新型冠状病毒肺炎住院病区支助中心人员的培训与管理

目的 探讨新型冠状病毒肺炎住院病区支助中心人员的培训与管理方法及效果。方法 对支助中心工作人员进行强化培训，内容包括疾病相关知识及院感理论，现场防护用品使用，工作流程及路线，应急处理预案等，并采取科学管理，包括规范着装与隔离，清洁消毒，修订支助中心岗位职责、工作流程和路线图，合理调配人力资源，注重工作人员身心健康，加强患者人文关怀，患者健康宣教与管理等。结果 转运患者2 450例次，转运药品4 120趟次，转运标本3 638趟次，均圆满完成任务，无工作人员感染。结论 对支助中心工作人员进行强化培训及科学管理保证了新型冠状病毒肺炎病区正常运转和患者及工作人员安全。     

医院陪检人员服务质量的绩效管理

目的提高陪检人员素质和陪检质量。方法针对医院陪检质量不高的问题,对支助中心制定针对性绩效管理计划、绩效考核标准并实施,1年后评价效果。结果实施绩效管理后,陪检人员考评总得分、陪检工作量、工作质量、不良事件及护士对陪检人员的满意度得分显著优于实施前(均P0.01)。结论在医院支助中心采用绩效管理模式对陪检人员进行量化管理,有利于提高陪检人员专业素质,提高陪检工作质量,从而提高临床医护人员及患者满意度。     

专业化转运团队在院内急重症患者转运中的作用

目的探讨支助中心专业化转运团队在院内急重症患者转运中的作用。方法对支助中心转运组员工进行院内急重症患者转运的专业培训,与急诊科医护人员共同组成专业化转运团队,共同做好转运前准备、制定转运方案、实施转运。比较实施专业化转运前后各4个月院内急重症患者转运意外事件发生率以及患者和接收科室护士满意度。结果实施专业化转运后患者及接收科室护士满意度显著高于实施前(均P0.01);意外事件发生率实施前后比较,差异无统计学意义(P0.05)。结论专业化转运提高了支助人员的转运水平,保障了院内急重症患者转运安全,提高患者及接收科室医护人员满意度。     

无缝式手术患者转运交接系统的研发及应用

目的研发手术患者转运交接系统,优化交接流程,实现无缝式交接。方法 2019年4~7月使用传统的电话沟通、口头传达方式进行手术患者转运交接;2020年4~7月研发并应用无缝式手术患者转运交接系统,通过信息化管理手段优化手术患者交接,信息同步推送,扫码识别患者身份,全流程监测患者路径信息。结果系统应用后,工勤人员接入患者用时、连台手术间隔时间、手术患者转运交接不良事件发生率显著低于应用前,护士及工勤人员满意度显著提升(均P<0.01)。结论手术患者转运交接系统的应用,优化了交接流程,确保各环节标准化、精细化、高效化。     

MDT式流程管理在多发肋骨骨折合并肺挫裂伤患者院内安全转运中的应用

目的探讨MDT式流程管理在多发肋骨骨折合并肺挫裂伤患者院内安全转运中的应用效果。方法按入院时间将2016-08—2019-05间收治的97例多发肋骨骨折合并肺挫裂伤患者分为2组。对照组48例予以常规模式管理,观察组49例在对照组基础上予以MDT式流程管理。比较2组院内转运用时,转运中不良事件(病情恶化、再损伤)及意外事件(脱管、扭曲、药物延迟)发生率。结果观察组院内转运用时较对照组短,转运中不良事件和意外事件发生率较对照组低,差异有统计学意义(P0.05)。结论对多发肋骨骨折合并肺挫裂伤患者的院内转运中采用MDT式流程管理,能缩短院内转运用时、降低转运中不良事件及意外事件发生率。     

危重患者长途转运流程优化研究

目的提高危重患者长途转运效率和安全性。方法将388例长途转运危重患者按时间段分为对照组186例、观察组192例;对照组采用常规转运流程;观察组采取成立长途转运管理小组、制订转运流程和患者交接单,细化转运前中后环节工作职责等优化转运流程方式转运患者。结果两组患者均安全送达目标医院及科室;观察组接诊时间、准备用物时间、院内转运接收时间显著短于对照组(均P0.01),患者及接收科室护士满意率显著高于对照组(均P0.01)。结论优化长途转运流程可显著提高危重患者长途转运效果,保障患者转运安全。     

