“责任固定”排班模式在脑血管手术病房中的应用研究

目的探讨"责任固定"排班模式在脑血管手术病房中的应用效果。方法 2017年9月前采用APN排班模式(A班:7:30-16:00;P班:16:00-24:00;N班:24:00-7:30),APN排班存在非工作高峰时间段人员浪费、休息天数少及护士更易产生工作疲溃感等问题。2017年9月开始实施"责任固定"排班模式,固定周一至周五由同1名责任护士上班(7:30-16:00,周末休息),并配备1名护士辅助输液(7:30-11:30);责任班下班后由下午班接班:16:00-22:00;最后为后班:22:00-7:30。采用问卷调查法,比较护士在2种排班模式下的工作满意度、工作疲溃感、患者满意度及护理质量情况。结果实施"责任固定"排班模式后,护士的满意度、工作疲溃感、护理质量及患者满意度等指标均有不同程度的改善,且与APN排班差异具有统计学意义(P0.05)。结论 "责任固定"排班模式能提高护士满意度、降低工作疲溃感,且能提高患者满意度、护理工作质量及健康教育效果。     

APN排班模式在基层医院产科中的效果评价

目的 评价APN排班模式在基层医院产科中的实施效果.方法 将本院产科护士16人,每日设A、P、N三班,A班4人(A、A1、A2、A3),上班时间为7:30～15:00;P班3人(P、P2N2、P1),P和P1上班时间为14:30～22:00,P2N2的上班时间为17:30～1:00;N班1人(N1),上班时间为0:30～8:00.结果 与传统排班方式比较,APN排班模式实施后护理质量由实施前的94.24分提高到实施后的97.83分,健康宣教知晓率由82.08%升高到97.92%,患者对护士工作的满意度由95.22分上升到99.14分,差异均有统计学意义(P＜0.05).结论 APN排班模式加强了护士的责任心,加速了年轻护士的成长,提升了护理质量,改善了护患关系,提高了患者对护士的认知度与满意度.     

连续性P班制在呼吸内科中的应用

目的 在APN排班模式的基础上,探讨高效、优质的晚夜班排班模式,更好地实现人性化护理、提高护理质量、促进护士的身心健康.方法 在原有APN排班基础上实行P班连续1周的排班模式,比较实施前及实施6个月后患者对护理服务的满意度及护士对不同排班方式的意愿.结果 实施连续性P班后,患者对护理工作的满意度明显提高,差异具有统计学意义(均P＜0.05).所有护士均倾向于选择连续性P班的排班模式.结论 连续性P班的排班模式更能体现人性化服务及管理,满足患者及护士的需求,适应新的医学模式要求.     

连续排班模式在东莞地区某基层医院产科的应用

目的 探讨连续排班模式在东莞地区某基层医院产科的应用效果.方法 2008年1月起根据医院产科的工作特点,在护理人员人数不变的条件下,采用连续排班模式,根据班次分成3组,即APN 3班,A班(8:00-16:00)7人,P班(16:00-22:00)3人、N班(22:00-8:00)2人,每班均有1名护理组长把关护理质量.结果 经过半年的排班模式改革实践后,进行患者及护士的满意度调查,2008年上半年患者满意度为97%.较2007年同期的90%明显提高;有94%的护士对APN连续排班模式感到满意,愿意选择此排班模式.结论 采用连续排班模式,增加了中午及晚夜班的护理人员数,解决了薄弱时间段人力及技术力量不足的问题.提高了薄弱时段急诊、突发事件的应急能力.同时对患者及护士均体现了人性化管理,减轻了护士长的工作压力,培养了科室的护理骨干.     

