海恩法则在护理不良事件管理中的应用

目的探讨海恩法则在护理不良事件管理中的应用效果。方法运用海恩法则对2015年护理不良事件进行分析,采取重视护理技能训练,提高护士素质;建立健全风险评估、防范、上报及讨论机制;针对病房仪器、设备、药物加强管理等一系列措施。比较管理前后护理不良事件发生率。结果实施后护理不良事件发生率与实施前护理不良事件发生数相比减少,差异有统计学意义(P0.05)。结论应用海恩法则的警示作用,能增强护理管理者对风险的预见性,易于发现护理安全隐患,减少护理不良事件的发生。     

海恩法则在预见性护理安全管理中的应用

目的 应用海恩法则的警示作用,启示护理管理者增强风险的可预见性,善于发现护理安全隐患,减少护理不良事件发生.方法 建立健全风险评估、风险防范、风险上报及讨论机制;强化护理人员培训与安全意识教育;建立奖惩机制,加强制度执行力.结果 实施后护理不良事件发生率与实施前护理不良事件发生数相比减少.结论 预见性护理安全管理,能有效减少护理不良事件的发生.     

预见性风险评估在精神科安全护理中的干预效果研究

目的探讨预见性风险评估在精神科安全护理中的干预效果。方法选取本院重性精神疾病患者990例,随机分为对照组470例,观察组520例。两组患者住院期间均接受传统的护理模式,观察组在此基础上实施精神科风险管理预案及预见性风险评估。比较两组患者在住院期间的风险发生率、风险告知执行率、风险评估执行率、患者健康教育知晓率、满意率等。结果观察组住院期间风险发生率明显低于对照组,差异有统计学意义(P0.05)。结论通过实施精神科风险管理预案及应用风险评估表,强化了精神科护理人员风险防范意识,提高了护理人员的风险识别能力,有效降低了精神科护理不良事件的发生。     

手术室管道滑脱风险评估表的研制与应用

目的探讨手术室管道滑脱风险评估表的研制与应用效果。方法根据手术室管道最易滑脱的四个阶段中存在的具体护理问题,综合考量设定相应分值。每个阶段的最高评分为12分,≥8分者视为该阶段的管道滑脱高危风险者,应根据相应阶段的护理措施实施预见性护理。结果使用手术室管道滑脱风险评估表,针对各阶段手术室管道护理中的管道滑脱风险采取相应的护理措施后,大大降低了手术室术后患者管道滑脱的不良护理事件。结论对手术后留置引流管的患者使用管道滑脱风险评估表,根据评估结果,实施相应的预见性护理措施,能有效地预防手术室管道滑脱不良护理事件的发生。     

预见性护理在电视胸腔镜心脏手术患者中的应用

目的 比较预见性护理与常规护理在VATS心脏手术患者中的作用,探讨VATS心脏手术患者的护理.方法 将2007年1月～2011年12月手术的75例患者作为观察组,在常规监护基础上实施护理干预.2004年10月～2006年12月手术的78例患者作为对照组,按心脏术后常规监护.比较两组患者术后护理不良事件和并发症发生率.结果 两组患者术后护理不良事件和并发症发生率差异有显著意义(P＜0.01、P＜0.05).结论 VATS心脏手术患者实施预见性护理干预,能有效减少术后不良事件和并发症的发生率,保障患者的安全.     

护理风险评估在骨肿瘤病人中的应用

[目的]对骨肿瘤病人实施护理风险评估并采取防范措施,以降低护理不良事件发生率。[方法]对住院病人实施护理风险评估,根据评估情况筛选出具有危险的病人,针对性采取防范措施,加强健康教育,对比实施护理风险评估前后护理不良事件发生率。[结果]实施护理风险评估后护理不良事件发生率显著降低。[结论]对骨肿瘤病人实施有效的风险评估并采取防范措施,加强健康教育,可减少护理不良事件的发生。     

护理安全管理中护理标识应用的效果

目的 探讨护理标识在护理安全管理中应用的临床效果.方法 随机选取我院建立护理标识系统前后1年患者1 000例,将护理标识系统建立前患者设为对照组,将护理标识系统建立后患者设为干预组,每组500例.对干预组患者实施护理标识管理,比较两组患者护理满意度及护理不良事件发生率.结果 干预组患者护理满意度明显高于对照组(P＜0.05);同时干预组患者护理不良事件发生率明显低于对照组(P＜0.05).结论 护理标识应用于护理安全管理临床效果确切,能够有效提高患者护理满意度,降低护理不良事件发生率.     

