综合医院护士“心身耗竭综合征”的调查及相关因素分析

目的:了解综合医院护士心身耗竭状况及相关因素,并采取相应措施予以解决。方法:采用职业枯竭量表(MBI)、90项症状自评量表(SCL-90)、生活满意度量表(LSIA)共三个量表对317名临床护士进行调查及相关因素分析。结果:SCL-90、MBI中的因子与常模相比有显著性差异;MBI的情绪衰竭、去人格化与SCL-90中的各因子都呈正相关,与个人成就感无相关性;LSIA与MBI的情绪衰竭呈负相关,与MBI的去人性化、个人成就感无相关性。结论:护士心理健康水平较正常人群偏低,护士的职业枯竭状况与个体心理健康水平具有相关性,与生活满意度无关。     

随州市护士工作倦怠状况及其与工作压力源和控制感的相关性研究

目的 探讨护士的工作倦怠状况及其与工作压力源、控制感的关系.方法 运用护士工作倦怠量表(MBI)、护士工作压力源量表(NJSI)、工作心理控制感问卷(WLCS)对随州市3所医院356名护士进行调查,采用Person相关法分析工作倦怠与工作压力源、控制感的相关性.结果 356名护士工作倦怠量表测评中,高度情绪枯竭者占45.5%,高度去人格化倾向者占31.4%,低度个人成就感者为38.6%.在个人成就感纬度上,中专组护士的得分显著低于大专组护士(P＜0.05);在去人格化倾向纬度上,手术室组得分显著低于其他科室组(P之0.05或P＜0.01).相关分析表明,护士情绪枯竭和去人格化维度得分与工作压力源5个方面因子、控制感均存在显著正相关(P＜0.01或P＜0.001),个人成就感仅与管理及人际关系方面因子、控制感存在显著负相关俨＜0.05或氏0.001).结论 临床护士普遍存在工作倦怠问题,低学历护士工作倦怠情况较严重,手术科室护士相对其他i临床科室护士工作倦怠情况较轻.医院应通过降低护士工作压力源、培养护士内控的性格,以缓解其工作倦怠的情况.     

护士心理授权状况与工作倦怠的相关性分析

目的：了解护士的心理授权现状和工作倦怠情况,分析两者间的相关性,探索预防和降低护士工作倦怠的新对策。方法整群抽取广州5家三甲医院的临床护士203人,采用心理授权量表及工作倦怠量表进行调查。结果护士的心理授权感知得分（4．75±0．67）分,为中等水平;其中自我效能得分最高为（5．34±0．73）分,工作影响得分最低为（3．64±0．11）分;护士有较严重的工作倦怠,其中个人成就感丧失维度（3．83±0．62）分,情绪枯竭维度（2．96±0．81）分,去人格化倾向维度（1．89±0．84）分;护士心理授权感知与工作倦怠关系密切,与情绪枯竭、去人格化倾向、个人成就感各维度呈负相关（r值分别为－0．436,－0．366,0．514;P＜0．01）。结论临床护士的心理授权处于中等水平,临床护理管理者应加强护士对心理授权的感知,以降低工作倦怠感的产生。     

护理人员职业倦怠与人口学特征的关系研究

目的 探讨一般人口学特征与护理人员职业倦怠的关系.方法 采用工作倦怠量表（MBI）调查护士185名.结果 不同年龄、工作年限的护理人员情绪衰竭得分差异有统计学意义;不同文化程度、科室的护理人员个人成就感得分差异有统计学意义;不同年龄、工作年限及职称的护理人员去人格化得分差异有统计学意义;回归分析显示,仅年龄因素是去人格化的预测因素.结论 护理人员的人口学变量与职业倦怠有相关关系,但对职业倦怠的预测作用甚小.     

急诊护士工作疲溃感及应对方式调查分析

目的:调查急诊护士的工作疲溃感情况,探讨工作疲溃感与应对方式及其他因素的关系,为减轻急诊护士的工作疲溃感,提高工作效率及护理质量提供依据。方法:使用Maslach工作疲溃感量表和简易应对方式问卷对北京市4家县级医院107名急诊护士进行问卷调查。结果:急诊护士的工作疲溃感处于中高度耗竭。积极应对方式与情绪枯竭(EE)、去人格化倾向(DP)呈负相关,与个人成就感(PA)呈正相关;消极应对方式与情绪枯竭(EE)呈正相关;健康状况、家庭支持、工作态度与情绪枯竭(EE)和去人格化倾向(DP)呈负相关;工作态度与个人成就感(PA)呈正相关。结论:护理管理者要重视并采取措施降低急诊护士的工作疲溃感,急诊护士应在生活和工作中采取积极应对策略以减轻疲溃感。     

