以技术服务为导向的排班模式对患者满意度的影响

目的探讨以技术服务为导向的排班模式在优质护理示范病区的应用效果。方法对全科护理人员进行转变思想观念的教育,以患者为中心,以技术服务为导向,改革排班方式,为患者提供全方位、优质、安全的护理服务。结果以技术服务为导向的排班模式,在提供优质护理服务的同时,全方位满足了患者的身心需求,患者满意度明显提高;同时,护理人力资源配置与临床护理工作量相匹配,护士赞同新的排班模式,工作主动性增强。结论以技术服务为导向的排班模式加强了护士人力资源的科学管理,合理满足了患者的医疗需求和生活需求,提高了患者满意度,促进了优质护理服务的持续性发展。     

手术出院患者社区护理需求与实际利用状况

目的 调查手术患者出院时社区护理服务需求及出院1周内实际利用社区护理服务的状况.方法 采用整群抽样的方法选取某综合医院257例手术患者为研究对象,运用自制调查表,在患者出院当日调查社区护理服务需求情况,在患者出院1周时电话随访社区护理服务实际利用情况.结果 96.0%的手术患者出院时存在社区护理需求;需求的社区护理服务项目涉及疾病护理、健康指导及预防保健类服务;需求多种服务方式.出院1周内社区护理实际利用率为16.5%;分别有54.5%和63.6%的患者利用了伤口护理和给药护理服务,服务内容以疾病护理为主,服务方式以社区卫生服务中心(站)护理为主.结论 手术出院患者对社区护理服务的需求状况与实际利用情况两者存在矛盾.积极开展手术患者社区护理服务,拓展服务内容,完善服务模式,提高社区护理参与程度以满足患者的强烈需求,具有重要意义.     

舒适护理在颈椎病患者康复期的应用

优质护理服务的服务宗旨是以患者为中心,以质量为核心.舒适护理是优质护理服务中的一种整体化、个性化、具有创造性的临床护理模式,对颈椎病患者在康复期开展舒适护理,可以使患者治疗依从性增强,身心均处于最佳状态,减少了并发症,增强了自信心,提高了患者对疾病的抵抗力,取得良好的护理效果.开展优质护理服务,为患者提供了满意的服务,是我国医改政策所需,也是我国护理事业发展的一个必然趋势.     

住院患者护理满意度量表的研究进展

<正>质量是医院管理工作的核心内容,而护理质量则是医院管理中的重要组成部分。以患者为中心是护理质量管理的基本原则,以患者满意为导向的评价是持续改进护理质量的重要途径[1]。2000年,WHO指出[2]医院管理者在制订相关服务政策时,要把患者满意度考虑在内。2014年7月10日,国家医政医管局发布国家卫生计生委开展优质护理服务评价工作的通知,在第三条中提出医院要高度重视患者对护理服务的满意度[3]。虽然患者对护理服务的满意度     

以专科服务小组为主导的“互联网+护理服务”模式构建与实践

目的 构建以专科服务小组为主导的“互联网+护理服务”模式,开展居家护理服务,提高护理服务质量。方法 组建专科服务小组,包括管道、静疗、伤口造口、母婴、康复及中医6个小组,通过多种形式对小组成员进行培训,考核通过后对居家患者开展“互联网+护理服务”。服务结束后使用满意度评价表调查患者对“互联网+护理服务”的满意程度。结果 2019年7月15日—9月15日共开展了61例居家护理服务,其中母婴小组26例,伤口造口小组8例,管道小组14例,静疗小组3例,康复小组6例,中医小组4例;98%的患者对居家护理服务满意,患者认同以居家护理服务小组开展“互联网+护理服务”。 结论 以专科服务小组为主导开展的“互联网+护理服务”能为患者提供优质的居家护理服务,患者满意度高,护士自我价值提升。     

人文关怀能力在护理领域中的研究现状

<正>随着生物-心理-医学模式的发展,加之护理从由"功能制"到"责任制"再到"责任制整体护理"模式的转变,人文关怀护理逐渐引起人们的重视。开展"以患者为中心""以人为本"的人文关怀护理理念,将其融入患者的护理服务中,在提供基础护理服务和专业技术服务的同时,加强与患者的沟通交流,以期为患者提供人性化的护理服务[1]。人文关怀能力逐渐在护理教育、临床护理、护理管理和老年护理中得到广泛应用,本文通过回顾总结人文关怀能力在护理领域中的应     

术前访视影响因素分析及研究进展

<正>术前访视的定义为护理人员在术前收集患者有关生理、心理、社会文化等方面的资料,为患者提供合适、有针对性、个性化的护理服务,以有效缓解患者术前焦虑情绪,使血压、心率趋于稳定,并有利于提高患者的遵医行为[1]。术前访视的发展,体现了以患者为中心的护理服务理念已深入人心。近年来,其作为手术患者围术期的护理服务逐渐成为研究热点,其效果也得到广大护理工作者的认可。但在实际工作中,如果掌握不好访视方法及影响因素,有可能不仅达不到访视目     

临床护士职业素质培养研究进展

为深化“以患者为中心”的服务理念,强化基础护理,提高护理质量,卫生部新提出了“优质护理服务示范工程”活动,主题是“夯实基础护理,提供满意服务”。按照优质护理服务模式的要求,逐步提高护理质量,贯彻“以患者为中心”的护理理念,是现代护理服务科学发展的必然趋势。满足患者日益增长的护理需要是护理工作中面临的重要挑战”。     

优质护理服务在心胸外科临床护理中的运用探讨

目的探讨优质护理服务在胸外科临床护理中的运用。方法以我院普通胸外科收治的88例患者作为对象,均提供优质护理服务。统计并发症,调查护理满意度。结果本组88例患者共5例出现并发症,发生率为5.6%;88例患者的护理满意度平均分为98.5分。结论胸外科临床护理中优质护理服务的应用价值高,建议推广。     

PDCA管理模式在呼吸内科优质护理服务中的应用

<正>为全面贯彻落实国家医药卫生体制改革的方针政策,推进优质护理服务示范工程活动,全面加强临床护理工作,让患者享受到更优质的服务。本科室于2010年作为本院首批优质护理服务试点病房,以"患者满意,社会满意,政府满意"为目标,积极参与到卫生部开展的"优质护理服务示范工程"活动中。并将PDCA管理模式应用于活动中,不断加强护理内涵建设,     

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.