基于前瞻性管理的护理风险评估信息系统的构建与应用

目的 基于前瞻性管理模式自主研发护理风险评估信息系统,规范护理风险评估及管理流程,提高护理风险评估执行率及护理安全质量.方法 评价旧版评估系统存在的不足、回顾分析不良事件的风险值,制定构建新版评估系统的改进目标,通过查阅文献、行业标准、专家咨询等确定评估量表,应用"Delphi""sql sever""Java."".net"信息技术构建信息模块.对新旧版评估系统运行效果进行比较.结果 新版护理风险评估执行率提高、不良事件发生率下降、护理风险相关记录得分比升高、风险评估及记录所需时间减少,应用前后数据间的差异均有统计学意义(P＜0.05).结论 基于前瞻性管理的护理评估信息系统利于提高护理风险评估执行率,规范护理风险管理,提升护理工作效率,降低护理不良事件发生率.     

预见性干预在心身疾病风险管理中的应用

目的:探讨预见性干预在心身疾病风险管理中的应用。方法:对心身疾病患者风险的评估与识别,采取有效的预见性干预措施。结果:实施预见性干预后,护理不良事件发生率由3.73%降至0.41%;干预前后高危患者护理质量、患者满意度比较差异有统计学意义(P<0.05)。结论:实施预见性干预对预防缺陷的发生,减少护理纠纷起到了重要的作用。     

依据《患者安全目标》制定的针对人工耳蜗植入术低龄患儿预见性护理干预措施

目的探讨依据《患者安全目标》制定的针对人工耳蜗植入术低龄患儿预见性护理干预措施的临床实施效果。方法选取2018年7月—2020年6月医院收治的89例人工耳蜗植入术患儿,按照基础资料组间均衡可比的原则将其分为对照组45例和观察组44例,对照组实施常规预见性护理措施,观察组实施依据《患者安全目标》制定的预见性护理措施,比较两组患儿实施不同护理措施后住院时间、住院费用、不良事件发生率。结果观察组患儿住院时间、住院费用及不良事件发生率均低于对照组,差异有统计学意义(P<0.05)。结论对人工耳蜗植入术低龄患儿实施依据《患者安全目标》制定的预见性护理干预措施,可有效避免患儿住院期间的不良事件发生率,缩短住院时间和减少住院费用,减少安全隐患。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

VEGF和NSE在良恶性嗜铬细胞瘤中的表达及意义

目的探讨肿瘤标志物血管内皮生长因子（VEGF）和神经元特异性烯醇化酶（NSE）在良、恶性嗜铬细胞瘤组织中的表达,分析其可能的临床价值及病理学意义,为临床鉴别良、恶性嗜铬细胞瘤提供辅助依据。方法应用免疫组化（SP法）检测16例恶性嗜铬细胞瘤、18例良性嗜铬细胞瘤及17例正常肾上腺髓质组织中细胞因子VEGF和NSE表达情况,显微镜下判断组织切片的染色结果。结果①恶性嗜铬细胞瘤VEGF表达明显强于正常肾上腺髓质和良性嗜铬细胞瘤（P〈0.01）。良性肿瘤和正常肾上腺髓质的VEGF表达差异无统计学意义（P〉0.05）。恶性嗜铬细胞瘤强阳性率明显高于良性嗜铬细胞瘤（P〈0.01）。②良、恶性嗜铬细胞瘤NSE表达差异有统计学意义（P〈0.05）,良性嗜铬细胞瘤NSE的表达高于正常肾上腺髓质的NSE表达（P〈0.05）。恶性嗜铬细胞瘤强阳性率高于良性嗜铬细胞瘤（P〈0.05）。③VEGF和NSE共同阳性表达在良、恶性嗜铬细胞瘤之间差异有统计学意义（P=〈0.01）。结论临床上检测VEGF和NSE可能为鉴别良、恶性嗜铬细胞瘤提供辅助依据,共同检测VEGF和NSE可能提高良、恶性嗜铬细胞瘤鉴别的敏感性。