跌倒高危患者对相关危险因素的知晓度调查分析

目的:了解住院跌倒高危患者对跌倒危险因素的认知情况,为提供针对性的护理干预提供依据。方法:采用问卷调查的方式对132例住院跌倒高危患者进行调查。结果:住院跌倒高危患者对跌倒危险因素的知晓度为42.42%~53.79%;不同年龄段及不同文化程度的高危患者对跌倒危险因素知晓程度有差异,不同文化程度的高危患者对防跌倒的依从性不同。结论:跌倒高危患者对跌倒危险因素的知晓度欠佳,文化程度低及中青年患者对跌倒危险因素知晓度较低,文化程度高、年龄较大的患者对跌倒危险因素知晓度较高。文化程度越低,依从性越好;文化程度越高,依从性越差。应加强对跌倒高危患者的防跌倒知识宣教,采用形式多样、个性化的宣教策略,提高患者对跌倒高危因素的知晓度及依从性,预防跌倒发生。     

品管圈活动提高住院患者跌倒防范措施落实率的作用

目的探讨品管圈活动提高住院患者跌倒防范措施落实率的作用。方法 2014年5月起我院开展品管圈活动,确立以"提高住院患者跌倒防范措施落实率"为主题,进行现状调查和要因分析,制订全院患者防跌倒的具体措施,并监督和管理落实情况。比较实施前后防跌倒措施的落实率;患者防跌倒措施的知晓率;护理人员防跌倒知识的考核情况;不同风险等级的进步率及目标达成率。结果品管圈活动后,住院患者跌倒防范措施的综合落实率由75.52%提升至90.40%,前后比较差异有统计学意义(P<0.0001);患者防跌倒知识知晓率由46.18%提高至83.70%;护理人员防跌倒考核成绩由平均66.30分提高至平均93.70分;进步率和目标率均有提升。结论品管圈应用于住院患者防跌倒的管理中,可有效提高跌倒防范措施的落实率,保证患者安全,提升医院的管理质量。     

安全实例在眼科住院老年患者防跌倒宣教中的应用

目的 探讨安全实例宣教在对眼科住院老年患者跌倒宣教中的作用及影响。方法将200例眼科住院老年患者,按入院时间分成干预组与对照组,前100名患者为对照组,后100名患者为干预组,对干预组100例住院老年患者采取安全实例宣教,帮助老年患者掌握跌倒的高风险因素及预防措施,并做好相关护理措施。对照组做普通防跌倒知识宣教及其他护理措施,并比较2组防跌倒相关知识掌握程度及跌倒发生率。结果观察组对防跌倒相关知识了解程度及依从性明显高于对照组(均P<0．01);干预组跌倒发生率为0,对照组跌倒发生率1%,2组比较差异有统计学意义(P<0.05)。结论 跌倒实例宣教可有效地提高患者对防跌倒知识的了解程度和依从性,减少眼科住院老年患者跌倒发生率,提高老年患者生活质量。     

老年患者院外跌倒的影响因素分析

目的:探讨老年住院患者院外跌倒的影响因素。方法:针对我院2012年9月~2013年9月的7例老年住院患者院外跌倒的情况,采用问卷调查的方法对家属、患者、主管医师、责任护士、护理组长及病区护士长进行影响跌倒的原因调查,对调查收集的各种影响因素采用帕洛特图法进行分析。结果:影响老年住院患者院外跌倒的因素为医护人员对患者防跌倒知识的反复再教育不到位和患者对跌倒的认知不到位以及跌倒时周围环境缺乏相应的防跌倒设备及措施。结论:为降低老年住院患者院外跌倒的发生,应充分评估患者及患者的活动环境,加强对患者及家属的认知教育,反复强化,提高患者的在院依从性。     

跌倒危险因素评分表在神经内科病房中的应用

目的探讨跌倒危险因素评分表在神经内科住院患者中的应用效果。方法应用跌倒危险因素评分表对2010年1～ 8月本院收治存在跌倒危险因素的167例患者进行评估,根据评估结果采取针对性预防护理措施。出院前调查患者跌倒发生率及对护士防跌倒护理工作满意度。结果患者住院期间未发生跌倒不良事件,患者对护士防跌倒护理工作满意度为99.8% 。结论对神经内科患者采用跌倒危险因素评估表进行评估,根据评估结果,采取针对性护理措施预防跌倒,能有效预防患者跌倒不良事件的发生。     

