非内分泌科护士糖尿病知识认知现状及专科培训模式探索

目的了解非内分泌科护士对糖尿病专科知识认知现状,探讨开展非内分泌科糖尿病专科培训的必要性及培训开展的模式。方法自行设计问卷,采用便利抽样法抽取深圳市某三甲医院79名非内分泌科室护士进行问卷调查。结果非内分泌科护士糖尿病知识认知合格率为27.85%;不同科室、年龄、职称、工作年限、护士层级的护士糖尿病知识认知存在差异(P0.05)。45.57%的护士认为很有必要开展糖尿病专科培训,43.04%的护士希望培训内容侧重专科理论与实践,31.65%的护士希望培训侧重于糖尿病护理知识与技能。结论非内分泌科护士对糖尿病专科知识认知合格率低,对开展糖尿病专科培训的意愿强,培训模式侧重于专科理论和实践结合教学。     

临床非内分泌科护士糖尿病知识的认知现状及培训需求调查

目的了解临床非内分泌科护士糖尿病知识的认知现状及培训需求,以期为今后开展非内分泌科护士糖尿病专科知识培训提供依据。方法采用便利抽样法选择2012年4月新疆某三级甲等综合性医院36个非内分泌科室的362名护士作为调查对象。采用自行设计的问卷对其进行糖尿病相关知识及培训需求调查。结果非内分泌科护士的糖尿病知识测试成绩为10～20分,平均(15.79±2.10)分。护士在糖尿病基本知识、饮食知识、运动知识、监测知识、药物知识、并发症及足护理等方面的全部答对率分别为30.1%、73.2%、46.4%、21.0%、28.5%、36.5%。不同学历、职称及工作时间的护士在糖尿病知识总评分上的差异有统计学意义(P<0.05或P<0.01)。95.3%的护士认为有必要进行糖尿病相关知识的统一培训,79.6%的护士希望培训后能提高对糖尿病患者的健康教育能力。结论临床非内分泌科护士对糖尿病知识的认知普遍不足,应对其进行系统、规范化的培训。     

院内多专科一体化糖尿病管理模式的构建与实践

目的 :分析综合医院建立多专科一体化糖尿病管理模式的做法及其对非内分泌科糖尿病患者的管理效果。方法 :护理部牵头组建多专科一体化糖尿病管理团队,成立糖尿病管理指导委员会,选拔各科室骨干作为联络护士组成覆盖全院的糖尿病管理小组。对联络护士进行系统的糖尿病管理知识培训,制定并督导普通病区对糖尿病患者实施全程管理。结果 :糖尿病联络护士培训后理论知识良好率较培训前提高,糖尿病知识各单项成绩较培训前提高,差异具有统计学意义(P0.01)。非内分泌科住院的糖尿病患者血糖监测质量明显提高,异常血糖得到及时处理,无不良事件发生。结论 :多专科一体化糖尿病管理提高了非内分泌科护士的糖尿病知识水平,提高了非内分泌科糖尿病患者护理质量,促进了糖尿病患者管理系统化、规范化。     

糖尿病联络护士在非糖尿病病区护理风险管理中的作用分析

本次研究将选取我院各科室护士,每个科室选择1~3名护士,一共选择护士60名。将护士组成糖尿病联络护士小组,并对所有组员进行糖尿病相关知识的系统培训。待小组成员掌握了糖尿病相关知识后,让组员去带动非糖尿病科室护士学习糖尿病相关知识。结果糖尿病联络护士小组成立前后其护理技能与相关知识掌握程度以及并发症发生率等指标均存在明显差异,且成立后各指标明显优于成立前(P0.05)。通过为糖尿病护士进行糖尿病相关知识的系统培训后,能够对非糖尿病病区护理风险管理中起到的作用效果非常明显。     

情景模拟在糖尿病专科护士培训中的应用效果

目的探索情景模拟在糖尿病专科护士培训中的应用方法及效果。方法 2013-2016年,采用整群抽样选择盐城市糖尿病护理专科护士培训基地招收的74名护士为研究对象。其中2013-2014年招收的36名护士为对照组,采用常规方法培训;2015-2016年招收的38名护士为观察组,以常规培训为基础,在实践过程中运用糖尿病临床案例进行情景模拟培训。培训结束后分别采用护理表现六维量表、结业答辩成绩、理论及操作考核成绩对其进行评价。结果培训后,两组护士理论考核成绩、操作考核成绩、幻灯制作成绩的比较,差异均无统计学意义(均P0.05);观察组护士的护理表现六维量表总分及各维度得分、结业答辩成绩中的应变能力、专业知识、个案护理得分均高于对照组,差异均有统计学意义(均P0.05)。结论情景模拟的应用有助于提高糖尿病专科护士培训的效果。     

