护士岗位管理对危重患者及家属满意度和护理质量的影响

目的:探讨护士岗位管理对危重患者及家属满意度和护理质量的影响。方法:回顾性分析实施护士岗位管理前后危重患者、家属满意度及护理质量。结果:实施护士岗位管理后患者及家属满意度高于实施前(P0.05),护理质量优于实施前(P0.05)。结论:护士岗位管理可有效提高危重患者及家属满意度,提升护理质量。     

手术室护士岗位管理与绩效考核的实施与评价

目的:探讨手术室护士岗位管理与绩效考核的效果。方法:对手术室护士进行工作岗位类别、级别的设置,修订岗位说明书,岗位竞聘与护理工作的数量、质量、患者满意度、工作态度相挂钩的绩效考核体制,实施护士岗位管理与绩效考核并轨管理。结果:实施护士岗位管理与绩效考核后,医生对护士工作的满意度及护士对绩效考核的满意度均有明显提高。结论:手术室实施护士岗位管理与绩效考核,可有效地激发护理人员的工作积极性、提升护理质量。     

护理人员岗位管理在护理质量和满意度中的效果研究

目的：研究实施护理人员岗位管理在护理质量和满意度中的效果。方法介绍我院实施护士岗位管理的方法,对实施前（2011年）、实施第3年（2014年）的临床护理质量及患者对护理工作满意度进行对比分析。结果实施护理人员岗位管理3年后,临床护理质量和患者及护士对护理工作满意度明显优于实施前,差异有统计学意义（P<0.05）。结论实施护理人员岗位管理可以提高护理质量,提高患者和护士的满意度,在持续推动优质护理服务中发挥了积极有效的作用。     

以岗位绩效量化考核为切入点提升外科中医护理质量

目的 探讨在深化优质护理服务活动中实施护士岗位绩效量化考核,以提升外科中医护理质量的效果,方法 制定岗位绩效量化考核方案,在外科病区实施护士岗位绩效量化考核,对实施前后患者、护士的满意度以及中医护理质量质控成绩进行比较.结果 实施护士岗位绩效量化考核后,患者、护士的满意度及中医护理质量均显著提高(P＜0.01).结论 实施护士岗位绩效量化考核,可提高护士工作的积极性,全面提升中医护理质量,推动优质护理服务的深入开展.     

冠心病监护室实施专职夜班排班方式对患者满意度的影响

目的探讨冠心病监护室实施专职夜班排班方式对患者满意度的影响。方法 16名护士专职夜班,除主班、辅助班、心电监护班外其余10名护士专职白班,每1~2个月轮换。结果患者责任护士和优质护理知晓率(P0.01)以及患者满意度均提高(P0.05);护士对排班模式的满意度提高(P0.05)。结论实施专职夜班排班方式落实了责任制护理,改善了护患关系,提高了患者满意度和护士满意度。     

护理岗位管理绩效考核与分配在普外科的应用效果

目的建立护理岗位管理绩效考核与分配方案,探索该方案对改善护士薪酬分配体验、提高护士满意度和患者满意度的效果。方法基于护理岗位管理所要求的"多劳多得、优劳优得、效率优先、优绩优酬"的分配原则,根据护士层级、岗位、班次和工作量,结合工作服务质量评价进行护士绩效分配,比较实施前后护士工作满意度和患者满意度的差异,评价实施绩效考核与分配改革的效果。结果普外科通过实施护理岗位管理绩效考核与分配方案,护士的满意度、科室护理质量和患者满意度均有明显的提高(P0.01或P0.05)。结论通过实施护理岗位管理绩效考核与分配方案,改善了普外科护士薪酬分配比例,调动了护士积极性,提高了护士和患者满意度,提升了护理质量。     

三级甲等医院护士岗位管理实施效果评价研究

目的 :探讨护士岗位管理的实施效果,为岗位管理的进一步推行提供实证依据。方法 :选取陕西区域护士岗位管理试点与非试点共6所三级医院,分为对照组和干预组,干预组实施护士岗位管理,对照组采用原管理方法,采用已构建的护理质量、患者评价、护士评价、医生评价、住院服务利用5个维度的评价指标体系对护士岗位管理实施效果进行问卷调查,并分析干预效果。结果 :干预后1年干预组得分高于对照组,差异均有统计学意义(P0.05);采用倍差法从医生、护士、护理质量及住院服务利用4个方面总体评价,结果显示护士岗位管理实施效果显著。结论 :实施护士岗位管理,有利于提高医生、护士对护理岗位的认可度,提高患者对护理工作的满意度,提高护理质量和住院服务利用。     

护士岗位层级管理在心内科的临床实践

目的:探讨护士岗位层级管理在心内科的临床实践情况以及效果.方法:随机选取我科2014年10月-2015年10月期间心内科的护士20名,对其进行护士岗位层级管理,在实施的过程中记录并观察护士岗位层级管理实施前后医生、护士以及患者对心内科护理工作的满意度和护理质量.结果:心内科在实施护士岗位层级管理一年后,医生满意度由之前的89.23％提高到了96.36％,患者满意度由原来的90.51％增加到了98.87％,护理的质量评分也从88.89％提高到了97.21％.(P＜0.05).结论:对心内科的护士实施岗位层级管理,特有助于提高心内科护士的工作责任感和积极性,同时也提高了护理的质量,患者的满意度,最终促进了科室的优质护理工作的深入开展.     

值班护士长夜查房制度的改革与运行效果

目的 探讨护士长夜查房改革实施方法。结果 通过实践,提高护士长管理能力、危重患者的护理质量及夜间护理工作质量,使护士满意度、患者满意度得到提升。 结论 实施护士长夜查房改革后加强了夜班护理质量薄弱环节的管理,提高夜间护理质量,促进了护理工作的顺利开展。     

护士岗位管理的探索与实践

目的:探讨提升护理科学管理水平、调动护士积极性、稳定和发展临床护士队伍的有效管理方法。方法:护士岗位管理主要从以下几个方面进行管理:成立专项管理小组;收集数据,认真调研,做好岗位设置与分析;建立标准,拟定方案;完善绩效考核制度;宣传、转变观念,统一认识、推动顺利实施;深入了解、阶段总结、不断完善。将我院于2013年实施护士岗位管理与2012年未实施护士岗位管理的情况进行比较。结果:实施护士岗位管理后护士工作满意度、护士离职率,患者对护士满意度以及医师对护士工作满意度明显优于实施前,差异具有统计学意义,P0.05。结论:实施护士岗位管理是当前护理发展的重要任务,是提升护士工作满意度的有效途径。     

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.