护理干预对首发精神分裂症病人生活质量的影响

目的探讨护理干预对首发精神分裂症病人生活质量的影响。方法将80例首发精神分裂症病人随机分为研究组和对照组各40例，两组均予以利培酮系统治疗，研究组在此基础上，予以综合性护理干预措施，时间为8同，随后进行为期半年的随访，采用阴性症状与阳性症状量表（PANSS）及生活质量综合评定问卷（GQOLI）分别于治疗前及随访结束时进行评估。结果随访结束时，两组病人的PANSS总分及阴性、阳性症状评分均较治疗前明显降低（P〈0．01）．但研究组明显优于对照组（P〈0．01）；并且研究组GQOLI评分显著高于对照组（P〈0．01）。结论护理干预有助于改善首发精神分裂症病人的精神症状，提高其生活质量。     

脊柱侧弯后路矫形内固定术的配合与护理

目的探讨脊柱侧弯后路矫形内固定术的配合及护理方法。方法对10例青少年患者行脊柱侧弯后路矫形内固定术,配合医生手术并严密观察病情变化。结果所有患者手术过程顺利,无一例脑脊液漏,脊髓损伤及切口感染等术后并发症发生,术后随访两年脊柱侧弯畸形均得到了明显矫正。结论手术护士熟悉手术步骤,全面掌握各种仪器及器械操作是手术配合成功的关键。完善的术前准备及密切的术中观察是减少脊柱侧弯病人术中并发症的重要因素。     

总责任护士主导的医护一体化护理模式在创伤骨科的应用

目的探讨总责任护士主导的医护一体化临床护理模式在创伤骨科的应用效果。 方法选择2016年7月至2017年6月在南京大学医学院附属鼓楼医院创伤骨科行手术治疗的骨折患者200例，按照入院先后顺序分为对照组90例(实施创伤骨科常规护理)和观察组110例(实施医护一体化工作模式，包括成立医护合作小组、实施总责任护士主导的医护一体化查房、个体化诊疗方案的共同决策、疼痛管理、早期出院计划与延续护理)。比较2组患者的术后护理效果和医护合作满意度。对数据行t检验和χ²检验。 结果总责任护士主导的医护一体化模式下，观察组患者术后72 h内数字评分法(NRS)评分为(4.09±1.64)分，疼痛干预有效率为77.57%，对照组术后72 h内NRS评分为(5.15±1.69)分，疼痛干预有效率为57.95%，2组比较差异均有统计学意义(P值均小于0.05)；观察组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为2、1、3，对照组下肢深静脉血栓、泌尿系统感染、便秘的发生例数分别为9、7、11，两组比较差异均有统计学意义(χ²＝4.486、4.296、6.812，P＝0.027、0.036、0.009)。观察组术后康复开始时间为(21.48±6.41)h，术后住院时间为(11.08±2.19)d；对照组术后康复开始时间为(36.48±10.75)h，术后住院时间为(13.95±2.93)d，2组比较差异均有统计学意义(t＝11.670、－7.616，P值均小于0.05)。2组医护合作满意度结果显示，观察组患者信息的交流得分为(3.78±0.85)分，共同参与治疗或护理决策得分为(3.86±0.87)分，医师和护士的关系得分为(4.00±0.84)分，总分为(3.87±0.67)分；对照组患者信息的交流得分为(3.32±1.00)分，共同参与治疗或护理决策得分为(3.23±0.93)分，医师和护士的关系得分为(3.45±0.96)分，总分为(3.33±0.84)分，2组比较差异均有统计学意义(P值均小于0.05)。 结论总责任护士主导的医护一体化护理模式的应用，以亚专科为核心，重新整合医护资源，共同参与制订患者的诊疗护理方案，共同聚焦患者安全与质量，加强了医护间的配合，提高了医疗护理服务质量，提升医护合作满意度。     

Estimating relative physical workload using heart rate monitoring: a validation by whole-body indirect calorimetry

