住院患者防跌倒专科化管理的方法及效果

目的实施住院患者防跌倒专科化管理,降低住院患者跌倒发生率。方法根据专科化管理的需要,修订防跌倒工作管理方案并建立防跌倒联络小组,由老年病专科护士对全院的护理管理人员、防跌倒联络小组和临床护士进行住院患者防跌倒知识培训,建立各专科的防跌倒指引。将防跌倒管理工作纳入夜查房督导内容,老年病专科护士负责日常检查督促,指导科室实施专科化防跌倒措施,对医院发生的跌倒病例进行资料回访,定期进行总结分析,并提出整改意见。结果 2008年全院患者跌倒发生率较2007年有明显下降(P0.01);护理人员对跌倒危机评分准确率和防跌倒护理措施落实率明显提高(P0.01)。结论专科化管理模式能发挥老年病专科护士业务特长,有效降低患者跌倒发生率。     

建立专科护理小组对改进医院跌倒不良事件管理的效果

目的 :探讨建立专科护理小组对改进医院跌倒不良事件管理的效果。方法 :在老年病专科护理小组领导下成立跌倒不良事件管理小组(以下简称"小组"),建立并落实医院"患者防跌倒工作制度",在医院推行患者防跌倒护理,建立无惩罚跌倒不良事件网络直报系统,小组对跌倒事件上报后24小时内进行回访,并帮助科室进行根因分析,书写整改建议,每季度向全院进行跌倒不良事件分析汇报及典型案例分享。结果 :临床护士对患者跌倒风险评估的准确率提高。结论 :专科护理小组对跌倒不良事件的专业化管理使临床护士防跌倒护理工作更有成效,也有利于医院防跌倒工作的不断改进。     

老年专科护理小组对住院患者跌倒防范的影响

目的:探讨老年专科护理小组对住院患者跌倒防范的影响。方法:收集老年专科护理小组实施防跌倒护理干预前后的住院病例,比较其跌倒发生率、跌倒致损伤发生率。结果:老年专科护理小组实施防跌倒护理干预后住院患者跌倒发生率、跌倒致损伤发生率较干预前均下降(P<0.05)。结论:老年专科护理小组对全院住院患者实施防跌倒护理干预,在防范住院患者跌倒方面取得肯定、良好的临床效果。     

应用追踪检查方法对住院患者实施防跌倒管理的实践

目的 探讨追踪检查方法对防跌倒管理的实践效果.方法 建立三级追踪架构,即由病区质量管理小组在本病区实施一级追踪,由老年病专科小组对全院高危患者实施二级追踪,由护理部质控组在全院范围内实施追踪;应用追踪方法从制度、流程、培训、执行、检查、反馈、整改、落实、成效九要素进行持续质量改进.结果 通过三级追踪检查,2012年入院高危患者风险评估符合率94％,动态评估符合率88％,较2011年上升20％和28％;护士防跌倒知识掌握合格率93％,护理措施落实有效率91％,较2011年上升10％和15％.三级追踪检查方法实施前(2011年1-12月)和实施后(2012年1-12月)跌倒护理不良事件上报例次比较差异无统计学意义(P＞0.05),跌倒损伤分级情况比较差异有统计学意义(P＜0.05).结论 追踪检查方法对防范住院患者跌倒起到积极作用,提高了跌倒高危患者的评估符合率和预防措施的有效率,降低了跌倒患者损伤程度,保障了患者安全.     

叙事视频联合回授法在神经内科患者防跌倒宣教中的应用

目的探讨叙事视频联合回授法在神经内科患者防跌倒宣教中的应用效果。方法选取2018年1—6月在上海市松江区中心医院神经内科住院的跌倒高危患者100例,根据住院号单双数分为观察组(n=50)、对照组(n=50)。对照组患者由责任护士根据防跌倒宣教告知单对患者及家属进行防跌倒口头宣教,观察组在对照组基础上予以防跌倒叙事视频联合回授宣教法。比较两组患者防跌倒知识掌握情况与跌倒发生率。结果观察组跌倒发生率低于对照组(P0.05),防跌倒知识掌握情况优于对照组(P0.05)。结论叙事视频联合回授法可降低神经内科住院患者的跌倒发生率,提高患者防跌倒知识的掌握率,确保临床护理安全。     

