2009～2013年我国分级护理文献计量研究

目的探讨2009~2013年我国分级护理相关研究文献资料,了解护理人员在该领域的研究状况及发展趋势,为分级护理的进一步研究和发展提供理论指导和借鉴。方法利用中国生物医学文献数据库、中国期刊全文数据库和维普中文科技期刊数据库,对2009~2013年国内正式发表的分级护理文献进行检索,利用Excel2003软件建立数据库对文献年度变化、地区分布、期刊分布、内容等进行计量学分析。结果2009~2013年国内共发表分级护理相关文献168篇;广东、湖北、北京、山西四省市的发文量较多,共62篇,占总文献量的36.90%;刊录文献较多的期刊是《护理研究》、《全科护理》、《中国护理管理》和《护理学杂志》,4种期刊共收录文献55篇,其载文量占总文献量的32.74%;文献合作度为2.71,合著率为66.07%;研究热点集中在分级护理在临床工作中的应用及存在的问题,共76篇。结论目前国内关于分级护理的研究总体呈增长趋势;分级护理日益受到护理管理者及研究人员的重视;分级护理在临床工作中的应用及存在的问题是当前护理研究的热点;关于分级护理的研究跨地域、跨机构合作程度不够,地区及单位间的合作有待加强。     

《中华胃肠外科杂志》被引分析

目的分析评价《中华胃肠外科杂志》的载文质量和学术影响力。方法以“万方数据库”为依据．运用文献计量法和引文分析法对《中华胃肠外科杂志》2007-2011年所刊载的论文被引用情况进行统计分析。分析指标包括载文数、被引论文数、被引频次、被引年代分布及被引时差、被引作者及引证作者、引证期刊分布等。结果在1442篇刊载论文中,共有392篇论文被引用,平均被引率为27．18％。共被引998次。单篇平均被引2．55次。有16篇（4．08％）被引在10次以上。2007．2010年的年度即年指数分别为0．08,0．04,0．08,0．07;2011年被引半衰期是3．58。结论该刊被引率较高．说明载文质量高,已形成自身稳定的读者群：但高被引文献尚较少,增加具有深远影响的文献对提高杂志影响力有积极意义。     

中国科学引文数据库护理类期刊中混合方法研究的报告质量评价

目的 评价中国科学引文数据库收录的护理类期刊中发表的混合方法研究论文,分析我国护理领域混合方法研究存在的问题,以期提高混合方法报告质量。方法 计算机检索期刊官网、中国知网和万方数据库,搜索中国科学引文数据库收录的护理期刊中发表的混合方法研究论文,检索时限为2018年7月1日至2023年6月30日。由2名研究者独立筛选文献和提取资料后,采用混合方法研究报告标准的6个条目对纳入的文献进行评价。结果 共纳入14篇文献。2篇文献符合5个条目,2篇文献符合4个条目,1篇文献符合3个条目,5篇文献符合2个条目,4篇文献符合1个条目。混合方法研究报告整体质量一般。结论 我国护理领域混合方法研究报告质量有待提高,建议参考混合方法研究报告标准提高报告规范性,同时加强混合方法研究的学习,提高混合方法研究的运用能力。     

《中华男科学》杂志2000～2002年载文及引文分析

目的 :评价《中华男科学》杂志的地位和社会影响力。　方法 :用文献计量学方法对 2 0 0 0～ 2 0 0 2年《中华男科学》杂志载文及其引文情况进行统计分析。　结果 :除综述性文献和译文外 ,3年 16期共载文 34 3篇 ,其中333篇文献有引文 ,占载文总数的 97.0 8%;论著共计 183篇 ,占 5 3.35 %;基金项目论文 6 2篇 ,占总载文量的18.0 8%;载文量与基金项目论文篇数逐年增加 ;分布在全国 30个省及直辖市 ,作者中 43.37%为高级职称 ,拥有博士、硕士学位的占 40 .80 %;期刊与作者平均自引率为 6 .30 %、3.39%;文献发表 5年内被引用的频率最高 ,普赖斯指数为 5 6 .0 3%;引文语种以英文文献为主 ,期刊占引文总数的 83.0 2 %。　结论 :该刊拥有一批优秀的作者群体 ,具有很强的社会影响力以及广阔的发展前景 ,是一高质量的学术期刊。     

