按顺序排查法超声诊断胎儿畸形

目的应用“按顺序对胎儿进行从头颅、脊柱、颜面、颈项、胸腔、心脏、胃、双肾、膀胱、四肢、脐血流、羊水、胎盘有顺序的逐步排查“方法检查胎儿畸形.方法 2004年5月～2005年12月期间利用本方法对4 091例孕妇(年龄19～39岁,14～40孕周)进行胎儿产前检查.结果单胎4 066例,双胎25例.其中共发现复合畸形9种17例,单一畸形20种120例,共计胎儿畸形137例.结论 “按顺序排查法超声诊断胎儿畸形“是产前胎儿检查的一种切实可行有效的方法,值得推广.     

高频超声在腹部检查中的应用价值探讨

目的探讨高频超声在腹部检查中的适用性和临床价值。方法351例常规探头检查发现可疑病变或诊断不明确的病人,或临床高度怀疑有病变的病人,并初步确定该病灶与体表距离,再用高频探头检查,其所得结果与临床手术、病理、CT或MR I结果对照,并与常规检查组检查结果比较。结果病灶位于距体表15~55mm者239例,高频组显示率为90%,常规组为65%;高频组临床符合率为83%,常规组为57%。结论高频超声在适用范围内能明显提高病变显示率和图像质量,相应地提高临床符合率,是常规检查的理想辅助手段。     

提高手术安全核查正确实施率的品管圈实践

目的开展品管圈活动,提高手术安全核查正确实施率。方法由9人组成品管圈小组,通过实施品管圈的活动步骤,分析影响手术安全核查正确实施的因素,制订并实施相应的整改措施。结果实施品管圈活动后手术安全核查正确实施率提高,差异有统计学意义(P0.01);实施品管圈活动后小组内成员对品管圈工具应用、团队精神、沟通协调能力、活动信心、责任心以及荣誉感提高。结论开展品管圈活动有效提高了外科手术安全核查正确实施率,提升医护团队协作意识,提高护理人员的管理能力。     

The POCUS Pulse Check: A Case Series on a Novel Method for Determining the Presence of a Pulse Using Point-of-Care Ultrasound

BackgroundDuring cardiopulmonary resuscitation, pulse checks must be rapid and accurate. Despite the importance placed on the detection of a pulse, several studies have shown that health care providers have poor accuracy for detection of central pulses by palpation. To date, the use of point-of-care ultrasound (POCUS) in cardiac arrest has focused on the presence of cardiac standstill and diagnosing reversible causes of the arrest.ObjectiveThis case series highlights a simple, novel approach to determine whether pulses are present or absent by using POCUS compression of the central arteries.DiscussionUsing this technique, we found that a POCUS pulse check can be consistently performed in < 5 s and is clearly determinate, even when palpation yields indeterminate results.ConclusionsIn this case series, the POCUS pulse check was a valuable adjunct that helped to change management for critically ill patients. Future prospective studies are required to determine the accuracy of this technique and the impact on patient outcomes in a larger cohort.     

Documenting outcomes of occupational therapy: the center for outcomes research and education.

This article presents two themes related to the development and implementation of sound outcomes research that emerged from a 3-year dialogue among fellows of the University of Illinois Center for Outcomes Research and Education (CORE). These themes are: that outcomes research needs to be an interrelated multi-method system of investigation, and it should be developed in collaboration with its key stakeholders (consumers and practitioners). Examples from the literature and from a cluster of papers published in this focus issue are used to exemplify the themes.     

Comparison of sequential and simultaneous breathing and pulse check by healthcare professionals during simulated scenarios

