老年专科护理小组对住院患者跌倒防范的影响

目的:探讨老年专科护理小组对住院患者跌倒防范的影响。方法:收集老年专科护理小组实施防跌倒护理干预前后的住院病例,比较其跌倒发生率、跌倒致损伤发生率。结果:老年专科护理小组实施防跌倒护理干预后住院患者跌倒发生率、跌倒致损伤发生率较干预前均下降(P<0.05)。结论:老年专科护理小组对全院住院患者实施防跌倒护理干预,在防范住院患者跌倒方面取得肯定、良好的临床效果。     

护理风险管理预防住院跌倒高危患者跌倒的实践及成效

目的探讨护理风险管理预防住院跌倒高危患者跌倒的实践及效果。方法 2010年1～12月对4230例跌倒高危患者采用常规预防跌倒管理方法,2011年1～12月对4900例跌倒高危患者采用预防跌倒风险管理。比较实施预防跌倒风险管理前后患者跌倒及跌倒损伤发生率,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率情况。结果实施护理风险管理后,跌倒高危患者跌倒及跌倒损伤发生率较实施前明显下降,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率较实施前明显提高。结论 防跌倒护理风险管理能有效预防患者跌倒,提升护理人员预防跌倒知识及能力,从而提高护理质量管理。     

个案追踪法在骨科老年住院患者防跌倒管理中的效果评价

目的探讨个案追踪法在骨科老年住院患者防跌倒管理中的应用效果。方法实施三级个案追踪,进行全面动态评估,规范防跌倒管理措施,提高患者依从性。结果个案追踪法管理跌倒事件后,跌倒发生率、跌倒损伤率均下降(P0.01或P0.05),由此引发的医疗纠纷减少。结论应用个案追踪方法学管理,有利于团队合作,有利于发现潜在问题,有效降低跌倒事件发生率。     

三级监控在防跌倒/坠床高危患者中的应用

目的观察对跌倒/坠床高危患者实施三级监控管理的效果。方法建立三级监控组织,实施跌倒、坠床高危患者随访,即责任护士对存在跌倒/坠床意外风险的患者进行评分、报告,做好预防、追踪及随访,护士长及护理部再次追踪及随访。评价实施三级监控管理的效果。结果实施三级监控流程管理后,跌倒/坠床高危患者上报率增加,跌倒/坠床不良事件发生率下降,与实施三级监控流程管理前比较,差异具有统计学意义(P0.05)。结论三级监控流程管理是对跌倒/坠床高危患者进行护理质量监控,预防跌倒/坠床不良事件的有效管理手段。     

追踪管理方法在预防神经内科患者跌倒中的应用

目的探讨追踪管理方法在预防神经内科患者跌倒中的应用效果。方法选择2016年1—12月神经内科患者120例,采取常规管理方法;2017年1—12月成立追踪管理小组对神经内科收治的120例患者实施追踪管理,并根据事件危险程度制定护理干预措施,比较追踪管理方法实施前后神经内科护士跌倒风险评估符合率、跌倒知识掌握率、环境安全落实率、正确交班率以及患者跌倒发生率、跌倒预防依从率及患者满意率情况。结果实施追踪管理方法后神经内科护士跌倒风险评估符合率、跌倒知识掌握率、环境安全落实率、正确交班率均高于实施前(P0.05),神经内科患者跌倒预防依从率及患者满意率均高于实施前(P0.05),患者跌倒发生率低于实施前(P0.05)。结论追踪管理方法能有效提高神经内科护士预防跌倒意识及管理能力,降低患者跌倒发生率,确保神经内科患者住院安全性,提高患者治疗满意率。     

“防跌五步法”防范住院患者跌倒的效果

目的探索“防跌五步法”在预防住院患者跌倒中的作用。方法建立并实施“防跌五步法”,包括以下5个步骤：跌倒危险因素评估,防范跌倒知识及行为培训,设立醒目警示标识,防范跌倒措施的落实,跌倒处理、报告及考评。比较实施前后的跌倒发生率、跌倒损伤率及跌倒损伤投诉率。结果实施“防跌五步法”后,高危患者的跌倒发生率从1．17％下降至0．81％,损伤发生率从0．87％下降至0．43％,跌倒损伤投诉率从61．5％下降至26．7％,差异均有统计学意义（P〈0．05或P〈0．01）。结论“防跌五步法”是一套有效的防跌倒方案,不仅能减少跌倒和损伤的发生,而且能减少因跌倒致伤的投诉。     

防跌倒管理流程在临床护理中的应用

目的建立和应用防跌倒管理流程,最大限度地降低住院患者跌倒的发生率。方法成立防跌倒管理小组,对护理人员培训;制定跌倒高危因素评估表;制定及实施防跌倒管理流程;每月进行质量考评。结果实施流程6月,住院患者跌倒率由实施前0.59%降至0.07%。结论实施防跌倒管理流程能降低住院患者跌倒的发生率。     

建立专科护理小组对改进医院跌倒不良事件管理的效果

目的 :探讨建立专科护理小组对改进医院跌倒不良事件管理的效果。方法 :在老年病专科护理小组领导下成立跌倒不良事件管理小组(以下简称"小组"),建立并落实医院"患者防跌倒工作制度",在医院推行患者防跌倒护理,建立无惩罚跌倒不良事件网络直报系统,小组对跌倒事件上报后24小时内进行回访,并帮助科室进行根因分析,书写整改建议,每季度向全院进行跌倒不良事件分析汇报及典型案例分享。结果 :临床护士对患者跌倒风险评估的准确率提高。结论 :专科护理小组对跌倒不良事件的专业化管理使临床护士防跌倒护理工作更有成效,也有利于医院防跌倒工作的不断改进。     

项目管理在防跌倒护理质量指标改善中的应用

目的探讨项目管理在预防老年病科住院患者跌倒中的应用效果。方法成立防跌倒护理质量改善项目管理组,采取多学科、多部门合作方式,应用描述性统计分析,χ2检验和t检验方法,对实施项目管理前后跌倒发生率、跌倒损伤程度等跌倒相关护理质量指标进行比较。结果项目实施后跌倒发生率、跌倒损伤程度明显下降,护士、患者、照护者防跌倒知识知晓率,跌倒高危风险评估率,跌倒评估正确率,防跌倒健康教育落实率均明显上升,且差异均有统计学意义(P0.05)。结论项目管理能有效降低老年住院患者跌倒伤害,提升护理质量。     

住院患者防跌倒专科化管理的方法及效果

目的实施住院患者防跌倒专科化管理,降低住院患者跌倒发生率。方法根据专科化管理的需要,修订防跌倒工作管理方案并建立防跌倒联络小组,由老年病专科护士对全院的护理管理人员、防跌倒联络小组和临床护士进行住院患者防跌倒知识培训,建立各专科的防跌倒指引。将防跌倒管理工作纳入夜查房督导内容,老年病专科护士负责日常检查督促,指导科室实施专科化防跌倒措施,对医院发生的跌倒病例进行资料回访,定期进行总结分析,并提出整改意见。结果 2008年全院患者跌倒发生率较2007年有明显下降(P0.01);护理人员对跌倒危机评分准确率和防跌倒护理措施落实率明显提高(P0.01)。结论专科化管理模式能发挥老年病专科护士业务特长,有效降低患者跌倒发生率。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.