“标杆管理”在护理管理中的实施探讨

目的 探讨以评定护理服务明星为载体,对加强护理管理、改善服务态度、规范护理行为、提高护理质量的效果.方法 成立护理服务明星评审小组,科室按照标准每月考核,每季度汇总上报护理部.每季度组织考评.比较评选护理服务明星后投诉发生率、病人满意度、各项护理质量指标的变化.结果 全院共评出院级明星护士102名,通过以点带面.在护理人员中树立卓越护理人员为标杆,形成正确的激励导向和激励机制.2006～2009年科室护理各项指标(护理质量、基本理论、技术操作)逐年上升,病人投诉发生率逐年下降,P<0.05,病人满意度逐年上升,P<0.05.结论 通过评选护理服务明星的做法,将标杆管理运用于临床护理实践中,可以调动护理人员的积极性,在全院形成积极向上的氛围,提高护理质量,树立医院的服务品牌,从而提高医院核心竞争力,促进医院可持续发展.     

The importance of aerobic metabolism in the renal concentrating process

The extent to which the concentrating function of the kidney depends on oxidative processes was investigated by infusing cyanide into one renal artery of dogs undergoing mild mannitol diuresis while receiving an infusion of vasopressin. This produced an abrupt fall in concentrating capacity (T(c) (H2O)) that was reversed when the cyanide infusion was stopped. The change could not be accounted for by the accompanying solute diuresis, since it was not reproduced by increasing the rate of mannitol infusion. The reduction in T(c) (H2O) induced by cyanide did not result from increased delivery of dilute urine to the collecting ducts, since free water clearance (C(H2O)), studied in other dogs during water diuresis, was unchanged or decreased by cyanide. Cyanide produced renal vasodilatation, as did intraarterial acetylcholine, but in contrast to the striking reduction in concentrating capacity evoked by cyanide, T(c) (H2O) was not significantly changed by acetylcholine.The data indicate that concentrating ability is closely tied to oxidative metabolism in the kidney, and it is suggested that the region where this is critically important is the red medulla and the thick ascending limb of Henle's loop.     

A three-dimensional electrode bioelectrochemical system for the advanced oxidation of p-nitrophenol in an aqueous solution

Three-dimensional electrodes serve as more efficient cathodes for the in situ generation of H₂O₂ in microbial fuel cells (MFCs) than two-dimensional electrodes and possess significant electric potentials in the advanced oxidation of organics. In this study, we investigated the performance of a three-dimensional MFC-Fenton system in degrading p-nitrophenol (PNP) in an aqueous solution with the objective of optimizing the operating parameters, including the initial pH, iron dosage, and loading resistance. A corresponding reaction pathway for PNP in the system was also proposed. The results showed that the three-dimensional electrode bioelectrochemical system efficiently oxidized PNP and removed total organic carbon over a short period (64 h). In addition, experiments showed that a lower initial pH enhanced the removal of PNP by the system. The highest removal efficiency of PNP was achieved with an initial iron concentration of 0.025 mol L⁻¹, and a lower or higher iron concentration resulted in decreased PNP degradation. Furthermore, the treatment capacity of the system was remarkably enhanced at a low loading resistance of 20 Ω. Under optimal conditions, the three-dimensional MFC-Fenton system achieved 95.7% PNP removal (within 8 h). Furthermore, the system showed a stable high treatment efficiency of approximately 90% for low PNP concentrations in wastewater over as long as 96 h.

PNP absorbed in and surrounded by GPEs has kinetic favorability in the degradation process by a three-dimensional electrode MFC-Fenton system.     

Polyaniline coated tungsten trioxide as an effective adsorbent for the removal of orange G dye from aqueous media

In this work, the core–shell PANI@WO₃ composite was obtained from the reaction of aniline monomer polymerization with WO₃ particles; sodium persulfate was used as an oxidant. Various analytical techniques such as scanning electron microscopy (SEM-EDS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Brunauer–Emmett–Teller (BET), and X-ray photoelectron spectroscopy (XPS) were used to characterize the as-prepared PANI@WO₃ adsorbent, which well confirmed that the WO₃ particles were coated by polyaniline polymer. The PANI@WO₃ composite was tested as an adsorbent to remove reactive orange G (OG) for the first time. pH, adsorbent dose, contact time, initial dye concentration, and temperature were systematically investigated in order to study their effect on the adsorption process. The experimental findings showed that the PANI@WO₃ composite has considerable potential to remove an aqueous OG dye. Langmuir and Freundlich''s models were used to analyze the equilibrium isotherms of OG dye adsorption on the PANI@WO₃ composite. As a result, the best correlation of the experimental data was provided by the Langmuir model, and the maximum capacity of adsorption was 226.50 mg g⁻¹. From a thermodynamic point of view, the OG dye adsorption process occurred spontaneously and endothermically. Importantly, PANI@WO₃ still exhibited an excellent adsorption capability after four regeneration cycles, indicating the potential reusability of the PANI@WO₃ composite. These results indicate that the as prepared PANI@WO₃ composite could be employed as an efficient adsorbent and was much better than the parent material adsorption of OG dye.