BACKGROUND: Basic life support guidelines for healthcare professionals recommend a sequential breathing and carotid pulse check allowing up to 10 s for each assessment. Life support providers are sometimes taught to do a simultaneous assessment of breathing and pulse check for up to 10 s. It is not clear whether this assessment improves diagnostic accuracy. METHODS: We recruited 119 healthcare professionals. The SIM-Man was used to develop 10 simulated cases scenarios. To assess performance, 89 participants did 10 simultaneous assessments followed by 10 sequential assessments, and 29 participants did the assessment techniques in reverse order. The primary outcome of the study was the number of correct diagnoses made with each assessment method. RESULTS: There were more correct diagnoses with a sequential assessment; 48.2% (569 out of 1180) compared to 33.5% (395 out of 1180) for the simultaneous method. Only 26.3% (n=31) had more than five accurate diagnoses with a simultaneous assessment, compared to 44.1% (n=52) for sequential assessments. Those performing sequential assessment achieved a median score of 5/10 correct diagnoses compared to a median score of 2.5/10 for the simultaneous method (Wilcoxon Z=-4.63, p<0.001). Sensitivity for the pulse check was 99% for both assessments; specificity was 48.9% for a simultaneous assessment and 61.9% for the sequential approach. For breathing check, specificity, sensitivity and accuracy were also higher with the latter method (sensitivity 99.6%, specificity 70.6% and accuracy 88%) CONCLUSION: A sequential assessment of breathing and pulse by healthcare professionals has greater diagnostic accuracy in simulated case scenarios.     

聚焦解决模式在实施人工流产术的未成年少女心理干预中的应用

目的 探讨采用聚焦解决模式对意外妊娠行人工流产术的未成年少女进行心理干预的效果.方法 将120例因意外妊娠行人工流产术的未成年少女按随机数字表法分为对照组和干预组各60例,对照组给予常规心理护理,干预组在此基础上采用聚焦解决模式进行心理干预,采用SCL-90症状自评量表在手术前和术后4周进行心理健康状况测量,比较干预效果.结果 手术前两组患者SCL-90总分、均分及各维度得分比较差异无统计学意义（P＞0.05）,两组患者与国内常模比较,除精神病性外,其余因子得分差异均有统计学意义（P＜0.05）.术后4周,两组患者SCL-9总分[（130.18 ±31.25）/（142.34 ±39.21）]、SCL-90均分[（1.41 ±0.37）/（1.55±0.41）]、躯体化[（1.42 ±0.41）/（1.57±0.46）]、人际关系敏感[（1.71 ±0.35）/（1.85±0.47）]、抑郁[（1.62±0.51）/（1.82±0.61）]、焦虑[（1.45 ±0.38）/（1.63 ±0.42）]、敌对[（1.50 ±0.38）/（1.69 ±0.49）]、恐怖[（1.30 ±0.33）/（1.55±0.40）]各因子得分比较,差异有统计学意义（t值分别为4.01,3.67,3.24,3.54,4.76,4.13,2.98,4.11;P＜0.05）.结论 采用聚焦解决模式对意外妊娠未成年少女进行心理干预,可提高其心理健康水平.     

Reluctant but resourceful middle managers: the case of nurses in the NHS

This study counters the widely held view that middle managers have little to contribute to strategic change in health care organizations. In particular, it argues that middle managers with a nursing background that manage clinical activity should be involved in strategic change beyond mere implementation of decisions made by executive management. Constraints upon this are noted - the power of doctors and central government intervention - that means middle managers enact a semiautonomous strategic role. Antecedents for the semiautonomous role are investment in organization and management development, developing lateral organizational structures that allow middle managers to make a contribution to the development, as well as the implementation of strategy and allowing middle managers to interact with other stakeholders outside the confines of the organization.     

Community Engagement in the CTSA Program: Stakeholder Responses from a National Delphi Process

In response to the Institute of Medicine (IOM) Committee''s December 2012 public request for stakeholder input on the Clinical and Translational Science Award (CTSA) program, two nonprofit organizations, the Center for Community Health Education Research and Service, Inc. (CCHERS) and Community‐Campus Partnerships for Health (CCPH), solicited feedback from CTSA stakeholders using the Delphi method. Academic and community stakeholders were invited to participate in the Delphi, which is an exploratory method used for group consensus building. Six questions posed by the IOM Committee to an invited panel on community engagement were electronically sent to stakeholders. In Round 1 stakeholder responses were coded thematically and then tallied. Round 2 asked stakeholders to state their level of agreement with each of the themes using a Likert scale. Finally, in Round 3 the group was asked to rank the Round 2 based on potential impact for the CTSA program and implementation feasibility. The benefits of community engagement in clinical and translational research as well as the need to integrate community engagement across all components of the CTSA program were common themes. Respondents expressed skepticism as to the feasibility of strengthening CTSA community engagement.     

