乡镇卫生院护理人员继续教育内容需求调查

[目的]了解乡镇卫生院护理人员继续教育内容需求情况,为制定护士继续教育计划提供依据。[方法]采用问卷调查法,对山东省13家乡镇卫生院368名护士进行问卷调查。[结果]有88.86%的护理人员认为有必要开展继续教育,低年龄、低职称、低工作年限的护士对继续教育的必要性认识较高,40岁、中级职称及工作30年以上的乡镇护理人员继续教育的必要性认识比较低;≤30岁,工作年限≤10年护理人员对人文素质维度培训需求比较高,中专学历的护士对知识维度培训需求比较高;≤30岁护理人员对病房组织管理能力和职业防护知识和能力培训需求较高;30岁护理人员对紧急救护的继续教育需求较高;不同职称护理人员均选择护患纠纷处理技巧作为需求程度较高的继续教育内容;不同工作年限护理人员均选择心肺复苏作为需求程度较高的继续教育内容。[结论]乡镇卫生院护理人员对接受继续教育持有积极的态度,能充分认识到继续教育的必要性;对继续教育内容的需求还处于较基础的内容,在以后的继续教育中除了护理专业知识和技能培训外,更应注重护理人文、护理科研等知识的培训,提高乡镇护理人员的整体素质和护理质量。     

我院护士对继续教育需求的调查与分析

目的调查临床护士对继续教育需求现状。方法采用自行设计的问卷对114名临床护士进行调查。结果护士接受继续教育的主要目的是提高知识和能力、扩大视野及开拓思路。对继续教育培训内容需求最高的为专科知识技能、护理新知识新进展和危重症监护技术。护士最需要的继续教育途径是医院内培训、示教模拟训练和远程教育。结论护理管理者应合理安排继续教育培训内容、培训途径及时间,重视继续教育考核,提供继续教育支持。     

医院在职护士继续教育学习需求调查

目的探讨对在职护士继续教育中的学习需求,为改革护士继续教育形式提供依据。方法采用问卷调查方法,于2010-03对我院护士进行问卷调查。结果 （1）97.4%护士希望参加＂健康教育知识＂的培训;92.3%护士希望参加有关＂人际沟通＂的培训;89.7%护士希望参加有关＂护理科研能力＂的培训;82.1%护士希望参加＂护理新知识新技术＂的培训。（2）98.5%的护士接受继续教育目的是为了晋升职称;有64.6%的护士认为继续教育可以提高工作能力。结论继续教育是提升护士临床业务水平的重要途径,在以后的护士继续教育中,实行切实有效的途径,以达到提高护士综合素质的目的 。     

护理人员医学人文知识在职教育现状及需求研究

目的调查临床护理人员医学人文知识在职教育的现状及需求,为制订更有针对性的在职教育方案提供依据。方法采用分层抽样,对我院35个科室的553名护理人员进行问卷调查。结果仅43.4%的护士接受过医学人文知识在职培训,92.0%的护士非常需要或需要医学人文知识培训;不同年龄、工作年限、职称的护士对医学人文知识需求差异有统计学意义(P<0.01);而不同性别和学历的护士对医学人文知识需求差异无统计学意义(P>0.05)。结论护理人员医学人文知识在职教育不足,需求程度高,为促进护理人员专业素质和人文素养的全面协调发展,应加强临床护理人员医学人文知识的在职教育。     

区县级医疗机构护士继续教育需求调查

目的调查区县级医疗机构中护士的继续教育需求现状。方法采用自制问卷分别对区县级医疗机构的606名护士进行调查。结果94．39％的护士认为继续教育非常必要。培训内容前3位的依次是专科知识、医学新进展、科研知识,培训形式前3位的依次是科内培训、院内培训及外出参加短训班;不同职称、职位、学历、用工性质护士的培训需求不尽相同。结论对区县级医疗机构的护士继续教育培训非常必要,培训应根据不同级别护士分层次按实际需要进行,以提高培训效果。     

军队医院医生对护士继续教育的期望

目的 了解军队医院医生对护士继续教育的需求与内容期望,为护理继续教育的开展提供科学依据.方法 抽取9所综合性军队医院医生416名,使用"临床护士继续教育需求及期望问卷"对其进行问卷调查.结果 93.27%的医生对护士有进一步提高军人基本素养的期望,医生认为护士在病情观察能力、基础和专科护理操作技能与理论知识、急危重症患...     

精神科护士实施人文关怀需求的质性研究

目的 了解精神科护士实施各项护理措施时应用人文关怀知识的体验、存在问题与需求。方法 2012年1-4月应用质性研究中现象学研究方法,对我院10名临床护士和3名基层管理者(护士长)以及2名院部管理者进行深度半结构式访谈,对所获资料进行类属分析、整理、提炼主题。结果 护士对精神疾病患者实施护理措施的主要体验及问题需求：①护士的人文综合素质仍待提高;②不同能级护士对人文关怀知识掌握和应用程度差异较大;③年轻护士实施人文关怀护理容易受多重因素影响,主要包括自身情绪、患者病态思维与言行以及其家庭支持系统;④精神科管理人员认为实施人文关怀护理的成效与家属的文化素养和经济能力有较大联系;⑤护士的人文关怀理念在临床科室得到充实和体验;⑥护士希望通过网络教育途径加强人文关怀技能的学习。结论 精神科护士实施人文关怀护理的需求与效果受到多种因素影响,医院管理者应深入了解护士的内心感受,共同创造人文工作氛围,制定全面的激励制度,提供护士全面掌握与实施人文知识技能在职学习的良好途径与晋升模式,促进人文精神在护理领域的进一步渗透,使得护患双方受益。     

新形势下护士继续教育的内容及方式

目的 探讨在职护士对继续教育学习内容及方式的需求。方法 通过对166名在岗护士问卷调查，进行综合分析。结果 经调查显示166名在岗护士对于外语、新业务、新技术及健康教育相关知识（心理学、伦理学）有浓厚的学习兴趣。对于教育方式，最欢迎注重临床实践，以工作为基础和提高工作实践能力的学习方式。结论 166名在岗护士对继续教育的需求强烈，认为继续教育是人才培养的有效途径。     

护理程序在成人护理教学中的运用

整体护理的开展带来了护理技术的发展和护理知识水平的提高及护理学科与人文、社会、教育等诸学科的交叉渗透[1] 。随着现代医疗技术的发展 ,社会对高层次护理需求的增加 ,使中专毕业的护理人员难以满足社会和临床护理的需求 ,广大护士迫切需要以新知识充实、提高自己。许多在职护士需要进行继续教育。而传统教学模式下培养出来的护士 ,从理念到实践都很难适应新的模式的要求[2 ] 。护理教育模式也应随着护理模式的转变而做相应的调整和改变。因此 ,将护理程序理论用于成人护理教育 ,成为护理教育改革的必然。1　护理程序引入护理教育　　护…     

护理程序在成人护理教学中的运用

整体护理的开展带来了护理技术的发展和护理知识水平的提高及护理学科与人文、社会、教育等诸学科的交叉渗透^[1]。随着现代医疗技术的发展，社会对高层次护理需求的增加,使中专毕业的护理人员难以满足社会和临床护理的需求，广大护士迫切需要以新知识充实、提高自己。许多在职护士需要进行继续教育。而传统教学模式下培养出来的护士，从理念到实践都很难适应新的模式的要求^[2]。护理教育馍式也应随着护理模式的转变而做相应的调整和改变。因此，将护理程序理论用于成人护理教育，成为护理教育改革的必然。     

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.