以需求为导向的老年人急救培训方案制定及实施效果

目的 构建老年人急救知识与技能培训方案,以提高培训效果,为开展培训提供参考.方法 采用头脑风暴和文献分析法制定访谈提纲,利用访谈法了解老年人对开展急救培训的需求,采用归纳法提取访谈信息,利用头脑风暴和文献查阅法并根据访谈结果制定培训方案,采用实证研究和统计分析法评估培训前后老年人急救知识、技能变化及培训满意度.结果 通过培训,老年人急救知识与技能均有明显提高(P<0.05),对培训整体满意.结论 以需求为导向、结合老年人身心特点的急救知识与技能培训方案具有因需、因材施教特点,有利于满足老年人急救知识与技能需求,提高自救互救能力.     

一体化创伤急救模式在老年严重创伤患者急救中的应用效果

目的探讨一体化创伤急救模式在老年严重创伤患者急救中的应用效果。方法将该科收治的78例老年严重创伤患者随机分为一体化创伤急救模式干预组(观察组)以及常规急救干预组(对照组),每组39例。观察两组患者急诊室停留时间、特殊检查时间、急诊至手术间隔时间、入院至手术间隔时间等急救反应时间。比较两组患者的临床救治结果,主要包括抢救成功、致残及死亡比例,观察并发症情况。随访半年,采用SF-36评定其生活质量。结果与对照组比较,观察组的急诊室停留时间、特殊检查时间、急诊至手术间隔时间、入院至手术间隔时间均缩短明显,救治成功率升高明显,致残率、死亡率以及并发症发生率均降低明显(P<0.05)。两组存活患者均无失访现象,与对照组比较,观察组患者随访3、6个月时的PF、RP、RE得分均升高明显(P<0.05,P<0.01)。结论在老年严重创伤患者中应用一体化创伤急救模式,不仅可有效缩短急救反应时间、提高抢救成功率、降低致死及致残率,而且可提高其生活质量。     

急诊医生接诊技巧及急救措施

对于突发疾病或突然伤害,及时科学的急救处理可以有效减少患者死亡,改善预后,为进行下一步治疗创造机会。急诊患者发病急、病情重、病种复杂,加之患者家属紧张焦虑,急诊医生对此类患者的接诊应具有一定的技巧。随着医学的进步和人类文明的发展,急诊医生不仅应具备娴熟的急救知识和急救技术措施,同时也需要具有良好的沟通技能,在一定程度上它还是急诊医生救治患者成功与否的关键所在。本文就急诊医生接诊技巧和急救措施进行了综述。     

国内外冠心病患者家属CPR急救培训现状与展望

本文综述了国内外冠心病患者家属CPR的急救培训现状及目前培训存在问题,重视冠心病患者家属急救的培训,以期为后期冠心病患者家属的急救培训提供建议和启示。     

急救站点与援助急救队在院内心肺复苏急救系统中的作用

目的:探讨院内心脏骤停急救系统建立模式,提高抢救成功率。方法:设置院内急救站点,组建援助急救队,采用突然模拟实战演练,并寻找问题,不断改进,逐步建立院内急救系统。选择2016年5～12月传统急救演练模拟心脏骤停患者39人次为对照组, 2017年3～11月新设置急救演练模式后模拟心脏骤停患者42人次为干预组,分析2组院内急救首救医生到达救治点的时间(s)、开始心肺复苏时间(s)、高级生命支持到达时间(s)、除颤仪到达时间(s)。结果:设置院内急救站点及援助急救队后,干预组首救医生到达救治点的时间为(52.52±11.09)s、开始心肺复苏时间为(54.55±11.31)s、高级生命支持到达时间为(350.76±31.32)s、除颤仪到达时间为(379.33±35.12)s,均明显短于对照组(均P0.01)。结论:院内急救站点与援助急救队的设立,显著缩短抢救心脏骤停患者的各环节时间,明显提升抢救成功率,提高医院整体综合急救水平。     

医护合作培训临床护士急救技能的实践

急救护理学是护理学的一个重要分支，也是临床医疗救护上不可缺少的一部分。目前随着急诊危重病与创伤患者的日益增多，对急诊护士的整体素质也提出了更高的要求，要求护士能熟练掌握急救知识和技能，能在紧急情况下配合医生给病人及时、准确地实施心身整体救护和监护，这对提高抢救成功率和降低死亡率、致残率将起到重要作用。为提高护士现场急救医护配合能力和急救水平，     

