临床护士预防PICC导管相关感染的知信行现状及影响因素分析

目的：探讨临床护士对预防PICC导管相关感染的知信行现状,并分析其影响因素。方法：采用便利抽样法于2019年10月选取天津市5家医院215名临床护士,使用自行设计的知信行调查问卷进行调查,采用多重线性逐步回归分析其影响因素。结果：临床护士预防PICC导管相关感染的知信行总分为（90.86±5.23）分、知识（17.36±3.00）分、态度（24.13±1.83）分、行为（49.37±2.36）分;多重线性逐步回归分析结果显示,学历、是否为PICC专科护士、是否接受过PICC-CRI的知识培训是知识得分的主要影响因素（P<0.05）;是否为PICC专科护士、是否接受过中心静脉导管更换敷料的考核是影响预防态度的主要因素（P<0.05）。结论：临床护士预防PICC导管相关感染的知信行水平总体良好,其中预防PICC导管相关感染的态度和行为得分较高,但预防知识得分较低,建议加强相关理论知识的学习和培训,提高护士预防感染相关认知。     

临床护理人员对中心静脉置管引起感染的知识、态度及行为调查

[目的]了解护理人员对中心静脉置管引起感染的知识、态度及行为,以便采取有效干预措施,减少置管后感染的发生。[方法]采用自制问卷对3所“二甲”以上医院与中心静脉置管相关的110名护理人员进行调查。[结果]临床护理人员对中心静脉置管引起感染的相关知识得分18.00分±5.32分,态度得分7.74分±0.67分,降低置管感染的护理行为得分7.39分±1.10分。[结论]目前临床与中心静脉置管相关的护理人员缺乏降低中心静脉感染的有关知识,态度消极。     

肿瘤专科护士对预防中心静脉导管相关性感染的认知及行为调查

[目的]了解福州某三级甲等肿瘤专科医院护士对预防中心静脉导管相关性感染(CVCRI)的认知及行为。[方法]运用《预防CVCRI认知及行为问卷》,采用分层抽样与方便抽样相结合的方法选择100名在职临床护士进行问卷调查,回收有效问卷100份。[结果]100名临床护士预防CVCRI知识评分为11.73分±3.22分,处于较低水平;预防CVCRI行为评分为38.41分±3.80分,处于较高水平。既往是否受接受预防CVCRI培训等是影响肿瘤专科护士对预防CVCRI认知及行为水平的重要因素。[结论]肿瘤专科护士应重点加强CVCRI相关理论知识的学习培训,定期考核,执行标准化无菌操作流程,从根本上提高认识,才能改变不良行为,从而达到降低导管相关性感染发生率、提高病人满意度的目的。     

某三级综合医院新护士输液治疗知识掌握情况的调查

目的：了解新护士输液治疗护理知识的掌握情况,并分析问题、探讨对策。方法根据中华护理学会编写的《输液治疗护理实践指南与实施细则》自行设计调查问卷,采用方便抽样法对2013年79名新护士进行问卷调查,分析新护士在输液治疗护理知识方面存在的问题,并积极预防。结果79名新护士,问卷得分26～73分,平均（49．72±7．79）分。70～79分者1名,占1．27％;60～69分者9名,占11．39％;＜60分者69名,占87．34％。中专学历护士得分平均为（45．65±4．55）分,大专学历护士平均为（48．69±6．93）分,本科学历护士平均为（60．82±5．60）分,不同学历新护士输液治疗护理知识掌握情况比较差异有统计学意义（F＝21．097,P＜0．05）。其中本科护士平均分高于大专、中专新护士,差异有统计学意义（P＜0．05）;大专与中专护士相比,差异无统计学意义（P＞0．05）。不同学历护士在静脉输液感染控制和护理安全,输液穿刺、辅助工具的种类及应用,输液治疗的维护与管理3个方面,差异有统计学意义（P＜0．05）;在静脉输液相关并发症预防与处理、静脉穿刺血管评估与穿刺部位选择两个方面,差异无统计学意义（ P＞0．05）。结论新护士输液治疗护理知识掌握情况参差不齐,静脉输液相关并发症的处理、静脉穿刺的血管评估与穿刺部位选择是知识掌握中的薄弱环节,学校、护生后期临床实践应加强输液治疗护理知识相关的培训。     

ICU护士对中心静脉导管相关性感染集束干预策略认知状况的调查研究

目的 了解ICU护士对中心静脉导管相关性感染集束干预策略(CLB)认知状况及影响因素.方法 采用方便采样方法,应用自行设计的结构式调查问卷,对枣庄市2所三甲综合医院156名ICU护士进行问卷调查,并对结果进行分析.结果 ICU护士对中心静脉导管相关性感染集束干预策略认知平均得分为40.87±1.35(满分50分),行为平均得分为30.98±2.56(满分40分).影响其认知的因素有科室、学历、护士类别、ICU工作年限.阻碍ICU护士实施中心静脉导管集束干预策略行为的主要因素是“缺乏中心静脉置管引起导管相关性感染(CRBSI)相关知识的培训教育、科室没有制定预防CRBSI集束干预策略、科室没有中心静脉导管(CVC)标准化操作和维护流程、对CRBSI集束干预策略不熟悉、科室无CVC准入制度、无CVC护理记录制度、无预防CRBSI的教育墙报或操作图片强化学习和提醒”七个方面.结论 医院应加强ICU护士有关导管相关性感染集束干预策略知识的培训和教育;逐步完善相关的护理指南和操作规范;培养ICU专科护理人才,确保有效落实中心静脉导管相关性感染集束干预策略,有效降低导管相关性感染的发生率.     

