护理职业应激与心理因素分析

了解护士职业应激与心理因素的相关性.应用抑郁自评量表(SDS)和焦虑自评量表(SAS)及护士职业压力源量表对440名在岗护士进行调查.护士抑郁和焦虑发生率分别为36.1%和14.2%,两者并存者占10.6%,SDS和SAS标准分均值与国内常模比较有统计学意义(P＜0.01);护士职业应激总分1.96分±0.460分;心理状况与职业应激呈高度正相关(P＜0.001).护士群体精神状况低下,与其职业应激密切相关.管理者应在引导护士正确认识和舒缓职业应激的同时,考虑到女性的社会脆弱因素及其独特的生理特征.     

护士职业应激与心理因素分析

了解护士职业应激与心理因素的相关性。应用抑郁自评量表(SDS)和焦虑自评量表(SAS)及护士职业压力源量表对440名在岗护士进行调查。护士抑郁和焦虑发生率分别为36 .1%和14 .2%,两者并存者占10. 6%,SDS和SAS标准分均值与国内常模比较有统计学意义(P<0 .01);护士职业应激总分1 96分±0 .460分;心理状况与职业应激呈高度正相关(P<0 .001)。护士群体精神状况低下,与其职业应激密切相关。管理者应在引导护士正确认识和舒缓职业应激的同时,考虑到女性的社会脆弱因素及其独特的生理特征。     

护理人员心身健康状况的研究

[目的 ]了解肿瘤专科护士心身健康状况及影响因素。 [方法 ]采用抑郁自评量表 (SDS)、焦虑自评量表 (SAS)及护士职业压力源调查表 ,对 12 8名护士进行调查。 [结果 ]护士SDS得分为 44 .2 6分±9.2 2分 ,高于我国常模SDS标准分 41.88分± 10 .5 7分 (P <0 .0 1) ;SAS得分为 3 9.2 8分± 8.88分 ,高于我国正常人 3 7.2 3分± 0 .46分(P <0 .0 1) ;SDS、SAS得分与工作压力源呈正相关 ,高风险职业的压力、晋升和深造机会太少、经常倒班、工作量太大、担心出现护理纠纷和差错事故、社会地位低、工作职位竞争等为主要压力源。 [结论 ]护士心身健康状况与职业压力密切相关 ,而影响因素是多方面的 ,应引起各级管理者高度重视     

慢性乙型肝炎病人焦虑与抑郁的调查及其心理干预

[目的 ]了解慢性乙型肝炎病人的焦虑、抑郁状况 ,并进行心理干预效果评估。 [方法 ]采用焦虑自评量表 (SAS)及抑郁自评量表 (SDS)对 10 0例慢性乙型肝炎病人 (观察组 )及 10 0例健康人 (对照组 )进行问卷调查。根据调查存在的心理问题 ,对观察组实施为期 8周的心理干预 ,然后再测评SAS及SDS1次 ,并与心理干预前比较。[结果 ]观察组SAS及SDS评分均明显高于对照组 (P <0 .0 1) ,经心理干预后 ,其SAS及SDS评分分别由 3 6.82分± 6.2 4分和 41.16分± 10 .73分降为 3 2 .19分± 5 .72分和 3 5 .74分±9.16分 (P <0 .0 1) ;其焦虑及抑郁的发生率分别由 3 6.0 %和 43 .0 %降为 12 .0 %和 2 1.0 %(P <0 .0 1)。 [结论 ]慢性乙型肝炎病人存在一定程度的焦虑及抑郁 ,心理干预可缓解慢性乙型肝炎病人的焦虑及抑郁症状。     

唐山地区护理专业实践环境现状及与护士心理健康状况的关系

[目的]了解唐山地区护理专业实践环境现状及其与护士心理健康状况的关系。[方法]采用护理工作环境量表(PES)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对唐山市7所三级医院2 158名临床护士进行调查。[结果]PES总分为(84.05±6.89)分,总均分为(2.52±0.35)分,SAS评分为(40.20±13.74)分,SDS评分为(44.34±10.37)分;PES总分及各维度得分与护士SAS、SDS评分呈负相关。[结论]护理工作环境与护士焦虑、抑郁水平关系密切,医院应采取有效措施改善临床护士的工作环境,提高护士心理健康水平。     

