颅脑手术后颅内感染危险因素及用药途径的探讨

目的 探讨颅脑手术后颅内感染的危险因素及治疗方法.方法 对1 446例颅脑手术后48例发生颅内感染的患者进行了回顾性分析.结果 多种不同的危险因素与颅内感染的发生有关,在择期手术、其他部位手术、全麻手术相比较均有显著性差异(P均＜0.05).结论 急症、后颅凹手术、基础麻醉均为术后发生颅内感染的高危因素, 严格的无菌操作、开展微创手术、围术期使用有效抗生素、针对不同的危险因素采取相应的预防措施可减少术后颅内感染的发生,正确用药对治疗控制颅内感染效果较好.     

Incidence and risk factors of pneumonia acquired in intensive care units

Objective To estimate the incidence of pneumonia acquired in the intensive care unit (ICU), and to define risk factors for developing such an event.Design European prospective survey, in which all patients admitted to the participating ICU from January, 17 to 23, 1990, were followed until ICU discharge.Setting 107 general ICUs from 18 countries.Patients Of 1078 admitted to the ICUs, 996 patients without pneumonia at admission were studied.Measurements Pneumonia was diagnosed by the staff physician on the basis of clinical, radiological and microbiological criteria, secondly validated by an expert committee who reviewed all the forms and even recontacted ICU physicians. Crude incidence and time to occurrence of pneumonia were estimated, then both used as endpoints for prognosis analysis.Results 89 pneumoniae were observed: crude incidence was estimated at 8.9%, 7-day and 14-day pneumonia rates at 15.8% and 23.4%, respectively. The risk of developing pneumonia increased when either coma, trauma, respiratory support, Apache II >16 and/or impaired airway reflexes were present at ICU admission. To predict time to occurrence of pneumonia, only two variables remained significant: the presence of impaired airway reflexes at admission and the use of mechanical ventilation during ICU course.Conclusion The role of the injury to the respiratory system — with the subsequent need for respiratory support-appears central in determining the risk to acquire pneumonia in ICU. In the future, the predictive value of severity scores during ICU course should be otherwise assessed.     

应用多种统计学方法筛检3 148名中老年知识分子体检资料评价高血压危险因素的意义

目的 探讨高血压的危险因素. 方法 采用秩和检验、 Bayes判别分析、逐步回归分析与 Logistic回归分析 4种方法,利用 2001年包钢 3 148名知识分子的调查体检资料,对可能与高血压发生相关的 18项因素进行筛检. 结果 在 4种检验分析中年龄、高血压家族史、是否知道世界卫生组织建议的摄盐量、体质量指数具有极高的显著性(均有 P< 0.000 1);而腰臀比( P≤ 0.002 5);吸烟、酗酒均有显著意义.婚姻在秩和检验、 Bayes判别分析、逐步回归分析中有显著性( P≤ 0.011 4).心脑血管疾病知识、性别、高脂饮食在秩和检验、 Bayes判别分析中有显著意义,高盐饮食在 Bayes判别分析、逐步回归分析中有显著意义.饮酒指数只在秩和检验中有显著性. 结论 应用多种统计方法分析疾病的危险因素能比较全面合理地筛选出疾病的危险因素.     

Intensive care unit exposures for long-term outcomes research: development and description of exposures for 150 patients with acute lung injury

PURPOSE: Long-term follow-up studies in critical care have described survivors' outcomes, but provided less insight into the patient/disease characteristics and intensive care therapies ("exposures") associated with these outcomes. Such insights are essential for improving patients' long-term outcomes. This report describes the development of a strategy for comprehensively measuring relevant exposures for long-term outcomes research, and presents empiric results from its implementation. MATERIALS AND METHODS: A multistep, iterative process was used to develop the exposures strategy. First, a comprehensive list of potential exposures was generated and subsequently reduced based on feasibility, redundancy, and relevance criteria. Next, data abstraction methods were designed and tested. Finally, the strategy was implemented in 150 patients with acute lung injury with iterative refinement. RESULTS: The strategy resulted in the development of more than 60 unique exposures requiring less than 45 minutes per patient-day for data collection. Most exposures had minimal missing data and adequate reliability. These data revealed that evidence-based practices including lower tidal volume ventilation, spontaneous breathing trials, sedation interruption, adequate nutrition, and blood glucose of less than 6.1 mmol/L (110 mg/dL) occurred in only 23% to 50% of assessments. CONCLUSIONS: Using a multistep, iterative process, a comprehensive and feasible exposure measurement strategy for long-term outcomes research was successfully developed and implemented.     

