情景模拟演练在手术室应急预案培训中的应用

目的：探讨情景模拟演练在手术室应急预案培训中的应用效果。方法2012年将手术室全体护理人员根据职称和工作年限进行合理分组,随机每组搭配2名麻醉医生。分组情景模拟培训手术室应急预案。整体培训结束后进行考核并采用自制的问卷调查个体对培训效果的评价。结果修订完成并分组演练了12项手术室应急预案流程;情景模拟培训后理论及相关操作成绩与培训前比较差异均有统计学意义（P＜0．05）。结论情景模拟演练应用于应急预案培训,有利于应急预案的牢固掌握,增加了面对突发事件的真实感,提高了护士的实战应变能力,加强了团队合作精神;有利于进行动态的调整,保障患者安全。     

应急预案演练在消毒供应中心的实践与体会

目的:探讨应急预案演练在消毒供应中心应对突发事件的作用。方法:成立应急预案管理小组,建立健全应急预案管理制度,全员参与,每月在科内实施应急预案演练1次。结果:我院消毒供应中心自2005年实施演练管理以来,共发生下水道堵塞12次,水管破裂泛水1次,B-D试验不合格5次,工作人员不慎被烫伤4例次,锐器刺伤6例次,按照演练的程序及时排除了故障解决了问题,避免了风险,保障了消毒供应工作的正常进行。结论:实施应急预案演练管理,有利于培养一支高效的应急团队,提高工作人员应对突发事件的能力,降低消毒供应工作中的风险,是保障消毒灭菌供应工作质量的一个有效方法。     

预案演练教学法在儿科低年资护士培训中的应用

目的探讨预案演练教学法在儿科低年资护士专科知识培训中的效果。方法利用医院迎接"三甲"强化培训的契机,科室成立应急预案演练培训小组,结合儿科常见意外、突发事件撰写模拟情景,对科室毕业后独立上班3年内的低年资护士进行应急预案培训,培训后由低年资护士进行模拟演练,演练时培训考核小组对每个角色进行考核,符合应急预案要求,能现实解决专科应急问题方能过关。结果实施强化应急预案演练教学法1年后,低年资护士的专业理论知识、基础操作技能、突发事件的应急和综合能力考核比培训前提高,前后比较差异有统计学意义(P0.01)。结论应急预案演练教学法使儿科低年资护士更快地掌握专科知识而胜任儿科专科护士工作,提高护士的综合能力、护理质量及患者的满意度。     

产房模拟应急预案演练对助产士应变能力的影响

目的:探讨产房模拟应急预案演练对助产士应变能力的影响。方法:将50名助产士分为5组,每组10人,护士长制定演练方案,模拟情景,根据护士长述说的病情发展,小组成员分工明确,任务清晰,有效地对产妇进行应急抢救。结果:助产士较好的完成了演练过程,实现了学与练的结合,培训后助产士的急救理论、应急操作成绩与培训前比较有较大的提高(P0.01)。结论:通过应急预案的演练提高了助产士对突发事件抢救的应变能力,同时也增强了团队的凝聚力。     

儿科护理应急预案演练在学生实习前培训中的应用

目的 探讨应急预案演练在培养学生儿科护理综合能力中的效果.方法 选择即将进入临床实习的高职护理专业2个班的学生,按照班级分为试验组和对照组.试验组62名,实习前培训采用儿科护理应急预案演练法;对照组60名,采用传统的教学方法.培训结束后,对两组学生进行儿科应急理论知识与技能考核,并调查临床带教教师对两组学生临床工作的综合评价,试验组学生接受应急预案演练培训后的自我评价.结果 试验组学生的儿科护理应急理论知识与技能考核成绩均优于对照组(P＜0.01),临床带教教师对其评价明显高于对照组,试验组学生自我评价较好.结论儿科护理应急预案演练能提高学生实习前培训的效果,亦可增强学生的团队合作能力,缓解学生的心理压力.     

建立医院消毒供应应急储备技术流程的可行性研究

目的探讨可行的消毒供应应急储备技术流程。方法采用理论建立与演练相结合的方法建立医院消毒供应储备技术流程。结果储备物资质量完好达100.00%,物品应急供应模拟演练的数据达到了预期效果。结论医院消毒供应储备技术流程可以应用到基层医院作为消毒供应应急储备预案及培训内容。     

护理人员应对突发事件知识与技能培训效果的探讨

目的 探讨护士应对突发事件应急知识与技能培训的效果.方法 2008年1月～2009年12月以<突发公共卫生事件应急条例>为标准,护理部制订应急预案,建立医院护理应急救治队伍,成立应急指挥专家小组,采用集中突发公共事件理论知识教育培训、模拟训练、突发事件应急演练等方法对护士进行系统化应急培训.在参与突发公共卫生事件时按照预案规定程序,组织人员做好院前急救、消毒隔离及安全防护.结果 实施培训以来,全院各级护理人员应对突发事件的能力有了较大提高,全院护理人员应对突发事件应急知识培训合格率达97.73%,应急流程掌握率达98.31%,急救操作技能掌握率达98.34%,各项考核成绩较培训前有明显提高(p＜0.01).结论 对护理人员进行系统化突发事件应急知识教育培训,并将其考核纳入护理质量管理体系是提高其应对突发事件能力的有效方法.     

心肺复苏模拟演练对提高心血管科护士应急能力的效果观察

目的 探讨培训心血管科护士抢救心脏骤停患者应急能力的方法与效果.方法 将毕业3年的36名心血管科护士按随机方法分为2组,每组各18名,干预组采用情景模拟演练,对照组采用常规培训方法,比较2组人员前后的考核成绩.结果 2组人员培训前考核成绩比较差异无统计学意义(P＞0.05),培训后考核成绩干预组明显优于对照组(P＜0.01),差异有统计学意义.结论 情景模拟急救演练可提高护士的应急能力及学习兴趣,提高其心理素质,加深知识的理解和运用.     

应急预案情景模拟演练的设计及效果评价

目的探索应用情景模拟演练应急预案的效果。方法应急预案情景模拟演练实施包括选定主题、设计缺陷、编写脚本、布置场景、审核预演、实施演练等六个步骤。结果应用情景模拟演练应急预案后调查显示:95%的护士表示认同;97%的护士认为对突发事件的应对有帮助;98%的护士认为比理论授课、视频学习更为直观、更有助于记忆和综合能力的提升。结论情景模拟演练可以发现预案和流程中存在的缺陷;有助于提升护理人员的专业能力和综合实践能力;有利于护理人员化被动学习为主动学习。     

实施应急预案演练的做法与效果

目的通过应急预案演练,提高护理人员卫勤应急保障能力。方法成立护理应急分队,对护理人员进行培训,制定演练方案,进行突发事件应急救护演练。结果提高了护理人员的理论及技能考核成绩和医生对护理人员的抢救配合满意度（P〈0．01）。结论通过应急预案演练可以提高护理人员的应急能力和救护水平。     

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.