对急性心肌梗死患者采用急诊急救护理效果的评价

目的 评价针对急性心肌梗死（AMI）患者采用急诊急救护理的效果。方法 选取60例AMI患者按照随机抽签法分为对照组与干预组,对照组行常规护理,干预组行急诊急救护理,比较两组的一般资料、急诊急救指标、预后指标。结果 两组一般资料无明显差异（P>0.05）,干预组急诊的接诊时间、分诊的评估时间与急救时间均短于对照组（P<0.05）,干预组的卧床时间与住院时间均短于对照组（P<0.05）,干预组的院内复发率低于对照组（P<0.05）。结论 针对AMI患者行急诊急救护理的临床效果显著,能提升急诊急救的时效性,改善预后,值得推广应用。     

社区医生开展急性冠状动脉综合征规范化治疗培训的效果观察

<正>急性冠状动脉综合征(ACS)是冠状动脉(CA)粥样硬化斑块不稳定为基本病理生理特点,以急性心肌缺血为共同特征的一组综合征,包括不稳定型心绞痛(UAP)、非ST段抬高心肌梗死(NSTEMI)和ST段抬高心肌梗死(STEMI)。由于对ACS的病理基础和发病机制的研究有了很大的进展,进而导致了治疗策略的     

急救站点与援助队在院内心肺复苏急救系统中应用

【】目的 探讨院内急救系统建立模式,提高抢救成功率,提升医护人员应急能力。方法 设置院内急救站点,组建援助急救队,采用突然模拟实战演练,寻找问题,不断改进,逐步建立院内心肺复苏系统。选择2016 年 5月-12月传统急救演练模拟心脏骤停患者39人次为对照组, 2017 年3月- 11月新设置急救演练模式后模拟心脏骤停患者42人次为干预组,分析两组院内急救首救医生到达救治点的时间(s)、开始心肺复苏时间(s)、高级生命支持到达时间(s)、除颤仪到达时间(s)。 结果 设置院内急救站点及援助急救队后,干预组首救医生到达救治点的时间为52.52±11.09s、开始心肺复苏时间为54.55±11.31s、高级生命支持到达时间为350.76±31.32s、除颤仪到达时间为379.33±35.12s,明显短于对照组,P ＜ 0.01,差异有统计学意义。结论 院内急救站点与援助急救队的设立, 显著缩短各环节急救时间,明显提升医务人员救治能力,充分调动团队救治速度,提升抢救成功率。建立急救管理新模式,定期实战演练,提升医院整体综合急救水平,是患者生命安全的重要保障措施之一。     

"南海模式"早期胃癌筛查策略在基层社区中的应用评价

目的 基于全科医学+医共体的"南海模式"早期胃癌筛查策略在基层社区无症状人群应用过程的实施研究.方法 通过全科医学+医共体构建"南海模式"早期胃癌筛查策略,统计2019年1月至2019年12月在佛山市南海区里水镇早期胃癌筛查的实施研究中的相应数据;纵向对比本地区在开展胃癌筛查工作前后的内镜应答率及早癌检出率,并对早期胃...     

综合医院心肺复苏培训模式及其应用效果研究

目的 研究煤炭总医院自2012年以来心肺复苏培训的模式及效果,为提高培训效果,继而提高继续教育管理水平提供参考依据。方法 收集煤炭总医院2012～2014年3年间全部心肺复苏培训及考核记录,运用管理学、统计学、教育学等相关理论进行分析。结果 煤炭总医院开展的心肺复苏培训的主要模式有学术讲座、技能操作培训、技能考试、分层培训等。采用分层培训方式后,2014年煤炭总医院医务人员心肺复苏基本知识知晓率已经达到74.9%（χ2=31.3,P<0.0001）,操作技能合格率已经达到92.5%（χ2=6.3,P=0.012）,较2012年相比有明显提高。结论 分层培训是综合医院开展心肺复苏培训的一种有效模式,有助于提高继续教育培训效果和管理水平。     