In this work, the core–shell PANI@WO₃ composite was obtained from the reaction of aniline monomer polymerization with WO₃ particles; sodium persulfate was used as an oxidant.     

Removal of tetracycline by aerobic granular sludge and its bacterial community dynamics in SBR

In this study, the removal efficiency and mechanism of tetracycline by aerobic granular sludge (AGS) in SBR were investigated. The removal of tetracycline present in livestock and poultry wastewater and the effect on conventional pollutants, such chemical oxygen demand, and nitrogen and phosphorous removal performance have been assessed demonstrating that AGS was able to remove tetracycline by adsorption and biodegradation processes. The removal rate of tetracycline was more than 90%, and conventional pollutants were also efficiently removed. The high-throughput sequencing technology was applied to decipher the species succession and community structure of tetracycline-resistance granular sludge. The Chryseobacterium, Actinotignum, Lactococcus, Shinella and Clavibacter were gradually dominant and considered as the functional bacteria for the removal of tetracycline. The numbers of functional genes including amino acid, carbohydrate and inorganic ion transport and metabolism, as well as energy production and conversion, and secondary metabolites biosynthesis, were also increased. These functional genes played an important role in the biodegradation of tetracycline.

A lab-scale aerobic granular sludge sequencing batch reactor was introduced to explore the performance, formation and microbial succession of granular sludge for effectively removing tetracycline.     

Increasing incidence of bacterial, resistance to antibiotics by isolates from the urinary tract

This is a prospective study to determine the prevalence of antibiotic resistance among organisms causing urinary tract infections in a Teaching Hospital between August 2003 and July 2004 and to compare them with an earlier study in 1993. A total of 1,104 urine samples were collected in sterile universal containers from patients attending University of Nigeria Teaching Hospital and studied. All samples showing significant bacteriuna were studied and isolates identified using standard bacteriogical methods. Antibiotic sensitivity testing was performed on sensitivity test agar (Biotec, UK) using the disc diffusion method in accordance with the National Committee for Clinical Laboratory Standards (5). The results were compared with a previous study in 1993. A total of 3.36 urinary isolates were identified, with the coliforms being the most predominant (51.2%). followed by Staphylococcus aureus and Proteus species (28.9% and 7.1%) respectively. Compared to the earlier study, a significant increase in the resistance of the urinary pathogens to ofloxacin, ciprofloxacin and nalidixic acid was observed, however there was a decrease in the resistance to nitrofurantoin (p < 0.05) using chi-square test. The results of this study should now alert doctors about the increasing possibility of treatment failures, when ciprofloxacin, ofloxacin and nalidixic acid are used for the treatment of urinary tract infections without laboratory testing. A multi-faceted approach including continued and improved surveillance, a reduction in the unnecessary use of antibiotics and infection control are necessary.     

Continuing professional education: identifying the characteristics of an effective system

The need for a functioning system of continuing professional education (CPE) in nursing, midwifery and health visiting has received increased attention in recent years However, whilst the literature describes a number of benefits, detailed empirical studies have been limited There is, in particular, a dearth of information on nurses' perceptions of the important components of a CPE programme Using the results of a recent evaluation of the Welsh National Board's Framework for Continuing Education, this paper highlights a number of key issues identified by practitioners, educators and managers throughout Wales Using a structure—process-outcome model, attention is focused on the outcomes of CPE and the structure and process variables which facilitate or inhibit success The results indicate a strong commitment to the principles of CPE and identify a complex range of perceived benefits Potential barriers inhibiting both the uptake of CPE and the achievement of subsequent change are discussed and the need to create an equitable, well-resourced system is stressed     

Inhibition of voriconazole metabolism by chloramphenicol in an adolescent with central nervous system aspergillosis

For an adolescent with bacterial meningitis and subsequent cerebral aspergillosis, intravenous voriconazole dose requirements substantially decreased during coadministration with intravenous chloramphenicol and considerably rose after discontinuation of the antibiotic. In agreement with in vitro evidence, these data suggest that chloramphenicol is a rather significant inhibitor of hepatic CYP3A4 and/or CYP2C19.     

