失效模式与效应分析法在神经内科ICU医院感染控制中的应用

目的探讨失效模式与效应分析法(failure mode and effects analysis,FMEA)在神经内科ICU医院感染控制中的应用,发现高风险因素,为院感防控提供参考依据。方法根据神经内科ICU临床实际情况,通过FMEA风险评估法对34项医院感染风险事件进行风险评估,按照"二八法则"筛选出风险优先级事件。结果根据每一项风险因素的平均RPN值进行风险排序,按照"二八法则"筛选出风险优先级前6位的事件分别是:本科室医护人员手卫生依从性不到位(平均RPN值=5.6)、导尿管日常维护不到位(平均RPN值=4.17)、多耐患者未有效执行接触隔离措施(平均RPN值=3.80)、物表清洁消毒未有效执行(平均RPN值=3.73)、未严格掌握留置导尿指征(平均RPN值=3.70)、未保持尿液引流系统的密闭性(平均RPN值=3.53)。结论FMEA风险评估法可以发现神经内科ICU医院感染防控中的薄弱环节,为精准化感控措施的制订提供依据。     

ICU护理人力资源配置对脓毒症休克集束化治疗完成率的影响

目的调查分析我国重症医学科不同护理人力资源配置对脓毒症休克集束化治疗完成率的影响。方法基于全国重症医学质量控制大数据平台,调查全国1 065家医院重症医学科护理人力配置情况,比较不同省份（自治区、直辖市）ICU护理人力配置状况下脓毒症休克3 h内和6 h内集束化治疗完成率。结果3 h内集束化治疗完成率79.0%,6 h内集束化治疗完成率69.5%。护床比在≤1.5:1、1.5:1～2.0:1、≥2.0:1情况下,脓毒症休克3 h内集束化治疗完成率分别为0.69、0.79、0.83,6h内集束化治疗完成率分别为0.45、0.70、0.75。结论ICU护床比影响脓毒症休克集束化治疗完成率。护床比增加,脓毒症休克集束化治疗完成率提高。建议适当提高重症医学科护理人力资源配比,以提高脓毒症休克患者救治质量。     

肝移植病人的ICU期观察及护理

目的：通过对8例肝移植、1例肝肾联合移植术后护理经验的总结,介绍肝移植病人的护理重点及方法;方法：隔离室准备、神经系统及生命体征监测、排斥反应监测、预防感染及心理护理;结果：肝移植术后早期（ICU）的护理至关重要,直接关系到近远期疗效和生存率;结论：新技术的开展要求高素质的护理人员和高质量的护理水平。     

The role of specialist nurses in delivering effective care in a tertiary sarcoma referral service

Musculoskeletal sarcomas are rare cancers with an incidence of less than 1% of all cancers. Management of these tumors requires multidisciplinary care comprising of numerous specialists. Critical decisions following collaborative discussion among treating specialists followed by timely communication and starting prompt treatment are vital in delivering care in such rare sarcomas. While musculoskeletal surgeons, radiologists, and clinical oncologists are well known, the role of specialist nurses has been less described. They form a vital pillar in any tertiary sarcoma service by assisting in collaborative care, having consultations in nurse-led clinics, offering psychological support, imparting details of treatment to patient and helping in palliative care. This narrative review focuses on the role of trained specialist nurses in a tertiary sarcoma service and gives insight into their vital role in delivering timely, coordinated, effective care.     

冠状动脉-肺动脉瘘1例手术护理体会

0　引言　冠状动脉 -肺动脉瘘是一种少见的先天性冠状动脉畸形 ,导致冠状动脉血液分流入肺动脉 .因“窃血现象”,导致心肌缺血 [1 ] ,引起心悸、乏力、心绞痛等症状 ,并可引起心肌梗死 .我科以冠心病心绞痛诊断收治 1例冠状动脉 -肺动脉瘘的患者 ,在冠脉造影中意外检出 ,经手术治疗痊愈出院 .1　对象和方法　患者男性 ,47岁 ,因间断心前区疼痛伴胸闷、乏力 2 a加重 2 mo为主诉入心脏内科 .经扩冠、营养心肌、抗凝等治疗 ,拟行经皮冠状动脉腔内成形术 (PTCA) ,术中造影显示冠状动脉 -肺动脉瘘 ,转入心脏外科行手术治疗 .术后恢复顺利 ,第 3…     

Stress among student nurses: is it practical or academic?

