护合作量表、护士工作投入量表对北京市某三级甲等医院309名临床护士进行调查。结果 :医护合作量表总分为(91.20±15.89)分,总均分为(3.65±0.64)分;护士工作投入总分为(51.82±9.37)分,总均分为(3.46±0.62)分。多元回归分析显示,护士和医生的关系、共同参与治疗或护理的决策过程、患者信息的交流是护士工作投入的影响因素。结论 :改善医护合作关系可以提高护士工作投入水平,为患者提供更高质量的护理服务。     

对医护合作满意度的调查与分析

目的通过医护合作满意度调查了解医护合作现状并提出建议,改善医护合作状况。方法应用自行设计的问卷分别调查三级甲等医院医生和护士对医护合作的满意度。结果医生对于医护合作总体满意度得分高于护士。在医护合作感知、医护合作间信任和医护间平等几个维度中,医生和护士的差异具有统计学意义。结论要改善医护合作状况,除了需要整个医院各种辅助系统的支持外,也需要护理管理者的共同努力。     

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.     

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.