掌上电脑在临床护理中的应用调查

目的 了解护士在临床中应用掌上电脑(PDA)的情况,为进一步推广使用提供依据.方法 采用自制的调查问卷,对应用PDA科室的41名护士进行问卷调查.结果 80.5%护士喜欢应用PDA,认为操作简单,能提高工作效率、节约成本、减少护理差错和计费差错;41.5%护士认为PDA应用中存在一些问题;92.7%护士认为PDA会很快在临床普及使用等.结论 绝大多数护士对应用PDA持赞成态度,但目前PDA的临床应用较为局限,其功能有待于进一步开发和完善.     

先天性外中耳畸形患者听力重建与同步MEDPOR耳廓再造术的护理

目的 了解护士在临床中应用掌上电脑（PDA）的情况，为进一步推广使用提供依据。方法 采用自制的调查问卷，对应用PDA科室的41名护士进行问卷调查。结果 80．5％护士喜欢应用PDA，认为操作简单，能提高工作效率、节约成本、减少护理差错和计费差错；41.5％护士认为PDA应用中存在一些问题；92．7％护士认为PDA会很快在临床普及使用等。结论 绝大多数护士对应用PDA持赞成态度，但目前PDA的临床应用较为局限，其功能有待于进一步开发和完善。     

护士使用移动护理信息系统满意度及影响因素调查

目的了解护士对使用移动护理信息系统的满意度及影响因素,为提高护士满意度,推进移动护理信息系统的使用提供依据。方法采用自行编制的护士对使用移动护理信息系统满意度调查问卷对北京市某三级甲等综合医院的857名护士进行调查并分析。结果护士对PDA本身维度满意度得分最低(2.74±0.74)分,处于不满意水平;其他维度为一般水平,无达到满意水平的维度。不同职称、职务及PDA使用时间的护士对使用移动护理信息系统满意度得分比较,差异有统计学意义(P<0.05,P<0.01)。结论职称、职务、PDA使用时间对护士使用移动护理信息系统的满意度有一定的影响,护理管理者应根据护士的不同特征,采取针对性措施提高护士使用移动护理信息系统满意度。     

患者对护士使用PDA感受的调查分析

目的了解患者对护士使用PDA的感受,以改进护理工作,提高患者对PDA的接受度。方法采用自行设计的患者对护士使用PDA的感受问卷,对北京市某三级甲等综合医院的482例患者进行横断面调查。结果患者对护士使用PDA的正性感受排前3位的是身份识别、保证治疗安全及准确记录资料;负性感受排前2位的是担心数据录入错误及扫描腕带的繁琐感。结论患者能够肯定PDA在身份识别及保证治疗安全等方面的积极作用,同时护士应采取有效措施减轻患者存在的负性情绪,提高患者对护士使用PDA的接受度。     

护理管理执行力文化的构建与实施

目的 提高护理质量及患者满意度.方法 构建护理管理执行力文化,进行全员培训,提高认识;建立有效沟通渠道,与护士长进行分层次沟通,分层次召开护士座谈会,有效激励下属;制定各类制度实施细则以提高执行力.结果 患者满意度及护理质量显著提高(P＜0.01).结论 构建执行力文化有利于提高护士的综合素质和护理质量.     

临床护士自我调节疲劳现状调查及影响因素分析

目的 了解临床护士自我调节疲劳现状,分析其影响因素,为针对性干预提供参考.方法 采用一般资料调查表、自我调节疲劳量表、中国护士工作压力量表、心理韧性量表、组织支持感量表及社会支持评定量表对942名临床护士进行调查.结果 临床护士自我调节疲劳总分为47.00(43.00,51.00)分.多元线性回归分析显示,组织支持感、管理及人际方面的问题、对社会支持的利用度是护士自我调节疲劳的主要影响因素(均P＜0.01).结论 护士自我调节疲劳程度中度偏上,护理管理者应重视并针对主要影响因素制定干预措施,以提高临床护士自我调节能力,从而减轻疲劳程度.     

PDA与移动护士工作站在临床护理工作的应用与发展

对手持设备（PDA）与移动护士工作站系统、功能及其在,临床护理工作的应用状况和不足进行概述。移动护士工作站是以PDA作为硬件平台的手持终端执行系统,它将医院信息系统向病房扩展和延伸,实现了护士的床边操作。该系统优化了护理工作流程,提高了工作效率和工作质量,并有效预防和减少了医疗护理差错,同时促进了护理管理思想与管理模式创新,提升了护理管理层次。     

手术室护士对术前访视认知态度的调查

目的 了解手术室护士对术前访视的认知、态度及影响护士实施术前访视的因素,为进一步提高围术期护理质量管理提供依据.方法 根据围术期护理内容及参考有关文献自行设计调查问卷,对153名手术室护士进行调查.结果 手术室护士对术前访视缺乏全面正确的认知,仅45人(29.4%)愿意进行术前访视,37.9%护士能够认识其角色;愿意进行术前访视、术前访视是手术室护士的职责及术前访视过程中需运用专业知识及临床相关知识为影响护士对术前访视的主要因素(均P<0.05).结论 护士对术前访视工作中应承担的角色认识片面,这种片面认识易影响护士术前访视工作的开展.护理管理者需加强对术前访视工作继续教育的培训,并鼓励护士积极参与术前访视,以提高围术期护理质量.     

移动护士工作站在临床工作中应用效果

目的:探讨PDA在临床工作中的应用效果.方法:将PDA应用后3个月和应用前护理安全、护理质量和住院患者的满意度、医生对护士工作的满意度、护士对自身工作的满意度进行比较.结果:PDA的应用,减少了护理缺陷;提高了护理质量;住院患者的满意度、医生对护士工作的满意度、护士对自身工作的满意度均显著提高(P＜0.05,P＜0.01).结论:PDA的应用,优化工作流程,保障了护理安全,提高了护理质量,和谐了护患关系,调动了护士的积极性,有利于护理学科的发展.     

临床用药安全核查项目管理的研究

目的提高护理人员临床用药过程中安全核查落实率,提升患者用药安全。方法设计并实施包含护理安全核查概念导入、概念感知、概念学习、概念外化及概念践行五大步骤的项目管理方案,对护士临床用药实践中的安全核查进行为期6个月的干预。随机抽取32个临床科室623名护士比较干预前后临床用药安全核查落实情况。结果干预后,核查制度及医嘱处理、摆药、配药、给药4个环节核查落实率, PDA规范扫描落实率显著高于干预前(均P0.01)。结论从护士角度设计干预措施并实施,能有效提高护士PDA规范扫描落实率,改善护士用药护理安全核查的落实,有助于促进患者用药安全。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.