标本转运智慧化管理系统的应用效果

目的 应用标本转运智慧化管理系统,提高临床标本转运质量与效率。 方法 成立智慧化管理小组,引进标本管理系统并应用于标本转运质量管理中。应用1年后评价效果。 结果 标本管理系统应用后,与常规标本转运同时间段比较,标本转运时间显著缩短（均P＜0.05）,转运量相对提高,不良事件发生率减少。 结论 标本管理系统有效整合互联网、物联网及大数据资料,用于标本转运管理可显著提高标本转运时效性和准确性。     

智能任务分派分位点转运模式在急救患者院内转运中的应用

目的 探讨智能任务分派分位点转运模式在急救患者院内转运中的应用效果。 方法 采用类实验研究设计,选择2019年7~12月的急救患者60例为对照组,2020年7~12月的62例为干预组。对照组采用传统转运方式,干预组实施转运任务分派分位点院内转运模式。比较两组转运不良事件、转运时间。 结果 干预组转运总时间、急诊滞留时间、室外运送时间、科室交接时间显著短于对照组（均P＜0.05）。干预组任务延迟率显著低于对照组（P＜0.05）。 结论 智能任务分派分位点院内转运模式保证了转运患者信息传递的准确性,提升各环节的安全监控,降低运送延迟发生率。     

医院信息系统在护理后勤服务中心的应用

目的 探讨医院信息系统（HIS）在护理后勤服务中心的应用方法及效果。方法 通过后勤服务中心的计算机工作站对各个病区需取送标本、取血或陪检的信息进行审理、执行和完成，并自动统计工作量和病区护士满意度指标。结果 实行HIS4个月后，取送标本、陪检差错发生率显著较实施前减少（均P〈0．01）；护士满意度100％。结论 HIS应用于护理后勤服务中心，提高了工作效果和工作质量，实现了从传统管理向现代管理的转变。     

ICU患者院内安全转运护理体会

ICU患者由于病情特殊性具有较大的潜在危险性,院内转运其救治效果机会和风险是并存的.只有做好转运前的准备工作、加强转运途中的安全护理、患者的心理护理和制定完善转运工作流程,才能确保患者转运安全.     

清单制管理在危重患者院间长途转运中的应用

目的观察清单制管理在降低危重患者院间长途转运不良事件中的效果。方法将2014年1~12月符合院间长途转运标准的258例危重患者作为对照组,2015年1~12月261例作为观察组。对照组采取常规转运核查方法,观察组设计核查清单,转运护士根据清单逐项核查,比较两组转运中与仪器设备相关、与急救药品相关、与患者管路相关的不良事件发生率。结果观察组仪器设备功能障碍、氧气不足、电量不足、急救药品不足、导管堵塞等转运不良事件发生率显著低于对照组(P0.05,P0.01)。在药品过期方面,两组比较差异无统计学意义(P0.05)。结论清单制管理能有效降低危重患者长途转运中转运不良事件的发生率,为安全转运提供保障。     

危重症患儿院内安全转运流程化管理

目的探讨流程化管理在危重症患儿院内安全转运中的作用,保障患儿转运安全。方法选择2012年1月至2013年1月儿科急诊院内转运的626例危重症患儿为对照组,2013年2月至2014年1月院内转运的758例危重症患儿为观察组,对照组采用常规方法转运,观察组采用流程化管理方法转运,包括制定危重症患儿院内安全转运制度及流程,加强转运前、转运中及转运后的流程化管理等。比较两组患儿一次转运成功率及转运不良事件发生率。结果观察组均一次转运成功,对照组621例一次转运成功,5例实施二次转运成功,观察组一次转运成功率显著高于对照组(P0.05)。观察组转运发生不良事件21例,对照组为40例,两组比较,差异有统计学差异(P0.01)。结论将流程化管理应用于危重症患儿院内转运的管理与实践中,使转运医疗行为制度化、流程化,能够有效降低转运不良事件发生率,规避转运风险,为患儿安全转运提供保障。     

输送调度信息系统在医疗输送管理中的应用

目的 开发输送调度信息系统,提高医疗输送质量和效率.方法 构建含基础数据、任务操作、人员操作及查询报表四大输送模块的输送调度信息系统,对输送人员及输送工作实施相应的信息化管理.结果 应用输送调度系统后输送调度效率、输送质量、成本支出以及护士长满意度等方面效果显著.结论 输送调度信息系统的开发与应用,可有效提高医疗输送质量和效率.     

