建立临床科室护理岗位风险度评估体系的研究

[目的]建立和完善临床科室护理岗位风险度评估体系,推行体现高风险、高责任、高技术的岗位和护理人员劳动价值的激励机制。[方法]对近两年内临床科室护理进行秩和比分析,测评不同护理岗位的风险度。[结果]综合评分排名前三位的科室分别是综合ICU、神经外科和急诊内科。[结论]护理岗位风险度和绩效考核评估体系,对护理人力资源的配置指导、绩效考核和向高风险岗位倾斜政策的制订提供了有力的依据。     

运用德尔菲法构建临床护理科室分级管理指标体系

[目的]构建科学、合理的临床护理科室分级指标体系,为合理配置护理人员、绩效考核、实施护理岗位管理提供依据。[方法]应用两轮德尔菲(Delphi)法确定黑龙江省临床护理科室分级管理评估体系。[结果]两轮咨询专家积极系数分别为85%和100%,专家权威程度为0.907;确定的指标体系包括3个一级指标、12项二级指标、100项三级指标。[结论]专家的积极程度和权威程度较高,两轮函询后专家的建议已经趋向于一致,专家意见协调性好;构建的指标体系可用于临床护理科室分级评估。     

基于医院信息系统的护理工作量评价体系的建立与实施

[目的]基于医院信息系统(HIS)建立全面科学的护理工作量评价体系并实施。[方法]采用HIS系统和专家权重负荷相结合的方法建立临床病区护理工作量评价体系。[结果]形成了基于HIS系统的六项体现护理工作量及工作效率的指标,包括总床日数、出科人数、等级护理量、治疗护理量、病例分型(非手术科室)、手术分级(手术科室),依据分类赋予相应的权重。[结论]基于HIS系统建立科学全面的护理工作量评价体系,对护理单元的工作量进行客观评价,是护理绩效考核的重要部分,同时为护士岗位人力配置及绩效分配改革提供依据。     

岗位层级管理模式在医院人事改革眼科护理中的应用

[目的]探讨岗位层级管理模式在医院人事改革眼科护理中的应用。[方法]实行层级岗位管理护理模式,进行岗位设置、护士配置。护理部统筹全院护士绩效考核分配,门诊、手术室结合量化考核,提高临床夜班护士系数等。眼科护士分N0-N5共6个层级别培训和考核,制定层级培训手册。护理质量管理实行科室护理单元自控、护士长交叉检查、护理部组织护理质量管理委员会下设的专业小组管理、项目小组管理、护理总值班督导、护理部主任行政业务督导等质控考核,考核结果与绩效挂钩。比较人事制度改革实施前后病人满意度、护士岗位工作满意度及护士对统筹绩效考核分配满意度。[结果]实施岗位层级管理模式后,各层级护士对岗位工作满意度由90.55%提高到98.42%,护士对统筹绩效考核分配满意度由91.33%提高到96.06%,病人满意度由91%提高到97%。自2013年始医院护理质量评价每年获市级评估"A级",无护理服务投诉,无护理差错事故,护士离职1人离职率2.8%,离岗率0。[结论]在人事制度改革中,眼科护理实行岗位层级管理模式,护理部统筹绩效分配,能有效地实现同工同酬,能保证护理质量及提高病人满意度,为病人提供持续科学的优质护理服务,有效减少护理差错及护理人才流失,不同程度地引导眼科护士走向临床岗位,满足临床病人需求。     

护理岗位实施绩效考核的效果探讨

[目的]探讨护理分配制度与护理质量的关系。提高医院护理工作质量。[方法]在护理岗位推行了绩效考核制度，对实行绩效考核制度前后护理工作质量进行比较，分析推行绩效考核对护理质量管理产生的效应。[结果]护理岗位推行绩效考核起到了提高员工绩效、提高员工素质、保证护理目标的实施、增强管理效能等作用，有效地促进了医院护理质量的全面提高：[结论]将绩效考核引入护理管理，是新时期护理管理高效科学的管理模式．     

临床护士绩效考核满意度现状及影响因素分析

[目的]了解目前临床护士绩效考核满意度情况,并分析与其相关的影响因素。[方法]采用自行设计的一般资料问卷和临床护士绩效考核满意度问卷。对620名工作1年以上的临床护士进行调查。[结果]临床护士绩效考核满意度水平较高,总体得分为(4.30±0.70)分,其中考核体系满意度(4.24±0.72)分,考核主体参与满意度(4.15±0.73)分,考核应用满意度(4.43±0.74)分;每周工作时间、工作年限、所在科室对临床护士绩效考核满意度有一定影响。[结论]应关注临床护士对护理绩效考核的满意度,不断完善绩效考核管理,提高临床护士对护理绩效考核的满意度,从而提高其工作积极性。     

绩效考核在护理管理中的应用

[目的]探讨绩效考核在护理管理中的应用。[方法]护理部在对各临床科室护理管理考核的基础上重点对护士进行全面考核。[结果]护士工作主动性增强,护理差错事故、投诉、纠纷减少。[结论]绩效考核是护理管理中提高护理质量的重要手段。     

护士长绩效考核信息化模块的设计及应用

[目的]基于护理质量评价标准体系,探索科学的护士长绩效考核与奖金分配方法,提高护理管理效率。[方法]根据护士长绩效考核方案,在医院信息系统的基础上建立护士长绩效考核信息化模块,采集护理岗位、质量、安全、服务、教研等数据,自动生成护士长月绩效考核得分,实施绩效分配。[结果]实施护士长绩效考核信息化模块1年后,年度护理质量平均分和年度绩效考核平均分均有提高,差异有统计学意义(P0.05)。[结论]通过护士长绩效考核模块实施绩效分配,有利于提高护士长的工作积极性,促进护理质量持续改进,推进岗位动态管理。     

分层管理模式下护士绩效考核方案的实施与效果评价

[目的]探讨分层管理模式下护士绩效考核方案的实施与效果评价。[方法]在护士绩效考核方案中将分层管理指标纳入绩效考核,建立分层管理模式下的绩效考核方案,经全员培训后在河南科技大学第一附属医院本部40个临床科室实施,12个月后总结分析实施前后护士对绩效考核满意率、出院病人护理服务满意度、各科室护理质量分值等数据,进行效果评价。[结果]实施前后护士对绩效考核方案的满意率分别为85.83%、97.50%,差异有统计学意义(χ2=10.69,P0.05);实施前后出院病人护理服务满意度得分比较比较差异有统计学意义(P0.05);实施前后各科室月护理质量得分,差异有统计学意义(P0.05)。[结论]分层管理模式下护士绩效考核方案对护士有正性的激励作用,能有效提高护士对绩效工资分配满意率、出院病人护理服务满意度,有利于提高临床护理质量。     

护理岗位实施绩效考核的效果探讨

[目的]探讨护理分配制度与护理质量的关系,提高医院护理工作质量。[方法]在护理岗位推行了绩效考核制度,对实行绩效考核制度前后护理工作质量进行比较,分析推行绩效考核对护理质量管理产生的效应。[结果]护理岗位推行绩效考核起到了提高员工绩效、提高员工素质、保证护理目标的实施、增强管理效能等作用,有效地促进了医院护理质量的全面提高。[结论]将绩效考核引入护理管理,是新时期护理管理高效科学的管理模式。     

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.     

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.     

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.     

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.