优化抗凝剂皮下注射安全管理的临床实践效果分析

目的分析优化抗凝剂皮下注射安全管理的效果。方法运用循证护理理念检索相关文献,制定出抗凝剂皮下注射操作规范,包括抗凝剂皮下注射流程设计、并发症的防范及应急处理、案例分析总结、鼓励患者参与安全管理的规范护理。自制患者评价表对患者进行调查,用抗凝剂皮下注射不良反应发生率、患者对抗凝剂皮下注射知识知晓程度、护士皮下注射抗凝剂的规范护理落实程度及患者满意度进行效果评价。结果实施后抗凝剂皮下注射不良反应发生率明显下降,患者知识知晓程度明显提高,护士操作规范性高于实施前,患者满意度明显提高(P0.05或P0.01)。结论实施抗凝剂皮下注射安全管理,可减少不良反应发生率,改善护理安全。     

基于精益六西格玛管理的预灌式抗凝剂皮下注射规范化培训效果研究

目的 探讨精益六西格玛管理的预灌式抗凝剂皮下注射规范化培训效果。方法 应用精益六西格玛管理方法组建团队、获取证据、分析问题,形成改进策略,并对护士进行预灌式抗凝剂皮下注射培训,比较培训前后护士预灌式抗凝剂皮下注射相关知识知晓率、操作规范率、患者并发症发生率和患者对护士操作的满意度。结果 培训后护士预灌式抗凝剂皮下注射相关知识知晓率和操作规范率显著高于培训前,患者并发症发生率下降,患者满意度提升(P<0.01)。结论 精益六西格玛管理方法能够规范护士预灌式抗凝剂皮下注射操作流程,提高临床抗凝疗效,减少患者并发症发生,提高临床护理质量及患者满意度。     

临床护士抗凝剂皮下注射护理规范知信行现状及影响因素

目的:调查临床护士抗凝剂皮下注射护理规范的知信行现状并探索影响因素,旨在为临床护士的培训提供依据。方法:采用便利抽样法,选取2021年11月—2021年12月河北省某三级甲等综合医院541名临床科室护士为研究对象,采用临床护士抗凝剂皮下注射护理规范知信行调查问卷进行调查,采用多元线性回归分析其影响因素。结果:临床护士抗凝剂皮下注射护理规范知信行总分、知识维度、态度维度、行为维度得分分别为(145.36±18.03)分、(19.26±3.93)分、(43.35±4.94)分、(81.78±12.81)分。多元线性回归结果显示,临床护士抗凝剂皮下注射护理知识的影响因素为工作年限及是否接受过抗凝剂皮下注射培训,态度的主要影响因素是工作年限,行为的影响因素为知识、态度及是否接受过抗凝剂皮下注射培训。结论:临床护士关于抗凝剂皮下注射护理的态度积极,但知识水平和行为情况有待提高。管理者应该根据临床护士的不同特征加强抗凝剂皮下注射临床技能培训和学习,以多种方式提高护士的参与度和积极性,做好抗凝剂皮下注射的质控管理,力求做好病人的安全保障。     

应用ACEStar模式实施循证护理培训的效果评价

目的:探讨应用ACE Star模式实施循证护理培训的效果。方法:2012年2月~2015年2月我院基于ACE Star模式实施循证护理培训,培训前后分别采用护士循证实践问卷量表和循证护理实践障碍量表进行评价。结果:培训后护士循证护理实施能力明显得到提高,培训前后比较有统计学意义(P0.05)。培训前后对护士循证护理实践影响的障碍因素,除护理科研质量外,其他维度差异比较无统计学意义(P0.05)。结论:应用ACE Star模式实施循证护理培训效果明显,能够有效提升护士能力,值得推广。     

外科病区护士循证护理技能的培训方法研究

目的 探讨外科病区护士循证护理技能的培训方法.方法 选择2个外科病区的护士共计43人作为培训对象,根据循证护理4个步骤,制订提出问题、寻找循证支持、进行循证观察、临床循证应用的培训流程,按照流程对护士进行循证护理能力的培训.评价培训后的护士循证护理技能;护士获取信息资源能力;护士满意度调查.结果 培训前后护士循证护理技能比较,差异有统计学意义(P＜0.01);培训前后护士获取信息资源能力比较,差异有统计学意义(P＜0.01);95%的护士认为经过培训后提高了自身循证护理能力.结论 通过对外科病区护士进行循证护理能力的培训,达到了提高护士循证护理技能;提高护士获取信息资源能力的目的,对促进循证护理的推广应用有一定的指导意义.     

