床旁临时起搏器作为AMI的常备急救设备及其在基层医院推广应用研究

目的 床旁临时起搏器作为急性心肌梗死（AMI）的常备急救设备的价值及其在基层医院推广应用的可行性研究。方法 回顾性研究分析2001-2003年间不能床旁植入临时起搏器与2004-2005年能床旁植入临床起搏器抢救AMI的住院病死率、心衰、心源性休克、2mo后再次住院发生率。临时起搏器植入术安全性的指标比较。结果 不能床旁植入临时起搏器组的住院病死率为14．58％，心衰发生率为27．08％，心源性休克发生率为12．5％，2mo后再次住院发生率为16．67％。床旁植入临时起搏器组的住院病死率为3．57％，心衰发生率为7．14％，心源性休克发生率为3．57％，2mo后再次住院发生率为3．57％，两组相比p〈0．01有显著性差异。而起搏器植入的安全性指标：起搏器植入成功率为100％，脱位率为10．7％，并发症发生率为14.3％，住院病死率3．57％。结论 床旁临时起搏器抢救AMI住院病死率低，心衰发生率、心源性休克发生率及2mo后再次住院发生率低，应作为AMI抢救的常备急救设备，另外床旁临时起搏器植入是安全的、有效的，成功率高，操作不难，在基层医院（二甲医院）可推广应用。     

介入护理交接单的设计与应用

目的 通过介入护理交接单的设计与应用,优化介入护理流程,减少护理不良事件,提高介入患者的安全.方法 针对医院回访中心在2011年进行介入治疗的929例住院患者满意度的调查结果,分析由于介入流程与交接环节引起的影响患者满意度的因素,对其进行汇总研究.遵循实用、有序、规范、简捷、方便记录的原则,将交接相关项目及顺序优化排列,制定介入护理交接单.结果 使用“介入护理交接单”后,有助于护士养成按固定的合理顺序行事习惯,缩短了手术准备时间;对2013年交接单使用后进行介入治疗的950例介入患者的满意度回访结果及与介入有关的影响因素,与使用前2011年的929例住院患者满意度的调查结果,进行分析比较.术中资料完整性、管路安全性、患者的满意度等均明显提高.结论 介入护理交接单的设计合理,实用性较强,使用后,提升了介入患者交接及转运的安全性,有利于介入手术护士与病房临床护士一体化培训,提高了介入手术室的效率和效益,增加了家属对医院的安全感、信任感,提高了患者的满意度.     

移动式床旁CT-CereTom在导航引导下锁孔手术治疗幕上高血压脑出血中的应用

目的 探讨移动式床旁CT（Portable Bedside CT,PBCT）-CereTom在导航引导下锁孔手术治疗幕上高血压脑出血（Supratentorial hypertensive intracerebral hemorrhage）中的临床应用及其价值。方法 56例幕上高血压脑出血患者,手术前使用PBCT-CereTom行CT导航扫描。19例为床旁CT检查,37例为常规CT检查。手术后行CT扫描,了解血肿清除效果。结果 用mRS、GCS以及术后6个月GOS评分：术前GCS平均9分（范围：3~15分）,mRS平均4分（范围：2~5分）;出院时GCS平均14分（范围0~15分）,mRS平均3分（范围0~6分）,与术前相比差异有统计学意义（P〈0.001）;术后6个月总体生存率：94.64%（53/56）。GOS评分：57.1%（GOS 4~5）恢复良好,28.57%（16/56）合并（GOS 3）重残,8.6%（GOS 2）植物生存,5.7%（GOS 1）死亡;影像学评价：血肿清除率96.9%（范围：77.9~99.4%）,血肿清除率〉90%的病例数52例（92.86%）。结论 PBCT-CereTom的导航可以快速实施,并可保证图像质量,其导航引导下的锁孔手术快速、精准、安全和有效;术后实时了解血肿清除程度、血肿腔渗血情况,并可连续追踪观察;特别适合于危重患者的床旁检查。     

以医学史为切入点的医学人文教育用于胃肠外科床旁教学研究

目的 调查将胃肠外科发展史内容引入床旁教学前后,医学生对胃肠外科发展史的认知情况.方法 2020年9月至2021年2月对在复旦大学附属中山医院普通外科参加床旁教学的复旦大学上海医学院临床医学专业学生进行问卷调查.其中,2020年11月前的床旁教学中未专门安排胃肠外科发展史教学内容(对照组),2020年12月后的床旁教学...     