急诊危重症患者院内转运安全管理最佳证据总结

目的 检索国内外急诊危重症患者院内转运安全管理的相关证据,对最佳证据进行总结,为规范急诊危重症患者院内转运提供参考。 方法 系统检索国内外数据库关于急诊危重症患者院内转运安全管理的相关证据,由2名研究员对文献质量进行独立评价,结合专业人士的判断,对符合标准的文献进行资料提取。 结果 共纳入13篇文献,其中临床决策1篇、证据总结3篇、指南2篇、系统评价4篇、专家意见/专家共识3篇。最佳证据共30条,包括转运设备日常管理、风险评估、转运前准备、转运中监测与治疗、交接与记录、质控与培训6个方面。 结论 本研究总结的最佳证据可为制定急诊危重症患者院内转运方案提供参考。     

Metabolism of Round Spermatids in the Rat: Effect of Gossypol on the Glucose Transport/Stoffwechsel der runden Spermatiden bei der Ratte: Der Einfluß von Gossypol auf den Glukose-Transport

Low dose of gossypol (5 microM) completely inhibited uptake of 2-deoxy-D-glucose by rat spermatids. With gossypol 2-deoxy-D-glucose transport into spermatids increased curvelinearly for 10 minutes after the start of incubation, but reached a plateau afterwards, whereas without gossypol it continuously increased. The levels of fructose-1,6-bis-phosphate (FBP) and ATP were inversely correlated when the cells were exposed to glucose. However, in the presence of gossypol the levels of ATP and FBP decreased simultaneously. In addition, gossypol at 10 microM stimulated oxygen consumption when lactate was present. These results suggest that gossypol probably inhibits glucose transport into spermatids by lowering the ATP level by uncoupling respiratory chain-linked phosphorylation.     

Comparative study of laser and scalpel nerve transections.

This investigation was designed to compare standard scalpel transections of the tibial branch of the rat sciatic nerve with those performed using either a milliwatt carbon dioxide (CO2) or a potassium titanyl phosphate (KTP/532) laser. Four transection groups consisted of nerves sectioned with (1) scalpel (control), (2) milliwatt CO2 laser, (3) KTP/532 with microscope attachment, and (4) KTP/532 laser with 400-microns bare fiber. Each laser was used with the same parameters: 10 watts, 0.4-mm spot size, and continuous-wave mode. Horseradish peroxidase (HRP) was applied to the proximal stump for 30 min, and the animals were sacrificed 24 h later. Horseradish peroxidase (HRP)-labeled motoneuron cell bodies in the lumbar spinal cord were then counted. The average numbers of labeled neurons in each group were as follows: group I (n = 14) 518, group II (n = 8) 424, group III (n = 8) 351, and group IV (n = 8) 283. The standard deviations were quite large, however. When all laser transections were pooled and compared with paired scalpel transections, we found a significant difference, both by the paired t-test (P = 0.016) and by the Wilcoxon matched-paired test (P = 0.02). We conclude that laser transection significantly diminishes the number of neurons labeled by the retrograde transport of HRP.     

Inhibitor action on placental calcium transport

Summary Human term placental lobules were dually perfused with Krebs Ringer solution at 37°C under open circuit conditions. Provided that perfusate Ca²⁺ concentrations were between 2.33 and 2.55 mM, there was a steady release of Ca²⁺ into the fetal circulation and uptake of Ca²⁺ from the maternal circulation. There was no significant calcium (Ca) protein binding in the perfusates. Addition of dinitrophenol altered the release of Ca²⁺ to an uptake on the fetal circuit and enhanced Ca²⁺ uptake on the maternal circuit. It also produced a release of potassium (K)⁺ and an uptake of Na⁺ on both sides of the placenta. Ouabain had no significant effect on Ca movements although it produced a marked release of K⁺ into the fetal perfusate. The effect of cooling on the fetal circuit was similar to that of dinitrophenol (DNP), although it did not produce significant changes in either Ca²⁺ or K⁺ movements on the maternal side of the lobule. Both DNP and cooling reduced the Ca concentration ratio between fetal and maternal outflows to unity. Replacement of Na⁺ by choline Ringer had only transient effect on the extraction of⁴⁵Ca from fetal perfusate. These observations indicate that a Ca²⁺/Na (sodium)⁺ exchanger does not make a major contribution to the transplacental movement of Ca²⁺ from mother to fetus and that this process is more probably associated with membrane-bound ATPases.     

