老年慢性心力衰竭患者希望与疾病不确定感的相关性研究

目的探讨老年慢性心力衰竭(chrontic heart failure,CHF)患者希望与疾病不确定感的相关性。方法采用Herth希望量表、疾病不确定感量表对130例老年CHF患者进行调查。结果患者的希望得分为(30.16±5.62)分,85.39%的患者处于中、低等水平。家庭经济状况、患病时间、心功能分级影响患者希望得分。患者的疾病不确定感得分为(104.15±12.53)分,88.46%的患者处于中、高等水平。Pearson相关分析显示,希望与疾病不确定感呈负相关(r=-0.461,P0.01)。结论大部分老年CHF患者的希望处于中、低等水平,护理人员可通过减轻患者的疾病不确定感来提高其希望水平。     

肝癌患者家属疾病不确定感与其应对方式的相关性研究

目的评估肝癌患者家属疾病不确定感和应对方式的现状并分析两者的相关性。方法采用方便取样法抽取杭州市3所三级甲等医院肝胆胰外科的200名肝癌患者家属,采用一般情况调查表、疾病不确定感家属量表和医学应对问卷进行调查,使用Pearson相关对肝癌患者家属疾病不确定感与应对方式的关系进行分析。结果肝癌患者家属疾病不确定感总分为(85.29±13.80)分。相关分析显示,面对应对方式与患者家属的疾病不确定感呈负相关(P0.001),屈服应对方式与患者家属的疾病不确定感呈正相关(P0.05)。结论肝癌患者家属的疾病不确定感处于中等偏上水平,肝癌患者家属的疾病不确定感与其应对方式存在相关性。     

慢性心力衰竭患者家属疾病不确定感与患者生活质量的关系研究

目的了解慢性心力衰竭患者家属疾病不确定感与患者生活质量的现状,并探讨二者之间的关系。方法采用便利抽样法选取慢性心力衰竭患者及其家属各120例为研究对象,采用一般资料调查表、疾病不确定感家属量表、明尼苏达生活质量问卷对慢性心力衰竭患者及其家属进行测评。结果慢性心力衰竭患者家属疾病不确定感得分为(78.20±8.31)分,患者明尼苏达生活质量量表总分及身体领域、情绪领域、总体的健康相关生活质量评分分别为(69.70±7.90)分、(25.43±5.50)分、(17.01±4.42)分、(27.26±4.67)分,均处于中等水平;慢性心力衰竭患者家属疾病不确定感与患者生活质量具有相关性(r=0.610,P0.05)。多元线性回归分析结果显示,患者的年龄、心功能分级及家庭年收入、家属的年龄、疾病不确定感是慢性心力衰竭患者生活质量的影响因素(P0.05)。结论慢性心力衰竭患者家属具有较高水平的疾病不确定感,家属疾病不确定感对慢性心力衰竭患者生活质量具有正向预测作用。     

乳腺癌术后化疗患者家属疾病不确定感现状及影响因素

目的了解乳腺癌术后化疗患者家属疾病不确定感状况及其影响因素。方法采用一般资料调查问卷、Mishel疾病不确定感家属量表、状态焦虑量表、简易应对量表、社会支持量表对329名乳腺癌术后化疗患者家属进行问卷调查。结果家属疾病不确定感总分为(71.91±8.15)分,状态焦虑、积极应对方式、主观支持、与患者的关系、化疗副反应种类和文化程度是影响乳腺癌术后化疗患者家属疾病不确定感的重要因素。疾病不确定感与状态焦虑呈正相关,社会支持与积极应对方式呈负相关(P<0.05)。结论乳腺癌患者家属的疾病不确定感处于较高水平,医务人员要为家属提供患者疾病的相关信息,防止家属疾病不确定感给患者带来负性影响。     

慢性肾脏病患儿父母疾病不确定感与焦虑及应对方式的相关性研究

目的：了解慢性肾脏病患儿父母的疾病不确定感、焦虑及积极应对方式的现状及其相关性。方法对190名慢性肾脏病患儿父母采用一般资料调查表、疾病不确定感家属量表、焦虑自评量表及父母应对方式量表进行调查,对190例慢性肾脏病患儿父母进行问卷调查。采用Pearson相关分析了解两者间相关性。结果190名慢性肾脏病患儿父母疾病不确定感得分为（72.33±11.77）分,焦虑得分为（38.71±6.93）分,其中轻度焦虑有90名,占47.4%。慢性肾脏病患儿父母疾病不确定感总分和不明确性、缺乏澄清、缺乏信息维度得分与焦虑得分呈正相关（P<0.01）,与应对方式使用频率、作用程度得分呈负相关（P<0.05）。结论慢性肾脏病患儿父母疾病不确定感处于中等水平,存在焦虑情绪,医护人员需鼓励患儿父母采取积极的应对方式,减轻焦虑情绪,降低疾病不确定感水平。     