糖尿病非酮症高渗性昏迷患者的临床急救措施及治疗效果分析

目的研究糖尿病非酮症高渗性昏迷患者的临床急救措施及治疗效果分析。方法选择该院2015年1月—2019年3月收治的糖尿病非酮症高渗性昏迷患者26例作为研究对象,进行临床诊断和生化检查,根据实际情况静脉输液补充钾和钠、胰岛素,研究治疗效果。结果根据昏迷患者的渗透压、失水量及血糖水平,尽快给予静脉输液(钾和钠),治疗包括小剂量缓慢持续静脉滴注胰岛素和静脉输液逐渐补液,治疗有效19例,治疗显效6例,治疗无效1例。结论糖尿病非酮症高渗性昏迷患者应及早进行静脉输液调整体内渗透压、补充水分、小剂量静脉滴注胰岛素,获得良好治疗效果。     

参附在不同类型休克急救中对血压影响的研究

目的研究参附在不同类型休克急救中对血压的影响。方法入组130例患者完全随机分为对照组及参附干附组。并根据休克始环节各分为3个亚组,在治疗半小时后观察血压水平变化。结果不同类型的休克组、不同剂量的初始多巴胺剂量组是否使用参附对于血压升高变化的影响差异均无统计学意义(P0.05)。低血容量性休克各多巴胺剂量组使用参附无统计学差异;血管源性休克0~2μg·k-1·min-1组使用参附后血压水平升高较明显,差异均无统计学意义(P0.05)。心源性休克0~2μg·kg-1·min-1组使用参附后血压水平明显升高(P0.05)。结论参附在休克急救中有明确的升血压作用,在心源性休克的作用可能最好,在低血容量性休克容量未补足前常规剂量的参附可能无效果。心源性、血管源性休克患者可能通过使用参附减少多巴胺的使用剂量。大剂量使用多巴胺合用参附对血压改善可能无作用。     

以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死20例临床分析

目的分析以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死的临床特点,探讨其发生心力衰竭的特征和原因。方法综合分析20例以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死20例患者的病史和临床特点,根据心电图、心肌酶的动态变化、Killip心功能分级和心脏彩超报告的心功能指标,探讨普遍ST段压低型心肌梗死发生急性左心衰竭的特征和原因。随访10人的预后,1年内3人死亡。结果20例中,15例为无痛性心肌梗死;5例心肌酶轻度升高;随访1年内死亡率30％,均为糖尿患者;心电图特点：AVR和（或）V1导联S—T段抬高,余导联S—T普遍压低〉0．1mV,尤其V3～V6S—T段压低更明显,或T波呈对称性深倒置;心脏彩超：LVEF（40±10）％,LVEF〈40％8例,LVEF〉40％12例;节段性室壁动度减弱或不协调。结论以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死的临床特点为：（1）多合并有冠心病发病的主要致病因素;（2）以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死大多数为无痛性心肌梗死;（3）心电图显示心肌缺血及损伤的面积广泛;（4）表现为心脏收缩、舒张功能显著减弱或不协调;（5）心力衰竭是其严重的并发症,也是其主要死亡原因之一。     

纳洛酮对酒精性脂肪肝大鼠作用探讨

目的　探讨纳洛酮对酒精性脂肪肝的作用及其可能机制。方法　将 48只Wistar雄性大鼠,随机分为 4组:酒精性脂肪肝模型组、纳洛酮低剂量处理组、纳洛酮高剂量处理组,正常对照组。4周末,处死所有大鼠,检测血液中天门冬氨酸氨基转移酶 (AST)、丙氨酸氨基转移酶(ALT)、谷光甘肽-S转移酶(GST)和β 内啡肽(β EP)含量。同时行肝脏病理组织学检查。结果　纳洛酮处理组血浆AST、ALT、GST和β EP含量明显低于模型组(P<0 05 ),但又高于正常对照组 (P<0 05 ),且处理组内部相比,差异也有显著性 (P<0 05)。病理检查发现处理组肝脏脂肪变程度明显轻于模型组。结论　纳洛酮可以通过降低血浆中β EP水平而具有防治酒精性脂肪肝的作用。     