Studying outcomes of intensive care unit survivors: the role of the cohort study

Background As research focuses on long-term patient outcomes and the real world effectiveness of intensive care unit (ICU) therapies, the cohort study is increasingly being used in critical care research.Methods Using examples of prior cohort studies in intensive care, we review the key elements of this research design and evaluate its advantages and limitations for critical care research. Furthermore, through a systematic search of the literature we summarize data from 70 prior published cohort studies of medium- and long-term outcomes in adult critical care medicine.Discussion This research demonstrates that the prospective cohort study is a powerful research design that has not been fully leveraged to assess relationships between exposures and long-term outcomes of ICU survivors.Conclusions We make recommendations for the design of future cohort studies to maximize the impact of this research in improving the long-term outcomes of critically ill patients.Electronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .An erratum to this article can be found at This research was supported by National Institutes of Health (ALI SCCOR Grant # P050 HL 73994-01). D.M.N. is supported by Clinician-Scientist Awards from the Canadian Institutes of Health Research and the University of Toronto, and a Detweiler Fellowship from the Royal College of Physicians and Surgeons of Canada.     

Methodological problems in comparing audits from the Nordic countries. A critical review of results from audit on Nordic general practitioners' management of patients with psychiatric problems

The language of risk has many meanings, and in this article we demonstrate a discrepancy between individually perceived risk and the medical understanding of risk as understood and communicated by general practitioners (GPs). Risk is experienced and interpreted by people in a cultural context, i.e. the same objective risk can be perceived in many different ways and given a different meaning in daily life. GPs' evaluation of risk is made on the basis of our epidemiological knowledge, the medical culture of risk perception and the GP's personal experience and interpretation. The theoretical focus in the article is a synthesis of two theories: patient-centred general practice and theory based in anthropology about risk as culturally and socially constructed. We use empirical data from a qualitative study to illuminate the discussion.     

风险评估管理在医疗器械消毒供应中心的应用

目的 探讨风险评估管理在医疗器械消毒供应中心的应用效果。 方法 选取2017年1-3月消毒供应中心采用传统消毒管理模式时抽取的300件器械作为对照组,将2017年4-6月实施风险分级管理模式时抽取的300件器械作为观察组,2组均启用专业质控员,采用目测法、放大镜法、ATP法检测灭菌合格率检测。比较2组医疗器械灭菌合格率。结果 观察组的灭菌合格率明显高于对照组(χ²=34.713,P＜0.001)。 结论 消毒供应中心对医疗器械采用风险评估管理,能明显提高医疗器械灭菌合格率,降低医疗感染的风险,值得推广。     

Comparing Three Head-Pointing Systems Using a Single Subject Design

The keyboard is the most commonly used input method for interfacing with computers. When using a keyboard is not possible, alternative computer input methods are needed. Three methods using head control are: Head Master by Prentke Romich, Free Wheel by Pointer Systems, and LROP by Words+.

The purpose of this study was to compare these three methods for speed and accuracy using a single subject design for nine individuals with disabilities. Visual inspection of the data revealed that subjects obtained higher scores when using Head Master and LROP than Free Wheel. As a follow-up test, an analysis of variance test for repeated measures showed no difference between using Head Master and LROP but did show a significant difference between Head Master and Free Wheel, and LROP and Free Wheel.     

实施风险管理提高护理安全与质量

通过运用风险管理理念实施风险管理,防范或减少护理缺陷的发生以保证护理安全与工作质量的持续改进。首先进行全员培训,强化意识,提高防范能力。定期分析可能引起护理安全风险的相关因素,制定防范措施。同时,建立安全管理的考核制度,提高系统的实效性,推动护理质量的控制与持续改进。     

英美加澳和中国台湾地区医疗风险管理方法与评估工具的比较研究

目的 比较英美加澳与中国台湾地区医疗风险管理方法与评估工具,为我国医疗风险管理提供决策依据和政策建议.方法 计算机检索英美加澳与我国台湾地区政府机构和行业协会或学术团体的官方网站,查找并纳入与医疗风险管理与监测相关的法律、规范性文件、研究报告、综述和评价表格等,而后采用描述性对比分析方法,综合比较上述四国一区医疗风险管理方法与评估工具.结果①共纳入17篇规范性文件,41篇指南,37篇综述和49篇一般信息,共计146篇文献;②英国采用整合风险管理,澳大利亚和台湾采用经典风险识别、分析、评估与控制方法,美国和加拿大采用前瞻性FMEA方法识别与评估临床风险;③在医疗风险评估分级方面,英、澳将医疗风险严重程度分为5级,台湾分为6级;发生频率均分为5级;应对响应均按4级标准.④四国一区RCA分事件对象略有不同,RCA步骤与工具基本一致.结论 英美加澳与我国台湾地区主要采取前瞻性风险评估、基于已发生不良事件的风险评估及整合风险管理三种医疗风险管理模式,且评估工具相同;英、澳和我国台湾地区临床医疗风险分级大致相同,但分级定义有差异;四国一区不良事件分析方法与过程基本一致.     

实施风险防范预案降低护理风险事件的效果评价

目的 降低风险事件发生率,提高护理质量及风险防范能力.方法 分析护理风险事件产生的原因,制定相关的风险防范预案,比较实施前后的效果.结果 2组在风险事件发生率、服务满意率以及夜班风险事件发生率上有统计学意义(P<0.05);在具体的风险事件类型方面,2组在治疗执行不当、医嘱处理不当、不规范护理记录发生率上有统计学意义(P<0.05);在护理投诉、意外事件发生率上无统计学意义(P>0.05).结论 实施风险防范预案能降低护理风险事件的发生率,提高护理质量及病人满意率.     

