住院肿瘤患者及其家属出院后随访意愿情况调查分析

目的探讨住院肿瘤患者及其家属出院后随访意愿情况。方法自行设计肿瘤患者及家属随访意愿调查表,了解患者及其家属随访意愿、随访方式、随访时间、随访内容需求等方面。结果 93.9%的患者和96.9%的家属选择愿意接受随访;84.8%的患者和81.3%的家属愿意接受电话随访;42.4%的患者及43.8%的家属选择可在任意时间随访,33.4%的患者及40.7%的家属选择下午或晚上时间;69.7%的患者及62.4%的家属选择随访时间为10 min内;97.0%的患者及93.8%的家属选择由医生进行电话随访,33.3%的患者及31.2%的家属选择由护士进行电话随访;在随访内容方面,患者及家属根据需求选择了用药指导、复查提醒、预约住院、饮食指导、健康咨询、运动指导、心理疏导、并发症护理及PICC护理等,患者及家属在随访意愿情况方面表现高度一致(均P0.05)。结论住院肿瘤患者及家属在出院后愿意接受来自医院医护人员的随访,主要选择电话随访及由医生进行随访,随访内容是多方面的。     

严重烧伤早期患者血清可溶性P-选择素及可溶性E-选择素的变化及意义

目的探讨严重烧伤早期患者血清可溶性P-选择素(sP-选择素)、可溶性E-选择素(sE-选择素)的变化及意义。方法采用酶联免疫吸附法定量检测32例严重烧伤患者和20例体检健康者血清sP-选择素、sE-选择素水平。结果严重烧伤早期患者血清sP-选择素、sE-选择素水平高于健康者(P<0.05)。结论严重烧伤早期患者血清sP-选择素、sE-选择素升高与血管内皮细胞损伤及全身非感染性炎性反应有关,血小板可能在烧伤患者凝血功能异常中发挥一定的作用。     

有机磷中毒患者血浆NO、P-选择素水平变化与MODS的关系

目的探讨有机磷中毒(AOPP)患者血浆一氧化氮(NO)和P选择素水平变化及在多脏器功能障碍综合症(MODS)发生发展中的作用、机制及临床意义。方法用硝酸还原法和酶联免疫双抗夹心法分别测定MODS组25例及非MODS组31患者12、24、48、72、120 h及对照组32例血浆NO及P选择素水平变化,并进行统计学比较。结果 MODS组12、24、48、72、120 h血浆NO及P选择素较对照组有显著性差异(P0.05),而非MODS组仅24、48 h血浆NO及P选择素较对照组有显著性差异(P0.05);MODS组与非MODS组相比,24、48、72、120 h血浆NO及P选择素有显著性差异(P0.05)。结论有机磷中毒并发MODS患者血浆NO及P选择素水平明显升高,提示血管内皮功能损伤是参与导致有机磷中毒发生多脏器损害的原因之一。     

有机磷中毒患者血浆NO、P-选择素水平变化与MODS的关系

目的探讨有机磷中毒（AOPP）患者血浆一氧化氮（NO）和P选择素水平变化及在多脏器功能障碍综合症（MODS）发生发展中的作用、机制及临床意义。方法用硝酸还原法和酶联免疫双抗夹心法分别测定MODS组25例及非MODS组31患者12、24、48、72、120 h及对照组32例血浆NO及P选择素水平变化,并进行统计学比较。结果 MODS组12、24、48、72、120 h血浆NO及P选择素较对照组有显著性差异（P〈0.05）,而非MODS组仅24、48 h血浆NO及P选择素较对照组有显著性差异（P〈0.05）;MODS组与非MODS组相比,24、48、72、120 h血浆NO及P选择素有显著性差异（P〈0.05）。结论有机磷中毒并发MODS患者血浆NO及P选择素水平明显升高,提示血管内皮功能损伤是参与导致有机磷中毒发生多脏器损害的原因之一。     

