对消毒员进行规范培训的方法与体会

目的探讨消毒员规范培训方法,提高其专业水平及综合素质。方法编写消毒员培训专用教材,通过系统的讲课、一对一带教实践、理论及技能考试等方法对消毒员进行岗前和岗位培训。结果培训后消毒员理论及操作考试成绩有显著提高（P〈0．01或P〈0．05）;护理质量与实施前（护士做消毒工作）比较差异无统计学意义（P〉0．05）。结论编写实用的培圳教材,采用多种培训方式进行培训,可提高消毒员综合素质及专业水平,保证无菌物品灭菌质量。     

现代化消毒供应中心消毒员的知信行调查

目的了解现代化消毒供应中心消毒员的现状,探讨消毒员管理、培训新思路。方法对30所二、三级医院消毒供应中心护士长进行问卷调查,了解消毒员的管理模式、基本素质、继续教育和实际工作能力。结果不同医院的消毒员管理模式各不相同,消毒员文化素质、工作能力差距大,70%的消毒员不能很好地胜任岗位工作;80%以上的消毒员没有接受过继续教育培训。结论通过完善消毒员的管理制度,加强消毒员的继续教育,提高CSSD护士长的管理能力,来提高消毒员知信行能力,保障无菌物品的灭菌质量。     

消毒供应中心聘用制工人培训方法的探讨

目的:探讨集中式管理模式下消毒供应中心对聘用制工人的职业培训方法。方法:根据培训对象特点,实行集中式与过程式培训相结合的方式进行理论与操作培训。结果:满足了工人的岗位培训需求。结论:通过专业培训,聘用工人能够胜任岗位工作,提高了其工作能力与整体素质,确保了工作质量。     

消毒员在灭菌环节中存在的问题及对策

总结消毒员在灭菌环节中存在的问题，提出管理对策。质量控制小组对消毒员工作进行检查，主要存在问题为消毒员灭菌操作不够规范，对新设备操作不熟练。对消毒员进行培训，设立专人监督管理和考核，以提高消毒员的基础理论知识和实践操作能力，杜绝灭菌各环节中存在的安全隐患，确保灭菌物品质量。     

消毒供应室人员专业素质培训结果分析

目的了解消毒供应室人员对专业知识的掌握程度,探讨消毒供应室人员专业素质培训的方式,努力提高消毒供应室人员的专业水平。方法回顾性地总结分析2009年、2010年我院消毒供应室人员专科理论考试及技术操作考试情况,其中2010年增加培训次数及考核次数,并运用了激励机制。结果 2010年消毒供应室人员专科理论考试平均分明显高于2009年专科理论考试平均分,但技术操作考试平均分无明显变化。结论通过加强业务学习,增加培训次数和考核次数,应用激励机制的管理模式能有效提高消毒供应室人员专业水平。     

基层消毒供应中心消毒员解读灭菌物理参数现况与影响因素研究

目的了解基层消毒供应中心消毒员解读灭菌物理参数的现况,并分析其影响因素。方法采用方便抽样法,选取绍兴地区62名消毒供应中心消毒员作为调查对象,采用自制消毒员解读灭菌物理参数调查表进行问卷调查,采用x 2检验、二元Logistic回归分析探究基层医院消毒供应中心消毒员解读灭菌物理参数的影响因素。结果62名消毒员中能正确解读灭菌物理参数有10人(16.1%),不能正确解读灭菌物理参数有52人(83.9%)。二元Logistic回归分析显示,消毒员的年龄、学历、工作年限、参数单位值换算及培训情况是消毒员对灭菌物理参数认知情况的影响因素(P<0.05)。结论绍兴地区基层消毒供应中心消毒员解读灭菌物理参数的能力处于较低水平,年龄大、学历低、工作年限短、不能正确换算参数单位值、未按计划培训是正确解读灭菌物理参数的影响因素。     

消毒供应中心(CSSD)规范化培训、考核方法及效果分析

目的 探讨如何通过规范化培训使消毒供应中心人员适应新的管理模式、掌握新的操作方法、接受新的理念,完成新的任务.方法 科室和小组采取集中培训、分项培训、岗位培训和个人培训、医院继续教育培训、分组培训相结合的方式进行思想教育、专业理论、操作技能的培训.结果 培训后全科工作人员专业知识、岗位技能考核成绩明显提高,从( 74±2)分提高到(92±3)分,差异有统计学意义(P＜0.01).工作质量明显提高,全科工作缺陷发生由培训前每月50 ～ 60条减少到每月20 ～ 30条,差异有统计学意义(P＜0.01).结论 消毒供应中心规范化培训、考核对消毒供应中心规范化、专业化、科学化发展具有重要意义.     

消毒供应中心技术工人的培训与管理

目的探讨消毒供应中心技术工人的培训方法,建立规范的培训体系。方法自编培训教材,采用多种培训方法,对工人进行岗前及岗位培训,以其理论与操作考试成绩、消毒供应中心工作质量及科室对供应中心满意度作为培训效果的评价指标,并与对照组进行比较。结果培训后的技术工人均能达到各自岗位的任职要求,理论与操作考试成绩均能达标,消毒供应中心工作质量、科室满意度与对照组比较差异无统计学意义（P〉0.05）。结论通过系统及规范化的培训后,技术工人均能达到各自岗位的任职要求,保证消毒供应中心的工作质量。     

分层培训在消毒供应中心的应用价值

目的 探讨分层培训在医院消毒供应中心的应用价值.方法 将科室54人分为四个层次、五个级别进行理论和技能培训,并对培训结果进行对比分析.结果 54人经过分层培训后,知识考核与技能操作分别增长15.4％和17.6％,与培训前比较,差异有显著意义(P＜0.05).结论 高素质人力资源的配备是预防和控制医院感染的关键,对消毒供应中心各级人员的分层培训势在必行.分层培训培养了专业人员管理的综合能力,提高了消毒专业人员的整体素质和服务水平,有利于消毒供应中心专业的发展,具有推广应用价值.     

消毒供应中心新进人员专科岗位培训模式构建与评价

随着消毒供应中心集中管理模式的纵深推进,人力资源需求变化较大,新进入消毒供应中心的人员,学历、教育背景均存在很大的差异,如何确保新进人员的培训效果,探索符合消毒供应中心专科特色的专科岗位培训模式,是消毒供应中心管理者关注的重要课题。本文从构建专科岗位培训管理体系、分阶段实施专科岗位分区规范化与岗位轮转精细化培训、考核与评价等几个方面探索构建了消毒供应中心新进人员专科岗位培训模式,通过3年的实施,有利于新进人员在一年内全面、系统地掌握消毒供应中心专业知识及专业技能,为安全、独立承担科室的各个岗位工作打下坚实的基础。     

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.