Observing pain management practice on a medical unit following changes arising from an action research study

Aim. To describe pain assessment practice within a medical unit, to identify factors that may affect the assessment of pain and evaluate changes in practice. Background. Pain is a problem for patients in all areas of a hospital, but its assessment and management on medical units had not been investigated. An initial assessment of practice found that pain was not consistently assessed and managed on the unit. A variety of activities have been employed during an action research study to change pain management practice. Method. Naturalistic unstructured participant observation of nurses and structured patient interviews were conducted. Results. The need to communicate with many people led to interruptions, multi‐tasking and practical problems were observed which appeared to affect the provision of nursing care, in particular, the administration of medications. These factors also prevented a comprehensive assessment of pain, although the assessment of pain intensity appeared to have increased. Discussion. The constant activity and interruptions observed may make it difficult for patients to discuss their experience of pain in detail. These accepted, every day and taken‐for‐granted aspects of nursing observed appeared to reduce opportunities for comprehensive pain assessment. Conclusion. Pain assessment is one of a number of nursing activities, obtaining a pain score appears to have become routine practice. Nursing takes place in a complex environment, which may disrupt the provision of nursing care and impede communication. Relevance to practice. To increase nurses awareness of the complexity of every day practice, the numerous tasks required, interruptions to the provision of care and the resultant effect on pain assessment and management. They need to then identify and reflect on these factors prior to attempting to change their practice.     

心血管内科医护人员焦虑状况调查分析

目的探讨心血管内科医护人员的焦虑状况。方法采用焦虑自评量表(self-rating anxiety scale,SAS)对98名心血管内科医护人员进行问卷调查,并与国内常模比较。了解心血管内科医护人员焦虑状况。结果非焦虑者35名,占35.7%,焦虑者63名,占64.3%;心血管内科医护人员焦虑水平明显高于国内常模(P<0.05);心血管内科护士焦虑水平明显高于医生(P<0.05)。结论心血管医务人员心理健康状况与医疗职业特点密切相关,医护人员焦虑水平明显高于国内常模,护士焦虑水平明显高于医生,应切实提高其心理应对能力。     

Postoperative Heart Block in Children with Common Forms of Congenital Heart Disease: Results from the KID Database

Postoperative Heart Block in Congenital Heart Disease. Introduction: Cardiac conduction system injury is a cause of postoperative cardiac morbidity following repair of congenital heart disease (CHD). The national occurrence of postoperative complete heart block (CHB) following surgical repair of CHD is unknown. We sought to describe the occurrence of and costs related to postoperative CHB following surgical repair of common forms of CHD using a large national database. Methods and Results: Retrospective, observational analysis performed over a 10‐year period (2000–2009) using the Kids’ Inpatient Database (KID). Visits for patients ≤24 months of age were identified who underwent surgical repair of ventricular septal defects (VSD), atrioventricular canal defects (AVC), and tetralogy of Fallot (TOF). Patients were identified who were diagnosed with postoperative CHB, further identifying those requiring a new pacemaker placement during the same hospitalization. Costs associated with visits were calculated. There were 16,105 surgical visits: 7,146 VSD, 3,480 AVC, and 5,480 TOF. There was a decrease in postoperative mortality (P = 0.0001) with no significant change in postoperative CHB. Hospital stay and cost were higher with CHB and placement of a permanent pacemaker. Repair of AVC (OR 1.77; [1.32–2.38]) was associated with a higher rate of postoperative CHB. Length of hospital stay and total cost were significantly increased with the development of postoperative CHB and increased further with placement of a permanent pacemaker. Conclusion: There has been little change over time in the frequency of postoperative CHB in patients undergoing repair of VSD, AVC, and TOF. Postoperative CHB results in major added cost to the healthcare system. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1349‐1354, December 2012)     