临床护士糖尿病相关知识掌握情况的调查

目的了解临床护士糖尿病知识的掌握情况,为更好地实施糖尿病教育提供依据。方法采用非随机抽样方法,对北京市三所军队三级甲等医院的141名护士进行问卷调查。使用SPSS 12.0统计软件包进行数据录入,应用描述性统计、t检验、非参数检验、直线相关分析等统计学方法进行数据分析。结果本次调查139名护士,糖尿病知识测试总分最高为43分,最低为14分,平均为(27.79±5.56)分;答题正确率在50%以下的有28题,占50.9%。内分泌科护士比非内分泌科护士得分高(P<0.01),护士比护师及主管护师得分低(P<0.05)。认为需要在本科室开展糖尿病知识培训的为135人,占97.1%。结论临床护士的整体得分较低,对糖尿病知识掌握得不够理想,不利于糖尿病教育的开展;为提高整体护理质量,有必要在临床护士中广泛开展糖尿病知识培训,培训的重点应是非内分泌科护士和低职称护士。     

内科非内分泌科护士糖尿病知识培训的效果评价

目的 探讨综合医院内科非内分泌科护士糖尿病知识培训的效果.方法 自行设计问卷,对内科11个临床科室护士进行糖尿病相关知识调查,根据调查结果,由糖尿病专科小组到内科每个临床科室培训糖尿病相关理论知识和操作技能,开始培训前与培训后3个月对临床护士糖尿病相关理论知识和胰岛素笔使用操作进行考核.结果 内科非内分泌科护士培训后对糖尿病相关知识和操作技能有了显著性提高.结论 由糖尿病专科小组到内科每个临床科室培训糖尿病相关理论知识和操作技能,能提高综合医院内科非内分泌科护士的糖尿病相关知识和操作技能,提高住院糖尿病患者的教育效果.     

指南培训对非内分泌科护士胰岛素规范注射的影响

[目的]调查并分析上海市第一人民医院非内分泌科护士胰岛素注射相关知识的掌握现状,探讨《中国糖尿病药物注射指南》2011版培训后,非内分泌科护士胰岛素规范注射的知识和技能的改善情况。[方法]以随机抽样的方法抽取全院非内分泌病区150名护士进行胰岛素注射知识调查并按"指南"进行理论及操作培训,规范化培训后进行考核和效果评价。[结果]非内分泌科护士对胰岛素注射知识掌握较为欠缺;培训前理论考试合格率为54.0%、操作考试合格率为55.3%,培训后理论考试合格率为87.3%、操作考试合格率为81.3%,差异均有统计学意义(χ~2=40.2,P0.05;χ~2=23.4,P0.05)。[结论]"指南"培训提高了非内分泌科护士胰岛素规范注射的理论及操作技能。     

基于目标管理在骨科护士专科能力培养中的应用评价

目的 探讨目标管理在骨科护士专科能力培养中的应用效果.方法 选取我科在职护士40名,通过目标管理模式对40名护士进行培训,培训内容包括:专科护理知识、护理技能、康复护理.培训前后分别对40名护士进行专科护理知识、护理技能、康复护理考核,每个项目均为骨科常见项目或技能,每个子项目分值为100分,根据考核前后的分值进行评价,比较培训前后40名护士的专科能力.结果 通过目标管理模式对骨科护士进行培训后,护士的专科能力较培训前有明显提高(P<0.05).结论 应用目标管理模式进行专科能力培训,能有效提高护士的专科知识水平,对患者的病情评估更加精准,护士操作更加熟练标准,健康指导更加标准.通过目标管理模式进行培训,有利于提高骨科护士的专科能力,更好地为患者服务,提高了患者的满意度.     

非内分泌科护士对糖尿病知识掌握的现状及培训对策

[目的]了解非内分泌科护士糖尿病相关知识掌握程度及原因分析,为医院对非内分泌科护士糖尿病知识的培训提供依据及对策。[方法]采用世界健康基金会中国糖尿病教育项目组提供的"糖尿病知识问卷",对本院23个临床科室的69名非内分泌科护士进行糖尿病相关知识调查,针对回答较差的问题进行专项培训。[结果]69名非内分泌科护士中,得分良好占24.6%,一般占46.4%,较差占29.0%;经过培训后再次统计结果显示较前好转:良好占78.8%,一般15.2%,较差6.1%。其中对胰岛素分类方法、糖尿病足预防及护理等6个问题掌握较差。[结论]非内分泌科护士亟待加强糖尿病相关知识培训并成立相关机构保障培训持续推进及培训效果。     

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.