下肢关节置换病人深静脉血栓预防的现状调查

目的 调查下肢关节置换病人深静脉血栓（DVT）的预防的现状及骨科护士对关节置换病人DVT预防的专科知识水平.方法 对广东省39家医院39名赴港骨科专科护士,采取问卷调查的方法,调查目前临床下肢关节置换病人DVT预防的现状及护士对下肢关节置换病人DVT预防的专科知识水平.结果 39名护士所属的不同的医院中,61.5%的医院没有DVT风险评估和预防方面的指引,也没有常规对关节置换的病人进行DVT的危险评估.在预防方面,只有17.9%的医院有使用弹力袜;20.5%的医院有使用间歇压力泵.69.2%的护士以前从未接受过DVT的专题培训课程.28.2%的护士在临床护理中根据医嘱来选择预防DVT的方法,71.8%的护士根据自己的经验来选择预防DVT的方法.护士的专科知识平均分为40分.结论 所调查的医院对下肢关节置换病人DVT预防的重视不够,没有对此类病人进行相关的危险评估,也没有对护士进行相关的培训.临床骨科护士对下肢关节置换病人DVT的专科知识水平较低.     

脊髓损伤病人神经功能评估护士培训的实施与体会

成立专科护理培训小组并实施:理论授课与临床实践培训相结合。实施前后进行问卷调查及效果评价。实施前后护士脊髓损伤神经功能评估专科内涵、护理患者信心、压力经t检验有统计学意义,患者并发症及满意度有统计学差异。对护士进行脊髓损伤神经系统评估技能的专题培训可激发护士参与脊髓损伤病人管理的积极性,提高护理质量,改善病人的护理结局。     

标准化伤员在应急救援护理技能培训中的应用与效果

目的探讨标准化伤员(standardized wounded soldier,SWS)在骨科护士应急救援护理技能培训中的应用效果。方法采取便利抽样法选取解放军第117医院骨科中心的二级护士53名,按随机数字表法将其分为对照组(26名)和观察组(27名),分别进行传统教学培训及采用SWS的应急救援护理技能培训,为期3个月,培训结束后比较两组护士的应急处置、知识储备、应急评估能力的得分情况。结果培训后观察组护士的应急处置、知识储备及应急评估能力得分均高于对照组护士,差异均有统计学意义(均P0.01)。结论应用SWS对护理人员进行应急救援护理技能培训,能有效提高专科护士的知识储备及战创伤急救综合能力,有利于促进专科护理团队的建设。     

广东省骨科专科护士循证实践知识态度及行为调查分析

目的了解广东省骨科专科护士循证实践知识、态度及行为现状,为有针对性地促进循证实践提供依据.方法采用中文版循证实践问卷对广东省61名赴港培训并取得专科护理文凭的骨科专科护士进行调查.数据处理采用描述性分析、方差分析和两独立样本t检验.结果骨科专科护士的循证实践知识、态度、行为总得分为(119.46±24.31)分,其中循证实践知识维度得分(63.95±14.51)分、循证实践态度维度得分(26.16±4.56)分、循证实践行为维度得分(28.66±7.57)分.不同学历、职称骨科专科护士的循证实践知识、态度、行为得分差异无统计学意义;但管理岗位、骨科护理工作10年以上的专科护士循证实践知识得分较高(P<0.05);参加骨科专科护士培训时间较早者循证实践态度得分较低(P<0.01).结论骨科专科护士具有良好的循证实践知识、态度、行为基础,仍需提高循证知识与行为水平.护理管理者要支持专科护士开展循证护理实践,专科护士应积极参加循证实践相关培训,进一步提高循证护理实践知识与技能.     

252名骨科护士髋关节置换术后假体脱位预防的知信行水平分析

目的 了解骨科护士对髋关节置换术后假体脱位的预防知识、态度、行为现状,为有针对性地预防髋关节置换术后假体脱位的培训、干预和管理提供一定的参考。方法 采用便利抽样法,2018年2—3月选取深圳市8家三级甲等医院、6家二级甲等医院和1家骨科专科医院的骨科护士作为调查对象。采用自行设计的髋关节置换术后假体脱位预防知信行量表,对252名骨科护士进行调查。结果 252名骨科护士髋关节假体脱位知识得分35.0（30.0,40.0）,态度得分47.0（44.0,50.0）,行为得分49.5（43.0,54.0）;不同年龄、学历、职称、工龄和骨科专科护士、接受专科继续教育培训的骨科护士髋关节置换术后假体脱位知识的得分比较,差异具有统计学意义（P<0.05）。骨科专科护士、接受过专科继续教育培训的骨科护士,髋关节置换术后假体脱位预防的知识、态度、行为得分比较,差异具有统计学意义（P<0.05）。结论 本组骨科护士的髋关节假体脱位知识得分良好,预防态度和行为正向。护理管理者尤其应关注低年资、低学历、低职称护士髋关节假体脱位预防的知识掌握,及未接受专科护士培训和继续教育培训的骨科护士的知识、态度和行为,采取课堂授课、教学查房、病例讨论和经验交流的培训方式,加强对骨科护士预防关节脱位的培训,提高护士的认知和实践能力,促使护士在临床护理工作中对患者进行正确的评估及预防;建议医院将髋关节置换术后假体脱位列入护理质量指标管理体系,规范化护士的行为。     

