医务人员手卫生状况的调查

目的 了解医务人员手卫生知识掌握情况、所持态度和行为状况,为提高医务人员手卫生状况提供参考依据.方法 采用问卷方式随机对260名医务人员进行手卫生知识、态度和行为的调查,并对结果进行分析.结果 医务人员接受过手卫生培训的占77.31%,其中护士受训率为92%(138/150),高于医生受训率42%(63/150);93.46%的医务人员认为洗手是医疗常规的一部分,80.38%的医务人员了解手部消毒不彻底是医院感染的主要危险因素;洗手依从性约为68.00%,护士诊疗后洗手和脱掉手套后洗手依从性低于医生,分别为75.33%和92.67%.常见的忽视洗手的原因主要为:紧急状况60.00%,工作繁忙55.00%.结论 我们应加强宣传教育,提高医务人员手卫生知识,改善洗手设施,推广使用含乙醇的手消毒剂,正确使用手套,配备充足的护理人力,采用多模式干预提高医务人员北手卫生状况.     

医务人员手卫生状况调查

目的了解医护人员手卫生状况,以便加强手卫生质量管理。方法采用回顾性调查方式,对北京某医院在岗医务人员手消毒效果和手卫生依从性状况进行监测。结果在2009-2011年期间,对该医院临床一线医务人员手共采样检测132人次,手卫生质量总合格率为76.52%。医生手卫生质量合格率为63.69%,护士手合格率为80.65%,均未检出致病菌和耐药菌株。护士洗手依从率为24.14%,医生洗手依从率为8.33%。结论该院医务人员手卫生质量合格率较低,手卫生措施依从性较差,应当重点加强管理。     

医务人员手卫生依从性的影响因素及措施

目的加强和提高医务人员手卫生依从性,降低医院感染,保障患者安全。方法采用自行设计的问卷调查表．对万安县人民医院265名医务人员手卫生情况进行现场调查。结果回答手卫生知识正确率的医务人员依次为护士28．79％、医生12．66％、医技人员3．33％、实习生7．14％、保洁员0．00％;≤40岁及工作6～10年的医务人员对手卫生的认知度较好．〉40岁及工作〉20年的医务人员对手卫生的认知度较差。影响洗手的因素中以工作忙、手上没见污物可免洗手及多次洗手会损伤皮肤占前3位。结论医务人员对手卫生知识掌握普遍较差。应加强教育培训、创造手卫生氛围、改善手卫生措施、改进手卫生方法、加强监管等措施、强化手卫生意识,这样才能提高手卫生依从性。     

医务人员手卫生依从性现状调查北大核心

目的了解医务人员手卫生执行情况及相关影响因素,便于持续改进和提高医务人员手卫生执行率,有利于降低医院感染率。方法采用问卷调查和现场查看的方法,对某医院医务人员手卫生现状进行调查。结果该医院医务人员洗手依从率不足60%,影响手卫生洗手依从性的主要原因是工作紧张没有时间洗手、设施不健全、使用不方便、监管力度不够,护士洗手依从性及洗手正确率高于医生,而医生又高于医技人员。结论加强全院医务人员手卫生知识培训和执行监督工作,同时完善手卫生相关设施,有利于提高手卫生依从性,降低医院感染。     

基层医院医务人员手卫生依从性调查

目的:了解基层医院医务人员洗手行为的依从性,探讨相应的管理对策。方法:采用自行设计的调查问卷并结合现场观察洗手过程的方法,调查不同科室医务人员洗手知识的知晓情况及其洗手执行率。结果:医务人员的手卫生依从性不容乐观,接触患者前为58.4%,戴手套前仅为47.5%,儿科手卫生依从性最高,为78.8%,急诊科最低,为47.3%,护士的手卫生依从性高于医生。结论:实施灵活多变的培训方式及措施;及时、实事求是地反馈医院感染监测结果;进行医务人员手卫生依从性的调查;完善、改造和配备洗手设施;提供"伸手可得"的速干手消毒剂,规范洗手行为,确保洗手到位,有效降低医院感染的发生。     

医务人员手卫生现状

目的了解本院医务人员手卫生依从性及相关因素的情况,以便改进和提高医务人员手卫生质量。方法采用问卷调查和现场查看的方法,对本院医护工人员手卫生现状进行了调查。结果本医院的医务人员的洗手依从率尚不足50%。临床医生在洗手依从性及洗手正确率等方面明显低于护士。影响医务工人员洗手依从性的原因主要是工作负荷大和手卫生设施不足或使用不便。结论本医院的医务人员洗手依从性较低,需要加强相关法规和技术培训,以提高医务人员手卫生质量。     

医务人员手卫生依从性调查分析

目的：了解医务人员手卫生的现状,探索依从性高的手卫生执行措施。方法采用随机抽取和问卷调查方法,对本院230名医务人员进行手卫生依从性调查分析。结果医务人员能掌握手卫生相关知识占64．4％～78．8％,能正确采用六步洗手法者占63．4％。使用速干手消毒剂后手卫生依从性明显优于六步洗手法,在接触患者前及无菌操作前依从率明显提高。结论医务人员对手卫生知识认知程度不均衡,优化手卫生措施,科学配置洗手设施,推广使用速干手消毒剂,提高医务人员手卫生依从性。     

洗手依从性及洗手效果调查分析

目的了解医务人员洗手依从性并分析其影响因素,以采取相应的改进措施。方法随机抽取本院7个病区124名医务人员,由医院感染管理科专职人员按照《医务人员手卫生规范》中洗手或卫生手消毒要求的标准,每月选择住院部某一病区医务人员的洗手依从性进行调查,调查时间规定在上午8:00～10:30或下午15:00～17:00。比较医务人员洗手执行率及合格率。结果护士的洗手依从性和洗手效果比医生好,下午医务人员的洗手依从性比上午好。差异有统计学意义(p<0.05)。结论加强培训,规范洗手,完善洗手设施,选用合适的手部消毒剂以提高洗手依从性。     

门急诊工勤人员手卫生现状调查分析

目的了解门急诊工勤人员手卫生知识掌握情况及洗手效果，保障医疗安全和工作人员的职业安全。方法采用问卷对56名工勤人员手卫生知识进行调查，并以取样后细菌培养的方式监测洗手效果。结果工勤人员中55．36％接受过手卫生培训，23．21％掌握六步洗手法，75．00％洗手后用工作服擦干。接触患者后的洗手率为37．50％，接触患者物品及科室物品后洗手率为21．43％，73．21％的工勤人员认为接触患者血液或体液时需戴手套，69．64％的工勤人员认为手有伤口时需要采取保护措施。洗手合格率：导医员为87．50％，标本收送员为33．33％，卫生保洁员为26．67％，救护车司机为25．00％。结论工勤人员对手卫生认知程度较低和洗手依从性较差，应加强培训，提高门急诊工勤人员洗手率和洗手合格率。     

256名医务人员手卫生规范实施现状分析

目的了解医务人员手卫生实施情况。方法从全院随机抽取256名医护人员,包括113名护士、92名医生和51名工勤人员进行了手卫生监测。结果 2012年护士和医生第一到第四季度的手卫生依从性逐渐增高,第二季度、第三季度和第四季度,护士和医生均较工勤人员的依从性好。护士的洗手正确率最高,工勤人员的较低。结论工勤人员洗手依从性和正确率均较低,日后应加强培训。     

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.     

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.     

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.     

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.