Albumin-based Solutions for Peritoneal Dialysis: Investigations with a Rat Model

Abstract: To evaluate albumin, an osmotic agent for peritoneal dialysis, the peritoneal fluid and solute transport were investigated during a 4-h single cycle peritoneal dialysis with albumin-based dialysis solutions. Two different albumin solutions were used in 15 normal Sprague-Dawley rats: isotonic 7.5% albumin solution (ADS 1, n = 7) and a combined 7.5% albumin and 1.36% glucose solution (ADS 2; n = 8). A standard 1.36% Dianeal solution was used to provide control values (n = 6). The rate of the intraperitoneal volume change (Q_v) was positive during the initial 90 min with ADS 2 and during the initial 60 min with Dianeal 1.36% solution but negative with ADS 1. The peritoneal bulk flow reabsorption rate, Q_a, was similar in all three groups. The estimated rate of transcapillary ultrafiltration (Q_u=Q_v+Q_j was positive with all three solutions throughout the dialysis. With ADS 1, Q_u increased gradually during the initial 90 min and then remained stable, but it decreased with ADS 2 and Dianeal 1.36% solution. Q_u with ADS 2 did not differ from that with Dianeal 1.36% solution during the initial 60 min, but it was significantly higher during the latter part of dialysis. The value of Q_u during the last 2 h of dialysis was 0.026 ± 0.010 and 0.025 ± 0.009 ml/min with ADS 1 and ADS 2, respectively, and it was significantly higher than that with Dianeal 1.36% solution (0.005 ± 0.007 ml/ min; p< 0.017). After 4 h of dialysis, 76.1 ± 10.2 and 78.8 ± 11.1% of the initial amount of albumin remained in the peritoneal cavity with ADS 1 and ADS 2, respectively. Since a positive value of Q_u was maintained for at least 4 h during dialysis with the two albumin-based solutions and was significantly higher after 4 h of dialysis than with the Dianeal 1.36% solution, and since (Q_a) was similar with the three solutions, the present findings indicate that the differences in the Q_v values are due to the differences in the transcapillary ultrafiltration rate (Q_U). Furthermore, ADS 2, a solution containing both crystalloid and colloid osmotic agents, resulted in higher and more prolonged ultrafiltration than did the conventional glucose solution. After 4 h of dialysis, about 20–25% of the initial amount of albumin was absorbed, indicating that albumin-based dialysis solutions may compensate for the protein loss into dialysate in continuous ambulatory peritoneal dialysis (CAPD) patients. The results of the present study may provide useful reference data in the evaluation of alternative osmotic agents.     

Comparison of helicopter versus ground transport for the interfacility transport of isolated spinal injury

Background contextThe use and need of helicopter aeromedical transport systems (HEMSs) in health care today is based on the basic belief that early definitive care improves outcomes. Helicopter aeromedical transport system is perceived to be safer than ground transport (GT) for the interfacility transfer of patients who have sustained spinal injury because of the concern for deterioration of neurologic function if there is a delay in reaching a higher level of care. However, the use of HEMS is facing increasing public scrutiny because of its significantly greater cost and unique risk profile.PurposeThe aim of the study was to determine whether GT for interfacility transfer of patients with spinal injury resulted in less favorable clinical outcomes compared with HEMS.Study design/settingRetrospective review of all patients transferred to a Level 1 trauma center.Patient samplePatients identified from the State Trauma Registry who were initially seen at another hospital with an isolated diagnosis of injury to the spine and then transferred to a Level 1 trauma center over a 2-year period.Outcome measuresNeurologic deterioration, disposition from the emergency department, in-hospital mortality, interfacility transfer time, hospital length of stay, nonroutine discharge, and radiographic evidence of worsening spinal injury.MethodsPatients with International Classification of Diseases, Ninth Revision (ICD-9) codes for injury to the spine were selected and records were reviewed for demographics and injury details. All available spine radiographs were reviewed by an orthopedic surgeon blinded to clinical data and transport type. Chi-square and t tests and multivariate linear and logistic regression models were done using STATA version 10.ResultsA total of 274 spine injury patients were included in our analysis, 84 (31%) of whom were transported by HEMS and 190 (69%) by GT. None of the GT patients had any deterioration in neurologic examination nor any detectable alteration in the radiographic appearance of their spine injury attributable to the transportation process. Helicopter aeromedical transport system resulted in significantly less transfer time with an average time of 80 minutes compared with 112 minutes with GT (p<.001). Ultimate disposition included 175 (64%) patients discharged to home, 15 (5%) expired patients, and 84 (31%) discharged to extended care facilities. After adjusting for patient age and Injury Severity Score, the use of GT was not a significant predictor of in-hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.3–5), hospital length of stay (11.2+1.3 vs. 9.5+0.8 days, p=.3), or nonroutine discharge (odds ratio, 1.1; 95% confidence interval, 0.5–2.2).ConclusionsGround transport for interfacility transfer of patients with spinal injury appears to be safe and suitable for patients who lack other compelling reasons for HEMS. A prospective analysis of transportation mode in a larger cohort of patients is needed to verify our findings.