APN排班模式在外科优质护理中的应用

目的:探讨APN连续排班模式在外科护理中的应用效果。方法:我科自2010年1月实施APN排班,即A班工作时间为8∶00～15∶30,P班为15∶30～22∶30,N班为22∶30～8∶00,对比实施APN排班前后护理质量、护理人员心理状况及病人满意度。结果:实施APN排班后,在护理管理、消毒隔离、操作技术和护理技术考核等4个方面得分均高于实施前。APN阶段护理人员的焦虑程度更低;患者的总体满意度为93.33%,高于实施前的85.67%。结论:在外科护理中采取APN排班方法,能够保证护理工作的连续性和重要性,有效提高整体护理质量,同时各级护理人员工作职责明确,护士在工作中产生的问题能得到及时指导并纠正,有效地减少了护患纠纷,护士的工作状态和心理状况明显改善,提高病人对护理措施的满意度。     

责任制连续性APN排班模式在儿科中的应用

目的:探讨责任制连续性APN排班模式在儿科病房中的应用。方法:2010年3～9月科室实施的传统三班倒周期性排班,2010年10月～2011年5月实施责任制连续性APN排班模式,观察实施前后患者满意度、护理工作质量和护士满意度情况。结果:实施责任制连续性APN排班模式后,患者满意度、护理质量和护士满意度均明显优于传统排班模式(P<0.05)。结论:实施责任制连续性APN排班模式,有利于提高患者满意度、护理质量和护士满意度,值得临床推广。     

APN排班模式在优质护理服务示范病房中的应用

目的探讨实行APN连续排班模式对院内开展优质护理服务的影响。方法选取2010年4—10月的排班模式为对照组,2010年10月至2011年4月排班模式为观察组,对照组采用传统护理排班模式,观察组采用APN排班模式,比较两组每月护理工作质量、患者满意度、护士身心健康状况。结果实验组患者满意度为95．0％,高于对照组的75．0％,两组比较差异有统计学意义（Х^2=37．77,P〈0．05）;每月护理工作质量两组比较差异有统计学意义（P〈0．05）,APN连续排班模式下的护士身心健康状况均高于传统排班模式,两组比较差异有统计学意义（P〈0．05）。结论采用APN排班模式能明显提高医院护理工作质量、患者满意度、护士身心健康状况,有利于优质护理服务示范工程的开展。     

连续排班模式的实施与效果评价

目的探讨连续排班模式(又称APN连续排班)对临床护理质量及护理人员身心状况的影响。方法2008年3月起以普外科二区为试点实行APN连续排班模式,比较实施前及实施6个月后患者对护理工作的满意度、护士自评疲劳症状及实习护生对不同排班带教方式的意愿。结果实施APN排班模式6个月后,患者对护理工作的满意度由实施前的91.78%上升为实施后的97.11%(P0.01);护士自评疲劳症状改善,总分由实施前的(9.12±2.775)分下降至实施后的(7.15±1.461)分(P0.05);88%的实习护生倾向于选择APN排班的跟班不跟人的带教模式。结论APN排班更能合理利用和配置护理人力资源,满足患者、护士及实习护生的需求,适应新的医学模式要求。     

两种排班模式对儿科护士工作生活质量的影响

目的:探讨DN排班模式与APN排班模式对儿科护士工作生活质量的影响。方法:对儿科护士实施APN排班和DN排班,比较两种排班模式下Brooks护士工作生活质量量表(BQNW)得分。结果:DN排班模式儿科护士BQNW得分高于APN排班模式护士(P0.05)。结论:DN排班实现了连续性排班模式与护理层级管理的有机结合,优化病房护理人力资源管理,降低护士工作负担和风险,提高护士工作生活质量。     

夜班周班制对肿瘤放疗科优质护理的影响

目的 探讨夜班周班制在肿瘤放疗科开展优质护理服务中的实施效果.方法 按照APN排班,实行N班周班制,时间22:00～8:00,P班周班制,时间15:00～22:00,A班,时间为8:00～15:00.结果 经卡方方法的统计学检测,夜班周班制排班,护士容易接受,护理工作质量得到保证,患者满意度提高.结论 夜班周班制排班能充分利用护理人力资源,班次人员相对固定,有利于优质护理工作质量的提高.     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.