基层中医医院开展护理科研的实践与体会

目的 探讨基层中医医院开展护理科研的途径和方法,提高基层中医医院护理人员科研能力,促进中医护理事业发展.方法 通过建立护理科研管理小组,根据基层中医医院的特点,加强护理人员学历教育和有针对性地进行科研知识培训,培养科研意识思维,建立并实施激励机制等有效管理措施开展护理科研.结果 提高护理科研能力,激发了护理人员的创新意识和科研积极性,提高了护理人员的学历结构层次比例,护理科研从无到有,论文数量、质量逐年上升.结论 基层中医医院开展护理科研,可取得较好成效.     

基层医院开展护理科研的实践与体会

[目的]探讨切实有效的基层医院开展护理科研的方法。[方法]建立护理科研管理小组,通过各种教育途径强化护理人员科研意识,培养科研能力,采取有效管理和激励机制等。[结果]激发了护理人员的创新意识和科研积极性,论文数量、质量逐年上升。[结论]基层医院开展护理科研可以提高护理人员整体素质,提高护理质量。     

举办“护理综述报告会”的做法及体会

目的检验和提高中、高级护理人员的科研能力。方法制定综述书写要求和评分标准；由地方知名专家和本院专家相结合进行评审；选择优秀综述进行现场报告并给予奖励；对综述质量采用调查问卷反馈并进行综合分析。结果74．2％的中高级护理人员踊跃投稿，91．30％的护理人员认为基本掌握了书写方法，了解了护理新进展，提高了科研能力。结论护理文献综述报告会是护理科研管理方法创新的有益尝试，是继续教育的有效举措，能比较客观地反映护理人员的科研能力。     

基层医院护理科研滞后原因调查及管理对策

目的 提高基层医院护理科研能力,探索一套行之有效的管理方法.方法 通过对4所县级医院近10年临床护理人员开展科研现状进行回顾性调查.结果 基层医院护理科研滞后的主要原因与护理人员自身因素及管理因素有关.结论 加强基层医院护理科研能力必须从提高护理人员自身素质人手,切实为护理人员开展科研创造条件.     

基层医院开展护理科研的实践与体会

[目的]探讨切实有效的基层医院开展护理科研的方法。[方法]建立护理科研管理小组,通过各种教育途径强化护理人员科研意识,培养科研能力,采取有效管理和激励机制等。[结果]激发了护理人员的创新意识和科研积极性,论文数量、质量逐年上升。[结论]基层医院开展护理科研可以提高护理人员整体素质,提高护理质量。     

护理科研流程管理

目的探讨护理科研流程管理,促进护理科研工作开展。方法建立护理科研管理流程,健全组织机构,选用具有科研与写作能力的护理骨干参与,发动全员,聘请专家教授为指导老师,定期讲学、讲评,督促和指导护理科研与写作。结果激发护理人员的科研兴趣和自信心,形成良好的科研氛围,提高护理人员的科研能力与写作水平。结论加强护理科研的整体规划,使护理科研取得了成效。     

护理科研流程管理

目的 探讨护理科研流程管理，促进护理科研工作开展。方法 建立护理科研管理流程，健全组织机构，选用具有科研与写作能力的护理骨干参与，发动全员，聘请专家教授为指导老师，定期讲学、讲评，督促和指导护理科研与写作。结果 激发护理人员的科研兴趣和自信心，形成良好的科研氛围，提高护理人员的科研能力与写作水平。结论 加强护理科研的整体规划，使护理科研取得了成效。     

广西护理人员科研开展困难的调查与分析

目的 了解广西护理人员科研开展情况,分析科研开展困难的原因,为广西护理科研管理提供科学依据.方法 采用分层抽样法,自行设计调查问卷对广西11所医院的1 770名护理人员进行调查.结果 27.06%的护理人员参加过科研活动,2.09%的护理人员主持过护理科研,92.26%的护理人员认为开展科研有困难.开展科研困难的主要原因有:缺乏科研知识和技能,缺乏领导、同事的支持和帮助,缺乏相应的时间等.结论 医院管理者应重视护理人员的实际困难,并有针对性地帮助解决,才能有效提高护理人员的科研素质和能力,激发护理人员的科研热情和积极性,有效地提高护理科研整体水平.     

医院临床科室护理科研的管理实践与效果

目的探讨临床科室护理科研论文管理的做法与效果。方法科室组建护理科研小组,由护士长任组长,采取自愿报名及护理组推荐相结合的形式,小组成员每年选拔一次,科室每月进行一次授课,组织护理科研、论文写作知识培训、每年制订护理科研计划,明确奖励机制,修改并指导其他护士撰写的论文,建议投稿方向,形成系列论文。结果组建护理科研小组后护理人员撰写论文和论文发表的数量及质量均有所提高,发表杂志级别从原来的非统计源期刊到中华级论文,并有了课题、成果及专利。结论临床科室成立护理科研论文小组可促进护理人员结合临床实际,总结经验,为临床解决实际问题,带动科室形成良好氛围,有效提高科室护士护理科研的写作水平及创新意识。     

组建学习型护理团队提升护理人员科研能力的实践

目的评价组建学习型护理团队对提升护理人员科研能力的效果。方法在神经内科22名护理人员中组建学习型护理团队,进行科研能力培训与学习。在实施前和实施后,采用护理人员科研能力量表测评护士科研能力的变化。结果实施学习型护理团队后,护理人员的科研能力总分及科研基础知识、论文写作知识、统计学知识、软件操作能力4个维度得分均有不同程度提高(P0.05)。结论在临床护理工作中组建学习型护理团队,有利于提高护理人员的科研能力。     

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.