Effects of aerobic exercise on energy metabolism in the hypertensive rat heart

BACKGROUND AND PURPOSE: In order to explore the possible effects of physical therapy interventions on people with hypertension, we evaluated the effects of aerobic exercise training on myocardial energy metabolism in an animal model of hypertension. SUBJECTS: We used 36 female spontaneously hypertensive rats (rats with genetically induced hypertension) and 12 normotensive Wistar-Kyoto rats. METHODS: The normotensive rats were sedentary and formed the CONsed group. The spontaneously hypertensive rats were randomly divided into 3 experimental groups (12 rats per group). Hypertensive rats that were sedentary formed the HTNsed group, those that received 8 weeks of exercise training formed the HTNx8 group, and those that received 16 weeks of exercise training formed the HTNx16 group. We measured systolic blood pressure, heart wet weight, maximal activities of cardiac energy metabolism enzymes, glucose transporter content, and total concentrations of protein, glycogen, and triglyceride. RESULTS: Systolic blood pressure was greater than 200 mm Hg in the CONsed group at the time of testing. Exercise training modestly (approximately 11-18 mm Hg) lowered blood pressure in the HTNx8 and HTNx16 groups. Fatty acid enzyme activity was greater in the CONsed group than in HTNsed and HTNx8 groups, but activity was roughly equivalent between the CONsed group and the HTNx16 group. Glucose enzyme activity was greater in the HTNx16 group than in the CONsed group and HTNsed group. Intracellular glycogen concentration was greater in the HTNx8 group than in HTNsed group. CONCLUSION AND DISCUSSION: Results of this study suggest that aerobic exercises may help to normalize cardiac energy metabolism in mammals with hypertension.     

Exploring the guidelines for the management of severe head injury.

A significant improvement in patient outcomes can be achieved by in-hospital interventions aimed at the prevention of secondary brain injury. The Guidelines for the Management of Severe Head Injury is a scientific, evidence-based document that evaluates the current evidence for practice and interventions to reduce secondary brain injury and improve outcome for traumatic brain injury (TBI) patients. The Guidelines covers a wide range of topics including trauma systems, oxygenation and blood pressure resuscitation, intracranial pressure monitoring, intracranial hypertension, nutrition, and pharmacological interventions for the severe TBI patient in the intensive care environment. Head injury care requires an interdisciplinary approach involving emergency room personnel, trauma nurses, and critical care nurses. Critical care nurses will find this document especially applicable because secondary brain injuries are often the result of events that occur in the ICU setting: hypoxemia, hypotension, and intracranial hypertension.     

Cross-linked β-CD-CMC as an effective aqueous binder for silicon-based anodes in rechargeable lithium-ion batteries

As a non-active material component, the binder can effectively maintain the integrity of battery electrodes. In this work, based on the inspired structure of fishing nets, a three-dimensional mesh adhesive using widely sourced raw materials CMC and β-CD was designed. These cross-linked cyclodextrins have the advantage of dispersing the stress at the anchor point and moderating the significant volume changes of the Si anode. The Si/β-CD-CMC electrode maintains a reversible capacity of 1702 mA h g⁻¹ even after 200 cycles at a high current of 0.5C. This work represents a significant step forward in Si anode binders and enables the cross-linked cyclodextrins to have potential applications in energy storage systems.

A three-dimensional mesh β-CD-CMC adhesive was designed based on the structure of fishing nets. This cross-linked binder has the ability to disperse the stress at the anchor point and moderate the significant volume changes of the Si anode.     

Ottawa panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis

Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D, and the Ottawa Panel. Ottawa Panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis.ObjectiveTo update the Evidence-Based Clinical Practice Guidelines (EBCPGs) on aerobic walking programs for the management of osteoarthritis (OA) of the knee.Data SourcesA literature search was conducted using the electronic databases MEDLINE, PubMed, and the Cochrane Library for all studies related to aerobic walking programs for OA from 1966 until February 2011.Study SelectionThe literature search found 719 potential records, and 10 full-text articles were included according to the selection criteria. The Ottawa Methods Group established the inclusion and exclusion criteria regarding the characteristics of the population, by selecting adults of 40 years old and older who were diagnosed with OA of the knee.Data ExtractionTwo reviewers independently extracted important information from each selected study using standardized data extraction forms, such as the interventions, comparisons, outcomes, time period of the effect measured, and study design. The statistical analysis was reported using the Cochrane collaboration methods. An improvement of 15% or more relative to a control group contributes to the achievement of a statistically significant and clinically relevant progress. A specific grading system for recommendations, created by the Ottawa Panel, used a level system (level I for randomized controlled studies and level II for nonrandomized articles). The strength of the evidence of the recommendations was graded using a system with letters: A, B, C+, C, D, D+, or D–.Data SynthesisEvidence from 7 high-quality studies demonstrated that facility, hospital, and home-based aerobic walking programs with other therapies are effective interventions in the shorter term for the management of patients with OA to improve stiffness, strength, mobility, and endurance.ConclusionsThe greatest improvements were found in pain, quality of life, and functional status (grades A, B, or C+). A common limitation inherent to the EBCPGs is the heterogeneity of studies included with regards to the characteristics of the population, the interventions, the comparators, the outcomes, the period of time, and the study design. It is strongly recommended to use the Cochrane Risk of Bias Summary assessment to evaluate the methodologic quality of the studies and to consider avenues for future research on how aerobic walking programs would be beneficial in the management of OA of the hip.     

Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy

BACKGROUND AND STUDY AIMS: The widespread use of cholangioscopy in the management of difficult choledocholithiasis has been limited by the need for two expert operators. This report describes the use of a technique of single-operator duodenoscope-assisted cholangioscopy (SODAC) in the successful management of 75 patients with choledocholithiasis. PATIENTS AND METHODS: The single-operator technique, allowing simultaneous control of both the duodenoscope and cholangioscope, was prospectively studied between June 1999 and June 2001 in the diagnosis and treatment of choledocholithiasis. RESULTS: A total of 109 SODAC procedures were conducted in 75 patients to manage choledocholithiasis. The indications were: firstly, SODAC-guided electrohydraulic lithotripsy (EHL) of stones in which conventional methods, including mechanical lithotripsy, had not been successful (52 SODAC procedures in 26 patients); and secondly, direct visualization of the biliary tree after cholangiography to assess the presence of stones (57 SODAC procedures in 49 patients). The locations and numbers of the stones, but not their size, were predictive of the number of SODAC-guided lithotripsy sessions required. All of the patients were free of stones at the end of the study period, and no complications were recorded. CONCLUSIONS: Single-operator SODAC-guided electrohydraulic lithotripsy was effective in the treatment of difficult cases of choledocholithiasis in which conventional methods had previously failed. The technique may allow increased use of cholangioscopy in the management of choledocholithiasis.     

A case of malignant hyperthermia captured by an anesthesia information management system

Many cases of malignant hyperthermia triggered by volatile anesthetic agents have been described. However, to our knowledge, there has not been a report describing the precise changes in physiologic data of a human suffering from this process. Here we describe a case of malignant hyperthermia in which monitoring information was frequently and accurately captured by an anesthesia information management system.     

The Chester step test—a simple yet effective tool for the prediction of aerobic capacity

Objectives The assessment of cardiorespiratory fitness is becoming more commonplace in both community and occupational health settings. This study investigates the reliability and validity of the Chester step test, a submaximal test for the prediction of aerobic capacity, when compared to maximal oxygen uptake ( O₂Max) measured during a treadmill test.Design Participants completed a O₂Max Treadmill Test using a standardised fast incremental ramp protocol designed to elicit exhaustion in 8–12 minutes. Following this, on separate days, subjects then completed the Chester step test (CST) on two occasions (CST1 and CST2). During the submaximal step test, subjects were asked to step on to and off a 30-cm step at a rate set by the metronome beat on an audio cassette. The initial step rate was 15 steps per minute and every 2 minutes the tempo increased by 5 steps per minute. The subject continued stepping until he/she reached 80% of their maximum predicted heart rate, or reported a rating of perceived exertion of 15 (hard) on the Borg scale, or reached the end of the 10-minutes 5-stage test.Setting Human Performance Laboratory, University College ChesterParticipants Sixty-eight subjects (mean age 30.6±9.7 years; range 18–52 years) with a wide range of ages and abilitiesMain outcome measures Gas exchange and heart rate were measured continuously using a Polar heart rate monitor. Heart rate and rating of perceived exertion were recorded after each 2-minute stage.Results Results revealed a high correlation (r=0.92) between O₂Max and CST1 (P<0.001) and a standard error of the estimate of 3.9 ml O₂/kg/min, thus confirming the face validity of CST as a predictor of O₂Max. Using the method of analysis recommended by Bland and Altman (1986) [Lancet 5 (1986) 307] the mean difference between repeated predicted measures using CST was −0.7 ml O₂/kg/min. The limits of agreement analysis also demonstrated that a measurement repeated on a separate day was within 4.5 ml O₂/kg/min of the original predicted measurement. The Chester step test is therefore appropriate for use in situations where a change in aerobic capacity is expected to be more than 3.8 ml O₂/kg/min higher or more than 5.2 ml O₂/kg/min lower than the baseline measurement.Conclusions The Chester step test was shown to be a valid test for the estimation of aerobic capacity within this group. The error of measurement is sufficiently small and suggests that this method is well suited to monitoring changes in aerobic capacity in rehabilitation settings.