浅析儿科门诊输液室的优化管理

目的:探讨儿科门诊输液室优化管理程序,提高护士专业理论水平和服务水平.方法:针对性地实施各项规范化的护理服务和管理程序,重点优化护理流程,细化管理,加强护士的业务培训,提高头皮静脉穿刺成功率,增强护士病情观察和与患儿及家长的有效沟通能力.结果:护理工作满意度逐年提高,儿科门诊输液室连续10年无护理差错发生.结论:儿科门诊输液室的优化管理,显著提高了护理质量和患者满意度,有效地构建了和谐的医患关系,值得推广.     

Application of scene-based games to children hospitalized in special wards receiving intravenous infusion

目的 提高特需病房患儿静脉输液一次穿刺成功率.方法 将120例患儿按入院时间段分为对照组49例,按常规行整体护理和静脉输液操作;观察组71例,输液前通过情景游戏的方式与患儿互动后,再对患儿进行静脉输液操作.比较两组患儿配合程度、一次穿刺成功率及家长满意度.结果 观察组3项指标显著优于对照组(均P＜0.01).结论 情景游戏的开展有利于提高患儿静脉输液依从性,从而提高一次穿刺成功率和家长满意度.     

情景游戏用于特需病房患儿静脉输液效果观察

目的提高特需病房患儿静脉输液一次穿刺成功率。方法将120例患儿按入院时间段分为对照组49例,按常规行整体护理和静脉输液操作;观察组71例,输液前通过情景游戏的方式与患儿互动后,再对患儿进行静脉输液操作。比较两组患儿配合程度、一次穿刺成功率及家长满意度。结果观察组3项指标显著优于对照组(均P0.01)。结论情景游戏的开展有利于提高患儿静脉输液依从性,从而提高一次穿刺成功率和家长满意度。     

儿科门诊静脉输液的量化考核管理

目的 探讨对儿科门诊护士实行静脉输液量化考核管理的方法及效果.方法 对护士进行统一培训后,将输液护士进行分组包干,由护士长每日组织各组长检查并对护士的输液质量进行评价,将量化考核结果与护士效益工资挂钩,并比较实施前后护士按规范完成操作的时间及一次穿刺成功率.结果 实施静脉输液量化考核管理后,护士一次穿刺成功率显著提高,...     

儿童外周静脉穿刺疑难会诊平台的构建与应用

目的 对儿童外周静脉疑难穿刺进行规范化管理,以提升护理服务质量.方法 组建平台建设团队,成立儿童外周静脉穿刺疑难会诊小组,设计儿童外周静脉穿刺疑难会诊平台,即在原有京颐护理质量管理系统上报事件管理模块中设置儿童护理会诊,会诊科室通过信息系统提出会诊申请,以儿科门诊护士为主导的会诊小组完成会诊并实施相关诊疗措施.统计会诊穿刺成功率、首次穿刺成功率、会诊满意度等.结果 2019年6月至2020年12月共完成外周静脉疑难穿刺会诊505例,会诊穿刺成功率为100％,首次穿刺成功率为88.91％;平均会诊时间为8.93 min;患儿家属对会诊满意度达97.90％.结论 儿童外周静脉穿刺疑难会诊平台能满足临床科室会诊需求,使会诊更加方便、快捷,有利于全院儿童外周静脉穿刺的同质化管理,有助于提高儿童疑难外周静脉穿刺成功率及患儿家属满意度.     

输液室护士静脉穿刺技术的培训

目的 提高护士静脉穿刺水平,减轻患者痛苦.方法 根据门诊输液人员结构及静脉穿刺技术创建静脉穿刺培训小组,采取"一帮一"或"一帮多"带教培训模式,将自我训练与教师指导相结合、培训效果与绩效工资挂钩等措施.结果 5名护士成为静脉穿刺技术能手,工作效率显著提高,静脉输液肿漏率由6.5%下降到3.3%.结论 静脉穿刺技术培训能提高小儿静脉一次穿刺成功率,提高患儿及其家属的满意度;护士静脉穿刺技术水平显著提高.     

改变输液操作程序对小儿静脉穿刺成功率的影响

静脉输液是儿科常用的给药途径。控制静脉穿刺时患儿躁动不合作，提高静脉穿刺一针成功率，减轻患儿痛苦，是减少护患纠纷，提高工作效率和护理质量的保证。我科在临床实践中，改变原有输液操作程序，提高了静脉穿刺一次成功率，报告如下。     

LED静脉观察仪在患儿静脉穿刺中的应用

静脉输液是儿科门诊治疗患儿疾病的重要手段和用药途径.由于患儿静脉细小,穿刺较成人困难.为了使护理人员能够快速、准确地找到血管,提高静脉穿刺成功率,降低患儿的痛苦,减少护患纠纷,我科应用LED(发光二极管)静脉观察仪(南京林康医疗科技有限公司生产)选择血管进行穿刺,效果较好,现报告如下.     

改变输液操作程序对小儿静脉穿刺成功率的影响

静脉输液是儿科常用的给药途径.控制静脉穿刺时患儿躁动不合作,提高静脉穿刺一针成功率,减轻患儿痛苦,是减少护患纠纷,提高工作效率和护理质量的保证.我科在临床实践中,改变原有输液操作程序,提高了静脉穿刺一次成功率,报告如下.     

减压穿刺法在患儿头皮静脉输液中的应用

目的探讨减压穿刺法在患儿头皮静脉输液中的应用效果。方法将120例患儿按输液单双日分为两组各60例。对照组采用常规头皮穿刺输液;观察组采用减压穿刺法,即降低输液瓶、升高调节器高度进行患儿头皮静脉输液。结果两组一次穿刺成功率及穿刺回血时间比较,差异有显著性意义（P〈0.05,P〈0.01）。结论采用减压穿刺法进行患儿头皮静脉输液,静脉回血早,可提高一次穿刺成功率,有效保护患儿血管,提高其家属满意度。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。