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Elizabeth Bonham PhD RN PMHCNS BC 《Journal of child and adolescent psychiatric nursing》2009,22(3):169-169
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Robin E. Remsburg PhD APRN BC Margaret Richards MS RN Sharon Myers MS MSB RN Darlene Shoemaker MS RN-C Charlotte Radu BSN RN-C Laura Doane BSN RN Kathy Green BSN RN 《Geriatric nursing (New York, N.Y.)》2001,22(6):318-325
This article describes the development, implementation, and evaluation of a career ladder for certified nursing assistants in long-term care. A career ladder is an effective way to maximize the use of unlicensed workers without changing the skill mix (eg, no loss of licensed nursing positions) and allow the licensed nurse more time to perform higher-level clinical tasks, such as assessments, patient education, and documentation. Implementation of an unlicensed worker career ladder also can improve nursing assistant retention. 相似文献
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BC SHARMA RP SINGH YK CHAWLA KL NARASIMHAN KLN RAO SK MITRA JB DILAWARI 《Journal of gastroenterology and hepatology》1997,12(8):582-584
Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patients with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n= 47) showed significant reduction in SPP (pre-operative 43.56±7.9 vs postoperative 29.96±7.7 cm of saline), splenic size (6.5±2.8 vs 4.00±2.6 cm below costal margin) and varices grades (2.96±0.5 vs 0.92±0.8). Patients with blocked shunt (n= 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6±3.0 vs 6.3±4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3±13.5 vs 33.8±7.6 cm of saline), splenic size (9.1±3.3 vs 6.8±4.6 cm below costal margin) and varices grades (2.8±0.7 vs 1.05±0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency. 相似文献
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The objective of this study was to determine the impact of the learning
curve of one surgeon on the term delivery rate following laparoscopic
salpingostomy for tubal infertility. This was a retrospective audit of
ongoing clinical practice, undertaken in two tertiary level infertility
programmes. Subjects in this study were women undergoing surgery for total
occlusion of the distal Fallopian tube. The main outcome measure was
cumulative term delivery rates. On stepwise life-table analysis the length
of infertility, primary and secondary infertility, tubal diameter and
whether surgery was performed in the first or second half of the series
were significantly associated with outcome. These data suggest that there
is a learning curve in obtaining skills to perform laparoscopic
salpingostomy, that patient selection may improve with experience, and that
selection criteria should be emphasized during didactic teaching and the
preceptorship process.
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