A White Dean and Black Physicians at the Epicenter of the Civil Rights Movement

Robert Q. Marston, MD, a gregarious Rhodes and Markel Scholar, native Virginian, and well-connected National Institutes of Health-trained medical scientist found himself the new dean and hospital director of a promising academic medical center at age 38. It was 1961 and the University of Mississippi Medical Center (UMMC) in Jackson was, unknown to him, about to be at the geographic center of the struggle for African American civil rights. That struggle would entangle UMMC in a national search for social justice and change the course of American history and American medicine. Shortly after his arrival, the new dean received and refused a written request from the Secretary of the Mississippi Chapter of the National Medical Association (NMA) to make educational venues at the segregated medical center available to black physicians. The same year, UMMC became the primary medical provider for sick and injured Freedom Riders, sit-in and demonstration participants, and others who breached the racial divide defined by the state's feared Sovereignty Commission. That divide was violently enforced by collaboration among law enforcement, Citizens' Councils, and the Ku Klux Klan. The crescendo of the civil rights struggle that attended Marston's arrival included a deadly riot following James Meredith's integration of the Ole Miss campus in Oxford in 1962, the death of National Association for the Advancement of Colored People (NAACP) Field Secretary Medgar Evers at UMMC in 1963, a national controversy over UMMC's role in the autopsies of 3 civil rights workers murdered in Neshoba County, an attempt at limited compliance to Title VI of the Civil Rights Act of 1964, and a federal civil rights complaint against UMMC by the NAACP Legal and Educational Fund in 1965. That complaint noted that UMMC was out of compliance with the Civil Rights Act of 1964 and seriously threatened its federal funding and academic operations. Marston developed a compliance strategy that included the hiring of the first black faculty member, a request for an immediate federal civil rights inspection, and secretive overnight integration of the hospitals and clinics. A key to his strategy was engagement of support from the black community, with whom he had previously developed no relationship. Marston asked NAACP Field Director Charles Evers for support, and met with 5 black Mississippi physicians. Among the 5 was Robert Smith, MD, a founding member of the Medical Committee for Human Rights, the NMA officer whose request for NMA membership-access to the medical center was ignored. He was unaware of their local and national civil rights roles and active dialogue with the federal government on implementation of Title VI. The desire of the black physicians to see UMMC become an equal opportunity health resource resulted in their quiet assistance that aided UMMC compliance initiatives and played a major role in the successful outcome of the 1965 investigation of the charges of Title VI violations. This success established Marston as a national figure in academic medicine and contributed to his selection for positions as Director of The National Institutes of Health and President of the University of Florida. As commemorations of the 50^th anniversary of Freedom Summer of 1964 proceed, UMMC has become arguably the most racially integrated academic health center in the United States.     

Development of a Screening Questionnaire for the General Hospital and General Practices

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1, 167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-Ill-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Luebeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.     

Impact of Family Medicine Training on the Quality of Care for patients of diabetes in Saudi Arabia

IntroductionDiabetes mellitus (DM) is one of the challenging health problems worldwide. Primary care centers manage and treat most of DM cases. Diabetes requires ongoing, and evidence-based health care which should be provided by highly qualified physicians.AimThis study aims at evaluating the Family Medicine training efficacy on the quality of care for diabetic patients.MethodologyThis is a cross-sectional study conducted among patients with DM at the AlJafer training center situated in AlAhssa, Saudi Arabia. The data of diabetic patients who were followed up initially with general practitioners (GPs) and later with family physicians (FPs) collected from the patients’ electronic files. Clinical parameters including HbA1c, blood pressure, total cholesterol, LDL, and statin, aspirin initiation measured during initial visits and follow-ups to compare the quality of diabetic care between the two groups (FPs vs. GPs). All statistical analyses carried using SPSS version 21.ResultsEighty-three patients were included in the study. Regarding the measurement process, FPs more likely to measure HbA1c twice a year than GPs (P:<0.001). The number of patients with HbA1c level >8% decreased significantly during the period of follow-up with FPs (P:<0.001). Furthermore, a significant number of patients meet the BP target ≤130/85 during the follow-up period with FPs. The statin initiation is substantially achieved more by FPs (P < 0.001).ConclusionFamily medicine training has a significant influence on the clinical outcomes of patients with DM. This study’s findings suggest that FPs ensure a better quality of care in terms of clinical and process measures.