床边工作制护理模式在消化内科病房中的应用

目的探讨床边工作制护理模式在消化内科病房中的应用。方法采用配对的实验方法,将2009年8月～2010年7月住院的病人660设为对照组,2010年8月～2011年7月住院的病人660例设为观察组,对照组采用传统责任制护理模式,观察组采用床边工作制护理模式。比较两组病人护理质量各项指标评分、护理服务满意度、疾病知识知晓率情况。结果实行床边工作制护理模式后,临床护理工作质量各项指标评分、护理服务满意度、病人疾病知识知晓率均较传统责任制模式明显提高,组间比较,差异具有统计学意义(均P<0.01)。结论 床边工作制护理模式提高护理服务质量,融洽护患关系,提高病人服务满意度,值得推广应用。     

护理“大包干”责任制与护士床边工作制在血液病区的应用

目的探讨护理"大包干"责任制与护士床边工作制在血液病区中的应用。方法 2010年7月～2011年10月在血液病区实施护理"大包干"责任制与护士床边工作制,推行护士管床、管病人的工作制(病人设为观察组),并与2009年3月～2010年6月实施传统责任制整体护理(病人设为对照组)进行护理质量(包括护理措施落实、基础护理、危重病人护理)及满意度比较。结果实施护理"大包干"责任制与护士床边工作制后,护理质量及病人满意度明显提高,前后比较,均P<0.01,差异具有统计学意义。结论在血液病区实施护理"大包干"责任制与护士床边工作制,有利于为病人提供专业、全面、连续性的整体护理,提高护理质量和病人满意度。     

护士床边工作制在创建优质护理服务示范工程中的应用

目的探讨护士床边工作制在创建优质护理服务示范工程中的作用及不足之处。方法将2010年3—6月在乳甲外科住院治疗的150例患者分为实施护士床边工作制之前患者75例（对照组）和实施后患者75例（实验组）通过问卷方式对实施护士床边工作制前后住院患者护理服务满意度及护理质量满意度进行调查评价。结果实施后住院患者对护理服务满意度及护理质量满意度分别为93．3％和96．0％,较实施前80．0％的满意度有明显提高,两组比较差异有统计学意义（P〈n05）。结论护士床边工作制的实施,能够体现护理服务的科学化、专业化、规范化和精细化水平,保障患者安全和医疗护理质量,显著提高住院患者满意度,在创建优质护理服务示范工程中起到积极的推动作用。     

改进床边工作制护理模式在心内科的应用效果观察

目的：探讨床边工作制护理模式在心内科病房中的应用效果.方法：选择2012年8月～2013年1月在我院心内科东区住院的660例患者作为观察组,选择同期在本院心内科西区住院的660例患者作为对照组.对照组采用传统护理工作模式,观察组采用改进的床边工作制护理模式进行护理,比较两组患者护理服务满意度.结果：观察组患者对护理服务的满意度明显高于对照组.结论：改进床边工作制护理模式能明显提高患者对护理工作的满意度,有效促进护患关系的良性发展,值得推广应用.     

床边护理工作制在神经内科病房的实践及效果评价

目的探讨床边护理工作制在神经内科病房的实践及效果。方法将2009年5月～2010年4月实施传统分组护理工作制的病人1205例设为对照组,2010年5月～2011年4月实施床边护理工作制的病人1205例设为观察组。比较两种工作制病人对护理服务满意度、护士被点名表扬数、病人不良意见数、护理不良事件数、基础护理完成率及护理工作质量情况。结果实施床边护理工作制后病人对护理服务满意度、护士被点名表扬数、基础护理完成率、护理工作质量评分均明显优于传统分组护理工作制,而且护理不良事件发生数及病人不良意见数明显减少,组间比较,差异具有统计学意义(均P<0.05)。结论神经内科病房应用床边护理工作制,能夯实基础护理,提高护理服务质量及病人对护理工作的满意度。     

妇科开展床边工作制护理73例效果观察

目的:探讨在妇科开展床边工作制的方法及效果。方法:将146例因各种妇科疾病需择期行手术患者随机分为观察组和对照组各73例,对照组采用常规护理,观察组采用床边工作制的护理,比较两组患者护理后的住院时间、患者满意度及并发症率。结果:观察组住院时间显短于对照组(P<0.05);观察组护理质量的满意度(97.8%)显著高于对照组(89.0%)(P<0.05);观察组并发症的发生率(13.7%)显著低于对照组(28.8)(P<0.05)。结论:床边工作制护理有利于提高护理质量和患者满意度,缩短住院时间,降低并发症的发生率。     

责任包干工作制在静脉输液护理质量管理中的应用

目的:探讨责任包干工作制在静脉输液护理质量管理中的应用效果.方法:选取2010年10～12月神经内科住院需要静脉输液治疗患者50例为对照组,采用常规静脉输液护理;选取2011年1～3月同类患者50例为实验组,实施责任包干工作制静脉输液,观察、比较两组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度情况.结果:实验组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度均优于对照组(P＜0.01).结论:静脉输液实施责任包干工作制应用效果显著,可有效提高工作效率和护理质量,从而提高患者满意度.     

大包干责任制和床边工作制在临床护理工作中的应用

目的 探讨大包干责任制和床边工作制在临床护理工作中的应用效果.方法 于2010年7月开始在全院各临床科室推行护士管床、管患者的"大包干责任制",将护士站前移,建立治疗、护理、记录为一体的多功能护理车为流动护理工作站,实行护士床边工作制.比较实施前后基础护理质量指标及护理服务满意度.结果 实施后基础护理质量指标各种不良事...     

床边工作制在提高普外科手术患者围术期综合生活质量及满意度中的应用

目的:探讨床边工作制在提高普外科手术患者围术期综合生活质量及满意度中的应用效果。方法:选取2013年1月~2014年2月普外科手术患者120例,将其随机等分为对照组和观察组,对照组采用常规护理,观察组采用床边工作制,比较两组患者干预前和干预后1,2周的WHOQOL-100量表评分、Zung量表评估结果和对护理各个方面的满意度。结果:观察组患者干预后1,2周WHOQOL-100量表、Zung量表评估结果、对护理各个方面的满意度均优于对照组(P0.05)。结论:床边工作制在改善普外科手术患者围术期综合生活质量中发挥着积极的作用,且可显著提升患者的护理满意度。     

优质护理服务中床边工作制对患者满意度的影响

目的:探讨床边工作制对患者满意度的影响。方法:在我院12个病房中选出2010年日均住院患者20例以上的病房8个,再随机抽选神经外科、骨外科、心内科、妇科4个病房作为实验组,实行床边工作制,其余4个病房为对照组,实施原有的小组负责制的层级护理模式。实施6个月后,对在院住院3 d及以上患者进行满意度调查,将实验组实施床边工作制前后的患者满意度进行比较,并对两组患者对护理服务满意度进行同期比较分析。结果:实施6个月后,实验组患者对护理服务的总体满意度由实施前的82.06%提高到95.22%,明显高于对照组的83.30%(P<0.05)。结论:实行床边工作制有利于提高患者满意度。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.