Medical doctors' perception of the "number needed to treat" (NNT)

The "number needed to treat" is assumed to be readily understood, but empirical evidence to support this assumption is sparse. 72% of medical doctors recommended a preventive drug therapy when NNT was 50 compared to 52% when NNT was 200. 77% of doctors recommending against a preventive drug therapy thought that only one out of NNT patients benefits from therapy. Since this assumption may be misleading, we suggest that the NNT should be used with caution in clinical practice. Objective &#114 - &#114 While the number needed to treat (NNT) is in widespread use, empirical evidence that doctors or patients interpret the NNT adequately is sparse. The aim of our study was to explore the influence of the NNT on medical doctors' recommendation for or against a life-long preventive drug therapy. Design &#114 - &#114 Cross-sectional study with randomisation to different scenarios. Setting &#114 - &#114 Postal questionnaire presenting a clinical scenario about a hypothetical drug as a strategy towards preventing premature death among healthy people with a known risk factor. Benefit after 5 years of treatment was presented in terms of NNT, which was set at 50 for half of the respondents and 200 for the other half. Subjects &#114 - &#114 Representative sample (n=1616) of Norwegian medical doctors. Main outcome measures &#114 - &#114 Proportion of doctors that would prescribe the drug. Reasons for recommending against the therapy. Results &#114 - &#114 With NNT set at 50, 71.6% (99% CI 66.8-76.4) of the doctors would prescribe the drug, while the proportion was 52.3% (99% CI 47.5-57.1) with an NNT of 200 ( &#104 2 =50.7, p<0.001). Multivariate logistic regression analysis indicated that the effect of NNT on the likelihood for recommending the therapy was age-dependent; young doctors (<36 of age) were more sensitive to the difference in NNTs than older doctors. Thirty-six percent (n=464) of the doctors would not prescribe the drug, and 77.4% (99% CI 68.5-86.2) of those agreed with an argument stating that only one out of NNT patients would benefit from the treatment. Conclusion &#114 - &#114 Medical doctors appear to be sensitive to the magnitude of the NNT in their clinical recommendations. However, many doctors believe that only one out of NNT patients benefits from therapy. Clinical recommendations based on this assumption may be misleading.     

住院患者静脉血栓栓塞症的风险评估:护理的价值

静脉血栓栓塞症(VTE)是住院患者常见的并发症之一,住院患者可能存在VTE高危因素。护理作为VTE防治的重要组成部分,护士应准确识别危险因素、及时正确进行VTE风险评估,采取恰当的预防措施对预防VTE意义重大。     

Classroom and Clinical Teaching in Nursing: Delineating Differences

Although ability to teach in the classroom is generally considered sufficient preparation for clinical teaching, the reality can be a surprisingly different multidimensional role. The author presents a list of 15 specific and significant differences that exist between the two teaching performances. The settings are compared using three components common to both: instructional, evaluative, and interpersonal interactions. Myths, misconceptions, and realities about the two teaching arenas are discussed. A conceptual relationship between the two instructional settings is presented. Recommendations are offered to reduce teacher anxiety, confusion, and frustration created by existing myths/misconceptions.     

呼吸内科猝死患者原因分析与护理

对呼吸内科2006～2009年38例猝死患者的原因进行回顾性分析,发现猝死原因主要有气道阻塞、用力大便、肺栓塞、重度电解质紊乱等.针对猝死原因,对2010年1月至2011年8月的患者进行全面的评估,同时与临床医生合作,采取护理干预措施和针对性管理,结果减少了猝死风险的发生率.     

护士主导的心血管疾病高危人群发病风险沟通策略研究进展

对国外心血管疾病高危人群发病风险沟通团队构成、护士主导的心血管疾病高危人群发病风险沟通策略及沟通流程进行综述,以期为护士开展心血管疾病高危人群发病风险沟通理论研究及实践工作等提供借鉴和参考.     

罗库溴铵不同维持给药方法的药效动力学比较

目的:观察不同的罗库溴铵维持给药方法的药效学特点,探讨最佳给药方式。方法:40 例ASAⅠ~Ⅱ级,无神经肌肉疾患病人随机分成罗库溴铵持续泵注组(Ⅰ组)和间断给药组(Ⅱ组),采用TOF刺激监测拇内收肌的收缩反应。应用静脉麻醉药诱导和维持,术毕不用拮抗剂。记录罗库溴铵起效时间、临床作用时间、术毕恢复时间和罗库溴铵的用量。结果:Ⅰ组平均泵注速率为(5.97±2.03)μg/(kg·min),Ⅱ组维持肌松追加用药间隔时间平均(30.2±16.2)min,即单位时间平均用量(5.43±2.17)μg/(kg·min),与Ⅰ组比较无明显差别。停药后,Ⅰ组恢复过程明显快于Ⅱ组(P<0.05)。结论:持续泵注罗库溴铵优于单次静脉给药。