认知行为疗法用于精神分裂症恢复期病人情绪障碍的效果评价

[目的 ]了解精神分裂症恢复期病人的自尊水平以及焦虑抑郁情绪 ,并进行认知治疗效果评价。 [方法 ]将14 4例恢复期精神分裂症病人随机分为研究组和对照组 ,研究组实施认知行为治疗 ,在治疗前后 ,分别采用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)和自尊量表 (SES)、自卑感量表 (FIS)对两组进行评定。 [结果 ]研究组实施认知行为治疗前后SAS、SDS、SES、FIS评分以及焦虑抑郁的发生率 ,差异均有统计学意义 (P <0 .0 5 ) ,且治疗后两组间SAS、SDS、SES、FIS评分以及焦虑抑郁的发生率 ,差异也有统计学意义 (P <0 .0 5 )。 [结论 ]恢复期精神分裂症病人存在低自尊水平和焦虑抑郁症状 ,认知行为治疗可缓解恢复期精神分裂症病人的情绪障碍。     

心理干预对改善慢性乙型病毒性肝炎病人心身症状的研究

[目的 ]探讨一般支持性心理治疗和认知疗法对改善慢性乙型病毒性肝炎病人心身症状的作用。 [方法 ]将60例慢性乙型病毒性肝炎病人随机分为两组 ,实验组在临床治疗的同时采用支持性心理治疗和认知疗法。入院时、入院 2周、入院 4周用症状自评量表 (SCL -90 )、Zung焦虑自评量表(SAS)、Zung抑郁自评量表 (SDS)分别评估病人心理状况。 [结果 ]心理干预后 2周SCL -90躯体化、焦虑、精神症状得分及SAS、SDS标准分与干预前比较 ,差异有统计学意义 (P <0 .0 5 ) ;干预后 4周SCL -90各因子得分及SAS、SDS标准分与干预前比较差异均有统计学意义 (P <0 .0 5 )。对照组治疗前后SCL -90的因子得分及SAS、SDS标准分差异无变化(P >0 .0 5 )。 [结论 ]一般支持性心理治疗和认知疗法能有效改善慢性乙型病毒性肝炎病人的心身症状。     

急诊科护士工作压力、应对方式与焦虑抑郁水平的相关性分析

目的探讨急诊科护士工作压力、应对方式与焦虑抑郁水平的相关性。方法选取2016年3月至2017年5月我院急诊科护士50名作为研究对象,利用护士工作压力源量表、应对方式调查问卷、焦虑自评量表(SAS)及抑郁自评量表(SDS)等工具对护士的情况进行调查。结果急诊科护士的工作压力评分与SAS评分及SDS评分呈正相关(P 0. 05),不合理应对方式与SAS评分及SDS评分呈正相关(P 0. 05),合理应对方式与SAS评分及SDS评分呈负相关(P 0. 05)。结论急诊科护士的工作压力较大,易产生焦虑抑郁精神症状,急诊科护士应采取合理化的方式应对工作压力,避免通过自责、逃避、求助等方式应对工作压力。     

食管癌病人心理健康状况的调查研究

[目的 ]了解食管癌病人心理健康状况及其影响因素。 [方法 ]应用抑郁自评量表 (SDS)、焦虑自评量表 (SAS)及相关因素调查表 ,对 15 1例食管癌病人和13 4例普通疾病病人进行对照测评。[结果 ]食管癌病人抑郁、焦虑发生率明显高于国内常模 ,也高于普通疾病病人(P <0 .0 1) ;食管癌病人在经济、家庭、社会、疼痛及疾病相关知识缺乏、治疗副反应等方面与普通疾病组存在差异(P <0 .0 1)。 [结论 ]针对食管癌病人抑郁焦虑等心理障碍进行对症心理治疗和护理干预十分重要。     

脑动静脉畸形术后病人心理弹性与焦虑、抑郁的相关性研究

[目的]探讨脑动静脉畸形术后病人心理弹性与焦虑、抑郁的相关性。[方法]采用一般资料调查表、中文版心理弹性量表(CDRISC)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对95例脑动静脉畸形术后病人进行问卷调查。[结果]脑动静脉畸形术后病人的心理弹性总分为(59.44±14.35)分,SAS、SDS量表得分分别为(52.65±12.63)分、(57.25±11.26)分;Pearson相关分析结果显示,心理弹性总分及各维度得分与SAS、SDS得分呈负相关(P0.05);多元逐步回归分析结果显示,坚韧维度得分负向预测焦虑、抑郁(P0.05)。[结论]脑动静脉畸形病人的心理弹性水平较低,护士应重视病人心理弹性对负性情绪的保护作用,促进其有效地应对和适应。     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.