胃癌根治手术患者术后疾病不确定感与信息需求及应对方式的关系

目的探讨胃癌根治手术患者术后疾病不确定感与信息需求及应对方式的关系。方法2018年10月至2019年10月应用一般资料调查问卷、疾病不确定感量表、癌症患者信息选择问卷及应对方式问卷对92例胃癌根治手术患者进行调查,采用Pearson单因素分析胃癌根治手术患者术前疾病不确定感与信息需求及应对方式的关系,多元回归分析影响胃癌根治手术患者术后不确定感的相关因素。结果胃癌根治手术患者术后疾病不确定感评分为(101.45±8.75)分。经Pearson单因素分析可知,胃癌根治手术患者疾病不确定感总评分及信息缺乏维度与信息需求总评分及其预后维度以及消极应对评分呈正相关(P<0.05),而与积极应对评分呈负相关(P<0.05)。经多元回归分析可知,学历初中或以下、治疗为无效、信息需求高水平及消极应对是影响胃癌根治手术患者术后疾病不确定感的危险因素(P<0.05),而积极应对是胃癌根治手术疾病不确定感的保护因素(P<0.05)。结论胃癌根治手术患者术后疾病不确定感较明显,尽量满足患者信息需求,指导患者以积极的方式面对疾病将有助于减轻患者疾病不确定感,改善患者预后。     

慢性心力衰竭病人疾病不确定感与应对方式的相关性研究

[目的]调查慢性心力衰竭(CHF)病人疾病不确定感水平、来源及所采用的应对方式,分析两者之间的相关性.[方法]采用中文版Mishel疾病不确定感量表(MUIS)、Jalowiec应对方式量表(JCS)以随机抽样法对98例CHF病人进行问卷调查.[结果]CHF病人的疾病不确定感处于中等水平,乐观的应对方式使用较多,保守的应对方式使用较少;疾病不确定感与宿命、逃避两类应对方式呈正相关(P＜0.01),与面对、乐观、自我依赖、寻求支持4类应对方式呈负相关(P＜0.01或P＜0.05),与感情冲动、保守两类应对方式未发现相关性(P＞0.05).[结论]护理人员应提供针对性的信息支持,降低疾病不确定感,帮助病人建立有效的应对方式,降低病死率,提高生活质量.     

喉癌患者疾病不确定感现状及影响因素分析

目的分析喉癌患者疾病不确定感及影响因素。方法回顾性分析2017年1月—2019年8月本院82例喉癌患者临床资料,根据评估中文版Mishel疾病不确定感量表(MUIS-A)患者疾病不确定感水平,将其分为疾病不确定感低水平组(低水平组)、疾病不确定感中水平组(中水平组)及疾病不确定感高水平组(高水平组),并将低水平组和中水平组纳入非高水平组,比较高水平组与非高水平组在不同性别、年龄、文化程度、家庭月收入、婚姻状况、医疗费用方式等情况之间的差异,使用Logistic回归分析评估影响喉癌患者出现高水平疾病不确定感的危险因素;并比较低水平组、中水平组及高水平组之间的社会支持[社会支持评定量表(SSRS)]、心理弹性[心理弹性量表(CD-RISC)]、应对方式[简易应对方式问卷(SCSQ)]水平,利用Pearson相关分析评估喉癌患者疾病不确定感与社会支持、心理弹性、应对方式的相关性。结果经多因素Logistic回归分析,发现文化程度为小学及初中、家庭月收入人均3000元、未婚或丧偶及医疗费用自费支付是影响喉癌患者出现高水平疾病不确定感的独立危险因素(OR=2.257、2.635、2.008、1.855,P0.05)。经Pearson相关分析,发现喉癌患者MUIS-A评分与SSRS、CD-RISC及积极应对SCSQ评分呈显著负相关(r=-0.429、-0.432、-0.397,P0.05),与消积应对SCSQ评分则呈显著正相关(r=0.415,P0.05)。结论文化程度、家庭月收入、婚姻状况、医疗费用方式均能影响喉癌患者疾病不确定感水平,且疾病不确定感与社会支持、心理弹性、应对方式等关系密切,临床积极干预非常有其必要性。     

宫颈上皮内瘤变患者疾病不确定感与焦虑抑郁的调查分析

目的了解宫颈上皮内瘤变患者疾病不确定感及焦虑抑郁现状,分析其影响因素。方法采用方便抽样法,通过自行设计的一般资料问卷、疾病不确定感量表和综合医院焦虑抑郁量表对符合纳入标准的243例宫颈上皮内瘤变患者进行问卷调查。结果患者疾病不确定感量表得分(93.75±10.906)分,多元线性回归分析显示,文化程度是影响患者疾病不确定感的主要因素。患者可疑焦虑和可疑抑郁发生率分别为18.5%和19.3%,焦虑和抑郁发生率分别为47.7%和30.0%,年龄和疾病分级是影响患者焦虑的主要因素。Pearson相关分析显示,患者疾病不确定感量表得分与焦虑和抑郁得分呈正相关性(r=0.310、0.299,P0.01)。结论宫颈上皮内瘤变患者疾病不确定感处于中等水平,焦虑抑郁情绪明显。     

慢性肾脏病患儿主要照顾者的照顾准备度现状及影响因素分析

目的调查慢性肾脏病患儿主要照顾者的照顾准备度现状,并分析其影响因素。方法采用便利抽样法选取120名慢性肾脏病患儿的主要照顾者为调查对象,使用一般资料调查问卷、疾病不确定感量表、照顾准备度评估量表进行调查。结果慢性肾脏病患儿主要照顾者的照顾准备度总分为(15.89±2.75)分,疾病不确定感总分为(74.59±10.23)分;Pearson相关性分析显示,主要照顾者疾病不确定感与照顾准备度呈负相关(r=-0.435,P0.01);多元逐步回归分析显示,年龄、文化程度、家庭月收入、辅助照顾者人数以及疾病不确定感是影响主要照顾者照顾准备度的因素(P0.05)。结论慢性肾脏病患儿主要照顾者的照顾准备度有待提高,医护人员可根据影响因素采取相关干预策略,帮助其降低疾病不确定感,提高照顾准备度。     

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."