儿童疼痛评估工具及选择的研究进展

主要从儿童疼痛评估的重要性、不同年龄儿童疼痛评估工具及其选择、评估障碍三方面对儿童疼痛评估工具及其选择的研究进展进行综述。     

血清P-选择素及E-选择素对急诊危重患儿病情及生存状况的评估价值分析

目的探究血清P-选择素及E-选择素水平对急症危重患儿病情及生存状况的影响。方法选取2013年1月至2014年10月接受治疗的50例重症危重患儿(试验组)和50例同期体检的健康儿童(健康对照组)。比较两组研究对象血清P-选择素及E-选择素的变化情况。结果试验组患儿治疗前的P-选择素和E-选择素水平均高于健康对照组,差异有统计学意义(P0.05);治疗后两组间差异均无统计学意义(P0.05)。不同PCIS评分的P-选择素、E-选择素水平均不同,PCIS评分越低,患儿的P-选择素、E-选择素水平越高,差异有统计学意义(P0.05)。不同程度脓毒症患儿的P-选择素、E-选择素水平均不同,非感染危重症患儿的P-选择素、E-选择素水平较低,脓毒症患儿其次,严重脓毒症患儿最高,差异均有统计学意义(P0.05)。结论血清P-选择素及E-选择素对急症危重患儿病情及生存状况具有重要影响。急症危重患儿的病情越严重,生存状况越差,患者的血清P-选择素及E-选择素水平越高,对患儿进行手术抢救的成功率越低,患儿病死率越高。     

严重烧伤患者血清sP、sE-选择素的变化及其意义

目的:探讨严重烧伤早期患者血清中可溶性E-选择素(solubleE-selectin,sE-选择素)、可溶性P-选择素(solubleP-selectin,sP-选择素)的变化及意义。方法:采用酶联免疫法(ELISA)定量检测32例严重烧伤患者和20例健康体检者血清中sP-选择素、sE-选择素的水平。结果:健康体检者血清中sP-选择素、sE-选择素均有表达,严重烧伤早期患者血清中sP-选择素、sE-选择素水平明显高于健康体检者。结论:严重烧伤后早期患者血清中sP-选择素、sE-选择素升高,可能与血管内皮细胞损伤及全身非感染性炎症反应的发生机制有关,血小板可能在烧伤后机体凝血功能异常中发挥一定的作用。     

儿童疼痛评估工具及选择的研究进展

主要从儿童疼痛评估的重要性、不同年龄儿童疼痛评估工具及其选择、评估障碍三方面对儿童疼痛评估工具及其选择的研究进展进行综述.     

肝硬化患者血清sP-选择素与肝功能及肝纤维化的关系

[目的]探讨肝硬化患者血清可溶性粘附分子P-选择素(sP-选择素)与肝功能及肝纤维化的关系.[方法]选择75例肝硬化患者,测定sP-选择素、肝功能及Ⅳ型胶原水平.[结果]肝硬化组血清sP-选择素及Ⅳ型胶原水平均显著高于正常对照组;血清sP-选择素与肝功能、肝功能Child分级和Ⅳ型胶原水平明显相关.[结论]血清sP-选择素水平可能是临床观察肝硬化患者病变活动的重要指标.     

P-选择素与动脉粥样硬化的研究进展及在疗养院的应用

炎性反应在动脉粥样硬化的发病机制中起关键性作用。P-选择素（P-selection）作为炎症标志物及细胞粘附分子介导了细胞之间的粘附、活化，启动了动脉粥样硬化，是炎症和栓塞的中心环节。该文综述了P-选择素对动脉粥样硬化的影响，包括：P-选择素分布结构及生物学作用；P-选择素与动脉粥样斑块及炎症的形成；血浆P-选择素水平的测定在疗养院的应用现状。     

以肺外症状为主要表现的42例结节病误诊探析

目的探讨以肺外症状为主要表现结节病的临床特点及误诊原因、防范措施。方法检索中国知网和万方医学网近5年文献,对纳入文献及我院同期收治的以肺外症状为主诉的结节病误诊病例进行汇总分析。结果共纳入42例。以皮肤症状为主诉就诊25例,误诊为结节性红斑和神经性皮炎各4例,过敏性皮炎和湿疹各3例,红皮病和结核病各2例,寻常狼疮、扁平苔藓、脂囊瘤、硬皮病、银屑病、普通感染和耳廓炎性纤维增生各1例;以神经系统症状为主诉就诊7例,误诊为Guillain-Barres综合征3例,周围神经病2例,结核病和脑转移瘤各1例;以关节症状为主诉就诊4例,误诊为反应性关节炎3例,致密性骨炎1例;以脾脏病变为主诉就诊3例,误诊为转移瘤、淋巴瘤和纤维化型先天性肝内胆管扩张症致门静脉高压、脾大及脾功能亢进各1例;以甲状腺受累症状为主诉就诊2例,均误诊为甲状腺功能亢进;以心脏症状为主诉就诊1例,误诊为冠心病。误诊时间10 d~20年。42例均经病理组织学检查确诊,予相应治疗,1例视力受损严重未恢复,1例神经受累仍有反复及进行性加重,余病情均缓解。结论以肺外症状为主要表现的结节病患者症状无特异性,及时行胸部CT及病理检查非常重要,对累及肺外重要脏器者糖皮质激素和(或)免疫抑制剂治疗要充分。     

