血管外科结构化电子病历设计及应用前景研讨

基于国内外文献检索及既往病历书写、临床科研经验确定数据结构化节点,通过设计病历书写选择框、逻辑引用、信息系统互联影像、检验系统等方法建立结构化病历模板并在实际临床工作中应用评估,以此设计涵盖多种血管外科疾病的智能化、结构化病历系统,规范临床医师病历书写,提升病历质量,为后期临床科研提供结构化数据支持,并为血管外科专病数...     

授权在压疮管理中的应用

目的探讨授权管理模式在降低医院压疮发生率中的应用效果。方法成立伤口造口专科护理小组,通过授权管理方法,明确被授权人职责,对被授权人进行授权管理培训。建立压疮风险管理小组,制定压疮质量控制及会诊制度,实时监控全院压疮情况并进行质量分析、总结反馈。结果通过实施授权管理,医院压疮发生比例由2015年0.050%下降至2017年0.042%,2015～2017年24 h内压疮及时上报率、复核准确率、压疮防护处置正确率均逐年上升。结论授权管理模式能降低住院患者压疮发生风险,提升压疮护理管理质量。     

压疮干预指导组在医院压疮管理中的作用

目的 探讨压疮干预指导组在医院压疮管理中的作用.方法 成立压疮干预指导组,每月1～6日检查1次全院各科使用Braden计分表（压疮危险计分）的及时性和准确性,针对使用中存在的问题进行改良;Braden计分≤12分者,各科负责护士需于24 h内通过院内网络上报压疮干预指导组,组长指定组员24 h内跟踪检查、指导、帮带,及...     

护理会诊在压疮管理中的应用

目的 对压疮护理进行规范化管理,降低压疮发生率,提高已发生压疮的治愈率.方法 于2006年在压疮管理制度的基础上,建立压疮护理会诊制度,选拔合适的会诊人员,确立会诊范围及职责,规定护理会诊时间及程序,考评压疮护理质量.结果 实施后住院患者压疮发生率显著降低,已发生压疮的治愈率显著提高(P＜0.05,P＜0.01).结论 压疮护理会诊制度的建立,提高了压疮护理质量,能有效降低住院患者压疮的发生,提高压疮治愈率.     

压疮管理中奖惩机制的应用

目的探讨压疮管理中奖惩机制的应用效果。方法将2000年1月至2002年12月预报压疮患者2070例设为对照组，2003年1月至2005年12月预报压疮患者3633例设为观察组，在压疮管理中对照组实施一般管理，观察组实施奖惩机制。观察两组住院期间难免压疮的发生率及院外带入压疮的治疗效果。结果住院期间观察组发生难免压疮361例（9．94％），对照组266例（12．85％），两纽比较，差异有显著性意义（P〈0．01）；观察组院外带入压疮治疗效果显著优于对照组（P〈0．01）。结论在压疮管理中引入奖惩机制，可增强护理人员责任心，降低难免压疮发生率，促进压疮的好转。     

应用电子冰帽患者头部压疮的预防护理

目的探讨预防头部压疮的有效护理措施。方法将入选的244例危重患者(均应用电子冰帽)按入院顺序分为两组,2010年3～12月收治的142例作为对照组,采用常规护理方法预防头部压疮;2011年1～10月收治的102例作为预防组,采取强化预防护理措施,包括充分评估压疮的危险因素,积极观察、加强防护、及时对症处理等。结果预防组头部压疮的发生率显著低于对照组(P<0.05)。结论头部压疮的护理重在预防,采取有效的护理措施,可减少及避免头部压疮的发生。     

集束化护理在骨科压疮高危患者管理中的应用

【摘要】目的 探索集束化护理对骨科压疮高危患者的护理效果。方法 将2015年9月～2016年9月入院的126例骨科压疮高危患者,按入院的先后顺序分为两组,其中对照组69例,研究组57例,对照组采取常规压疮预防措施,研究组采取集束化护理。结果 对照组69例,53例有效,有效率76.81%,压疮发生率17.39%;研究组57例,49例有效,有效率是85.96%,压疮发生率5.26%。两组差异显著（P<0.05）。结论 集束化护理能提高骨科压疮高危患者护理有效率、降低压疮发生率。     

压疮管理中奖惩机制的应用

目的 探讨压疮管理中奖惩机制的应用效果.方法 将2000年1月至2002年12月预报压疮患者2 070例设为对照组,2003年1月至2005年12月预报压疮患者3 633例设为观察组,在压疮管理中对照组实施一般管理,观察组实施奖惩机制.观察两组住院期间难免压疮的发生率及院外带入压疮的治疗效果.结果 住院期间观察组发生难免压疮361例(9.94%),对照组266例(12.85%),两组比较,差异有显著性意义(P＜0.01);观察组院外带入压疮治疗效果显著优于对照组(P＜0.01).结论 在压疮管理中引入奖惩机制,可增强护理人员责任心,降低难免压疮发生率,促进压疮的好转.     