集束化护理对预防中心静脉导管相关血流感染的影响

目的探讨集束化护理策略对预防ICU中心静脉导管相关血流感染（CRBSI）的影响。方法将实施中心静脉置管的重症患者78例随机分成对照组和观察组各39例。对照组进行常规中心静脉置管护理,观察组给予集束化护理,并对2组CRBSI发生率、平均住院日及中心静脉导管带管天数进行比较。结果实施集束化护理后,观察组CRBSI发生率为5．1％,低于对照组的20．5％;观察组ICU平均住院日及中心静脉导管置管天数低于对照组。结论集束化护理可降低CRBSI发生率,并间接缩短患者ICU平均住院日及中心静脉导管带管天数,对预防ICU中心静脉导管相关血流感染有着重要的临床意义。     

三级医院 ICU 中心静脉导管相关血流感染预防与控制现状调查及防控策略

目的：了解某市三级医院ICU中心静脉导管（CVC）相关性血流感染（CRBSI）预防与控制质量安全管理现状,探讨其对策。方法用自行设计的问卷,调查某市8家三级医院ICU CRBSI防控现状,分析252名ICU护士CRBSI预防和控制相关知识认知、赞同度及行为情况。结果8家医院中6家医院具有预防CRBSI标准操作规程,2家医院有CVC导管维护专用记录单。基于美国CDC《指南》推荐的循证支持的CRBSI特殊预防措施,各家医院执行不佳。252名ICU护士对导管感染相关知识、组合干预与维护措施赞同度、导管相关感染预防和控制行为得分分别为（55．88±7．46）,（20．21±1．48）,（72.59±6．83）分。结论某市三级医院ICU缺乏统一的CRBSI预防与控制标准操作规程及CVC置管核查表和维护核查表,应加强医护人员CRBSI防控知识的培训,提升行为依从性,降低CRBSI的发生率,提高危重患者的救治成功率。     

临床护士对中心静脉导管堵塞预防相关知识和行为的调查

目的 了解临床护士中心静脉导管堵塞预防相关知识和行为现状。方法 采用自制问卷调查江苏省30家三级医院中675名从事中心静脉导管护理的临床护士的中心静脉导管堵塞相关知识和行为。结果 临床护士中心静脉导管堵塞预防知识总得分为2～13分,平均(8.75±1.99)分,得分率为62.48%。对“推荐使用单阀或负压无针接头降低导管堵塞发生”的准确率最低,为25.33%;行为总得分为11～48分,平均(43.17±6.31)分,得分率为89.94%。“遇到纤维蛋白鞘或导管内血栓,向导管注射造影剂作X线检查确定后,给予导管内溶栓治疗”条目得分最低,得分率为79.00%。结论 临床护士中心静脉导管堵塞预防知识处于中等水平,行为水平较知识水平高,但仍有待提升。     

中心静脉导管相关感染的预防研究进展

近10余年来,中心静脉导管（PICC）已被广泛应用于长期输液、给药等临床实践。尽管在PICC导管材料、种类及置管技术上不断取得进步,但中心静脉导管相关感染（CVC—RI）仍很常见,是长期静脉置管的重要并发症,特别是导管相关血行感染（CRBSI）。骆小京等报道导管感染致死率为3％。美国疾病控制中心（CDC）报道,美国平均CRBSI感染率为5．3／1000导管留置日,感染患者中平均病死率为12％-25％。因此,加强此类感染的防治极其重要。现将PICC导管相关感染的诊断、发生原因、预防处理综述如下。     

ICU中心静脉置管时间与导管相关性感染的研究

目的探讨ICU中心静脉置管时间与导管相关感染发生率的因果关系。方法分析ICU中心静脉置管151例患者的导管相关感染（CRI）情况。结果共发生感染23例,感染率15．2％;导管相关血行感染（CRBSI）发生3例,感染率1．98％;感染发生率2．1／千导管置管日。感染病原菌以金黄色葡萄球菌和表皮葡萄球菌为主。回归分析显示：导管留置时间与感染率之间存在一定联系（r^2=0．81）,但差异无显著意义（P=0．29）。结论未发现ICU中心静脉置管时间与导管感染有明确相关性。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."