The importance of maintaining spinal precautions

Spinal injuries are devastating, often leaving the patient paralyzed or with a permanent deficit. Aspiring athletes may not be able to persue their dreams secondary to a spinal injury; families are often left without a major wage earner to support them; and individuals are dependent upon others for the fulfillment of their basic needs. Education is essential for the prevention of primary and secondary spinal injuries; nurses play a key role in both these areas.     

The role of peer assessment and peer review in nursing

With the implementation of clinical governance and professional self-regulation, substantial responsibility is devolved on to clinical nurses. Central to these two concepts is accountability for practice. We are accountable for our professional competence and knowledge to various parties such as the professional statutory body, the employer, society as well as ourselves. Although self-assessment provides each individual with a medium for ascertaining his/her own level of performance and, therefore, identifying his/her learning needs, peer review and peer assessment provide healthy means for obtaining feedback and external perceptions. They also bring with them several other benefits and meet other recommended professional requirements. Peer review is an intrinsic component of clinical governance, and it can be initiated and implemented at one-to-one, departmental or organizational level.     

血浆胶体渗透压对危重症患者预后的意义

目的 分别对危重症患者血浆胶体渗透压、总渗透压与预后的关系进行研究,探讨其与危重症患者预后的关系.方法 回顾性分析2002年1月至2005年12月入住首都医科大学附属北京朝阳医院急诊重症监护病房(EICU)与外科监护病房(SICU)的1568例患者,依据其入院时的血浆胶体渗透压与总渗透压的测定值分别进行分组,计算其病死率,并且进行X2统计学检验比较.血浆胶体渗透压以20 mmHg(即1.2mOsm/kgH2O)为界分为两组;总渗透压以280 mOsm/kgH2O与310 mOsm/kgH2O为界分为三组.结果 低胶体渗透压组与正常胶体渗透压组患者相比病死率高(24.5% vs.17.7%,P=0.001);而在总渗透压的分析中,低渗透压组与正常渗透压组患者相比病死率低(17.0%vs.24.5%,P=0.000).结论 危重症患者血浆胶体渗透压较总渗透压与预后的关系更为密切,可作为一个危重症患者预后的判断指标,危重症患者维持正常血浆胶体渗透压应当引起重视.     

Measles and the importance of maintaining vaccination levels

Measles is caused by the paramyxovirus which spreads through airborne droplets. The disease has an incubation period of between six and 19 days. People with measles are usually infectious for one to two days before the rash appears but the total period during which an individual is infectious is not known.     

The evolving story of medical emergency teams in quality improvement

Adverse events affect approximately 3% to 12% of hospitalized patients. At least a third, but as many as half, of such events are considered preventable. Detection of these events requires investments of time and money. A report in a recent issue of Critical Care used the medical emergency team activation as a trigger to perform a prospective standardized evaluation of charts. The authors observed that roughly one fourth of calls were related to a preventable adverse event, which is comparable to the previous literature. However, while previous studies relied on retrospective chart reviews, this study introduced the novel element of real-time characterization of events by the team at the moment of consultation. This methodology captures important opportunities for improvements in local care at a rate far higher than routine incident-reporting systems, but without requiring substantial investments of additional resources. Academic centers are increasingly recognizing engagement in quality improvement as a distinct career pathway. Involving such physicians in medical emergency teams will likely facilitate the dual roles of these as a clinical outreach arm of the intensive care unit and in identifying problems in care and leading to strategies to reduce them.