消毒供应中心实习生满意率低的原因及对策探讨

目的调查分析消毒供应中心的实习生满意率低的原因,据此制订出相应的应对教学措施。方法年终以问卷调查的形式在即将结束实习的学生中进行调查,分析消毒供应中心2011年实习生满意率低的原因,找出消毒供应中心在实习教学工作中的薄弱环节。并据此制订出相应的教学措施予以实施,将与1年后的实习生满意度进行对比。结果实习生满意度由67％提升至96％,并进入了医院实习生满意度前3名。结论通过落实新的教学措施,突出手供一体、教学互动、个性化教育和双师型人才的理念取得了显著的效果。     

Consumer Participation in Identifying Research and Development Priorities for Power Wheelchair Input Devices and Controllers

A focus group comprised of persons who use power wheelchairs and professionals working in the field were asked to participate in a brainstorming session to determine priorities for the development and application of power mobility input devices and control concepts. The group consensus was that durability and reliability are the most important criteria. Essentially, the expectation is that a power wheelchair must work everyday in the way a person needs it and wants it. At the same time, there is a desire to enhance and advance the features of input devices and control systems. Many would say these changes constitute designing “smarter” power wheelchairs, such as systems that can independently detect obstacles and can provide users with more feedback. This paper presents the rationale behind forming this focus group and details of the results of a brainstorming session where ideas were generated and prioritized. The five most important issues as determined by the group are discussed in depth.     

Detection of Suction and Regurgitation of the Implantable Centrifugal Pump Based on the Motor Current Waveform Analysis and Its Application to Optimization of Pump Flow

In this study, a detection algorithm for suction and regurgitation of the centrifugal pump during left heart bypass without relying on external flow or pressure sensors was developed and evaluated in acute studies using adult goats. The detection scheme relies on power spectral density (PSD) analysis of the motor current waveform through which the waveform deformation index (WDI) is obtained. This index is defined as the ratio of the fundamental component of the PSD to the higher PSD components, and its value increases with the deformation of the basic waveform. By assuming that the undistorted motor current waveform can be represented by a pure sine waveform, we theoretically synthesized various waveforms which have different second harmonic components. We were able to synthesize the waveform whose shape was close to the distorted motor current waveform under varying suction levels obtained in a mock loop study. From this study, we came to the conclusion that the WDI value of 0.2 can serve as a threshold level in deciding the suction and regurgitation speeds (rpm) during left heart bypass. In the study using adult goats, we were successful in minimizing both regurgitation and suction when the centrifugal pump speed was adjusted based on the WDI algorithm. The resultant bypass flow ranged from 1.5 to 2.0 L/min which was around 60% of the total flow. Further study is underway to evaluate the applicability of the WDI method in optimizing bypass pump flow.     

Dietary Restriction Reduces the Prevalence of Osteonecrosis of the Caput Femoris in Spontaneously Hypertensive Rats

We investigated the effects of dietary restriction (DR), an experimental intervention known to suppress several strain-specific diseases, on the prevalence of osteonecrosis of the caput femoris in spontaneously hypertensive rats (SHR). At 6 weeks of age, the food intake of DR rats was restricted to 65% of the mean intake of control rats fed ad libitum (AL). Acute osteonecrosis of the caput femoris without reparative tissue response (RTR) was observed at 10 and 15 weeks in both DR and AL groups; no such acute lesion was seen at 20 and 30 weeks. The prevalence of osteonecrosis, osteonecrosis with/without reparative tissue response was significantly reduced in DR rats at 15 and 20 weeks, but not at 10 weeks. DR reduced the body weight by 30% and the length of the femur by 10%. Ossification of the caput femoris, known to be delayed in AL rats compared with Wistar Kyoto rats, was also restored by DR. Our results showed that dietary restriction reduced the prevalence of osteonecrosis and modulated the mechanical factors involved in the lesion. They also indicate that utilization of dietary restriction is a useful research tool for investigating the underlying mechanisms of osteonecrosis of the caput femoris in SHR. Received: 4 March 1997 / Accepted: 9 July 1998     

优质护理服务供需平衡的扎根理论研究

目的探索优质护理服务运行规律,为发展完善优质护理服务模式奠定基础。方法采用参与式观察与深度访谈收集资料,通过开放编码、主轴编码和核心编码方式进行分析。结果优质护理服务需要护理服务、护理支持系统与患者需求、患者支持系统之间的平衡,支点为基于经济社会发展、疾病谱和人口老龄化制定的国家政策。结论优质护理服务的开展,可促进临床护理服务质量和患者满意度的提升,但需强化护理支持系统,以提高护理人员满意度。     