跌倒风险分级护理在心内科患者防跌倒管理中的应用

目的 探讨跌倒风险分级护理在心内科住院患者防跌倒管理中的作用.方法 将2011年4月～2012年3月收治我心内科住院的病人作为实验组,进行跌倒风险分级护理,与2010年3月～2011年3月收治的病人作对照,比较两组跌倒人次、护理的满意度,再进行实验组自身前后防跌倒知识、态度的得分比较.结果 实验组患者的跌倒人次明显低于对照组,护理的满意度高于对照组,实验组出院时的防跌倒知识和态度得分明显高于入院时.结论 跌倒风险分级护理可减少心内科住院患者的跌倒次数,增加患者对护理的满意度,提高患者的防跌倒知识和态度,值得在临床上推广.     

多科联合品管圈活动在住院患者跌倒风险认知中的应用

目的 探讨多科联合品管圈活动在提高住院患者对防跌倒知识宣教知晓率中的应用效果。方法 2016年7月多科联合品管圈小组成立,组员来自一个督导管辖下的6个病区护理质量评价员,运用质量管理工具,确立“提高住院患者对防跌倒知识宣教知晓率”为主题,首先调查得出各病区患者对防跌倒知识宣教知晓率低的真因,然后进行分析、制定对策并实施,运用自制《防跌倒知识十知道调查表》在实施前后对住院患者跌倒风险的认知进行效果评价。结果住院患者对防跌倒知识宣教的知晓率从活动前的60%提高到94%,目标达标率113%。 结论 多个科室联合应用品管圈活动在有效提高不同病区患者对防跌倒知识宣教的知晓率方面效果显著,在保证患者安全的同时提高了患者的满意率,提升了医院的管理质量。     

跌倒护理单应用于手外科术后患者防跌倒的效果观察

目的:探讨"跌倒护理单"在患者术后防跌倒中的应用及注意事项。方法:对手外科275例术后患者启用"跌倒护理单",严格按"跌倒护理单"要求采取护理措施并对其效果进行评估。结果:使用"跌倒护理单"后患者跌倒发生率明显下降,患者及家属对护理人员工作满意度上升。结论:术后患者使用"跌倒护理单"能提升跌倒高危预报率,减少跌倒发生率。     

外科老年患者术后跌倒的影响因素分析及预防对策

目的 分析外科老年患者术后跌倒的影响因素,为针对性提出防跌倒策略提供依据.方法 采用回顾性分析选择2016年1月至2018年1月外科术后发生跌倒的老年患者18例,应用院自制跌倒危险因素评估表对患者跌倒的影响因素进行调查分析,分析各因素与跌倒相关性.结果 跌倒发生的时间分布中00∶00-08∶00时间段占72.2%,跌倒发生的地点中在厕所间占66.7%.外科术后患者体能虚弱、服用特殊药物、麻醉止痛药应用等疾病因素占发生跌倒危险因子排序的前3位.跌倒与年龄、各系统机能退化也存在相关性.结论 预防外科老年患者术后跌倒,应从外在因素、疾病因素、生理因素等多方面进行分析,从而制定针对性防跌倒策略.     

小组合作管理对康复期脑卒中患者预防跌倒的影响

目的探讨小组合作管理对康复期脑卒中患者预防跌倒的影响。方法 2010年1月至2011年1月45例患者作为观察组,2008年12月至2009年12月45例患者作为对照组,对照组由护理组负责防跌倒管理,观察组采用小组合作管理模式,即由康复医生、治疗师、护士共同参与防跌倒管理,分别在入院时和出院前调查观察组患者预防跌倒知识的掌握情况和预防跌倒措施的依从性及两组跌倒发生率。结果出院前观察组患者预防跌倒知识和预防跌倒措施的依从性得分与入院时比较,差异有统计学意义(P<0.05);住院期间跌倒发生率观察组低于对照组,两组比较差异有统计学意义(P<0.05)。结论小组合作管理能更专业、更全面地帮助脑卒中患者或陪护掌握预防跌倒的方法,提高执行预防跌倒措施的依从性,从而减少跌倒的发生。     

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.