烧伤康复期患者韧性水平与生存质量的相关性研究

目的 了解烧伤康复期患者韧性水平与患者生存质量之间的相关性,为烧伤患者的心理危机预防和干预提供理论指导.方法 对255例烧伤康复期患者的一般资料、韧性、生存质量进行问卷调查.结果 烧伤患者韧性得分处于中等水平,生存质量水平处于中等偏低水平,烧伤康复期患者的韧性水平与生活质量之间存在显著正相关,韧性水平对患者心理健康水平影响较大,韧性中的坚韧与力量因子得分与心理健康得分成显著正相关.结论 应通过干预来帮助人们提高韧性,达到发展潜能,预防行为障碍的效果,帮助患者提高韧性从而产生正向的心理适应能力.     

功能性便秘患者的心理韧性与社会支持应对方式的相关性研究

目的探讨功能性便秘患者的心理韧性与社会支持、应对方式的关系。方法运用一般资料调查表、中文版Connor-Davidson心理韧性量表(CD-RISC)、社会支持评定量表(Social support rating scale,SSRS)、简易应对方式问卷(Simplified coping style questionnaire,SCSQ)对130例功能性便秘患者进行问卷调查。结果功能性便秘患者的心理韧性和社会支持总分分别为(61.86±17.68)分、(35.74±6.76)分,应对方式中积极应对条目均分为(1.78±0.52)分,消极应对条目均分为(1.59±0.66)分;相关分析显示功能性便秘患者的心理韧性总分及各维度得分与社会支持总分及客观支持维度、积极应对方式得分呈正相关;多因素分析结果显示积极应对方式是功能性便秘患者心理韧性的独立预测因子(P0.05)。结论功能性便秘患者的心理韧性与社会支持、积极应对方式相关,提示可从社会支持和应对方式的干预着手,提高患者的心理韧性水平。     

不同职称护士心理韧性、应对方式及社会支持的相关性分析

目的:探讨护士的职称与心理韧性、应对方式及社会支持的相关性。方法:选用中国版心理韧性量表(CD-RISC)、简易应对方式量表(SCSQ)、社会支持评定量表(SSRS)对某三级甲等医院298名内外科护士进行问卷调查。结果:不同职称护士在坚韧性、心理韧性总分、客观支持、主观支持、社会支持总分方面比较差异有统计学意义(P0.01,P0.05);不同职称护士积极应对总分、社会支持总分与常模比较差异有统计学意义(P0.01),护士和护师在心理韧性总分方面明显低于常模(P0.01);影响护士职称的因素有婚姻状态、学历、工作年限和工作班次。结论:中级职称护士的心理韧性水平、应对方式及社会支持水平高于初级职称护士,对影响职称的因素进行干预,有助于提高护士的水平,促进护理事业的发展。     

烧伤康复期患者抑郁状况及其影响因素的研究

目的 调查烧伤康复期患者的抑郁状况及其影响因素,分析抑郁与应对方式的关联性. 方法 采用抑郁自评量表和简易应对方式问卷对南昌大学第一附属医院烧伤中心129例烧伤康复期患者进行问卷调查.结果 烧伤康复期患者抑郁发生率为33.33％,抑郁总分为(48.26±9.24)分,经过分析发现不同性别、不同婚姻状态、不同职业的烧伤患者抑郁得分存在差异,此外患者抑郁总分和各维度得分与积极应对方式成中度负相关关系,而与消极应对成中度正相关关系,因此应对方式是烧伤患者抑郁发生的有效预测因子.结论 烧伤康复期患者抑郁状况与应对方式之间存在显著相关,积极的应对方式有助于降低抑郁的发生率.     

肥胖型多囊卵巢综合征不孕女性心理韧性调查及影响因素分析

目的:调查肥胖型多囊卵巢综合征(PCOS)不孕女性的心理韧性水平,分析其影响因素,为提高患者心理韧性水平提供理论依据。方法:采用横断面调查法,采用心理韧性量表(CD-RISC)、社会支持评定量表(SSRS)、医学应对问卷(MCMQ)、纽芬兰大学幸福度量表(MUNSH)以及一般资料调查表对294例肥胖型PCOS患者进行问卷调查。结果:本组患者心理韧性得分为(61. 86±14. 60)分,低于国内常模水平;心理韧性得分在不同年龄分组、结婚年限分组、流产次数、治疗周期次数上存在统计学差异(P 0. 05);相关性分析表明,患者的流产次数、治疗周期次数、屈服应对方式得分与心理韧性水平呈负相关(P 0. 05),社会支持总得分、主观支持、面对应对方式、回避应对方式、主观幸福感得分与心理韧性水平呈正相关(P 0. 05);多元回归分析显示,患者年龄、结婚年限、流产次数、治疗周期数、主观支持程度、应对方式、主观幸福感是影响心理韧性水平的主要因素,共同解释了肥胖型多囊卵巢综合征合并不孕症女性心理韧性50. 3%的变异。结论:肥胖型PCOS不孕女性心理韧性水平较低,医务人员在实施健康教育时应加强心理健康教育,以改善其心理韧性水平,保持积极的心理健康状态,以期取得良好的生殖治疗效果。     

