基于认知负荷理论的教学在低年资助产士护理培训中的应用

目的:探讨基于认知负荷理论的教学在产房低年资助产士护理培训中的应用效果。方法:2020年6～7月对15名助产士实施基于认知负荷理论的护理培训,将2019年6月1日～2020年5月31日2545例分娩产妇作为对照组,将2020年8月1日～2021年2月28日2141例分娩产妇作为观察组。比较培训前后助产士助产知识考核得分,两组分娩产妇新生儿窒息发生率、产后出血情况、自然分娩率及护理满意度。结果:培训后低年资助产士理论知识、临床操作技能、应急能力、人际关系、自我管理能力及职业操守评分均高于培训前(P0.01);观察组新生儿轻度窒息、重度窒息及总窒息率均低于对照组(P0.01),复苏成功率高于对照组(P0.01);观察组产妇产后出血率低于对照组(P0.01),产后12、24 h出血量少于对照组(P0.01);观察组产妇自然分娩率及满意度评分均高于对照组(P0.01)。结论:基于认知负荷理论的护理培训可有效提升助产士护理知识掌握水平,降低新生儿窒息率,减少产妇产后出血,提升自然分娩率及护理满意度。     

改进产房责任组长排班模式对护理质量的影响

目的 探讨产房责任组长排班模式对护理质量的影响.方法 产房传统排班方法是责任组长与组员分白班、全夜共2个班次一起参与导乐接生,间接指导导乐助产士的工作,不承担管理责任;改进排班模式下责任组长不参与导乐接生,对每一位进入产房的产妇逐一全面评估.监督并指导导乐助产士的工作,协助观察产程,发现问题及时处理,协调本班的工作及时进行外援支持,并组织本组的群体宣教、产妇满意度调查、业务学习、专业技术考核,组员分A、P、N共3个班次导乐接生.比较两种排班模式下助产士工作压力、技术水平,患者满意度.结果 改进排班模式后助产士工作压力比较,除了管理及人际关系方面的问题外,其他4个方面的压力评分均较传统排班模式低;改进排班模式后,在责任组长的指导下参与导乐助产士64%认为判断产程异常的水平有所提高,55%认为对胎心异常的鉴别能力增强,68%认为对危重患者的观察能力加强,41%认为会阴伤口缝合技术有所提高:改进排班模式后产妇产后出血率及新生儿窒息率均有所下降,患者总体满意度提高.结论 改进责任组长排班模式后助产士工作压力减轻;助产士技术水平提高;产妇产后出血及新生儿窒息率下降;患者满意度提高.     

风险管理在产房临床护理管理中应用的效果评价

目的 探讨风险管理在产房临床护理管理中的应用效果.方法 选取2011年实施风险管理后在我院分娩的1200例孕产妇作为观察组,将2009年采用传统护理管理模式期间的1186例孕产妇作为对照组.比较2组产房常见护理缺陷、产后出血、新生儿窒息、难产、护理纠纷的发生率及患者满意度.结果 观察组新生儿标记缺陷、产后出血、新生儿窒息、难产的发生率均显著低于对照组,患者满意度显著高于对照组.结论 认真总结产房风险因素,实行产房风险管理,可显著提高分娩的护理质量,提高患者满意度.     

新生儿实施早期基本保健人文关怀标准化模式的效果

目的 研究早期基本保健人文关怀标准化模式的临床效果。方法 选取我院 2021 年 7 月至 2022 年 12 月产房低危孕产妇 200 例为研究对象。随机将患者分为对照组（n=147）和观察组（n=150）。对照组实施常规护理，观察组实施早期基本保健人文 关怀标准化模式。对比两组的新生儿窒息、低血糖、24h 内肺炎发生率以及产妇产后出血发生率、产妇及家属满意度。结果 观 察组新生儿窒息发生率、低血糖发生率及产妇产后出血发生率低于对照组（P <0.0 5）。妇及家属满意度高于对照组（P <0.0 5）。 结论 新生儿实施早期基本保健人文关怀标准化模式，能够减少新生儿窒息发生率、低血糖发生率及产妇产后出血发生率，提 升护理满意度。     

孕期助产士一对一全程健康指导护理模式对自然分娩的影响

目的:探讨孕期助产士一对一全程健康指导护理模式在分娩中的应用效果及其对自然分娩的影响。方法:选择2013年1月~2015年6月在我院产科收治的160例单胎妊娠孕产妇,将其随机等分为对照组和观察组。对照组孕产妇在孕期仅在产科门诊进行常规产前检查和常规门诊指导,观察组孕产妇在孕期均配备1名助产士,由助产士进行一对一的全程健康指导护理。对比两组孕产妇的自然分娩率、产程时间、产后出血率以及护理满意度,并对比两组新生儿的Apgar评分。结果:观察组孕产妇的自然分娩率高于对照组(P0.05),总产程时间短于对照组(P0.05),产后出血率低于对照组(P0.05),护理满意度高于对照组(P0.05)。观察组新生儿的1,5 min Apgar评分均高于对照组新生儿(P0.05)。结论:在孕期由助产士对孕产妇进行一对一的全程健康指导护理,能够有效提高阴道自然分娩率,缩短产程时间,减少产后出血的发生,改善新生儿健康状态,同时还能有效提高产妇对护理服务的满意度。     

