闭环式反馈控制法应用于新护士培训的效果研究

[目的]应用闭环式反馈控制法提高新护士培训效果.[方法]对照组为2005年-2006年在外科实习的新护士72人,采用常规的将新护士分配给各临床专科进行1年的轮转培训.实验组为2007年7月-2009年7月分配至外科的新护士131人,采用小组培训与轮转培训相结合,并在培训过程中应用闭环式反馈控制法.分析两组不同培训阶段考核合格率及新护士转岗、离职率.[结果]实验组培训合格率高于对照组,新护士转岗、离职率低于对照组.[结论]闭环式反馈控制法用于新护士培训中可有效地提高护士阶段性考核成绩,降低转岗、离职率.     

模拟质量控制检查法在低年资轮转护士培训中的应用效果

目的观察模拟质量控制检查法在低年资轮转护士培训中的效果。方法选择24名新入科低年资轮转护士,以2012年6月为界,前1年入科护士11人为对照组,后1年入科护士13人为观察组。对照组单独上岗前进行为期2个月的常规培训,观察组在对照组基础上增加模拟质量控制检查法培训。培训前及入科后2月进行理论考核,同时入科后2月再对两组进行床边综合能力考核及对培训满意度调查。结果培训前两组低年资轮转护士理论成绩差异无统计学意义;培训后2月低年资轮转护士的理论成绩及床边综合能力考核成绩和对培训的满意度观察组高于对照组,经比较,差异有统计学意义。结论模拟质量控制检查法可提高低年资轮转护士培训效果。     

基于岗位胜任力的多元化护士规范化培训模式的构建及应用

目的探讨基于岗位胜任力的多元化护士规范化培训模式的构建及应用效果。方法选取2019年8月至2020年8月滕州市中心人民医院新入职护士38名为研究对象, 随机分为对照组和实验组各19名。对照组护士给予传统培训方法, 实验组在此基础上实施基于岗位胜任力的多元化护士规范化培训模式干预, 对比干预后两组护士的考核成绩、核心胜任力、护理质量情况。结果实施基于岗位胜任力的多元化护士规范化培训模式后, 实验组护士的理论成绩及技能成绩、护士核心胜任力各维度评分、护理质量各维度评分均显著高于对照组, 差异有统计学意义(均P<0.05)。结论通过构建基于岗位胜任力的多元化护士规范化培训模式, 并将该模式应用于新入职护士培训中, 能显著提升护士的综合考核成绩, 提高其核心胜任能力, 优化临床护理质量, 值得临床推广应用。     

新护士规范化岗前培训的方法与效果

目的完善新护士的岗前培训,提高护理队伍的整体水平。方法将2008年应届毕业的70名新毕业护士随机分成两组,对照组和实验组,每组35人,对照组采用我院传统方法进行培训,实验组采用修改后规范化培训方法;对两组护士的考试成绩和一次通过率进行比较,并对两组护士培训的满意度进行调查。结果实验组护士的理论考核成绩、实践考核成绩、礼仪形象考核成绩及考核平均成绩、考核一次性通过率明显高于对照组（P〈0．05）;实验组护士对培训的理论知识、实践操作的满意程度及对上岗前心理准备的满意程度优于对照组（P〈0.05）。结论规范化岗前培训模式调动了新护士的积极性,提高新护士理论知识与实践操作技能,有利于新护士的培养。     

消毒供应中心护理人员规范化培训的实践

目的总结消毒供应中心护理人员规范化培训实践体会。方法建立培训小组,按护士层级制定培训内容,采用集中、分层、分组方式实施规范化培训。观察212~214年度护理人员专业知识、操作技能考核成绩及工作缺陷发生情况。结果规范化培训后护理人员专业知识、操作技能考核成绩明显提高,专业知识平均成绩从85.8分提高到94.分,操作技能成绩从84.9分提高到95.9分;工作缺陷明显减少,由培训前的273起/年减少到91起/年。结论规范化培训能提高消毒供应中心护理人员岗位操作技能。     