规范病人外出检查流程管理方法与评价

目的:规范医院住院病人外出检查的流程管理,提高医疗护理服务质量,确保病人安全。方法:科室通过建立病人外出检查登记本,在护士站设置检查信息专用白板和设置病人外出检查确认本三方面途径对408例病人实施规范病人外出检查流程。结果:408例病人外出检查前准备工作成功率为100%,病人核对准确率为100%,病人家属及医护人员满意度分别为97%、100%。结论:病人外出检查规范化流程管理可有效保证病人外出检查顺利,保障病人的安全,提高病人、家属及医护人员满意度。     

Service users and other stakeholders' evaluation of a liaison mental health service in an accident and emergency department and a general hospital setting

Liaison mental health care has been an emerging specialism of mental health nursing in the UK since the early 1990s. Studies have so far looked only briefly at service user evaluation. A qualitative study involving 47 interviews with service user and professional stakeholders was undertaken to determine what is important to stakeholders in a liaison mental health-care service. The largest group of stakeholders interviewed were service users. Analysis of the data was undertaken using the service user interviews to guide the development of themes. The majority of the issues identified were raised by both service users and professionals. The three key themes were, the practicalities of the service including waiting time, the staffing profile and receiving the service, which included issues such as the opportunity to talk and outcomes. The findings provide new information regarding what service users and other stakeholders expect from a liaison mental health service and important areas to consider when offering a satisfactory service.     

Educational Impact Drives Feasibility of Implementing Daily Assessment in the Workplace

Abstract

Construct: Authors investigated the perspectives of stakeholders on feasibility elements of workplace-based assessments (WBA) with varying designs. Background: In the transition to competency-based medical education, WBA are taking a more prominent role in assessment programs. However, the increased demand for WBA leads to new challenges for implementing suitable WBA tools with published validity evidence, while also being feasible and useful in practice. Despite the availability of published WBA tools, implementation does not necessarily occur; a more fulsome understanding of the perspectives of stakeholders who are ultimately the end-users of these tools, as well as the system factors that both deter or support their use, could help to explain why evidence-based assessment tools may not be incorporated into residency programs. Approach: We examined the perspectives of two groups of stakeholders, surgical teachers and resident learners, during an assessment intervention that varied the assessment tools while keeping the assessment process constant. We chose diverse exemplars from published assessment tools that each represented a different response format: global rating scales, step-by-step surgical rubrics, and an entrustability scale. The primary purpose was to investigate how stakeholders are impacted by WBA tools with varying response formats to better understand their feasibility for assessment of cataract surgery. Secondarily, we were able to explore the culture of assessment in cataract surgery education including stakeholders’ perceptions of WBA unrelated to assessment form design. Semi-structured interviews with teachers and a focus group with the residents enabled discussion of their perspectives on dimensions of the tools such as acceptability, demand, implementation, practicality, adaptation, and integration. Findings: Three themes summarize teachers’ and residents’ experiences with the assessment tools: (1) Feedback is the priority; (2) Forms informing coaching; and (3) Forcing the conversation. The tools helped to facilitate the feedback conversation by serving as a reminder to initiate the conversation, a framework to structure the conversation, and a memory aid for providing detailed feedback. Surgical teachers preferred the assessment tool with a design that best aligned with their approach to teaching and how they wanted to provide feedback. Orientation to the tools, combined with established remediation pathways, may help preceptors to better use assessment tools and improve their ability to give critical feedback. Conclusions: Feedback, more so than assessment, dominated the comments provided by both teachers and residents after using the various WBA tools. Our typical assessment design efforts focus on the creation or selection of a robust assessment tool according to good design and measurement principles, but the current findings would encourage us to also prioritize the coaching relationship and include efforts to design WBA tools to function as a mediator to augment teaching, learning, and feedback exchange within that relationship in the workplace.     

