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991.
Griffin-Heslin VL 《Accident and Emergency Nursing》2005,13(4):251-257
Dignity is a highly abstract, vague concept that is difficult to measure within the context of general nursing. Despite this, it is a central phenomenon to nursing and so it is crucial that health care workers have a clear depiction of dignity. This concept analysis uses the framework established by Walker and Avant [Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed., Appleton and Lange, Connecticut] in order to heighten knowledge and awareness of the concept dignity. This approach also ensures that the concept is not being used erroneously. Respect, autonomy, empowerment and communication have been identified within the literature as being the defining attributes of dignity. Within these, further attributes are defined, which explain the complex, ambiguous concept that it is. This concept analysis is important for areas where the maintenance of dignity may be unintentionally overlooked. This can be related to many Emergency Departments in various parts of the world, where patients are awaiting beds. This is prevalent and has been slowly worsening for more than a decade [Derlet, R.W., Richards, J.R., 2000. Overcrowding in the Nation's emergency departments: complex causes and disturbing effects. Annals of Emergency Medicine 35 (1), 63-68; Schneider, S., Zwemer, F., Doniger, A., Dick, R., Czapranski, T., Davis, E., 2001. Rochester, New York: A decade of emergency department overcrowding. Academic Emergency Medicine 8, 1044-1050; Nairn, S., 2003. The politics of beds. Accident and Emergency Nursing 11, 68-74]. Commonly patients are nursed in a corridor, which does not lend itself to upholding the dignity, privacy and confidentiality of those patients [Ball, J., Dixon, M., Dolan, B., Holt, L., Wilkinson, R., 2000. Why are we waiting? Emergency Nurse 8 (1), 173-180]. However, patients' dignity should be maintained at all times and health care workers need to recognise that they themselves need dignity in order to promote dignity in others. 相似文献
992.
周冉冉 《中外女性健康研究》2020,(2)
目的:分析急诊重症监护室机械通气患者清醒撤机时辅以集束化激励式心理干预的临床应用价值。方法:选取2018年1月至2019年1月我院重症监护室收治94例机械通气患者为研究对象,对照组单纯辅以常规护理干预,观察组辅以集束化激励式心理干预,比较护理效果。结果:观察组患者一次拔管成功率明显高于对照组,再插管率、病死率均明显低于对照组(P<0.05)。另外,观察组患者机械通气时间(4.21±1.14)d、住ICU病房时间(8.42±0.24)d均较对照组相比更短(P<0.05)。结论:重症ICU病房内机械通气患者清醒后撤机时辅以集束化激励式心理干预效果更佳,可提高一次拔管成功率,降低病死率。 相似文献
993.
Serhad Omercikoglu Erhan Altunbas Haldun Akoglu Ozge Onur Arzu Denizbasi 《The American journal of emergency medicine》2017,35(3):383-390
Introduction
Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.Methods
500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers.Results
488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5 mm, BDI 8.5 mm, C1 6.5 mm, C2 5.7 mm, C3 6.3 mm (6 mm for C1–3 for practical purposes), C4 11.7 and C5–7 17 mm.Discussion
We believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports. 相似文献994.
Chih-Chia Hsieh Ching-Chi Lee Hsiang-Chin Hsu Hsin-I Shih Chien-Hsin Lu Chih-Hao Lin 《The American journal of emergency medicine》2017,35(1):39-44
Background/Purpose
To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).Methods
This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively.Results
For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05).Conclusions
For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation. 相似文献995.
医院灾害应急准备的国内外文献分析 总被引:3,自引:2,他引:3
目的系统检索报告/介绍应对国内外重大灾害的医院应急准备相关文献并加以总结与分析,为我国医院建立应对突发事件的应急准备提供参考。方法系统检索MEDLINE(1950~2008.6)、CNKI(1980~2008.6)和相关网站,对符合纳入标准的文献的主要结果进行描述性分析。结果共纳入85篇文献,其研究类型以专家意见和现况调查居多,分别占43.53%和29.41%。应对突发事件的医院应急准备是一个减灾、准备、反应和恢复的动态过程。应急准备可考虑以下内容:短期内成批接纳伤员能力、防灾减灾预案、合作与协调、培训与演习、人力资源、物资设备、实验室能力、伤员分检分类、诊断和治疗、消毒、经费保障、员工安全、后勤保障和心理支持等。医院应急准备可采用调查、清单或专用评估工具进行评价。结论医院应急准备是灾害救援的重要环节,医院应针对不同灾害和本地实情及各类灾害风险作好切实可行的灾害救援应急预案。 相似文献
996.