146名护士工作问卷调查分析

目的　了解护理人员的情绪枯竭情况 ,分析产生的原因 ,寻找改善措施。方法　采用Maslach编制的护士工作问卷 (MBI) ,内容包括情绪枯竭 (EE)、去人格化倾向 (DP)、个人成就感 (PA)三个因子和自编相关问题问卷 ,对本院 14 6名护理人员进行问卷调查。结果　 14 6名护士工作问卷结果在不同组间比较 ,差异无显著性 (P <0 0 5 ) ;情绪枯竭与去人格化倾向之间呈显著性正相关 (P <0 0 1) ,而与个人成就感、专业喜欢程度、对医院信心呈显著性负担关 (P <0 0 1)。结论　情绪过度疲惫和衰竭可影响护理服务的质量、工作时的完美感、成就感、竞争力和对专业的喜欢程度与对医院的信心。建议 :合理定编与配备专职心理护理师 ;积极引进新技术 ,发展护理生产力 ;建立健全护理支持系统 ;遵循价值规律 ,推出护理经济概念 ;塑造一个健康的自我 ;热爱护理事业 ,勇于接受新的挑战 ,刻苦勤奋 ,合理思维     

唐山市三级甲等医院护士职业耗竭现状调查

目的 了解护士职业耗竭的程度,并分析其影响因素,为护士人群降低职业耗竭提出积极建议.方法 采用Maslach Burnout Inventory(MBI)量表,对三级甲等医院的187名护士的心身耗竭情况进行调查.结果 与标准样本比较反映"情绪枯竭"(EE)的分值为中等分,"去人格话倾向"(DP)的分值为低值,"个人成就感"(PA)的分值为高分,三者与标准样本比较其差异均有统计学意义(P<0.05).对医院待遇的满意度,与"个人成就感"(PA),"情绪枯竭"(EE),"去人格化倾向"(DP)有关,差异有统计学意义(P<0.05).结论 增加护士经济收入,完善医院的设备,加强护士心理素质教育,是降低耗竭的主要方法 .     

人性化管理对儿科护理人员离职意愿及职业倦怠的影响

目的:探讨人性化管理对儿科护理人员离职意愿及职业倦怠的影响。方法:以我院儿科2015年6~12月在职的52名护理人员为调查对象,于2015年6月后实施人性化管理。在人性化管理前6个月和后6个月使用职业倦怠量表(包括情绪枯竭、去人格化、个人成就感)和离职意愿量表(包括离职意愿Ⅰ、离职意愿Ⅱ、离职意愿Ⅲ)进行职业倦怠与离职意愿评价。结果:实施人性化管理后,儿科护理人员情绪枯竭、去人格化和个人成就感评分与人性化管理前相比差异有统计学意义(均P0.05)。人性化管理后儿科护理人员离职意愿Ⅰ、离职意愿Ⅱ的评分均明显低于实施前(P0.05)。但是人性化管理前后离职意愿Ⅲ评分差异无统计学意义(P0.05)。结论:人性化管理能够有效降低儿科护理人员离职意愿,预防职业倦怠,值得在儿科护理人力资源管理中运用。     

广州市三级甲等医院急诊科护士工作授能与职业倦怠相关性分析

目的:调查急诊科护士工作授能与职业倦怠现状,分析两者的相关性。方法:便利选取广州市4所三级甲等医院269名急诊科护士进行问卷调查。结果:本组急诊科护士工作授能总分为(17.28±2.97)分;护士职业倦怠中情绪枯竭、去人性化倾向、个人成就感分别为(20.15±10.14)分、(5.06±2.13)分和(32.65±8.07)分;工作授能与职业倦怠中的情绪枯竭维度和去人格化倾向维度呈负相关(P0.05),与个人成就感维度呈正相关(P0.01)。结论:广州市三级甲等医院急诊科护士职业倦怠程度受工作授能水平的影响,管理人员可以通过提高护士的工作授能水平降低护士职业倦怠水平。     

护士工作倦怠与身心健康、工作满足感相关性的调查研究

目的 探讨护士工作倦怠与身心健康、工作满足感的关系。方法 采用Maslaeh工作倦怠量表、心身症状量表、工作满足感量表对245名护士进行问卷调查，并对结果进行分析。结果 （1）护士情绪疲惫与个人成就感呈中度倦怠、去人格化呈低度倦怠，身心健康水平、工作满足感呈中度水平。（2）护士情绪疲惫、去人格化与身心健康呈正相关（r=0．459，r=0．180，P〈0．01），与工作满足感呈负相关（r=-0．284，r=-0．208，P〈0．01），个人成就感与工作满足感呈正相关（r=0．303，P〈0．01），与身心健康无显著相关性。（3）多元线性逐步回归分析显示，情绪疲惫是身心健康的主要预测因子、个人成就感与情绪疲惫是工作满足感的主要预测因子。结论 护士工作倦怠影响身心健康与工作满足感。     

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.     

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.     

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.     

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.