Measuring physical workload in occupational medicine is fundamental for risk prevention. An indirect measurement of total and relative energy expenditure (EE) from heart rate (HR) is widely used but it has never been validated. The aim of this study was to validate this HR-estimated energy expenditure (HREEE) method against whole-body indirect calorimetry. Twenty-four-hour HR and EE values were recorded continuously in a calorimetric chambers for 52 adult males and females (19–65 years). An 8-h working period was retained, comprising several exercise sessions on a cycloergometer at intensities up to 65% of the peak rate of oxygen uptake. HREEE was calculated with reference to cardiac reserve. A corrected HREEE (CHREEE) was also calculated with a modification to the lowest value of cardiac reserve. Both values were further compared to established methods: the flex-HR method, and the use of a 3rd order polynomial relationship to estimate total and relative EE. No significant difference was found in total EE when measured in a calorimetric chamber or estimated from CHREEE for the working period. A perfect linear and identity relationship was found between CHREEE and energy reserve values for intensities ranging from 15% to 65%. Relative physical workload can be accurately assessed from HR recordings when expressed in CHREEE between 15% to 65%, and EE can be accurately estimated using the CHREEE method.     

A European perspective on intravascular catheter-related infections: report on the microbiology workload, aetiology and antimicrobial susceptibility (ESGNI-005 Study)

The laboratory workload, microbiological techniques and aetiology of catheter-related infections in European hospitals are mostly unknown. The present study (ESGNI-005) comprised a 1-day (22 October 2001), laboratory-based, point-prevalence survey based on a questionnaire completed by microbiology laboratories in European (European Union (EU) and non-EU) hospitals. Also included were questions requesting retrospective information for the year 2000. In total, 151 hospitals from 26 European countries participated, of which 78.1% were teaching institutions. Overall, the estimated population served by these institutions was 121,363,800, and the estimated number of admissions during 2000 was 6,712,050. The total number of catheter tips processed during 2000 was 142,727, or 21/1,000 admissions, of which 23.7% were considered to be positive in the institutions using semiquantitative or quantitative techniques. Overall, EU centres received significantly more catheter tip samples/1,000 admissions and had a significantly higher rate of 'positivity' (p < 0.0001) than non-EU centres. Of the institutions surveyed, 11.4% (7.2% in EU countries and 23.7% in non-EU countries; p 0.04) used only qualitative techniques for catheter tip sample processing. On the day of the study, 167 microorganisms were recovered from significant catheter tip cultures (122 patients), of which Gram-positive bacteria represented 70.7%, Gram-negative bacteria 22.2%, and yeasts 7.2%. The five most common microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, Candida spp., Enterococcus spp. and Pseudomonas spp. Overall, 19% of catheter tip cultures were polymicrobial. In the case of S. aureus, 40% of isolates were resistant to oxacillin, as were 63.4% of coagulase-negative staphylococcus isolates. Of 37 Gram-negative isolates, 35% were resistant to cefotaxime, 31% to ceftazidime, and 27% to ciprofloxacin. Imipenem and cefepime had the lowest reported rates of resistance (11%).     

以工时为核心的护士绩效考核实践

以护理工时为基础,建立以工时核算为核心的老年科护士绩效考核方案,并与医院信息系统相关联。改革后,护士工作效率提高,护理质量提升,护士满意度增加。认为工时绩效考核方案具有一定科学性和合理性,能够充分体现护理人员劳动价值,促进团队协作,提升护理质量。     

基于信息化的急诊患者早期分级预警方案效果分析

基于早期预警评分系统,构建了急诊患者早期分级预警方案,并借助信息化手段,将方案嵌入急诊护理信息系统中,设置了颜色分级提醒功能,实现了分级预警闭环管理。实施后,急诊患者生命体征监测频次增加,抢救成功率提高,护理不良事件发生率降低。认为基于信息化的急诊患者早期分级预警方案提高了急救质量,保障了患者安全,但需在医护协作、护理人力分配、信息资源整合等方面持续改进。     

美国医保支付制度改革对我国康复护理服务的启示

梳理了美国医保支付制度改革进程,总结了捆绑支付模式内涵及其对康复护理服务的影响。结合我国国情,借鉴美国医保支付制度改革经验,认为我国应建立基于价值评价的康复护理服务医保支付制度,充分发挥医保基金的引导和保障作用,健全多元化的复合型医保支付体系,创建“以人民的健康为中心”的连续型医疗服务保障体系。     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。