上海某三甲医院合作医院骨科护士规范化培训需求调查

目的 了解上海某三甲医院合作医院骨科护士对规范化培训内容的需求,为完善骨科护士规范化培训提供依据。方法 采用自行设计的培训需求调查表,对214名区域合作医院内骨科护士进行调查。结果 66.82%的护士希望学习颈、腰椎疾病的知识,65.89%的护士希望了解功能锻炼方面的骨科知识,83.18%的护士希望了解的急危重症知识是创伤性休克;44.26%的护士最希望学到的骨科操作技能是骨科患者体位护理,72.9%的护士想了解静脉栓塞预防治疗仪的骨科相关仪器知识;医联体骨科护士普遍希望能学习骨科具体操作技能; 64.02%的护士选择了课堂讲授的理论学习形式,83.18%的护士选择了现场演示的操作技能培训形式;49.07%的护士期望的培训时间是一周。结论 合作医院骨科护士参加培训机会略少,对专科知识的需求强烈。培训的内容应满足护士的需求,以实用为主。对护士进行规范化培训,使合作医院内患者能获得同质化护理服务。     

上海市骨科康复护理现状调查研究

目的 了解上海市骨科康复护理开展的状况及目前存在的主要问题,为上海市骨科康复的实施提供依据.方法 采用自行设计的骨科康复护理现状调查问卷,对上海市区和郊区共15所医院的300名骨科护士进行调查,收回287份,有效问卷282份.调查数据用SPSS 11.0软件进行统计分析.结果 骨科护士很少开展康复护理评估、指导病人做功能锻炼和训练日常生活活动能力以及心理护理.99.6%的护士认为康复训练对骨科病人的功能恢复很重要,92.9%的骨科护士认为自己应该指导病人做功能锻炼.骨科护士康复护理总论知识得分(30.26±13.87)分;骨科临床康复护理知识得分(58.76±10.41)分.结论 上海市骨科护士康复护理知识水平亟待提高,应增强对护理人员康复护理知识的普及,加强骨科康复护理工作的管理.     

基于目标管理在骨科护士专科能力培养中的应用评价

目的 探讨目标管理在骨科护士专科能力培养中的应用效果.方法 选取我科在职护士40名,通过目标管理模式对40名护士进行培训,培训内容包括:专科护理知识、护理技能、康复护理.培训前后分别对40名护士进行专科护理知识、护理技能、康复护理考核,每个项目均为骨科常见项目或技能,每个子项目分值为100分,根据考核前后的分值进行评价,比较培训前后40名护士的专科能力.结果 通过目标管理模式对骨科护士进行培训后,护士的专科能力较培训前有明显提高(P<0.05).结论 应用目标管理模式进行专科能力培训,能有效提高护士的专科知识水平,对患者的病情评估更加精准,护士操作更加熟练标准,健康指导更加标准.通过目标管理模式进行培训,有利于提高骨科护士的专科能力,更好地为患者服务,提高了患者的满意度.     

上海基层医院骨科护士规范化培训需求调查

目的了解三甲医院合作医院的骨科护士对专科培训的需求,为完善骨科护士规范化培训提供依据。方法于2018年2—4月,采用自行设计的培训需求调查表,对上海交通大学附属第六人民医院8所区域合作医院的214名骨科护士进行调查。结果护士对创伤性休克相关知识、颈椎及腰椎疾病知识、骨科患者功能锻炼方法等内容的需求程度较高,需求人数均在65.00%以上。在操作技能及仪器设备方面,被调查护士对骨科患者的体位护理及静脉栓塞预防治疗仪的使用等相关内容需求较为突出,需求人数分别占46.26%和72.90%。64.02%的护士选择了课堂讲授的理论学习形式,83.18%的护士选择了现场演示的操作技能培训形式。49.06%的护士期望培训时间为1周。结论基层医院骨科护士对专科知识的需求强烈,应通过开展以护士需求为导向、以实用为主的规范化培训,促进医联体各医院护理服务的同质化。     

脊髓神经运动功能评估图卡的设计及在脊髓损伤患者中的应用

目的 探讨自制的脊髓神经运动功能评估图卡在临床护理工作中的应用效果。 方法 采用美国脊髓损伤协会制定的脊髓损伤神经分级标准,设计并制作了脊髓神经运动功能评估图卡。选取我院骨科病区的40名护士为研究对象,采用分层抽样法,将其随机分为实验组（20名）和对照组（20名）,对两组护士进行脊髓神经运动功能理论及操作培训。选取2016年6月—9月在我院骨科病区住院手术治疗的398例脊柱脊髓疾病患者为评估对象。实验组采用自制的脊髓神经运动功能评估图卡进行评估;对照组实行常规的脊髓神经运动功能评估。 结果 两组理论与操作考核成绩相比,差异无统计学意义（P＞0.05）;与对照组相比,实验组评估错评率降低了9.5%,漏评率降低了16.2%;评估耗时显著短于对照组（P<0.05）。 结论 脊髓神经运动功能评估图卡可降低评估误差率,节省评估用时,提高护士专科护理能力和工作效率。     

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.     

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.