上海市护理人员学历职称结构需求研究

目的了解医院行政管理者、护理部主任、医生对护理人员学历职称结构需求的观点。方法2006年7-8月,采用头脑风暴法、专家咨询法确定调查问卷,采用分层随机抽样法,在上海市4类不同级别医院选取134名医院行政管理者,57名护理部主任和280名医生作为调查研究对象,调查内容主要包括目前他们认为合理的护理人员学历结构和职称配置结构。采用EXCEL2001中文版将有效的465份调查数据录入,建立数据库,对调查结果进行统计描述。结果医院行政管理者认为护理人员学历结构应以大专为主（占45.98%）,职称结构以初级职称为主（占55.11%）;护理部主任认为护士最佳学历应以大专为主（占53.37%）,职称结构以初级职称为主（占49.23%）;医生认为护理人员学历结构应以大专为主（占52.17%）,职称结构以中级职称为主（占45.96%）。结论应采取措施提高护理人员学历职称结构,促进护理学科整体发展。     

Modulation of antigen-induced chronic fatigue in mouse model of water immersion stress by naringin, a polyphenolic antioxidant

It is believed that physical stress, infection and oxidative stress are involved in the development of chronic fatigue syndrome. There is little evidence stating the beneficial role of nutritional supplements in chronic fatigue syndrome. Based on this, this study was designed to evaluate the effect of naringin, a natural polyphenol, in a mouse model of immunologically-induced fatigue, wherein purified lipopolysaccharide (LPS) as well as Brucella abortus (BA) antigen was used as immunogens. The assessment of chronic fatigue syndrome was based on chronic water-immersion stress test for 10 mins as well as measurement of hyperalgesia for 19 days. Immobility time and tail withdrawal latency as well as oxidative stress were taken as the markers of fatigue. Mice challenged with LPS or BA for 19 days showed significant increase in the immobility time, hyperalgesia and oxidative stress on 19th day. Serum tumor necrosis factor-alpha (TNF-α) levels markedly increased with LPS or BA challenge. Concurrent treatment with naringin resulted in the significant decrease in the immobility time as well as hyperalgesia. There was significant attenuation of oxidative stress as well as in TNF-α levels. Present findings strongly suggest the role of oxidative stress and immunological activation in the pathophysiology of chronic fatigue syndrome, and treatment with naringin can be a valuable option in chronic fatigue syndrome.     

壶腹周围癌35例误诊临床分析

目的分析壶腹周围癌的临床特点,以减少误诊。方法对我院收治并误诊的35例壶腹周围癌的临床资料进行回顾性分析。结果本组误诊为消化性溃疡8例,胆道感染、胆结石7例,药物性肝损伤、功能性消化不良各5例,慢性胃炎4例,病毒性肝炎、酒精性肝炎、急性胰腺炎各2例。经B超、CT、胰胆管成像(MRCP)明确诊断19例,手术确诊9例,经逆行胰胆管造影(ERCP)诊断6例,经超声内镜(EUS)下的细针穿刺活检诊断1例。结论 B超、螺旋CT、MRCP检查和肿瘤相关指标检测可提高壶腹周围癌的诊断率,必要时行ERCP及刷片、EUS下的细针穿刺活检或剖腹探查,早期诊断可改善壶腹周围癌的预后。     

彩超引导下经皮穿刺^125I粒子联合5-氟尿嘧啶缓释剂植入治疗肝门区肿瘤

目的探讨彩超引导下经皮穿刺放射性125I粒子及5氟-尿嘧啶（5-FU）缓释剂植入治疗肝门区肿瘤的可行性及疗效观察。方法患者术前空腹,彩超引导选择合适进针路径,避开周围血管及胆管,采用单点多向、多点多向的方法力求125I粒子均匀分布,并在125I粒子间间隔植入5-FU缓释剂。术后1、2、6个月分别对患者进行超声及CT检查,根据肿瘤大小变化对疗效进行分级。将疗效分为4级,Ⅰ级：肿瘤缩小50%以上;Ⅱ级：肿瘤缩小25%~50%;Ⅲ级：肿瘤缩小25%以下;Ⅳ级：肿瘤大小无变化或增大。结果所有患者分别于术后1、2、6个月复查。1个月：Ⅰ级1例,Ⅱ级3例,Ⅲ级9例,Ⅳ级3例;2个月：Ⅰ级8例,Ⅱ级5例,Ⅲ级2例,Ⅳ级1例;6个月：Ⅰ级8例,Ⅱ级5例,Ⅲ级2例,Ⅳ级0例;术后5个月死亡1例。生存期5~18个月,中位生存期为11个月。结论彩超引导下经皮穿刺放射性125I粒子及5-FU缓释剂植入治疗肝门区肿瘤是一种安全、可靠且较为有效的治疗方法。     