集束化护理管理在老年压疮患者护理中的应用效果

目的分析集束化护理管理在老年压疮患者护理中的应用效果。方法随机将60例老年压疮患者分为2组,各30例。予以对照组常规护理干预,观察组在常规护理的基础上联合集束化护理管理。比较2组患者治疗效果及对临床护理工作满意度情况。结果观察组患者治疗总有效率和对护理工作满意度情况均优于对照组,差异有统计学意义(P0.05)。结论对老年压疮患者规范进行集束化护理管理,可促进患者获得满意的治疗效果和对护理工作的认可度。     

集束化护理在骨折压疮高危病人管理中的应用

目的：探讨集束化护理对骨折压疮高危病人（Braden评分≤12分）的护理效果。方法将2015年9月至2016年9月于贵州省人民医院骨科治疗的126例骨折压疮高危病人纳入本研究,按入院的先后顺序分为两组,其中2015年9月至2016年3月入院的69例纳入对照组,采取常规压疮预防措施;2016年4月至2016年9月入院的57例纳入研究组,采取集束化护理预防压疮。出院时评估并比较两组病人的压疮发生率,并通过Braden评分评估两组病人的护理效果。结果对照组69例中,49例达有效护理,护理有效率为71.01%,12例发生压疮,压疮发生率为17.39%;研究组57例中,51例达有效护理,护理有效率为89.47%,3例发生压疮,压疮发生率为5.26%。两组间护理有效率和压疮发生率的差异均具有统计学意义（χ2=6.495,P=0.011;χ2=4.378,P=0.036）。结论集束化护理能提高骨科骨折压疮高危病人的护理有效率,降低压疮发生率。     

Brief review: Adoption of electronic medical records to enhance acute pain management

Purpose

The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists’ experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada.

Source

We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management.

Principal findings

The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution’s process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow.

Conclusions

Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.     

构建多维度电子病历系统

把多维度的概念引入电子病历中,能够创建出更为客观、科学、全面、精准地描述病人的状况、治疗的路线、处置的方法、治疗的结果等信息的电子病历系统.多维度电子病历将把电子病历带入科学发展的新阶段.Caché后关系型数据库作为第三代数据库产品的典型代表在全球医疗行业应用中取得了显著的成效,其以多维数组形式进行数据的定义和存储的特征,可以作为多维度电子病历系统建立的基础.     

Diagnosis and management of pressure ulcers

Pressure ulcers represent a significant health issue and cost for the growing number of elderly and debilitated patients. The plastic surgeon, as part of the wound care team, has the ultimate responsibility of forming a plan to allow for the eventual closure of the wound. This plan should start with breaking the cycle and eliminating the risk factors that led to the development of the wound. Simultaneously, the surgeon should order an MRI and erythrocyte sedimentation rate and take a bone biopsy to diagnose the extent of the wound and the bacteria present. If more than 10(5) bacteria are present, surgical debridement should be performed, followed by 6 weeks of intravenous antibiotics. Once the bacterial load has been lessened, a 6-week course of Regranex should be applied. Finally, after the wound bed has been prepared adequately, definitive surgical closure should be planned and performed.     

Forewarning management of pressure ulcers in tuberculosis patients

目的 降低结核病住院患者压疮发生率.方法 设计压疮预警管理项目,包括建立压疮三级监控小组,设计预警内容,制定监管制度确保预警管理项目落实.实施1年后评价效果.结果 实施压疮预警管理项目后临床护理人员压疮知识知晓率显著提高,院内压疮发生率及高危患者压疮发生率显著下降(P＜0.05,P＜0.01).结论 在全院实施压疮预警管理项目,可降低结核病住院患者压疮发生率.     

结核病患者压疮的预警管理研究

目的降低结核病住院患者压疮发生率。方法设计压疮预警管理项目,包括建立压疮三级监控小组,设计预警内容,制定监管制度确保预警管理项目落实。实施1年后评价效果。结果实施压疮预警管理项目后临床护理人员压疮知识知晓率显著提高,院内压疮发生率及高危患者压疮发生率显著下降(P<0.05,P<0.01)。结论在全院实施压疮预警管理项目,可降低结核病住院患者压疮发生率。     

Surgical and reconstructive management of pressure ulcers

Despite significant advances in therapeutic options, pressure ulcers continue to pose a challenge to physicians and surgeons and frequently require multidisciplinary input. In addition, they place huge financial burdens on health care providers. Generally classified as grades I to IV depending on the extent and severity of the ulcer, grades I and II are usually amenable to conservative management. Grades III and IV may require surgical intervention, which could either be simple debridement or complex reconstructive microsurgery. Direct closure or skin grafting is useful in only a small number of early pressure ulcers. For non-healing and advanced pressure ulcers, reconstructive surgery is indicated, which consists of soft tissue flap coverage such as fasciocutaneous, musculocutaneous, perforator, or free flaps. The selection of a particular flap depends on a variety of factors, for instance, the location and grade of the ulcer, vascularity of the surrounding tissue, mobility of the patient, and the experience and expertise of the surgeon. There are no clear guidelines at present regarding the suitability of a particular flap in the management of pressure ulcers at different stages. This article aims to provide an overview of the etiology, pathophysiology, and management of pressure ulcers in various anatomical locations, with particular emphasis on current advances in reconstructive surgical procedures.     

集束化干预策略在手术相关压疮跟踪管理的应用

目的探讨集束化干预策略在手术相关压疮手术室病区跟踪管理过程的应用效果。方法将1 005例手术相关压疮高发科室患者按照时间顺序分为常规组489例和集束化干预组516例,分别采取常规压疮管理及集束化干预策略进行手术相关压疮的预防护理。结果两组手术相关压疮发生率、压疮发生后手术室与病区责任认定不清的发生率比较,差异有统计学意义(均P0.01),普通病区及ICU护士对手术室工作满意率提升。结论集束化干预措施可有效降低手术相关压疮发生率及严重程度,减少手术室与病区术后责任认定不清的现象,提高病区护士对手术室工作满意度。     

Data collection in private practice and implementation with electronic medical records

The private clinical practice provides a unique environment for the collection of useful data on the severity of disease and on the management of patients with active diseases and conditions. By virtue of the higher volume of patients seen in a given period of time, compared to the academic setting, the continuity of care (in most practices), and the diversity of patients and disease states treated in the private setting is a potentially excellent source of valuable information. Yet these same features, particular the volume of patients needed to maintain an economically viable practice, and other necessary time commitments for practice in the private setting (bill paying, phone call management, general office management), present obstacles that most private practitioners find insurmountable.