探索新护士岗前培训模式的构建与实施

目的 探索新护士岗前培训模式,建立规范化培训体系,提升新护士临床实践能力.方法 2012年新入职的92名护士作为研究对象,随机分为对照组及实验组,对照组采用我院传统方法进行培训,实验组采用改进的基于临床实践能力的新护士岗前培训模式,培训周期结束后进行考核及效果评价.结果 实验组基础理论考核与对照组比较无明显差别（P〉0.05）,但基础技能、专科理论及技能考核成绩,同事及患者对护士工作满意度比较均高于对照组（P〈0.01）.结论基于临床实践能力的岗前培训模式,能促使新护士尽快完成从学生到临床护士的角色转换,提高岗位胜任能力.     

独立值班考核在新护士规范化培训中的应用

目的 探讨独立值班考核在新护士规范化培训过程中的实施效果.方法 选取2010年入职的64名新毕业护士作为对照组,2011年入职的68名新毕业护士作为观察组.对照组给予医院规范化培训,观察组在医院规范化培训的基础上给予独立值班培训,培训1年后参加护理部组织的独立上岗考核,对其考核结果进行分析.结果 观察组应急处理各项考核成绩均明显高于对照组.结论 独立值班考核的实施,强化了规范化培训成果,促进了新护士应急事件处理能力的提高,有效提高了新护士临床独立工作能力.     

临床教学路径在新生儿科轮转护士培训中的应用

目的探讨临床教学路径在新生儿科轮转护士培训中的应用效果。方法新生儿科成立轮转护士培训小组,制订轮转护士临床教学路径计划,共分为入科、熟悉、巩固、考核4个阶段,还包括集中培训和自学内容,培训1个月后由护士长或带教组长对轮转护士进行独立当班评价,考核合格准予独立当班。结果 45名轮转护士经过1个月的强化培训,理论知识考核成绩(86.35±3.54)分,操作考核成绩(89.76±2.37)分,工作日志完成得分为(91.32±3.19)分,均能独立完成患儿临床护理工作,顺利通过出班考核并独立当班,独立当班后无发生差错事故。结论合理的临床教学路径、有效的带教效果评价是轮转护士按时独立当班的重要保障。     

规范化培训-危重症轮转对新护士自我效能感的影响

目的分析规范化培训-危重症轮转对新护士自我效能感的影响。方法选取江阴市人民医院敔山湾院急诊科2018年3月至2019年3月危重症轮转的94名护士,以单盲随机抽样法分组,分为参照组(47例)接受常规入职培训和实验组(47例)接受规范化培训,对比两组理论知识、技能操作考核成绩、自我效能感、核心能力、自我评价得分、考核合格率。结果实验组培训后理论知识、技能操作考核成绩、自我效能感、核心能力以及自我评价得分均高于参照组,差异均有统计学意义(P<0.05)。实验组考核合格率(100.00%)与参照组(93.62%)比较差异无统计学意义(P>0.05)。结论规范化培训可提高危重症轮转护士专业能力、自我效能感、核心能力、考核合格率等,培训效果较好。     

消毒供应中心新进人员专科岗位培训模式构建与评价

随着消毒供应中心集中管理模式的纵深推进,人力资源需求变化较大,新进入消毒供应中心的人员,学历、教育背景均存在很大的差异,如何确保新进人员的培训效果,探索符合消毒供应中心专科特色的专科岗位培训模式,是消毒供应中心管理者关注的重要课题。本文从构建专科岗位培训管理体系、分阶段实施专科岗位分区规范化与岗位轮转精细化培训、考核与评价等几个方面探索构建了消毒供应中心新进人员专科岗位培训模式,通过3年的实施,有利于新进人员在一年内全面、系统地掌握消毒供应中心专业知识及专业技能,为安全、独立承担科室的各个岗位工作打下坚实的基础。     

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。