基层医院护理管理缺陷与应对

通过对基层医院护理管理存在的问题。护理管理缺陷：如护理管理人员素质参差不齐、护理质量检查着重形式、管理不严格，制度落实不到位、护理人员能力有限等；缺陷应对措施：包括改进护理质量评价标准，检查方法，注重为病人服务、加强对各级护理管理人员的培训、将以人为本的理念体现于质量管理之中，体现“以病人为中心，以病人为核心”的宗旨。     

基层医院护理质量管理缺陷及改进思路

通过对基层医院护理质量管理存在问题的总结分析，如管理人员管理素质参差不齐、护理管理重制度落实轻病人感受、护理质量评价项目设置与病人需求相矛盾、护理质量检查流于形式等，提出较完善的改进措施，包括改进护理质量评价标准、检查方法、注重为病人服务、加强对各级护理管理人员的培训、将以人为本的理念体现于质量管理之中，规范护理行为，使病人真正从护理管理中受益。     

基层医院护理质量的管理探索

分析了基层医院护理质量管理存在的问题:护士队伍不稳定,能力有待提高,服务观念落后,主动服务意识不强,护理管理人员整体素质参差不齐,后勤支持保障不够,制度落实不到住,与病人实际需求存在差距等.提出相应的对策,包括加强对护士的教育力度,加强与医院领导的沟通、协调,制定提高护理服务质量的具体措施,加强对护理质量的检查等,从而提高基层医院的护理质量.     

护理质量管理问题探讨

通过对现行护理质量管理存在的问题，如管理人员欠缺管理素质、护士管理缺乏激励机制、护理质量评价内容的设置与患者需求相矛盾、护士长管理重心偏移等问题进行分析，提出较完善的护理质量管理改善措施，包括：改进质量评价标准，注意患者服务的实效，加强对护理管理各层管理人员的管理培训，服务理念以人为本，将重视患者心理需求融入质量管理中，使患者真正从护理中受益。     

护理质量管理中持续改进存在的问题与对策

在护理质量控制发现：部分护理人员质量管理理念滞后；环节质量管理不到位；护理规章制度和流程与病人日益提高的需求相互矛盾；护理质量评价标准不能客观全面反映问题。针对上述问题提出：更新护理管理理念，提高护理人员参与意识；完善护理质量控制流程，加强环节质量管理；把“以人为本”的服务理念贯穿于护理质量管理过程中；修正护理质量评价标准，注重为病人服务的实效。     

护理质量管理中改革探讨

目的：了解护理管理实际需求和价值观的变化，促进护理质量持续改进与发展。方法：通过对现行质量检查重形式、轻患者需求，管理行为重结果、轻护理过程等存在的问题进行原因分析和措施整改。结果：服务理念以人为本，将重视患者身心需求融入护理质量管理中，多年来，全院无1例有效投诉和严重差错事故发生．医院护理质量在接受护理质控督查考核中成绩优秀。结论：更新各级护理管理人员的理念，重新调整质控运作方法，规范护理行为，患者才能够真正从护理质控中获益。     

现行护理质量管理存在问题及改革思路的探讨

本文通过对现行护理质量管理存在的护理管理人员欠缺管理素质;护理质量评价内容的设置与病人需求相矛盾;护理管理行为重落实制度、轻病人感受;质量检查流于形式等问题进行分析。提出完善护理质量管理的改进措施,包括:加强对护理管理人员的管理素质培训;修正质量评价标准;注重为病人服务的实效;强调持续质量改进;服务理念以人为本; 将重视病人的心理需求融入护理质量管理中;明确考核目的,激励护士全员参与质控管理;建立有效的质量管理体系;护理管理向现代企业化发展等,并不断地规范护理管理行为,使病人真正从护理管理中受益,满足患者的要求。     

新形势下基层医院护理质量管理的思路与措施

目的根据新形势下护理质量管理发展的现状及在管理实践中存在的问题,提出基层医院护理质量管理的思路与措施。方法总结护理质量管理中的经验与相关文献报道。结果护理质量管理在护理队伍整体素质与水平、患者感知服务管理、8小时工作日制、传统经验型的护理质量管理方法、护理质量监控、PDCA循环、护理质量标准化管理等方面存在问题。结论加强护理人力资源的管理和开发,丰富质量管理的内容与方法;实行12小时(24)工作日制;健全和完善护理质量管理的运行机制;完善护理质量标准化、专业化管理;推行"质量零缺陷"管理,强化预防性控制;护理质量管理应根据病人需求改进,实施感知服务,提高满意率;对护理质量进行持续改进。     

基层职工医院护理质量管理缺陷及对策

通过对基层职工医院护理质量管理存在问题的总结分析,提出较完善的改进措施,包括改进护理质量评价标准、检查方法,注重为病人服务,加强对各级护理管理人员的培训,将以人为本的理念体现于质量管理之中,规范护理行为,使病人真正从护理管理中受益.     

基层医院护理质量管理问题初探

随着社会经济的发展，人们生活水平的不断提高，人们实际需求和价值观念的变化，医学模式的转变，我国卫生事业进入一个新的发展时期，基层医院护理质量管理面临着许多新的问题。本文对目前基层医院护理质量管理中存在的主要问题，提出一些改进措施及改进中需要注意的问题。现将其介绍如下。     

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.