650名妇女孕前优生健康检查结果分析

目的：探讨孕前优生健康检查对计划怀孕妇女防治疾病和预防新生儿出生缺陷的重要性。方法：将2011年1月—2011年10月在山西省寿阳县人口和计划生育服务中心进行孕前健康检查的妇女作为研究对象,通过询问病史、妇科检查、TORCH[弓形虫（TOX）、巨细胞病毒（CMV）、疹病毒（RV）、单纯疱疹病毒（HSV）等一组病原体的英文名缩写]检测等手段发现风险因素。结果：研究对象中不良孕产史3例,妇科炎症72例,妇科肿瘤4例。TORCH检测阳性率分别为弓形虫-Igm（TOX-Igm）0.154%,巨细胞病毒-Igm（CMV-Igm）0.461%,风疹病毒（RV-Igm）0.307%,单纯疱疹-Igm（HSV-Igm）0.307%,单纯疱疹（HSV-Igm）0.154%。结论：计划怀孕妇女孕前有风险因素存在,应高度关注,孕前优生健康检查十分必要。     

PS1-62: Assessing Readiness for Team Care in Community-based Clinics: Barriers and Facilitators to Implementing an Evidence-based Intervention to Improve BP Control

Background/Aims Understanding the barriers and facilitators to implementing evidence-based models of care in typical community settings is critical to the successful translation of research-tested interventions into practice. The Electronic Communications and Home Blood Pressure Monitoring trial (e-BP), implemented in a large, integrated group practice, demonstrated that team-care and incorporating a pharmacist to manage hypertension via secure e-mail communications in an existing patient-shared electronic health record (EHR) resulted in almost twice the rate of BP control compared to usual care. We sought to assess whether e-BP could be implemented in community-based primary care clinics with very different contextual features (e.g. inexperience with pharmacist team members, limited IT infrastructure, and vulnerable patient populations). Methods We conducted interviews with purposive samples of health care providers, pharmacists and patients associated with four community-based, primary care clinics. Using template analysis incorporating a priori codes drawn from the Chronic Care Model and the Consolidated Framework for Implementation Research, we identified themes illuminating contextual barriers and facilitators, as well as strategies for adapting core components of e-BP for implementation to control hypertension in community practice settings. Results Community-based patients, pharmacists, providers and staff expressed eagerness to participate in an intervention like e-BP. They characterized its approach to healthcare as "the right thing to do" and expressed hope that participation would yield enough evidence about the benefits of this care model to support significant reimbursement reform. The intervention's sustainability was of paramount importance to stakeholders and needs to be considered in planning for implementation. Stakeholders were more concerned about being able to overcome barriers related to regulations and reimbursement than to clinic-level factors. Discussion Community-based clinic stakeholders would like to improve hypertension control and the care of other chronic conditions using team care and communications outside of office visits. However, ensuring a business case for implementation and sustainability of these models was a persistent theme. Using this case study, we will discuss methods and models for adaptation and implementation of evidence-based interventions into community practice.     

Checkmate 2用于放射治疗加速器输出剂量检测的可行性

  目的  探讨Checkmate 2作为日检工具用于放射治疗加速器输出剂量检测的可行性。  方法  按照国际原子能机构(International Atomic Energy Agency, IAEA)第277号报告建议方法刻度Varian 2300CD加速器的两档光子线6、15 MV及五档电子线6、9、12、16、20 MeV, 每日分别使用指型电离室和Checkmate 2测量各档能量100 MU的输出量, 得出各自剂量偏差, 最大允许偏差为±2%。分别实测环境温度气压值和读取Checkmate 2温度气压显示值, 计算温度气压修正因子。连续进行3个月工作日共66次测量, 比较每日各档能量测量值以及温度气压修正准确性。  结果  各档能量的电子线及X射线的Checkmate 2与指型电离室测量结果均满足绝对剂量偏差不超过2%的标准, 且两者比较差异均无统计学意义(P > 0.05)。实测及Checkmate 2测量得出的平均温度气压修正因子分别为1.032±0.007和1.033±0.007, 两者差异无统计学意义(P=0.452);相关性分析显示两者呈正相关(r=0.92, P=0.000)。  结论  Checkmate 2可真实反映加速器剂量输出的大体趋势, 且测量工作耗时短、操作简便, 是直线加速器晨检剂量输出检测的良好工具。     