应用知信行模式提高内科护士防住院患者跌倒效果的研究

摘要 目的 探讨应用知—信—行模式对内科病房护士进行防跌倒教育的效果。方法 对88名内科病房护士以知信行模式进行干预：强化防跌倒知识,建立防跌倒信念,促进行为改变,并在干预前后进行知信行的问卷调查,比较干预前后护士的认知、信念、行为的平均分值,住院患者跌倒的发生率。结果 干预前后认知、信念、行为分值比较差异有统计学意义（P<0.01）,住院患者跌倒的发生率由0.397%下降到0.13%。     

老年专科护士项目负责制工作模式的效果评价

目的评价老年专科护士以项目负责制工作模式开展老年常见问题护理的效果。方法由4名老年病专科护士组成工作小组,制定工作目标计划,以项目负责制模式开展工作,每人负责1个项目,以3个病区为试点开展预防跌倒、病人安全喂食、便秘管理、尿失禁干预4个方面的工作。观察护理干预效果、不良事件发生率,并与实施前进行比较。结果2009年度实施项目负责制工作后,与实施前（2008年度）便秘管理、尿失禁干预有效率明显提高,病人满意率提高,差异均有统计学意义（P〈0．001）;老年病人跌倒、误吸发生率下降,但与实施前差异无统计学意义（P〉0．05）。结论专科护士以项目负责制模式开展工作,能发挥团队优势,充分发挥专科护士职能,提高老年护理质量。     

综合病例站点式培训对提高规培护士防跌倒能力的效果

目的探讨综合病例站点式培训对提高规培护士防跌倒能力的效果。方法选取2016年7月至2017年7月我院入职的规培护士62名作为调查对象,随机将其等分为对照组和观察组,观察组采用综合病例站点式培训进行干预,对照组实施常规流程式培训,比较两组培训后护士防跌倒相关知识、态度及行为变化。结果培训后,两组护士防跌倒相关知识掌握水平评分明显升高(P 0. 05),观察组患者因素、特殊药物、大小便以及活动能力评分高于对照组;两组护士防跌倒态度评分均明显升高(P 0. 05),观察组预防责任承担、多部门联合参与、高危患者定期评估、跌倒后如实上报以及转科时积极评估等态度评分高于对照组;两组防跌倒行为评分均明显升高(P 0. 05),观察组患者和家属依从性评估、高危患者安全转运和高危患者卧床护理等行为评分高于对照组(P 0. 05)。结论综合病例站点式培训可提高规培护士跌倒知识掌握水平,改善防跌倒工作态度并熟悉跌倒护理工作流程,全面提高其防跌倒能力。     

专科护士-社区护士-个体-家庭四方联动护理模式在阿尔茨海默症患者中的应用效果

目的探讨专科护士-社区护士-个体-家庭四方联动护理模式在阿尔茨海默症(AD)患者中的应用效果。方法回顾性分析空军军医大学第二附属医院150例AD患者,根据护理模式不同分为常规组(73例)和研究组(77例)。常规组采用常规防跌护理模式,研究组在常规组基础上采用专科护士-社区护士-个体-家庭四方联动护理模式。比较两组的干预效果。结果干预1年后,研究组患者家属的出行、用药、穿着评分高于常规组,差异具有统计学意义(P<0.05)。干预前,两组患者的BBS、HFRM-Ⅱ、ADL、QOL-AD评分无显著差异(P>0.05);干预1年后,研究组患者的BBS、ADL、QOL-AD评分高于常规组,HFRM-Ⅱ评分低于常规组,差异具有统计学意义(P<0.05)。研究组患者的跌倒发生率低于常规组,差异具有统计学意义(P<0.05)。结论专科护士-社区护士-个体-家庭四方联动护理模式应用于AD患者中,可提高患者家属的预防跌倒知识掌握水平,增强患者的平衡能力,降低跌倒风险,提高日常生活能力及生活质量,减少跌倒发生。     

防跌倒专业团队推行护理安全文化的管理与成效分析

【】 目的 加强住院患者跌倒的管理,降低患者住院期间意外跌倒的发生率。 方法 于2012年5月起在我院成立防跌倒临床专业护理团队,通过专业护理团队实施预防跌倒安全管理模式,推行安全文化,包括知识普及、监控督查、疑难会诊。 结果 护理人员对护理安全知识知晓率上升,防跌倒相关措施的落实率提升,全院住院患者跌倒发生率同期对比下降,无相关投诉与纠纷。 结论 建立并实施防跌倒临床专业护理团队可以提高临床护理人员对预防跌倒的认知水平,降低住院患者跌倒率,有效提升护理安全,同时促进专科护理发展。     

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.     

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.