Enfermería familiar y comunitaria,cronología de una especialidad

More the 30 years have passed since the first Royal Decree that regulated nursing specialties was published in 1987. It is the Royal Decree published in 2005 that really allowed the training development of part of the specialties recognized in it (family and community nursing, paediatric nursing, geriatric nursing and occupational health nursing) since the obstetric-gynaecological specialist nurses (midwives) and mental health specialists had long since already started their training processes through the resident internal nurse model, today, training in the specialty of family and community nursing has been implemented in all the autonomous communities, but has not had the same development in terms of the incorporation of specialists in the health institutions of the respective health services of the autonomous communitiesThis circumstance is generating a great lack of motivation among community nurses, both specialists and those who hope to obtain the qualification through a specialty exam.Many of the objectives achieved to date have been made possible thanks to the work of the scientific societies of community nursing (Association of Community Nursing [AEC] and Federation of Associations of Community Nursing and Primary Care [FAECAP]), which have allowed progress to be made and the process not to be halted, although there are still many achievements to be made on which the aforementioned scientific societies continue to work.In a society in which nursing care is increasingly necessary and demanded, it must have greater consideration and position in health policies, since it has demonstrated its effectiveness and can be the model that allows the health system to be sustainable. Therefore, nurses who specialize in family and community nursing must cease constituting an opportunity and become a reality.     

医院图书馆虚拟参考咨询服务的若干问题探讨

数字参考咨询是图书馆随着网络化环境发展,医院信息化进程而衍生的一种新型参考咨询服务方式。是医院医疗、教学、科研和管理服务的有效手段。就医院图书馆数字参考咨询实际工作中有关FAQ设置和分类,虚拟服务个性化以及咨询服务的专业化问题等进行探讨,以更好地为医院信息化服务。     

综合性医院专病化门诊管理探讨

专病化引领了医院未来学科建设与人才培养的新方向。专病门诊作为专病化在门诊诊疗模式中的体现,无疑将成为医院门诊创新的趋势和热点,对提高医院诊疗水平与患者满意度意义重大。文中对综合性医院专病化门诊的概念和发展现状进行介绍,分析了目前我国医院开展专病门诊过程中的现存问题,在阐述专病门诊2种主要运行模式后,从注重初诊筛查、再造专病诊疗流程、严格准入管理、建立协调机制、优化利益分配5个方面对综合性医院专病化门诊的管理策略进行探讨。     

The duration of postoperative ileus after elective colectomy is correlated to surgical specialization

Aim: Postoperative ileus is an important factor of complications following gastrointestinal procedures. Its pathophysiology and the parameters, which may impact on its duration, remain unclear. The aim of this study was to measure the role of various clinical determinants on restoration of intestinal function after elective colorectal surgery. Methods: From July 2002 to September 2003, all patients who underwent laparotomy for colectomy (laparoscopic resections excluded) with either an ileotransverse, colocolic, or high colorectal anastomosis were entered in this prospective study. The intervals in hours between the end of the surgical procedure and passing of flatus (PG) and passing of stool (PS) were recorded by an independent investigator. PG and PS were eventually correlated with the following parameters: type of colectomy, early removal of nasogastric tube (NGT), mechanical bowel preparation (MBP), type of underlying disease, systemic administration of opiates, and surgical training (colorectal fellowship or other). Results: One hundred twenty-four patients were entered in this study. Four patients (3.2%) developed septic complications (3 anastomotic leaks and 1 intraabdominal abscess) and were excluded from the analysis. Median age in this population was 68 (range 30–95) years. Mean duration of postoperative ileus was 70±28 h (PG) and 99±34 h (PS). The type of colectomy, underlying disease, MBP, and early NGT removal failed, in univariate analysis, to correlate with the duration of postoperative ileus. By contrast, time intervals PG and PS were statistically shorter in the group of patients treated by a colorectal surgeon [56±23 vs 74±28 h (PG); 82±26 vs 103±35 h (PS), p=0.004], as well as in patients who received systemic opiates for less than 2 days [64±27 vs 75±28 h (PG), p=0.04; 88±32 vs 108±33 h (PS), p=001]. Conclusion: Restoration of normal intestinal function after elective open colectomy takes 3 (PG) to 4 (PS) days. In our series, specialized training in colorectal surgery has a positive impact on the duration of postoperative ileus. Surgical specialization should be considered an important parameter in future clinical trials aiming to minimize postoperative ileus.     

表格加焦点式护理记录单在颅脑损伤中的设计与应用

目的 通过对脑外伤表格加焦点式护理记录单的设计与临床应用,指导神经外科医护人员专业化、个体化观察病情,进一步优化细化护理内容,更好地保证脑外伤患者的医疗护理安全.方法 根据疾病种类和症状学特点设计脑外伤表格加焦点式护理记录单,与原运行的病情观察护理记录单对照,选择护理记录时间、护理记录缺陷发生率、护士专业知识考试结果、医生满意度作为效果评定指标.结果 临床应用130例患者,经效果评价,临床应用效果优于原运行护理记录单.结论 表格加焦点式护理记录单更能科学便捷地记录脑外伤病情及治疗护理过程,突出个体化、专业化的护理理念,值得推广.     

干部病区专科化收治模式应用分析

军队干部医疗保障是部队医院的重要任务之一。新形势下部队医院尤其是军区总医院级别医院的干部医疗保障工作,呈现出疾病诊疗不专业、患者住院时间长、医疗服务效率低等问题,文中对此进行全面分析,就干部病区专科化收治模式的创立及干部专科病区的设置进行阐述。认为通过新模式的应用和管理创新,使病区诊断准确率有所提升,治疗程序得到合理规范,医疗服务意识逐渐增强,可持续发展能力不断促进,既提高了部队干部的满意度,又提升医师工作积极性,干部病区呈现出全面发展的态势。