护理岗位实施绩效考核的效果探讨

[目的]探讨护理分配制度与护理质量的关系,提高医院护理工作质量。[方法]在护理岗位推行了绩效考核制度,对实行绩效考核制度前后护理工作质量进行比较,分析推行绩效考核对护理质量管理产生的效应。[结果]护理岗位推行绩效考核起到了提高员工绩效、提高员工素质、保证护理目标的实施、增强管理效能等作用,有效地促进了医院护理质量的全面提高。[结论]将绩效考核引入护理管理,是新时期护理管理高效科学的管理模式。     

Exercise intervention and health checks for middle-aged men with elevated cardiovascular risk: A randomized controlled trial

Abstract

Objective. To study the effects of a health check by a nurse alone or combined with an exercise intervention in middle-aged men at increased cardiovascular risk. Design. A randomized controlled trial. Setting and intervention. Primary care in Kirkkonummi municipality with 36 000 inhabitants. A health check by a nurse alone or combined with an exercise intervention to controls with no intervention was compared. Subjects. A total of 168 men aged 35 to 45 years with at least two cardiovascular risk factors and physical activity (PA) frequency < 3 times a week. Main outcome measures. Metabolic syndrome (MetS) as defined by International Diabetes Federation/American Heart Association and self-reported PA frequency. Results. Overall, focusing on health increased physical activity frequency in middle-aged men. After one year, 19% had increased PA to ≥ 3 times a week (95% CI 12–26). All study groups increased PA to ≥ 3 times: 26% of men in the exercise intervention group, 15% of men in the health check group, and 16% of controls. The differences between the groups were not statistically significant. The intervention did not have any meaningful impact on MetS or other cardiovascular outcomes at one-year follow up. Conclusions. Physical activity increased in all study groups of middle-aged men in this health-promotion trial. The interventions had no effect on metabolic syndrome or other cardiovascular outcomes in the participants. The trial increased awareness and collaboration in physical activity promotion among municipal health care and exercise services.     

Veterans’ Insights on Heart Rate Variability Biofeedback to Treat Fibromyalgia-Related Pain

BackgroundHeart rate variability biofeedback (HRVB) is a self-management strategy that guides individuals to breathe at a designated resonance frequency of the cardiovascular system. Resonant breathing may reduce FM-related symptoms as well as improve physical functioning and quality of life. Although prior research recommends HRVB for chronic pain, we found no studies testing the feasibility for individuals with FM regarding protocol adherence or acceptability of the treatment.AimsTo determine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) protocol in a group of Veterans with fibromyalgia (FM).DesignA multi-method feasibility and acceptability study.SettingsA Veterans Health outpatient pain medicine clinic.Participants/SubjectsWe enrolled 7 women and 3 men between the ages of 33 and 68 years with a diagnosis of FM.MethodsWe enrolled 10 veterans in a HRVB study using a recommended protocol to treat FM. Veterans were given a HRVB device, emWave2, and instructed to practice at home twice daily for 20 minutes per session. Following a 7-week intervention period, we conducted an end of study focus group. We used content analysis to develop themes to determine the feasibility of engaging in HRVB and adhering to the intervention protocol, as well as insights of veterans about the intervention.ResultsThree common themes emerged: intervention implementation, protocol adherence, and self-awareness.ConclusionsResults of this study suggest difficulties operating the emWave2 and scheduling challenges interfered with HRVB implementation. However, veterans reported self-awareness of the benefits of HRVB, positive physiological effects, and improved psychological effects. Future studies require a larger sample size to provide a deeper insight.     

应用失效模式与效应分析预防手术错误

成立手术室失效模式和效应分析（failure mode and effect analysis，FMEA）小组，对2006年所有手术进行手术错误风险评估，通过计算事先风险数，将6个潜在失效原因列为手术错误的高风险因子，分别是接错患者／接手术患者单抄错，接错患者／未与病房护士查对，查对不准确／患者表达能力受限，患者送错手术间／同时接几名患者，麻醉师、医生未查对／对麻醉师及医生无明确查对要求，部位错误／术前未做标识。根据评估结果，制定改进措施，并于2007年1月开始实施。结果表明，该6个导致手术错误的高风险因子的事先风险数都有不同程度的下降。可见加强查对、健全风险管理制度、明确相关人员的责任、合理使用查对标识对预防手术错误是有效可行的。