探讨一对一责任制陪伴对产妇分娩的影响

目的探讨在产房开展一对一责任制陪伴对产妇分娩的影响.方法 2001年2月对100例产妇实施功能制护理分娩(对照组),同年6～8月选取年龄、孕周与实验组相近的100例产妇实施一对一责任制陪伴分娩(实验组),比较两组产妇总产程分娩时间、剖宫产率、新生儿窒息率及产妇对助产士的满意度等.结果与对照组比较,实验组总产程平均缩短64.69 min (P＜0.05);剖宫产率降低19%(P＜0.01);产妇产后平均出血量及新生儿窒息率比较,无统计学意义;产房护理人员从17人减至15人;产妇对助产士的满意度从76%提高到98%;从无五星级护士到86.6%的助产士被评为五星级护士.结论一对一责任制陪伴分娩提高了产时护理质量,提高了助产士的自身素质及产妇满意度.     

产房护理风险管理的效果研究

目的探索产房护理风险管理的实施模式及其效果评价。方法2007年入院的孕产妇为对照组。采取传统管理;2008年人院的孕产妇为干预组,实施护理风险管理。观察两组产妇产程、产后情况、护理缺陷、意外事件发生情况、孕产妇满意度。结果干预组产后出血和新生儿窒息发生率下降（P〈0．05）,护理缺陷、意外事件等发生率下降（P〈0．05）．孕产妇对护理工作满意度提高。结论产房护理风险管理模式在降低护理缺陷、提高孕产妇满意度和提高产科质量方面有一定成效,可推广普及。     

弹性排班结合全程责任助产制在产房管理中的应用

目的 弹性排班结合全程责任助产制在产房管理的应用效果.方法 在护理人员人数不变的条件下,采用弹性排班结合全程责任助产制,比较实施前、后助产士人均工作时间和产妇满意度的情况.结果 实施弹性排班结合全程责任助产制前、后助产士人均工作时间差异有统计学意义(P<0.05);产妇满意度差异有统计学意义(P<0.05).结论 实施弹性排班结合全程责任助产制,有利于充分利用有限的护理人力资源,提高护理质量和产房工作效率,落实人性化护理服务,提高产妇满意度.     

助产士分级授权管理模式在产房质量控制中的应用

目的探讨助产士分级授权管理模式在产房质量控制中的效果。方法以本院产科2016年1月实施助产士分级授权管理模式为界限,将2015年1月~2015年12月产房工作划为实施前,将2016年1月~2016年12月产房工作划为实施后,比较助产士分级授权管理模式实施前后产房质量控制情况(记录会阴侧切除率、伤口愈合不良率、产后出血、新生儿窒息、肩难产、锁骨骨折发生率等)。采用本院自制的满意度问卷和职业成就感量表在实施前后对护理质量满意度和助产士成就感进行评价。结果分级授权管理实施后的会阴侧切率、新生儿窒息率均低于实施前,差异有统计学意义(P0.05);分级授权管理实施后产妇对助产士护理满意度评分为(94.29±5.18)分,助产士职业成就感自我评分为(80.16±9.31)分,均高于实施前,差异有统计学意义(P0.05)。结论在产科助产士管理中采用分级授权管理模式,能够改善产科质量,提高产妇对护理的满意度以及助产士的职业成就感。     

平产分娩产房中以助产士为主导的护理模式对母婴的影响研究

目的 探讨平产分娩产房中以助产士为主导的护理模式对母婴的影响。方法 选取我院 2019 年 1 月至 2022 年 3 月期间的 80 例产妇为研究对象。采取计算机表法将产妇分为对照组和研究组,每组各 40 例。对照组采用常规护理模式,研究组采取平 产分娩产房中以助产士为主导的护理模式。分析对比两组的并发症发生情况、新生儿不良结局及心理情绪。结果 研究组的平 产率（95.00%）明显高于对照组（65.00%）（P<0.05）。研究组的会阴感染、会阴裂伤以及产后出血等并发症发生率显著低于 对照组（P<0.05）。研究组早产儿、胎儿窘迫以及新生儿窒息等新生儿不良结局发生率显著低于对照组（P<0.05）。研究组的 焦虑自评量表评分和抑郁自评量表评分均显著低于对照组（P<0.05）。结论 平产分娩产房中采取以助产士为主导的护理模式能 够提高产妇的平产率,减少并发症,改善新生儿不良结局,缓解产妇的焦虑、抑郁心理情绪。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.