住院患者坠床跌倒的原因分析与防范措施

目的通过对住院患者坠床和跌倒事件进行分析,探讨住院患者发生坠床和跌倒的原因及防范对策。方法回顾性分析2013年7月1日至2014年6月30日全院上报的13例坠床和跌倒不良事件及原因。结果发生坠床3例占23%,跌倒10例占77%;其中60岁以上老年人10例占77%。坠床和跌倒不良事件与患者年龄、原发疾病、服用药物、环境因素有相应的关系。结论加强护士风险评估的培训学习,严格落实高危患者的防范措施,有效预防住院患者坠床和跌倒事件的发生。     

骨科患者跌倒与坠床的危险因素及预防护理措施

目的通过对骨科患者跌倒与坠床事件进行分析,评估住院患者跌倒、坠床危险因素,积极采取预防措施,降低跌倒和坠床事件的发生。方法对2011年7—12月300例骨科患者填写《宁夏医科大学总院预防跌倒坠床告知单》和《宁医大总院住院患者跌倒坠床危险评估表》。结果骨科患者跌倒和坠床事件发生不仅与生理因素有关,也与原发疾病、服用药物、跌倒坠床病史、环境因素有关。通过全面评估,全面的健康宣教,标志目标人群,积极采取预防措施,无一例跌倒坠床事件的发生。结论降低骨科患者跌倒和坠床事件的发生应从预防抓起,其中提高护士和患者的认识是重点,提供安全的环境是基础,加强预防措施的落实和监控是关键环节。     

预防跌倒／坠床管理流程在心内科住院患者中的应用

目的探讨在心内科应用跌倒／坠床危险因素评估对患者的安全管理。方法对2012年1—12月收治的2436例患者进行跌倒／坠床危险因素评估。结果通过跌倒／坠床危险因素评估在患者安全管理中的应用．减少并防范了院内跌倒／坠床发生,保证了心内科住院患者的安全,达到了安全目标。结论经过入院评估高危患者、病情观察、健康教育及安全管理等护理干预,制订出相应有效的护理措施,有效提高患者、家属及护士的安全意识减少患者跌倒事件发生,融洽了护惠关系,提高了患者对护理服务满意度,保证护理安全。     

护理干预对老年心肌梗死住院患者跌倒及坠床事件发生的影响分析

目的探究护理干预对老年心肌梗死住院患者跌倒及坠床事件发生的影响。方法将我院心内科收治的84例老年心肌梗死患者随机分为2组各42例,对照组患者采取心内科常规护理干预,干预组患者在心内科常规护理的基础上实施预见性护理干预,比较两组老年患者跌倒及坠床发生率和护理满意度。结果在不同的护理干预下,对照组患者跌倒及坠床发生率为21.43%;干预组患者跌倒及坠床发生率为4.76%,差异具有统计学意义(P<0.05);对照组护理满意度(75.19%)明显低于干预组(92.86%),差异显著(P<0.05)。结论预见性护理干预能够有效降低患者跌倒及坠床事件的发生率,保证患者住院期间的安全,提高患者护理满意度。     

心内科老年患者跌倒坠床的防范及健康宣教

分析心内科老年住院患者跌倒、坠床的危险因素,以探讨有效的防范措施及健康宣教。对13例患者跌倒与坠床的临床资料进行回顾性分析研究。通过建立有效的防范措施及健康宣教,能降低住院患者跌倒、坠床的发生,确保医疗安全。     

住院患者坠床/跌倒危险因素评估的方法及防范措施

目的通过对千余例住院患者坠床/跌倒危险因素评估,采取一系列防范措施从而保证患者住院期间的安全。方法护士运用坠床/跌倒危险因素评分标准,对所有住院患者可能存在的护理非预测不良事件（坠床/跌倒）进行评估,将符合标准的患者安排合适的病室和床位,采取一系列相应防范措施：对患者进行有关安全风险防范知识方面的宣传教育;发放坠床/跌倒危险告知书;床头悬挂警示牌等引起患者及医务人员的注意并加以重视。结果 2013年7-12月这6个月时间里,本科对千余例患者进行坠床/跌倒危险因素的评估,并采取有效的防范措施,无一例坠床/跌倒护理不良事件发生。结论对患者住院期间实施坠床/跌倒危险因素评估,不仅加强了护士工作的责任心,而且保证了患者的人身安全,从而减少了医疗赔偿及纠纷的发生。     

根本原因分析法在住院患者跌倒中的应用与反思

目的探讨住院患者跌倒发生的风险因素及管理。方法应用根本原因分析法（RCA）对2009年1月至2012年12月期间的62例住院患者跌倒个案进行调查分析,确定根本原因并提出强化培训干预措施,做好预防住院患者跌倒的护理质量的持续性改进。结果系统行为因素失效49例,占79．04％,是患者跌倒的根本原因;非系统行为因素失效13例,占20．96％。结论运用根本原因分析法对预防住院患者跌倒安全管理具有较好的导向作用,实施正确的系统行为是预防跌倒的根本,指导训练住院患者良好的健康行为是预防跌倒的关键,提示护理人员将保障患者安全工作常态化、规范化、制度化。     

护理干预对预防心内科老年患者跌倒及坠床的价值

目的探讨护理干预对预防心内科老年患者跌倒及坠床的临床价值。方法选择患者200例,分为两组,各100例,观察组针对跌倒和坠床进行护理干预,对照组则为实施特殊护理干预,比较两组患者发生跌倒和坠床事件比例,并统计两组整天护理满意度。结果观察组发生跌倒和坠床事件比例均显著低于对照组(P0.05),观察组满意度为96.0%,显著高于对照组的81.0%(P0.05)。结论针对老年心内科患者跌倒及坠床进行针对性护理,能显著减少跌倒和坠床率,提高护理满意度,值得临床重视。     

住院患者跌倒与坠床原因分析及预防措施

住院患者意外受伤是危及患者健康的严重问题,需要医护人员和家属通力合作,杜绝跌倒与坠床发生是护理管理的一项重要任务.在2009年患者安全目标管理年中,我院住院患者意外跌倒与坠床事件频发.本文对我院2009年7月～2009年12月住院患者发生的9起意外跌倒坠床事件进行分析,探讨其发生的相关因素及预防措施.     

住院患者应用患者跌倒坠床评估表的效果评价

在马斯洛的人类基本需要层次理论中,安全需要是仅次于生理需要的基本需要[1]。为了加强护理人员的安全防范意识,确保住院患者安全,防止患者在住院期间发生跌倒或坠床事件,结合临床观察并查阅相关资料[2],我们自行设计了住院患者防范患者跌倒坠床评估表,并应用于我科住院患者,据此评分确定跌倒坠床的危险度,采取针对性的预防患者跌倒坠床的护理措施,取得良好效果。现报道如下。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。