Capellan O Hollander JE Pollack C Hoekstra JW Wilke E Tiffany B Sites FD Shofer FS Gibler WB 《The Journal of emergency medicine》2003,24(4):361-367
We compared the predictive properties of an initial absolute creatine kinase-MB (CK-MB) to creatine kinase-MB relative index (CK-MB RI) for detecting acute myocardial infarction (AMI), acute coronary syndromes (ACS), and serious cardiac events (SCE). Consecutive patients > 24 years of age with chest pain who received an electrocardiogram (EKG) as part of their Emergency Department (ED) evaluation had CK and CK-MB drawn at presentation. Patients were followed prospectively during their hospital course. The main outcome was AMI, ACS or SCE (death, AMI, dysrhythmias, CHF, PTCA/stent, CABG) within 30 days. The sensitivity, specificity, PPV and NPV of CK-MB and CK-MB RI to predict AMI, ACS, and SCE were calculated with 95% CIs. We enrolled 2028 patients. There were 105 patients (5.2%) with AMI, 266 (13.1%) with ACS, and 150 with SCE (7.4%). Absolute CK-MB had a higher sensitivity than CK-MB RI for AMI (52.0 vs. 46.9, respectively), ACS (23.5 vs. 20.8, respectively), and SCE (39.6 vs. 36.0, respectively), but a lower specificity than CK-MB RI for AMI (93.2 vs. 96.1, respectively), ACS (93.1 vs. 96.1, respectively) and SCE (93.3 vs. 96.3, respectively); and lower PPV for AMI (35.7 vs. 46.5, respectively), ACS (42.0 vs. 53.4, respectively) and SCE (38.5 vs. 50.5, respectively). The negative predictive values were similar for all outcomes. We conclude that the risk stratification of ED chest pain patients by absolute CK-MB has higher sensitivity, similar NPV, but a lower specificity and PPV than CK-MB relative index for detection of AMI, ACS, and SCE. The optimal test depends upon the relative importance of the sensitivity or specificity for clinical decision-making in an individual patient. 相似文献
997.
998.
OBJECTIVE: The aim was to assess the timing and severity of self-reported headaches in patients utilizing a standard 28-day oral contraceptive (OC) cycle consisting of 21 hormone (estrogen + progestin)-containing pills and 7 placebo pills (ie, 21/7-day cycle) converted to a placebo-free extended OC regimen. METHODS: An open label single-center prospective analysis of headaches recorded daily on a severity scale of 0 to 10, along with the headache item of the Penn Daily Symptom Rating (DSR17) and a weekly modified Migraine Disability Assessment (MIDAS) headache questionnaire, during standard 21/7-day cycles followed by a 168-day extended placebo-free regimen of an OC containing 3 mg of drosperinone and 30 mcg of ethinyl estradiol (DRSP/EE). RESULTS: Of the 114 patients who began the trial, 111 completed the 21/7-day cycle portion of the study. Based on the headaches scales, there were significant differences in headache severity among the 28 days of the standard 21/7 cycles (P < .001). Greater headache severity occurred on days 25 through 28 during the 7-day placebo interval of the 21/7 cycles (P < .05). Of the 111 patients who completed the 21/7 phase of the study, 102 (92%) completed the 168-day extended placebo-free OC regimen. During the first 28 days of the extended placebo-free regimen, daily headache scores decreased (P < .0001) compared to those of the previous 21 active/7 placebo day cycle. The difference on a daily basis was first detected on extended cycle days 25 through 28 (P < .0001) and persisted throughout the remainder of the 168-day regimen. Subjects were divided into 2 groups (severe and mild) based on the median of the total headache score during the 21/7 OC cycle. The group with higher total headache scores demonstrated a significant (P < .0001) reduction in daily headaches beginning in the first 28-day interval of the extended placebo-free regimen, persisting throughout the entire 168-day extended regimen. In contrast, the group with the lower total headache score remained unchanged (P= .79) throughout the extended regimen. Impact of headaches on work, family, and social functions also improved on the extended placebo-free regimen in 6 of 8 measures (P < .05) assessed by weekly headache questionnaires. CONCLUSION: Compared to a 21/7-day OC regimen, a 168-day extended placebo-free regimen of DRSP/EE led to a decrease in headache severity along with improvement in work productivity and involvement in activities. This is a preliminary study and results may not be widely generalizable. 相似文献
999.
Timothy C. Wand MHN DASNurs Grad Dip MHNurs MNurs Kirsty Coulson BSc Grad Cert Critical Care Nurs 《Australasian emergency nursing journal : AENJ》2006,9(4):163-170
Aggression and violence are common in the emergency department setting. In recent years, there has been a greater recognition of this problem with State Governments in Australia responding with zero tolerance policies. This paper examines the current recommendations from nursing and medical literature with regard to the minimisation and management of aggression and violence in health care. A consistent theme throughout the literature is that early recognition and use of de-escalation strategies aimed at diffusing a volatile situation is the preferred approach. Use of restraint and a zero tolerance approach are last resort measures. It is important to have practical policies, protocols and procedures in place to manage aggression and violence in the emergency department. An emphasis on training and skill development, particularly communication and negotiation strategies, is imperative for all health care professionals. 相似文献
1000.