Update on research and clinical translation on specific clinical areas: From bench to bedside: How insight in immune pathogenesis can lead to precision medicine of severe juvenile idiopathic arthritis

Despite the enormous progress in the treatment of juvenile idiopathic arthritis (JIA), innovations based on true bench-to-bedside research, performed in JIA patients, are still scarce. This chapter describes novel developments in which clinical innovations go hand in hand with basic discoveries. For the purpose of this review, we will mainly focus on developments in severe forms of JIA, most notably systemic JIA and polyarticular JIA. However, also in less severe forms of JIA, such as oligoarticular JIA, better insight will help to improve diagnosis and treatment. Facilitating the transition from bench to bedside will prove crucial for addressing the major challenges in JIA management.If successful, it will set new standards for a safe, targeted and personalized therapeutic approach for children with JIA.     

Nurses discuss bedside handover and using written handover sheets

Background The analysis of nursing errors in clinical management highlighted that clinical handover plays a pivotal role in patient safety. Changes to handover including conducting handover at the bedside and the use of written handover summary sheets were subsequently implemented. Aim The aim of the study was to explore nurses’ perspectives on the introduction of bedside handover and the use of written handover sheets. Method Using a qualitative approach, data were obtained from six focus groups containing 30 registered and enrolled (licensed practical) nurses. Thematic analysis revealed several major themes. Findings Themes identified included: bedside handover and the strengths and weaknesses; patient involvement in handover, and good communication is about good communicators. Finally, three sources of patient information and other issues were also identified as key aspects. Conclusions How bedside handover is delivered should be considered in relation to specific patient caseloads (patients with cognitive impairments), the shift (day, evening or night shift) and the model of service delivery (team versus patient allocation). Implications for nursing management Flexible handover methods are implicit within clinical setting issues especially in consideration to nursing teamwork. Good communication processes continue to be fundamental for successful handover processes.     

Sonographic findings of hepatic venous gas in association with spontaneous rupture of a Klebsiella pneumoniae liver abscess: a case report

Hepatic venous gas (HVG) is a very rare ultrasonic finding, and it is defined as abnormal accumulation of gas in the hepatic venous system. Various diseases can cause HVG, and femoral venous catheter is the most common cause. We, herein, present the case of a 79-year-old female patient with HVG that was caused by spontaneous rupture of a Klebsiella pneumoniae liver abscess. This was first found by bedside ultrasonography. On the basis of the blood culture results, imipenem–cilastatin and cefoperazone sulbactam were administered and the effect was acceptable. After 41 days of antibacterial and symptomatic treatment in the hospital, the patient had recovered well and was discharged. All of the previous reports on HVG have been summarized by thoroughly reviewing the previous published work. Overall, this is the first patient with HVG in association with spontaneous rupture of a K. pneumoniae liver abscess, and it might provide insights for future studies regarding the treatment of this disease.     

高频超声在全身麻醉诱导期胃进气检测中的临床应用

目的探讨实时高频超声监测在全身麻醉诱导期胃进气检测中的临床应用价值。方法接受全身麻醉下择期手术患者80例,随机分为4组(P10、P15、P20、P25),使用丙泊酚、芬太尼、顺阿曲库铵麻醉诱导后分别进行面罩压力控制通气,通气气道峰压分别设置为10、15、20、25cm H2O,于肌松药推注完毕后45、90、135、180s及气管插管后5min记录患者脉搏氧饱和度(SpO2)及潮气量,通气期间采用双盲的方法使用听诊及高频超声检测胃进气的发生率。结果患者潮气量随着气道压力增高而增加,当气道峰压为10、15cm H2O时,潮气量随着肌松药作用时间而逐渐增加,当肌松药完全起效后达到最高,听诊和高频超声在检测胃进气时没有明显区别,但高频超声检测出胃进气的发生率略高;当气道峰压为20、25cm H2O时,潮气量随着肌松药作用刚开始时有增加,但达到一定程度后并不再继续增加,高频超声检测出胃进气阳性率明显比听诊法检测阳性率高。结论使用超声监测有助于发现胃进气,在麻醉诱导期使用气道峰压为15cm H2O的压力控制通气既可保证高质量的面罩通气,又能最大限度地减少胃进气的发生。     

信息化物品管理系统的应用效果分析

目的利用信息化物品管理系统提高医院管理水平,保证护理工作安全。方法在移动护理工作站、医院信息系统和无线网络等设施的基础上,建立信息化物品管理系统。分析应用信息化物品管理系统的临床效果,比较物品交接时间,药品丢失数量及护士工作满意度情况。结果与传统护理物品管理方式相比,使用信息化物品管理系统进行物品交接的平均用时显著降低(t=10.66,P<0.001),药品丢失数量明显减少(χ2=4.215,P=0.040),体温计丢失数量明显减小(χ2=4.643,P=0.031),护士工作满意度明显提高(χ2=5.699,P=0.017)。结论信息化物品管理系统使物品管理更规范、更准确、更科学,提高护士工作效率,改进护理工作质量,保障医疗安全。