医护人员暴发肺炎衣原体肺炎12例临床特征分析

目的总结肺炎衣原体(CP)肺炎暴发流行的临床特征及治疗方法。方法收集2009-01-04—2009-03-01中国医科大学附属第四医院暴发流行的12例医护人员CP肺炎咽试纸标本,应用聚合酶联反应(PCR)检测DNA,使用微量免疫荧光技术检测CP的IgG和IgM抗体,同时对肺高分辨CT结果进行分析,并评价疗效。结果本组暴发流行的CP肺炎其病原学介于CP与鹦鹉热衣原体之间的一种变异的衣原体种,且更倾向于鹦鹉热衣原体。临床表现为乏力10例,周身酸痛10例,发热6例,咳嗽、咳少量白痰2例,心悸、气短2例,皮疹1例,稀水样便1例,12例均无咯血、胸痛、呼吸困难及精神症状,肺部体征均为阴性。所有患者肺部高分辨CT均有改变,表现为多发或单发以小叶为中心阴影和腺泡状结节影3例,病变可发生在两肺各个叶段,多以外、中带分布;以小叶分布的气腔实变和磨玻璃样阴影分别为4例和1例,伴有支气管血管束增厚3例;球形影1例;结节影与实变影混合存在3例。结论医护人员CP肺炎的暴发流行具有群体发病,早期高分辨CT检查更能真实地反映病变大小、多少和分布范围。对氟喹诺酮类联合大环内酯类药物治疗有效。诊断时应与严重急性呼吸综合征、禽流感、支原体肺炎等进行鉴别。     

加强妇产科住院医师医学人文观培养

<正>住院医师规范化培训是医学生毕业后医学教育的重要组成部分,现在更成为国家层面调控的重大项目之一,但必须承认的是,无论是在培训内容、培训方式还是考核内容等方面,对住院医师医学人文观念的培养仍有很大欠缺~([1-2])。而妇产科又由于其本身的特殊性,对医师的人文素养要求更高。     

Evaluating the Health Information Technology Regional Extension Center in South Carolina

ObjectiveTo determine the impact of the South Carolina Regional Extension Center, Center for Information Technology Implementation Assistance (CITIA-SC), on physician practices engaged in the process of electronic medical record (EMR) adoption.Data sourcesData from a cross-sectional survey distributed in March 2011 to 1310 primary care practice groups throughout South Carolina was used to determine the degree of EMR adoption throughout the state (n=452 respondents; 34.5% response rate). Participation in CITIA-SC was determined by obtaining a list of practices from CITIA-SC.Study designA posttest-only design with nonequivalent groups was used to estimate the degree of EMR implementation, plans for and perceived barriers to implementation based on CITIA-SC participation.ResultsCITIA-SC practice sites faced similar barriers to EMR implementation as non-CITIA-SC participants, including initial or recurring cost of an EMR, low staff expertise with EMRs or computers, and productivity disruption. Additionally, CITIA-SC practice sites had fewer IT personnel on staff (p=0.0358) and were considering EMR implementation without a plan (p=0.0125). Despite these barriers, more practices participating in the CITIA-SC program were preparing to invest in an EMR system within one year when compared to nonparticipants (75.9% versus 28.3%, p<0.0001).ConclusionOur results indicated that the practice sites that participate in the REC had fewer IT resources and more perceived barriers to implementation. These results suggest that REC participant practice sites intend to implement an EMR, but recognize the need for technical assistance in the preparation and implementation of an EMR system.     

Ultrasound quality assurance and equipment governance

A case is presented to show the importance of good governance of ultrasound medical imaging equipment. Issues relating to the large numbers and diverse range of users and equipment are identified. Based on experience gained over 25 years, supporting upwards of 1000 systems, discussions consider why and how the testing of ultrasound systems should be approached by both the medical physics expert and end user. The management of the process is presented in the context of professional guidance and monitoring organisations’ standards are considered to give a suggested best practice.     

从中美电子病历标准的比较看中国电子病历标准的发展和完善

在借鉴美国电子病历标准基础上,对中美电子病历标准化的发展历史、现状和内容等进行分析比较,找出我国电子病历标准化存在的问题和解决方案,使我国的电子病历标准建设更加健康和规范。