Summary

• ? Previous research into stress among student nurses has only concentrated on the practical aspects of nursing and has ignored stress caused by the academic side of training. In comparing Registered General Nurse (RGN) and Diploma of Higher Education in Nursing (Dip. HE Nursing) students using a modified nurses stress scale, the intensity of stress was investigated.
• ? It was hypothesized that there would be a difference in the total stress scores between the two pre-registration education courses as well as within the practical and academic elements.
• ? Dip. HE Nursing students were significantly more stressed than RGN students, but equally for practical and academic elements. RGN students were significantly more stressed on the practical elements. Factors analysis clearly identified two factors: (i) the practical elements, and (ii) the academic elements of nursing. A third factor was also identified and this was related to stress induced by issues concerning death and suffering in the patient.
• ? These results have implications for the development of the nurse education course (Dip. HE Nursing) which is still in its infancy.

     

外科加强医疗病区耐甲氧西林金黄色葡萄球菌感染的分析

通过分析我院外科加强医疗病区(SICU)感染耐甲氧西林金黄色葡萄球菌(MRSA)患者的资料,总结引起MRSA感染的危险因素。方法:回顾性调查1996年1月～1998年12月入SICU的1069例患者资料,按感染细菌分为MRSA组和非MRSA组,比较两组的发病率及病死率;比较两组患者在ICU住院时间、广谱抗生素应用、血清白蛋白含量的差异,计算各因素的优势比(OR)。结果:MRSA20例,非MRSA57例,MRSA感染患者病死率为非MRSA的1.9倍,P<0.05;MRSA感染相关因素有ICU住院时间(P=003,OR=252)、广谱抗生素的应用(P=004,OR=16.10)、低白蛋白血症(P=0.01,OR=234)。结论:MRSA感染病死率高,ICU住院时间长、应用广谱抗生素、低白蛋白血症是引起MRSA感染的危险因素。     

The impact of nurses' encounters with cancer on their attitudes towards the disease

Summary

• ? A study to develop understanding of nurses' knowledge, confidence and educational needs in relation to cancer care was undertaken.
• ? Data from this study on nurses' attitudes and the effect of professional encounters with cancer on such attitudes are presented.
• ? A cancer attitude scale was completed by 127 nurses, and 68 of the sample were interviewed in depth.
• ? Data presented reveal a pervasive negative attitude towards cancer amongst these nurses, and the important negative impact that professional encounters with cancer have on nurses' feelings about the disease.
• ? Data presented are taken from a larger study, which is reported elsewhere (Corner, 1990; Corner & Wilson-Barnett, 1992).

     

抗菌药使用中药物治疗错误的研究

目的：研究抗茵药使用中药物治疗错误（ME）的发生情况，探讨其防范重点。方法：药师深入中心ICU病房，通过调查病历、直接观察的方式发现抗茵药ME。结果：10个月研究期间共发现ME301次，其中可预防药物不良事件（ADE）19次（3．3％），潜在ADE94次（16．2％）。有潜在危害ME（可预防的ADE＋潜在ADE）中有生命威胁6次（5．3％），严重88次（77．9％），明显19次（16．8％）。结论：抗茵药使用中ME经常发生，其中约1／3有潜在危害且往往带来严重后果，应该采取措施防范ME、特别是有潜在危害ME的发生。     

Long-term survival following emergency abdominal aortic aneurysm repair

Survival following emergency surgery for ruptured abdominal aortic aneurysm remains poor and is in stark contrast to that for elective repair. We have carried out a 5-year retrospective observational study to determine the long-term (5-year) survival of patients following emergency surgery for ruptured abdominal aortic aneurysm at a district general hospital in East Anglia. A total of 99 patients presented to the operating theatre for emergency repair of ruptured abdominal aortic aneurysm in this 5-year study period. In-hospital mortality was 70% and was unchanged over the 5 years. Overall long-term survival in those patients discharged from hospital was good. The ICU cost per long-term survivor was calculated to be pound sterling 36750.