循证护理实践规范抗凝剂皮下注射对房颤患者发生皮下出血的影响及其影响因素研究

目的 了解房颤患者接受抗凝治疗时结合循证护理后对皮下注射抗凝剂的操作规范性及不良反应所产生的影响。方法 选 取 2021 年 1 月至 2022 年 12 月期间于我院接受诊治的房颤患者 91 例作为研究对象。根据随机抽签法将患者分为对照组（45 例） 和研究组（46 例）。对照组接受传统皮下注射抗凝剂；研究组基于循证护理规范抗凝剂皮下注射操作。分析对比两组的皮下出 血发生情况、皮下注射抗凝剂相关知识知晓情况及抗凝治疗依从性。结果 研究组的皮下出血发生率和硬结发生率均显著低于 对照组（P<0.05）。研究组治疗原因、作用、注意事项、用药时间及不良反应等对皮下注射抗凝剂相关知识知晓评分均显著高 于对照组（P<0.05）。研究组的抗凝治疗依从性显著高于对照组（P<0.05）。结论 应用循证护理规范抗凝剂皮下注射相关操作， 能改善皮下出血发生情况和皮下注射抗凝剂相关知识知晓情况，提高抗凝治疗依从性。     

ICU护士对危重病人营养支持相关知识培训效果的评价

[目的]了解ICU护士营养支持相关知识的掌握程度,评价集中专题知识培训的效果. [方法]对82名ICU护士进行集中培训,并采用问卷调查的方式了解培训前后护理人员对危重病人营养支持相关知识的掌握程度. [结果]培训后ICU护士对危重病人营养支持相关知识的知晓率较培训前有明显提高;培训前后得分比较差异有统计学意义(P＜0.01).[结论] ICU护士对危重病人营养支持相关知识的掌握程度不够,对护士进行专题培训可提高护理人员对相关知识的掌握程度,指导护士参与对危重病人营养支持的护理实践.     

循证护理在护理业务查房中的应用研究

[目的]探讨循证护理在护理业务查房中的效果.[方法]随机选取2个病区,1个病区为实验组,护士34人,护生48人;1个病区为对照组,护士35人,护生46人.对照组采用传统的查房方法;实验组在传统方法的基础上建立循证小组并培训全体护士、查房前进行循证、最后确定最佳实证;查房效果从问卷调查及考试结果等方面评价.[结果]两组护士对查房效果评价差异有统计学意义(P＜0.05);护生对查房效果的评价中有几方面差异有统计学意义(P均＜0.05).[结论]在临床开展循证护理方法进行业务查房,能明显提高护士的综合素质和专科水平.     

APN连续性排班在护理质量管理的应用

目的 探讨连续性排班在护理质量管理的应用效果评价.方法 比较APN连续性排班实施前后1年责任护士对患者相关疾病知识比较、患者对疾病相关知识知晓率、护理不良事件发生情况、患者及医生对护理服务满意度、护理质量的变化.结果 实施APN连续性排班后,责任护士对患者相关疾病知识的掌握、患者对疾病相关知识知晓率、患者及医生对护理服务满意度均高于传统排班(P＜0.01),护理质量均较实施前明显提高,护理不良事件发生情况低于实施前(P＜0.05).结论 APN连续性排班模式能使责任护士熟练掌握患者病情、减少护理不良事件发生,有效提高患者对相关疾病知识的知晓率、护理工作的满意度,提升了护理质量.     

急诊科抗凝剂皮下注射护理规范及其效果评价

目的探讨急诊科抗凝剂皮下注射护理规范及其效果评价。方法从急诊科收治患者中随机性抽取80例作为研究对象,按照随机数字表法将其分为研究组和对照组各40例,在抗凝剂皮下注射时,对照组患者行常规护理,研究组患者行规范护理。比较2组患者抗凝剂皮下注射不良反应发生率,在患者出院前1 d采取本院自制护理满意度问卷调查表记录患者护理满意度。结果研究组患者不良反应发生率为15.00%(6/40),对照组不良反应发生率为52.50%(21/40),2组不良反应发生率差异有统计学意义(P<0.05);研究组患者护理满意度为92.50%(37/40),对照组患者护理满意度为77.50%(31/40),2组护理满意度差异有统计学意义(P<0.05)。结论急诊科抗凝剂皮下注射护理规范的应用,在有效降低患者不良反应发生率的同时,还能提高患者对护理人员的满意度。     

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.