武警部队医院医护人员复合性损伤知识现状调查

[目的 ]了解武警部队医院医护人员对复合性损伤知识掌握程度。 [方法 ]根据战伤救治标准、《护理操作常规》、《军事医学》教材 ,自行设计复合伤相关知识问卷 ,对武警部队医院 2 0 5名医护人员进行调查。[结果 ]部队医院医护人员掌握复合伤知识总均分偏低 ,在复合伤知识掌握上医生好于护士 ;军队护士好于地方合同制护士 ;机动师医院好于总队医院。 [结论 ]部队医院的医护人员复合伤知识欠缺。应建立有效的培训机制 ,加强护理人员复合伤知识的学习。     

武警部队医院医护人员复合性损伤知识现状调查

[目的]了解武警部队医院医护人员对复合性损伤知识掌握程度。[方法]根据战伤救治标准、《护理操作常规》、《军事医学》教材，自行设计复合伤相关知识问卷，对武警部队医院205名医护人员进行调查。[结果]部队医院医护人员掌握复合伤知识总均分偏低，在复合伤知识掌握上医生好于护士；军队护士好于地方合同制护士；机动师医院好于总队医院。[结论]部队医院的医护人员复合伤知识欠缺、应建立有效的培训机制，加强护理人员复合伤知识的学习。     

武警部队部分医护人员复合伤急救知识现状调查

目的了解武警部队医护人员对复合性损伤急救知识掌握程度。方法采用问卷调查法,根据战伤救治标准、第四版医疗护理技术操作常规及相关参考文献自行设计问卷,对相关医院的医护人员进行调查,并将调查结果用SPSS统计软件进行分析。结果医护人员对急救知识的掌握程度与复合伤知识相比较,差异具有显著性(P<0.05);且在护士群体中,不受学历、工作年限和职称的影响,急救知识掌握程度普遍好于复合伤知识;医生与护士相比较,对于急救知识的掌握程度无显著性差异(P>0.05),而对复合伤知识掌握程度医生好于护士(P<0.05)。结论部队医院的医护人员对于复合伤知识掌握欠缺,应建立有效的培训机制,对医护人员尤其是护理人员进行复合伤知识的培训。     

辽宁省养老机构护理人员养老护理知识掌握情况调查

[目的]了解辽宁省养老机构护理人员结构现状及养老专业知识掌握情况。[方法]采取整群抽样和等比例抽样方法抽取辽宁省养老机构护理人员2 004人,采用自行设计的养老相关知识测评问卷进行调查。[结果]养老机构护理人员养老护理相关知识总分为(18.15±4.07)分,得分最高的维度是生活照料知识(3.18分±0.90分),得分最低为道德法律知识(2.20分±0.94分);护龄、职称、聘用方式、文化程度、月薪对养老护理知识掌握有影响(P<0.05),护龄、职称、聘用方式、文化程度、月薪与总分呈正相关(P<0.01)。[结论]制定养老护理培训方案时要充分考虑护理人员护龄、月薪、职称、聘用方式、文化程度等因素的影响,制定出合理的分级培训措施。     

ICU护士感染性休克复苏治疗相关知识调查及培训效果评价

[目的] 了解ICU护士对感染性休克复苏治疗相关知识的掌握程度,评价集中专题知识培训的效果.[方法]以<2004年严重感染及感染性休克治疗指南>中复苏治疗相关知识作为培训内容,对我院105名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对感染性休克复苏治疗相关知识的掌握程度.[结果] ICU护士对感染性休克复苏治疗内容的知晓率培训后较培训前提高16.2%;复苏治疗相关知识培训前得分6.46分±1.75分,培训后得分7.01分±1.97 分,差异有统计学意义(P＜0.05).[结论] ICU护士对感染性休克复苏治疗相关知识的掌握程度不够,对ICU护士进行相关知识的培训可提高其对相关知识的掌握程度.     

