眼药放置盒在眼科点药护理安全中的应用效果分析

目的探讨应用眼药放置盒存放眼药提高眼科点药护理安全的效果。方法通过对2013年与2014年眼科住院患者采用不同的眼药保管方法发生点药差错的人次进行统计,比较这两年眼科住院患者点药安全情况。结果 2014年眼科使用眼药放置盒定点存放眼药后,发生不良事件总人次比2013年明显下降,差异有统计学意义(P0.05),同时患者对护理服务的综合满意度由之前的94.7%提升至99.7%。结论眼科住院患者使用眼药放置盒保管眼药能提高眼科点药安全,减少护理不良事件的发生,提高患者对优质护理服务的满意度。     

眼科高龄住院患者安全问题及护理对策

目的：探讨眼科高龄住院患者安全管理。方法：对影响眼科高龄住院患者安全的危险因素进行讨论分析,制定针对性的护理安全管理措施。结果：患者安全危险因素及时被消除,安全伤害事件减少。结论：做好眼科高龄住院患者的危险因素评估,制定、落实相应的护理措施,是确保眼科高龄住院患者安全,避免医疗纠纷的关键。     

眼科患者住院期间安全问题分析及对策

目的提高眼科护理人员对眼科住院患者护理安全的认识,加强对住院患者的安全管理.方法对眼科住院患者在住院期间可能存在的不安全问题进行回顾性分析和讨论,提出加强安全管理的对策和改进措施.结果实施安全管理措施几年来,将不安全因素减少到了最低限度,无患者伤害事件发生.结论细致的人性化管理和护理人员的安全性教育是预防不安全因素发生的有效方法.     

高龄眼科住院患者不安全因素分析与防范对策

目的:探讨高龄眼科住院患者的不安全因素与防范对策.方法:对影响高龄眼科住院患者安全的危险因素进行分析、讨论,采取相应的护理对策.结果:影响安全的因素被解除,安全伤害事件减少.结论:正确评估高龄眼科住院患者的不安全因素,制定、落实相应的护理防护对策,是确保患者安全,减少医疗纠纷的关键.     

眼科护理中不安全因素分析与防范对策

目的分析眼科护理中的不安全因素,并探讨其防范措施,综合提高眼科护理水平。方法选取我院2017年1月～2018年1月眼科接诊的500例住院患者,分析护理过程中所存在的不安全因素,并根据所存在的问题提出防范对策。结果 500例患者中有183例患者受护理因素影响,占比36.60%;受影响因素主要包括自身因素、环境因素、治疗因素以及护理人员因素。结论眼科护理中的不安全因素主要包括患者自身因素、护理人员因素、环境因素、治疗因素等,其中患者自身因素及护理人员因素是导致不安全因素的主要原因,针对以上不安全因素,应当制定、落实相应的防范措施,确保患者安全,减少医疗纠纷,提高眼科的护理水平。     

风险评估联合护理安全路径在眼科低视力患者安全管理中的应用效果研究

目的探讨风险评估联合护理安全路径在眼科低视力住院患者安全管理中的应用效果。方法选取2016年1月-2016年12月符合纳入标准的眼科低视力患者200例,按照随机数字表法随机分为为观察组和对照组各100例。对照组采用常规护理,观察组在常规护理的基础上实施风险评估联合护理安全路径管理,对两组患者住院期间护理风险事件发生情况及护理满意度进行比较。结果观察组患者住院期间护理风险事件的发生率明显低于对照组,护理满意度高于对照组,两组比较差异均有统计学意义(P0.05)。结论对低视力住院患者实施风险评估联合护理安全路径管理,可有效避免或降低护理风险事件的发生,保证患者的住院安全,减少护理纠纷,提高护理服务满意度。     

JCI标准下眼科住院患者护理质量与安全管理实践效果

目的:探讨JCI标准下眼科住院患者护理质量与安全管理实践效果。方法:通过设立护理质量管理小组,建立健全的护理规章制度,修订护理安全管理制度、护理操作常规、流程。运用PDCA管理循环模式,将国际患者安全目标贯穿于整个护理活动中。结果:使临床护理质量管理工作达到法制化、标准化、设施规范化,提高了患者满意度,减少了护患纠纷,杜绝了护理差错的发生,提高了护理工作效率。结论:通过JCI医院管理理念在眼科临床护理管理中的实践,能构建和谐的护患关系,提升护理质量,确保患者护理安全。     

品管圈在降低眼科住院患者眼药水漏点率中的应用

目的通过开展品管圈活动,降低眼科住院患者眼药水漏点率。方法由11名护士自发组成品管圈,回顾分析发生眼药水漏点的原因,制定对策并实施,然后进行效果评价。结果通过品管圈活动,眼科住院患者眼药水漏点率明显下降。结论开展品管圈活动保证了眼科用药安全,提高了护理质量。     

防跌倒护理措施在眼科住院老年患者中的应用

【】探讨防跌倒护理措施在眼科住院老年患者中的应用。方法: 运用医院统一的《防跌倒评估单》根据评估制定并实施相应的防跌倒护理措施。结果: 2011年12月～2012年12月眼科病区1850例患者中无人发生跌倒。结论: 运用《防跌倒评估单》实行有效的防跌倒护理,能以提高眼科病区的安全护理质量,使护理工作更具有人性化、规范化。     

眼科手术室护理安全隐患及防范对策

目的:提高护理人员对眼科手术患者的护理安全认识,加强对眼科手术室安全护理管理。方法:对影响眼科手术室护理安全隐患进行分析和讨论,并提出加强护理安全管理对策。结果:落实具体有效的防范措施,未发生患者护理安全不良事件。结论:健全各项护理安全管理制度,注重护理人员业务培训及护理安全管理教育,重视手术安全细节管理等,可保证眼科手术室的护理安全,增加了患者对医院的信任感。     

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.