专科护士在护理层级管理中对护理影响力的研究

目的 探讨专科护士在护理层级管理模式中对护理的影响力.方法 选择2009年1月～2011年7月产科特需病房全体在职护士为研究对象,特需病房11病区实施护理层级管理模式,特需病房12区实施传统整体护理.比较两种不同护理模式下病区护理终末质量、病人满意度、各级护士满意度及专科护士专业地位对各级护士职业成长的影响.结果 产科特需病房11区实施护理层级管理模式后与对照病区护理质量比较：基础护理质量（P＜0.001）、特Ⅰ级护理质量（P ＜0.005）、健康教育质量、患者满意度、各级护士满意度均有统计学意义（均P＜0.05）,专科护士专业地位对各级护士职业成长的影响显著.结论 分层级管理有利于提高护理质量,提高患者满意度,专科护士专业地位的确立增强了护士的职业成就感,提高了护士工作满意度,促进护士提高学历并努力向专科护士发展.     

“4S”品牌服务在拓宽专科护理服务内涵中的应用

目的:探讨"4S"品牌服务在拓宽专科护理服务内涵中的应用效果。方法:护理部在全院科室中选取4个护理单元率先创建和实施"4S"特色护理服务。比较实施前和实施后专科护理工作质量,包括患者满意度、医生对护理工作质量评价、护士自我工作质量评价三个方面。结果:"4S"品牌服务实施后患者对护理工作的满意度明显高于实施前(P0.01),医生对护理工作质量评价和责任护士自我工作质量评价明显优于实施前(P0.05,P0.01)。结论:"4S"特色护理服务品牌的创建以"4S"即微笑服务、温暖服务、精细服务、满意服务为总体框架,结合本科室专科特点实施,一科一品牌、专科措施有特色,形成专科护理服务品质,拓宽专科护理服务内涵,夯实优质护理服务。     

日常生活活动能力量表在实施基础护理中的应用

目的 探讨日常生活活动能力(activities of daily living,ADL)量表在实施基础护理中的应用.方法 选择内、外科系统4 个优质护理服务示范病房,将ADL 评定纳入责任护士工作流程,每日晨间床边交接班后,责任组长对所分管床位的患者进行评估,根据得分确定患者的自理能力,按其依赖程度下达护嘱,指导责任护士按照患者的个体需要正确实施基础护理,确保患者舒适、整洁,责任组长负责督查执行情况,护士长随机抽查,确保基础护理落实到位.结果 ADL 量表在优质护理服务示范病房实施前(2010 年10-12 月)后(2011 年1-3 月),基础护理质量考核得分、患者对护理工作满意度得分、医生对护士工作满意度得分比较,差异均有统计学意义(P<0.05).结论 在优质护理服务示范病房应用ADL 量表实施基础护理,可提高护理服务质量和护理服务满意度,达到优质护理服务工作的相关要求.     

分层责任包干制在优质服务示范病房中使用的有效性研究

目的验证护士分层责任包干制护理模式在优质服务示范病房中使用的有效性,改变护理模式,最大程度地满足病人的护理需求,提高护理人力的使用效率和患者的满意度。方法全院实行护士分层级管理,设立专科护士（N4）一责任组长（N3）一高级责任护士（N2）一初级责任护士（N1）一助理护士（N0）五层分层级管理模式,做好护士分层级培训与考核,职责明确,实行责任包干制,改革护士排班模式,实施层级的工作权限与绩效考核。比较实施前后护理工作质量、患者满意度、直接护理时间、护士的职业价值观等改善情况。结果实施护士分层级管理模式后,基础护理合格率、健康教育落实率、护士对患者病情掌握率、护理差错缺陷发生率等各项护理工作质量较实施前显著提高（P〈0．01）,患者的满意度明显提高（P〈0．01）,护士对患者的直接护理时间明显增加（P〈0．01）,护士的职业价值观得到明显提高（P〈0．05）。结论实施护士分层责任包干制护理管理模式,可以有效提升护理质量、病人满意度、直接护理时间及护士的职业价值观,提高了护理人力的使用效率。     

多媒体滚动播放宣教技术在乳腺科优质护理中的应用

目的 提高护理质量,满足患者对疾病相关信息方面的需求,提高患者满意度,减轻护理工作负担,使患者满意,护士满意。方法 护理中应用多媒体技术,8小时滚动播放,向患者传递入院、术前术后宣教、术后功能锻炼、经外周中心静脉置管(Peripherally Inserted Central Catheter,PICC)相关知识、乳癌化疗相关知识、中医专科护理方法、乳房自查方法、中医养生知识、出院宣教、康复患者的现身说法等内容。结果 患者对疾病相关信息方面的需求满意度大幅提升,住院期间总体满意度提高(p<0.05)。护士各护理宣教工作负担大幅减轻,整体工作满意度提高(p<0.05)。结论 多媒体滚动播放宣教技术的合理应用,可有效提高患者对信息需求方面的满意度,提高住院患者总体满意度,同时减轻护士宣教工作负担,提高护士工作总体满意度。     