巴州地区基层医院护理人员新生儿窒息复苏技术的知识、态度、行为现状

[目的]了解巴州地区基层医院护理人员对新生儿窒息复苏技术的知识、态度、行为情况,为提高护理人员的新生儿窒息复苏技能水平提供理论依据。[方法]将该地区15家医疗保健机构的新生儿科、儿科、产房的200名医护人员纳为研究对象,统一进行规范化的培训。培训前后分别发放自行设计的护理人员对新生儿窒息复苏技术的知识、态度、行为调查问卷,了解护理人员对新生儿窒息复苏技术的知识、行为及态度的得分情况。[结果]护理人员对新生儿窒息复苏技术的知识总分为29.98分±12.23分,态度总分为36.90分±7.07分,行为总分为31.61分±10.02分。[结论]巴州地区基层医院的护理人员缺乏对新生儿窒息复苏技术相关知识的掌握,态度较好,但行为不足,建议医院相关部门及护理管理者加强对护理人员对新生儿窒息复苏技术的培训。     

ICU护士对危重病人营养支持相关知识培训效果的评价

[目的]了解ICU护士营养支持相关知识的掌握程度,评价集中专题知识培训的效果。[方法]对82名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对危重病人营养支持相关知识的掌握程度。[结果]培训后ICU护士对危重病人营养支持相关知识的知晓率较培训前有明显提高：培珑前后得分比较差异有统计学意义（P〈0．01）。[结论]ICU护士对危重病人营养支持相关知识的掌握程度不够,对护士进行专题培训可提高护理人员对相关知识的掌握程度,指导护士参与对危重病人营养支持的护理实践。     

ICU护士对危重病人营养支持相关知识培训效果的评价

[目的]了解ICU护士营养支持相关知识的掌握程度,评价集中专题知识培训的效果. [方法]对82名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对危重病人营养支持相关知识的掌握程度. [结果]培训后ICU护士对危重病人营养支持相关知识的知晓率较培训前有明显提高;培训前后得分比较差异有统计学意义(P＜0.01).[结论] ICU护士对危重病人营养支持相关知识的掌握程度不够,对护士进行专题培训可提高护理人员对相关知识的掌握程度,指导护士参与对危重病人营养支持的护理实践.     

上海市三级甲等医院重症监护室护士机械通气镇静知识的调查

[目的]了解上海市三级甲等综合性医院重症监护病房(ICU)护士对机械通气镇静知识掌握程度及其影响因素。[方法]按监护室工作年限进行分层抽样,在14所上海市三级甲等综合性医院中抽取ICU护士133名,采用ICU护士机械通气镇静知识掌握程度问卷进行调查。[结果]ICU护士机械通气镇静知识总分为10.74分±1.94分,镇静知识掌握程度与是否接受过镇静知识培训有关。[结论]护士对镇静知识掌握现状不容乐观,应对ICU护士开展机械通气相关知识培训并制定规范的操作流程及护理方案,以保证镇静治疗的良好疗效。     

基于微信公众平台临床女护士避孕知识的干预研究

[目的]了解临床女护士避孕知识的现状,探讨利用微信公众平台对护理人员进行培训的效果。[方法]建立微信公众平台,推送有关避孕知识的文章、视频、音频等教育材料,提供线上线下免费咨询,干预时间为8周,每周发布1次,共计24条信息,干预前后调查女护士的避孕知识水平,并对微信培训模式做效果评价。[结果]微信公众平台干预前女护士避孕知识得分为5.98分±1.12分,掌握程度中等,干预后女护士避孕知识得分为7.68分±0.87分,掌握程度优良,知识水平得到明显提高,经比较差异有统计学意义(P0.05)。95%以上的护士对利用微信公众平台进行培训的效果认可,并希望培训模式继续。[结论]微信公众平台在临床女护士避孕知识干预中能显著提高避孕知识水平,受到女护士好评。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.