365例晚期癌症患者照顾者心理韧性现状及影响因素分析

目的 调查晚期癌症患者照顾者的心理韧性,并探讨其影响因素.方法 采取便利取样方法,选取于2017年1—7月我院收治的IV期肿瘤患者的照顾者作为研究对象.采用一般资料问卷,心理韧性量表,社会支持量表和照顾者负担量表对其进行调查.采用多元线性回归分析其影响因素.结果 本组晚期癌症照顾者心理韧性得分为(61.24±16.28)分;多元线性回归结果显示,照顾者负担、社会支持、文化程度和宗教信仰是心理韧性的主要影响因素(P<0.05).结论 晚期癌症患者照顾者心理韧性处于中等水平,有待提高.尤其是对于照顾者负担重、缺乏社会支持、文化程度高和无宗教信仰者,医护人员应分析具体原因给予个体化的干预.认真倾听关心照顾者,鼓励其通过日记或言语的诉说来抒发情感,通过动机性访谈等方式了解其照顾需求,积极提供足够的患者照顾信息和缓解经济压力的策略.积极利用和开发照顾者的支持系统,以提高其积极感受水平,从而提升其心理韧性水平.     

烧伤康复期患者自我效能状况及其影响因素研究

目的 :调查烧伤康复期患者自我效能水平并分析其影响因素。方法 :采用一般自我效能感量表(GSES)、社会支持评定量表(SSRS)、简明烧伤患者健康量表(BSHS-A)对158例烧伤康复期患者进行问卷调查。结果 :烧伤康复期患者一般自我效能总分为(22.19±5.27)分,一般自我效能得分与社会支持、生活质量及其各维度呈显著正相关(P0.01),且受性别、文化程度、主观支持、支持利用度、躯体功能的影响。结论 :烧伤康复期患者一般自我效能水平不容乐观,医务人员应加强对患者自我效能水平的干预,充分调动患者的社会资源,尤其应注意对患者早期躯体功能的训练,减少残障的发生,从而提高患者的生活质量。     

造口患者心理韧性水平及其影响因素分析

目的 调查和分析造口患者心理韧性水平、应对方式及心理韧性的影响因素,为提高造口患者的心理韧性水平提供理论依据.方法 运用一般资料调查问卷、心理韧性量表(中文版CD-RISC)、医学应对问卷(MCMQ) 对213例肠造口患者进行问卷调查.结果 造口患者心理韧性总分为(68.21±12.26) 分;造口患者面对得分为(14.92±3.14)分,低于国内常模(P<0.05);回避得分(16.31±4.53)分和屈服得分(10.77±3.57)分高于国内常模(均P<0.05);造口患者应对方式中的面对与心理韧性水平呈正相关,回避和屈服与其心理韧性水平呈负相关(P<0.05);面对、造口患者的年龄及文化程度为造口患者心理韧性水平的影响因素(P=0.000).结论 造口患者心理韧性水平有待提高,护理人员应针对造口患者的应对方式、年龄及文化程度等探索有效的干预模式,进而提高造口患者的心理韧性水平.     

肝硬化患者心理弹性水平及影响因素分析

目的 探究肝硬化患者心理弹性水平并分析影响因素.方法 采用便利抽样法,选取308例肝硬化患者为研究对象,采用一般资料调查表、心理弹性量表、简易应对方式问卷、社会支持评定量表进行问卷调查.结果 肝硬化患者心理弹性得分为(57.80±8.69)分.多元逐步回归结果显示,文化程度、婚姻状况、积极应对、消极应对、客观支持、社会支持利用度对肝硬化患者心理弹性的预测作具有统计学意义(P<0.05).结论 肝硬化患者心理弹性水平不高,文化程度、婚姻状况、积极应对、消极应对、客观支持、社会支持利用度是其影响因素.     

乳腺癌康复期患者体力活动水平及影响因素分析

目的 了解乳腺癌康复期患者体力活动水平及其影响因素,为提高乳腺癌患者体力活动水平提供依据.方法 采用方便抽样法选择在专科门诊进行随访的乳腺癌康复期患者共236例,使用国际体力活动问卷、领悟社会支持量表、自我效能量表、简易应对方式问卷进行评估及分析.结果 本研究43(18.2％)例乳腺癌康复期患者体力活动不足,144(61.0％)例患者体力活动适中,49(20.8％)例患者体力活动活跃;多分类有序Logistic回归显示:年龄、自感疾病严重程度、领悟社会支持、自我效能、积极应对可以影响乳腺癌患者体力活动水平(P<0.05).结论 乳腺癌康复期患者体力活动不足,建议根据影响因素针对性地实施各项措施促使患者正确认识疾病,给予其正确的活动指导,提高其体力活动水平.     

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.