手术室工作的护理创新

目的:将创新观念应用于手术室护理工作,以提高护理质量。方法从理念、管理、服务、机制等方面进行创新。结果提高了手术配合质量和病人的满意度。结论打破传统的手术室护理观念,将创新理念融入手术室的护理工作中。     

一级医院手术室护理质量管理

具有手术职能的社区卫生服务中心越来越普遍,那么手术室又是为患者进行手术诊断,治疗的重要科室,手术室护理工作质量好坏将影响着医疗质量和病人的安危。因此,为了保证手术室内有良好的工作秩序和高质量的工作效率,必须提高护理管理质量,必须有严密的护理管理知识,健全的制度和严格的无菌技术管理,使护理工作有序、高效地运转。手术室的管理包括护理人员管理、质量管理、手术室环境管理、消毒灭菌管理、急救物品管理、器械敷料管理等。     

预防手术室护理差错及纠纷

预防手术室护理差错及纠纷发生,实施手术室护理管理质量,既反映了手术室护士长的管理水平和工作能力,又使手术室的各项工作有章可循,依托在一个完整的质量管理体系中。严格执行各项规章制度从根本上预防护理差错和护理纠纷;尤其加强护理安全,手术室安全管理抓得好、要求严格、制度落实、措施有力、人员素质好、技术水平高,就可以确保安全无事故。因此应做到强化安全意识、完善管理制度、加强培训、提高护士素质;以患者为中心,提高服务意识,从思想上增强工作责任感、使命感。强化法律意识,避免手术室护理中被法律诉讼所涉及的法律相关问题。     

浅淡手术室的护理管理

手术室护理管理是医院护理管理的重要组成部分.手术室护理质量的高低,不仅取决于护理人员的素质和技术水平,而且取决于护理管理的效能.它主要对护理工作诸要素(人员、技术、财产、物资等等)进行科学的计划、组织、协调、控制,从而为手术病人提供优良的护理服务.现将我对手术室护理管理的一些粗浅认识和我们的具体做法概述如下:     

手术室的日常管理探究

总结近年来手术室护理工作中的一些管理方法和经验,促进手术室的工作更加人性化和规范化,以提高护理质量。手术室护士长不断地学习加强管理理念更新,认真做好手术室工作常态规范化管理,加强护理人员业务能力培训。护士能够熟练配合各科室医师开展的新技术新方法手术,全年无差错事故发生,手术进行顺利,收到表扬锦旗6面。无投诉,年度护理参赛获小组团体一等奖。手术室是抢救与治疗患者的重要场所,手术室护理管理直接关系到治疗的效果,重视手术室人员培训,加强工作中细节管理是工作质量和效率提高的关键,科室积极开展人性化专科服务增加了患者的满意度,加强手术室护理管理是手术成功的保障。     

手术室护理质量管理

手术室是对患者进行手术治疗以及担负抢救任务的重要科室。其护理质量的高低将直接影响医疗质量和患者的安危。因此,手术室必须有严格健全的规章制度和无菌技术管理,才能为患者提供优质、安全的护理服务。     

ISO9000族标准与手术室质量管理

为使手术室护理质量管理。技术管理．护理服务，尽快达到质量控制规范化、制度化，对ISO9000旗标准在手术室质量保证体系的应用进行研究。按标准要求建立了质量管理体系，文件设计，加强过程控制及持续质量改进，经过2年的探索与实践、收到了较为显著的临床效果．护理质量稳步上升。病人对护理工作满意度为96．39％。实践结果表明在手术室管理中推行1SO9000族标准是改进护理质量管理、促进质量管理向规范化、标准化、程序化先进化发展有效方法。     

围手术期人性化服务在手术室护理中的应用

目的探讨围手术期人性化服务在手术室护理中的应用效果。方法选取我院在2012年10月至2013年10月收治的146例实施手术治疗的患者作为研究对象,使用随机数字表,将其分为研究组和对照组(每组73例),对照组给予常规手术室护理,研究组在对照组基础上,给予人性化服务,比较两组患者的护理质量评分及满意度。结果研究组的护理质量总评分及各单项评分(手术室管理、护理安全、消毒隔离、护士素质),均显著高于对照组,P<0.05,差异均具有统计学意义;研究组患者的满意度为98.6%,对照组为80.8%,组间比较,差异具有统计学意义,P<0.05。结论手术室护理实施人性化服务,能有效提高手术室护理质量,提升患者满意度,具有重要的推广应用价值。     

优质护理服务理念在手术室护理管理中的运用效果评价

目的探讨优质护理服务在手术室护理管理中的应用效果。方法选择在本院接受手术治疗的192例患者,随机分为实验组和对照组,每组96例。对照组给予常规护理,实验组在常规护理基础上实施优质护理服务。最后分别比较对照组与实验组的手术室整体护理水平、护理人员的综合素质、手术医师及患者对优质护理服务满意度。结果实验组中总满意度为95.83%,远高于对照组的85.42%;其中实验组非常满意度的比例高达51.04%,而对照组仅为21.88%,两组满意度对比,差异具有统计学意义(P<0.05)。结论在手术室护理管理中实施优质护理服务取得较好的效果,不仅可提高手术室综合护理质量,同时还能达到较高的患者的满意度。     

应用6 sigma法建立手术室标准化护理常规的实施与成效

目的探讨6sigma质量管理理念与方法对规范手术室护理常规的成效,提高手术室护理质量的实施。方法运用6sigma的定义-测量-分析-改进-控制5个步骤管理模式对手术室标准化护理进行管理,并与实施六西格玛质量管理前进行比较。结果改进措施后护理质量高于改进措施前(P<0.05),差异有统计学意义;护士责任意识增强、医生的满意度提升,差异有统计学意义(P<0.05)。结论运用科学管理提高效率,减少失误,使手术室标准化护理的过程达到最优状态。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.