16例输卯管间质部妊娠的超声误诊分析

目的探讨输卵管间质部妊娠超声误诊的原因。方法回顾性分析2007年我院就诊被超声误诊为其他疾病而经手术和病理确诊为输卵管间质部妊娠的病人16例。结果16例超声误诊的病例中误诊为浆膜下肌瘤6例,双子宫一侧子宫妊娠的4例,滋养细胞疾病4例,残角子宫2例：结论输卵管间质部妊娠因部位特殊,容易被误诊为其他疾病而延误病情,分析结果提示结合临床病史与超声图像特征分析可减少误诊率,提高超声诊断输卵管间质部妊娠的准确性：     

The Role of the Physical and Occupational Therapist in Caring for the Victim of Alzheimer's Disease

The threats that dementia present to us as caregivers center mainly on the lack of predictability of the client's day-to-day responses and the overwhelming sense of loss of a meaningful life as victims regress before our eyes without any sense of hope for cure. The goals of our care must be focused on maintaining as high a quality of life as possible for as long as possible. Interventions are outlined and suggestions are made to help communicate through catastrophic reactions, depression and confusion. The methods of validation therapy are suggested to be superior to reality therapy in communicating acceptance and support for the demented patient who will never again know reality as we know it.     

Commentary on 'Achieving health improvements through interprofessional learning in south west England'

In the South African transitional context, the shift in philosophy and structure of health care towards primary health care has been dominating all decisions made by the various health sectors. The aim of this paper is to explore the role expansion of community pharmacy and its therapeutic alliance with nurses as an attempt at interprofessional care aimed to provide primary health care. To gain an in-depth insight into this complex issue a combination of qualitative and quantitative research methods were employed. An analysis of innovations such as granting special permits to a select group of pharmacists, as well as the unique therapeutic alliance established with nurses constitutes the core of the paper in which issues such as professional autonomy, as well as boundary disputes between occupations, have been raised in relation to the examples given. The paper demonstrates pharmacy's thrust towards a more meaningful role by means of changes in legislation, as well as through the partnership between nurse and pharmacist, which allows pharmacists to expand their professional activities without invading the nurses' professional domain.     

Intuition—A Problematic Form of Knowledge in Nursing

The purpose of this article is to discuss the concept and phenomenon of intuition in nursing. With an overview of theories of intuition in philosophy and empirical research as the starting point, the authors discuss the conceptualization of intuition in nursing. Concept analyses, intuition as phenomenological nursing knowledge, intuition as clinical knowledge and intuition as spiritual connection are discussed. The authors conclude that the conceptions of intuition in nursing differ with respect to their philosophical underpinnings and that it can be questioned whether ‘intuition’ is always a proper term for the kind of knowledge investigated. Intuition is seen as an important concept in nursing, but there are still philosophical as well as empirical and practical problems to investigate.     

Releasing and relieving encounters: experiences of pregnancy and childbirth

The experience of childbirth is an important life event for women, memories of which may follow them throughout life. The aim of the study reported here was to synthesize the results from four selected studies describing these experiences by focusing on women's and midwives' experiences of the encounter during childbirth, as well as experiences of pregnancy from the women's perspective. The setting was the Alternative Birth Care Centre (Sahlgrenska University Hospital, Goteborg) and Karolinska Hospital (Stockholm, Sweden). A qualitative method grounded in phenomenology and hermeneutics was used as a basis for the studies and synthesis. The essential structure may be conceptualized under the heading 'releasing and relieving encounters', which, for the woman, constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as presence and being one's body. Change is expressed as transition to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person who listens to and follows the woman through the process of childbirth. To be anchored is to be the person who respects the limits of the woman's ability as well as her own professional limits in the transition process. A releasing and relieving encounter implies a sharing of responsibility and participation for women. This may be understood as a unique feature, which differs from other caring encounters and should be further studied.