关于高年资护士的管理体会

目的 探讨高年资护士在护士分层级管理中的定位与策略,充分发挥高年资护士的重要作用.方法 通过实施连续性排班和护士的分层级管理,职称岗位竞聘和竞争上岗,明确高年资护士的岗位及职责.在护理查房、护理会诊等核心工作中,采用人性化管理的方法,合理安排高年资护士职责.结果 高年资护士竞争护理组长,开拓专业发展,体现了其专业价值,同时保证了护理工作质量.结论 对高年资护士的重新定位,实现了其护理价值.     

国内高年资护士职业发展的研究现状

高年资护士是传承和发展护理技术的中坚力量。本文通过对高年资护士的年龄定义范围、职业价值和发展意愿以及在临床一线的留任岗位、高年资护士职业发展中存在的问题及对策进行综述,为更有效地留住高年资护士在临床一线工作提供参考。     

护士的分层次管理对护理质量的提高

目的结合医院的实际情况，探讨护士在分层级管理中对护理质量的提高。方法通过科室内设护理组长和护士的分层级管理，职称岗位竟争上岗，对岗位责任进行分层次，明确了高年资护士的岗位及职责，在护理核心工作制度的落实和护理管理委员会及护理小组中发挥了重要的作用。结果高年资护士竟争护理组长，增强了责任感，专业能力和个人价值得到了认可，同时保证了护理工作质量提高。     

护士分层分组管理在优质服务示范病区护理管理中的应用

目的 探讨病房护士分层分组管理在优质服务示范病区护理管理中的应用及对护理质量、满意度的影响.方法 笔者所在科自2010年1月起开展并成立优质服务示范病区,采取护士分层分组管理,设立责任组长、责任护士和辅助护士三个层次,分组包片,以患者为中心,围绕患者需求为导向的分工方式,分为两个护理小组,组内每个护士分别负责4~8名患者的治疗和整体护理工作,并制定了责任组长、责任护士、辅助护士岗位职责.在责任组长的负责下,通过过程质控检查,现场强制改进,保证基础护理、专科护理以及心理护理工作落实到位.结果 通过分层分组管理,提高了护理工作质量和患者、医生对护理工作的满意度.结论 护士分层分组管理制度的实施,提高了护理人员的自身价值,加强了高年资护士对年轻护士的带教和支持作用,使护理资源得到合理应用,护理工作更贴近患者需求,从而减少了护理缺陷和医患纠纷,提高了护理工作质量和满意度.     

科室内护理组长在分层次管理中对护理质量的作用

目的结合医院的实际情况，探讨护士在分层级管理中对护理质量的作用。方法通过科室内设护理组长和护士的分层级管理，职称岗位竞争上岗，对岗位责任进行分层，明确了高年资护士的岗位及职责，在护理核心工作制度的落实和护理管理委员会及护理小组中发挥了重要的作用。结果高年资护士竞争护理组长，增强了责任感，专业能力和个人价值得到了认可。结论护士分层级管理对护理质量于很好的促进作用。     

基于胜任力的低年资护士岗位培训

目的探索胜任力的岗位管理在低年资护士培训中的应用,提升低年资护士对岗位胜任力的认识。方法科学设置岗位,根据护士的学历、职称、经验、技术水平和能力进行能级对应,确认低年资护士培训目标,落实低年资护士岗位胜任力。结果通过竞聘上岗,建立岗位责任制管理,明确岗位职责和培训目标,提升护士及患者满意度,差异有统计学意义(P0.05)。结论护士岗位管理胜任力的运用能增强低年资护士对岗位的认知,能显著提高低年资护士工作积极性,能增加护士主观能动性,并有效提高护理工作质量。     

低年资护士心理契约与工作满意度、离职倾向的相关性研究

目的:了解低年资护士心理契约、工作满意度、离职倾向之间的关系,提出有针对性的心理契约管理方案.方法:采用问卷调查法对362名低年资护士进行调查.结果:离职倾向处于中等水平,组织责任的感知和工作满意度呈偏低水平;组织规范责任、排班满意度对离职倾向最具预测力.结论:医院管理者应从组织责任履行的不足之处着手,侧重于低年资护士工作不满意的项目,满足其个体化需求,降低离职率.     

小组责任制护理工作模式的临床体会

目的探讨小组责任制护理工作模式的临床应用效果。方法改变传统的护理模式,实施小组责任制护理,牡丹江市红旗医院自2010年10月逐步推行小组责任制护理管理模式。将全科护士进行相应的分组,将每个病区分2～3个责任小组,每组由1名责任组长和4～5名护士构成,护理人员分为护理组长-责任护士-助理护士三个层级。护理组长负责本组护理质量的监督、检查和低年资护士的指导工作,从患者入院开始到住院期间的所有病情观察、护理计划的制定和实施均由责任护士完成。结果临床上应用小组责任制护理模式,可保证护理工作的安全和质量,合乎现代先进护理模式。结论经过实施小组责任制护理工作模式,增强了护士责任心和工作积极性,护士及病患的满意度均有所提高,整体护理质量亦得到提高。     

责任组长负责制排班模式在胸外科的应用效果分析

目的:探究责任组长负责制排班模式在胸外科临床护理的应用效果,改变护理模式,优化重组,提高护理人力的使用率,最大程度地满足患者需求,提高患者对护理的满意度。方法:自2013年1月起,在胸外科实施护理小组长负责制,实行护士长-责任组长-责任护士的垂直管理,使护理质量责任人由护士长扩展到责任组长和护士,细化分工,强化各岗位职责,问责到个人。对比传统排班模式及责任组长负责制两种模式的患者满意度、护理质量、护士工作压力。结果:实施责任组长负责制排班模式后患者对护理的满意度及护理质量有明显提高,护士工作压力较实施前降低,差异均有统计学意义(P0.05)。结论:实施责任组长负责制排班模式可提高患者对护理的满意度、提高护理质量、减轻护士工作压力。     

责任组长参加护理总值班督查对提高护理质量的作用

目的 了解责任组长参加护理总值班对护理质量的作用.方法 对责任组长参加护理总值班前后的护理工作和病人满意度比较.结果 责任组长参加护理总值班使护理疑难问题得到有效解决,病人对护理工作的满意度提高了.结论 责任组长参加护理总值班,在目前夜班年轻护士多的情况下,是提高护理管理效能,解决夜间技术指导欠缺,提高病人对护理工作满意度的方法.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.