护理小查房在提高肿瘤科护理质量中的应用效果分析

目的探讨护理小查房模式在提高肿瘤科护理质量中的效果。方法选取2016年7月~12月在本科住院的患者设为对照组采用常规的护理查房,选取2017年1月~6月在本科住院的患者作为观察组实施护理小查房方法,即每月双周星期二、四下午15:30,由护士长、责任组长或专科护士主持,围绕病区患者的情况进行15~20min的床旁查房。观察实施6个月后责任护士病情知晓率、专科知识掌握率、护理质量及患者满意度。结果实施护理小查房后,基础护理、一级护理、特级护理、总护理质量、患者满意度、护士病情知晓率、专科知识掌握率均明显高于实施前(P0.05)。结论实施护理小查房对提高护士业务水平、临床护理质量、患者的满意度起到积极的促进作用,有利于护理工作的开展。     

护士分层管理在优质护理服务病房的应用体会

目的总结护士分层管理模式在优质护理服务病房的应用体会。方法按学历、护龄、职称将护士分为责任组长、高级责任护士、初级责任护士、助理护士,组成责任包干制整体护理小组,每位护士按能级不同包干一定数量的患者,制订各级岗位职责,并实施全程护理。结果护士分层管理后,病房管理、基础护理、健康教育、专科护理等护理质量评价指标提升,患者一对一自请保姆陪护率、护理不良事件发生率下降;患者对护理工作满意度为99.8%。结论护士分层管理可提高优质护理服务质量和患者满意度。     

责任护士跟医日查房制度的建立与效果评价

目的探讨建立责任护士跟医日查房制度对综合护理质量的影响。方法将200例住院患者随机分为对照组及观察组。对照组100例按照传统方式由护士长带领责任护士与夜班护士进行床边交接,每日1次。观察组100例实施责任护士跟医查房制度,每日1次。结果观察组整体护理质量、患者对护理工作的满意度均优于对照组(均P0.01),护理不良事件发生率明显低于对照组,差异有统计学意义(P0.05)。结论责任护士跟医日查房制度的建立和实施有利于优质护理服务的开展。     

开展优质护理服务示范工程活动提高住院患者满意度

目的 开展优质护理服务示范工程活动,推行主动服务模式,提高住院患者对护理工作的满意度.方法 以卫生部办公厅<2010年"优质护理服务示范工程"活动方案>、广东省卫生厅<创建"优质护理服务示范工程"活动实施方案>、<广东省医院临床护理质量评价指南>3个文件的内容为指导思想,对10个试点病房开展"优质护理服务示范工程"活动:改革护士工作模式,建立护士管床管患者的整体护理责任制;科室弹性排班,优化护士工作时间;建立优质护理服务的长效机制,根据专科特色及患者需求细化服务内容;拓宽护理工作范围,进一步开展护理延伸服务;鼓励各种形式的创优活动,深化优质护理服务内涵.采用调查问卷比较活动实施前、6个月后住院患者对护理工作的满意度情况.结果 开展创优工作前后住院患者对护理工作总体满意度差异有统计学意义(P＜0.05);住院患者对护理工作满意度各模块条目比较, 除病区管理模块的比较差异无统计学意义(P＞0.05)外,服务态度和主动性、工作能力、关爱与沟通、健康教育4个模块比较差异均有统计学意义(P＜0.05).结论 开展"优质护理服务示范工程"活动可以改善护理服务质量,有利于提高住院患者对护理工作的满意度.     

基于岗位胜任力的“岗-能驱动”培训模式在临床护理人员培训中的实践与效果

目的探讨能够提高护士岗位胜任力的培训模式。方法采用专家咨询法、查阅文献等方式,制定了以岗位需求为导向、提高护士岗位胜任力的"岗-能驱动"培训模式,比较实施前后护理质量、患者满意度及护士工作满意度。结果实施后与实施前相比,护理质量在专科护理、基础管理、急救技能、护理文件书写方面有显著提高;患者满意度调查中,在护理管理、健康教育、业务水平方面有显著提高;在护士工作满意度方面也有显著提高。以上各组差异均有统计学意义(P0.05)。结论实施"岗-能驱动"培训模式,能够提升护士岗位胜任能力与护理质量,提高患者满意度和护士工作满意度。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。