PDCA 模式在烧伤整形科护理质量管理中的作用分析

目的 探讨烧伤整形科护理质量管理中PDCA模式的作用。方法 选择2020年11月-2022年7月我院收治的32例烧伤整形科患者为研究对象,采用随机数字表法分为对照组和观察组,每组16例。对照组行常规护理管理,观察组行PDCA模式护理管理,比较两组护理质量、患者满意度及并发症发生情况。结果 观察组护理质量各项评分高于对照组,差异有统计学意义（P＜0.05）;观察组患者满意度高于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率低于对照组,差异有统计学意义（P＜0.05）。结论 在烧伤整形科患者护理质量管理中应用PDCA模式,一方面能减少并发症发生,另一方面还可提升护理质量,且患者对整形美观的满意度较高,具有较好的临床应用价值。     

浅析我国海上灾害医疗救援培训模式

注重平时性的灾害医疗救援训练有助于提高海上医疗救援水平。文中参照美国海上灾害医疗救援训练的先进做法,对我国海上医疗救援训练的主要现状进行深刻剖析,并对海上医疗救援培训模式提出新观点,为我国未来海上救援训练发展提供借鉴。     

剖宫产后再妊娠分娩方式的临床分析

目的：探讨剖宫产后再妊娠的分娩方式及安全性。方法将2010年8月～2013年8月收治的80例剖宫产后再妊娠孕妇,根据分娩方式,随机分为阴道分娩组与再次剖宫产组,对两组产妇的并发症进行分析。结果80例剖宫产后再妊娠孕妇,经阴道试产56例,试产成功40例,占71.4例,其余40例患者行再次剖宫产。再次剖腹产组产妇的产后出血量高于阴道分娩组,住院天数多于阴道分娩组,差异显著（ P＜0.05）;再次剖腹产组的产后产妇与新生儿并发症发生率显著高于阴道分娩组,差异有统计学意义（ P＜0.05）。结论剖宫产后再妊娠产妇选择分娩方式需要根据自身情况而定,在满足阴道分娩适应证情况下,采取阴道试产安全、有效,是一种可行性较高的分娩方式。     

高职护理专业工学结合教学模式的探讨

目的探讨高职护理专业工学结合实践模式的方法和效果．促进护理人才培养模式的教学改革和创新。方法将2006级656名护理大专生归为实验组,2005级758名护理大专生归为对照组。对照组运用传统培养模式。实验组运用工学结合的培养模式,即在第3学期和第4学期,分别安排2周和4周进入教学医院进行实习式见习。学习结束后．自制问卷对实验组护生和带教教师进行工学结合培养模式认知调查,对两组临床课程平均成绩和实习阶段综合素质进行评价比较。结果实验组89．2％护生肯定工学结合培养模式能够明确护士角色,87．7％护生肯定该模式可以激发学习兴趣,76．9％护生肯定其可以加深对理论知识的理解;97．1％教师肯定其突出了教学过程的实践性,94．3％教师肯定其有利于培养护生职业行为．92．8％教师肯定其有利于培养护生的临床观察能力;80．0％护生和97．1％教师肯定其提高教学效果;78．5％护生和95．7％教师肯定其提高了护生的人际沟通能力。实验组临床护理课程期末考试平均成绩显著高于对照组（均P〈0．01）,综合素质评价优良率显著高于对照组（P〈0．05,P〈0．01）。结论高职护理专业采用工学结合实践模式,提高了护生主动学习能力和人际沟通能力,提高了教学效果;加强了学院和医院的深度合作．促进了“双师型”教师队伍建设。     

老年冠心病并存衰弱患者运动康复的最佳证据总结

目的 系统检索、提取、汇总和分析老年冠心病并存衰弱患者运动康复管理的最佳证据,为冠心病并存衰弱老年患者运动决策和干预提供参考。方法 遵循“6S”证据金字塔模型,由上自下循序检索国内外相关重要数据库中关于老年冠心病并存衰弱患者运动干预的文献,包括指南、证据总结、临床决策、专家共识、系统评价。由2名研究者独立进行文献筛选和质量评价,根据主题提取和汇总相关证据。结果 共纳入16篇文献,包括6篇指南、4篇专家共识、1篇证据总结、4篇系统评价、1篇临床决策。汇总形成8个主题(多学科团队、运动评估、运动流程、运动强度、运动方式、运动频率与时间、运动安全、随访)共29条最佳证据。结论 医护人员应结合临床实际情况及具体需求,选择最佳证据用于老年冠心病并存衰弱患者运动康复的临床实践,以减缓或逆转衰弱,提升患者生存质量。     

静息态fMRI在无痴呆型血管性认知障碍基线脑活动变化中的初步研究

目的 利用基于低频振幅算法(ALFF)的静息功能磁共振成像(fMRI)技术探讨无痴呆型血管性认知障碍(VCIND)与正常老年人静息状态下默认网络的改变情况.方法 将22例VCIND患者作为研究对象,23名正常老年人作为对照组,采用ALFF分析方法,比较两组平均脑ALFF图的差异.结果 VCIND患者在静息状态下较对照组在以下脑区ALFF值增高:左额下回/左颞上回(Maximum Z=-4.0682)、右额下回/右颞上回(Maximum Z=-3.9720)、左侧岛叶(Maximum Z=-3.5773);VCIND组患者在以下脑区出现ALFF值减低:舌回/小脑后叶(Maximum Z =3.8921)、前扣带皮层(Maximum Z=3.8081)、右楔叶/右舌回(Maximum Z=4.8272)、后扣带回/楔前叶(Maximum Z=3.9741)(P＜0.05).结论 VCIND患者在静息状态下ALFF有显著改变,主要表现为语言中枢等认知区域的局部ALFF增强及默认网络等功能连接点的ALFF减低.     