人肝癌裸鼠皮下移植瘤早期血液供应模式的定量研究

目的 定量评估不同时间点人肝癌裸鼠皮下移植瘤内血液供应模式的变化。方法 将1×10⁷/mL的MHCC97-H细胞悬液同一时间接种于40只裸鼠（0.2 mL/鼠）的左侧腹股沟皮下,分别于种瘤后第2、3、4、5周取瘤行HE染色和免疫组化染色（CD34和CD34/PAS双染色）,定量分析血管参数,包括微血管面积（microvascular area,MVA）、微血管密度（microvessel density,MVD）、血管生成拟态（vasculogenic mimicry,VM）,评估肿瘤内血管供应模式的变化。结果 随着肿瘤生长时间的延长,MVA先减小后增大,第3周肿瘤MVA小于第2周[（13 720.8±2 375.6）μm² vs.（28 795.5±3 412.7）μm²,P=0.013],第4周肿瘤MVA大于第3周[（29 221.3±3 958.5）μm² vs.（13 720.8±2 375.6）μm²,P=0.025];VM百分比呈明显升高趋势,第4周肿瘤VM百分比高于第2周（84.2%±15.4% vs.50.1%±14.6%,P=0.015）。结论 在人肝癌裸鼠皮下移植瘤新生血管形成的早期阶段,随着肿瘤生长时间的延长,VM逐渐成为肿瘤的主要血液供应模式。     

牡丹江市消毒供应中心护士职业认同情况调查及影响因素分析

目的调查和分析牡丹江市消毒供应中心护士职业认同情况调查及影响因素。方法选择2018年3月～2019年2月在牡丹江医学院附属红旗医院、牡丹江市第一人民医院和牡丹江妇产医院等18所医院消毒供应中心工作的113名护士为调查对象,采用护士职业认同量表进行调查,并收集护士的年龄、学历和工作时间等基本信息,以分析影响因素。结果 Logistic多元回归分析显示,年龄(OR=1.140,95%CI=1.059～1.312)、学历(OR=1.516,95%CI=1.712～1.881)、工作时间(OR=1.414,95%CI=1.598～1.989)和职务(OR=1.625,95%CI=1.698～1.894)四个方面是影响护士职业认同的独立危险因素。结论消毒供应中心护士职业认同的影响因素较为复杂,建议医院未来从加强对青年护士、新入职护士和低学历护士的职业认同感方面的培训入手,提高护士的爱岗敬业精神,全面改善职业认同感欠佳的问题。     

区域性消毒供应中心的网格化集中式管理

目的探讨网格化集中式管理模式在区域性消毒供应中心的运用效果。方法采用互联网结合WiFi无线网络技术,移动PDA技术,二维条形码技术,建立闸北区区域性消毒供应中心网络系统,闸北区内28个基层医疗机构均是管理系统里的一个网格,采用网格化集中管理模式进行管理,并与常规集中式管理进行效果比较。结果网格化集中式管理模式下消毒供应工作流程中回收、去污、消毒、包装、灭菌、储存和运送质量检查合格率,医疗机构满意率显著高于常规集中式管理,各岗位每人每小时消毒灭菌包个数显著多于常规集中式管理(均P0.01)。结论网格化集中式管理模式应用于区域化消毒供应中心可提高基层医院消毒物品质量,提高工作效率,达到资源共享和质量追溯。     

闭孔动脉跨区供血的长型股薄肌肌皮瓣

目的 为解决由股深动脉分支供血的股薄肌肌皮瓣因血管蒂在股薄肌中上1／3处，致使向骨盆会阴带蒂转移时距离受限的问题，探索该肌皮瓣由闭孔起始部为旋转点向骨盆会阴区域转移的方法。方法 根据闭孔动脉-旋股内侧动脉-股深动脉分支之间存在良好吻合支，设计以闭孔动脉跨区供血的长型股薄肌肌皮瓣转移的方法。这种方法可以切断股深动脉分支，使股薄肌肌皮瓣能够更松弛地转移至骨盆、外阴、耻骨、联合、腹股沟等区域。结果修复骨盆会阴区的畸形和缺损9例，所有肌皮瓣均全部成活，经术后3个月至3年的随诊，效果均满意。结论 闭孔动脉跨区供血的长型股薄肌肌皮瓣，可以作为常规的肌皮瓣在临床应用。     

Anatomy of the rectum and anal canal

The rectum and anal canal are the terminal portions of large intestine and the entire gastrointestinal tract. They are thus readily accessible to direct inspection and examination. The rectum functions as a distensible reservoir for faeces, while the anal canal possesses a powerful muscular sphincter in its wall which is important in maintaining faecal continence. Diseases of the rectum and anal canal, both benign and malignant, account for a very large part of colorectal surgical practice worldwide. This article emphasizes the clinically and surgically relevant aspects of the anatomy of the rectum and anal canal.