运动方式对人体骨峰值的影响

为了探讨运动方式对人体骨健康的作用效果和机理,随机选取华南师范大学体育系和化学系171名在校男生作为研究对象,应用单光子吸收法（SPA）和标准体质测量法对其骨密度（BMD）和体质指标进行了检测。采用SPSS8.0软件包对数据进行分析处理。结果显示(1）短跑组、足球组、篮球组、武术组、中长跑组和体育人口组具有比对照组较高的骨密度值（BMD）,尤其是短跑组、武术组与对照组有高度显著性差异（P＜0.01）;(2）运动强度、运动史与骨密度值（BMD）呈正相关,而运动频率大于3次/周具有较佳的健骨效果;(3）肌力指标、肌力/身高指标与骨密度值（BMD）有显著正相关(r=0.661,r=0.623),而其它体质指标则不具有显著相关性。提示提高青年时期骨峰值、预防骨质疏松症的运动处方应为持之以恒地进行频率大于3次/周、每次运动时间不少于半小时的适宜于自身条件的高强度运动。     

Morbidity or mortality? Variations in trauma centres in the rescue of older injured patients

IntroductionPrior analysis demonstrates improved survival for older trauma patients (age > 64 years) treated at trauma centres that manage a higher proportion of geriatric patients. We hypothesised that ‘failure to rescue’ (death after a complication during an in-hospital stay) may be responsible for part of this variation. The objective of the study was to determine if trauma centre failure to rescue rates are associated with the proportion of older trauma seen.MethodsWe analysed data from high volume level 1 and 2 trauma centres participating in the National Trauma Data Bank, years 2007–2011. Centres were categorised by the proportion of older trauma patients seen. Logistic regression analyses were used to provide risk-adjusted rates for major complications (MC) and, separately, for mortality following a MC. Models were adjusted for patient demographics, comorbid conditions, mechanism and type of injury, presenting vital signs, injury severity, and multiple facility-level covariates. Risk-adjusted rates were plotted against the proportion of older trauma seen and trends determined.ResultsOf the 396,449 older patients at 293 trauma centres that met inclusion criteria, 30,761 (8%) suffered a MC. No difference was found in the risk-adjusted incidence of MC by proportion of older trauma seen. A MC was associated with 34% of all deaths. Of those that suffered a MC, 7413 (24%) died and 76% were successfully rescued. Centres treating higher proportions of older trauma were more successful at rescuing patients after a MC occurred. Patients seen at centres that treat >50% older trauma were 33% (OR = 0.67, 95% CI 0.47–0.96) less likely to die following a MC than in centres treating a low proportion (10%) of older trauma.ConclusionsCentres more experienced at managing geriatric trauma are more successful at rescuing older patients with serious complications. Processes of care at these centres need to be further examined and used to inform appropriate interventions.     

Failure to rescue in trauma: Coming to terms with the second term

IntroductionThe failure to rescue (FTR) rate is the probability of death after a major complication and was defined in elective surgical cohorts. In elective surgery, the precedence rate (proportion of deaths preceded by major complications) approaches 100%, but recent studies in trauma report rates of only 20–25%. We hypothesised that use of high quality data would result precedence rates in higher than those derived from national datasets, and we further sought to characterise the nature of those deaths not preceded by major complications.MethodsProspectively collected data from 2006 to 2010 from a single level I trauma centre were used. Patients age >16 years with AIS ≥2 who survived beyond the trauma bay were included. Complications, mortality, FTR, and precedence rates were calculated. Chart abstraction was performed for registry deaths without recorded complications to verify the absence of complications and determine the cause of death, after which outcomes were re-calculated.ResultsA total of 8004 patients were included (median age 41 (IQR 25–75), 71% male, 82% blunt, median ISS 10 (IQR 5–18)). Using registry data the precedence rate was 55%, with 132/293 (45%) deaths occurring without antecedent major complications. On chart abstraction, 11/132 (8%) patients recorded in the registry as having no complication prior to death were found to have major complications. Complication and FTR rates after chart abstraction were statistically significantly different than those derived from registry data alone (complications 16.5% vs. 16.3, FTR 12.3 vs.13, p = 0.001), but this difference was unlikely to be clinically meaningful. Patients dying without complications predominantly (87%) had neurologic causes of demise.ConclusionsUse of data with near-complete ascertainment of complications results in precedence rates much higher than those from national datasets. Patients dying without precedent complications at our centre largely succumbed to progression of neurologic injury. Attempts to use FTR to compare quality between centres should be limited to high quality data.Level of evidenceLevel III.Retrospective cohort studyOutcomes.     

机械通气治疗腹部外科术后急性呼吸衰竭的临床研究

目的探讨腹部外科术后发生急性呼吸衰竭的诱因及影响机械通气疗效的因素。方法回顾性分析91例患者腹部外科术后发生急性呼吸衰竭的基础疾病、诱因及机械通气治疗的效果。结果诱因包括术后发生肺部感染53例，严重腹腔感染或急性重症胰腺炎导致的急性呼吸窘迫综合征(ARDS) 38例。其中合并慢性阻塞性肺病(COPD)38例，重度营养不良32例，低钾血症14例。呼吸衰竭发生在术后(4.08±2.45)d，机械通气维持时间(21.66±21.42)d。死亡33例（36.3%），撤机成功58例（63.7%）。结论腹部外科术后发生急性呼吸衰竭时，应合理实施机械通气并调整撤机策略，避免机械通气依赖。及时处理原发病，有效控制腹腔感染，积极进行对症与支持治疗是影响机械通气成败的因素。