2000-2010年我国护理继续教育研究的文献计量学分析

目的了解我国护理继续教育的研究现状并进行分析,为进一步的研究提供参考。方法以中国知网《中国期刊全文数据库(CNKI)》、维普资讯《中文科技期刊全文数据库(CSTJ)》为数据来源,运用文献计量学方法对检索结果进行分析。结果检索出文献共计381篇;文献年度变化基本呈稳定状态;文献广泛分布于183种期刊,排名前12位的期刊载文占文献总量的39.11%;发文量排名前10位的省份发文225篇,占文献总量的59.06%;以第一作者发文2篇以上的著者共发文14篇,占总发文量的3.67%;文献的合作度为2.04,合著率为57.74%;有基金资助的文献12篇,占所有文献的3.15%;文献的研究内容主要以临床实践的经验介绍和现状及问题分析为主,分别占文献总量的29.66%、28.61%。结论我国护理继续教育研究的文献年发文量稳定,期刊分布合理,地域分布广泛,核心作者未形成,文献合作度和合著率低,资金资助少,研究的内容局限,研究者需在研究的广度和深度上进一步加强。     

《肝胆胰外科杂志》创刊20年载文统计分析

目的 总结<肝胆胰外科杂志>办刊经验.方法 采用文献计量学方法,用人工方法统计<肝胆胰外科杂志>1989-2008年的载文量、论文类型、学科分布、地区分布、机构分布、合作作者、作者职称构成;根据<中国学术期刊综合引证报告>的数据,统计<肝胆胰外科杂志>2001-2008年的影响因子、被引频次、即年指标、他引率、被引半衰期、Web下载率、基金论文比、h指数等指标;根据<中国期刊引文数据库>检索统计<肝胆胰外科杂志>1993年至2008年间载文的总被引频次、被引文篇数,并计算出论文被引率(被引文篇数/总载文数)、篇均被引频次(总被引频次/总载文数)、引用刊数.结果 <肝胆胰外科杂志>创刊20年来共刊载论文2373篇,年均载文量为118.6篇.论文的地区分布遍及全国30个省、市、自治区,其中华东地区六省市发文量占总载文量的68.76%;第一作者所属单位85.67%为地市级以上的医疗、科研机构;中高级职称的论文作者占91.42%:共有1216篇论文被356种期刊引用,被引率为53.92%.结论 创刊20年来,年载文量、被引频次、即年指标、基金论文比、被引半衰期等指标呈逐年上升趋势,但年均载文量较少,载文地区分布不均匀需要进一步改进.     

我国现象学研究的护理文献计量分析

目的分析近年来我国护理领域现象学研究的现状。方法采用文献计量学方法,对2000年1月至2015年9月收录在中文期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和万方数据库的现象学研究相关护理文献进行统计分析。结果共纳入文献1 055篇,分别发表在149种期刊上;第一作者来自33个不同省市,上海、北京、江苏3个省/市发表文献量居多;Colaizzi资料分析方法最为常用,共532篇(50.43%);研究受科研基金资助者354篇,占总文献量的33.55%;论文引文以中文文献为主(90.24%)。结论现象学研究方法已引起护理领域的广泛关注,核心期刊群已初具雏形,但文章整体质量尚有待提高,需加强相关理论知识与科研方法学习,不断提高文献的质量水平。     

基于文献计量学分析太极拳防治骨质疏松研究现状

目的探究太极拳防治骨质疏松的现状及未来发展趋势,从而为进一步研究提供参考依据。方法检索所有公开发表的关于太极拳防治骨质疏松的文献,分析文献年代分布、文献类型和语言、期刊分布、核心机构、高频关键词、疗效指标等特点。结果纳入文献共210篇,近10年共发表136篇论文,占全部论文量的64.76%,是太极拳防治骨质疏松研究的热点时期,论文数量总体呈逐年上升趋势;文献以中文期刊类临床研究论文为主,中文期刊中,《中国骨质疏松杂志》和《中国老年学杂志》的载文量最高;太极拳、骨密度、老年人、女性等为出现频率最高的关键词;骨密度、平衡能力、骨代谢指标为太极拳防治骨质疏松的常用评价指标。结论近10年为太极拳防治骨质疏松研究的热点时期,目前研究集中在中美两国,研究类型以临床研究为主。现代证据表明太极拳防治骨质疏松疗效确切,但结局指标缺乏规范,仍待更深层次的理论挖掘与更高水平的临床证据支持。     

我国大陆心血管外科学领域近5年SCI-E论文产出分析

目的分析中国大陆作者发表的心血管外科学术论文,为今后相关文献的发表提供参考。方法在线检索Web of Science数据库,收集2008~2012年我国大陆作者发表的心血管外科学领域论文,分别从发表年度、文献类型、载文期刊、作者等方面进行计量分析。结果共检索到中国大陆地区心血管外科学者发表的文章427篇,包括研究论文401篇,会议论文10篇,综述16篇。虽然自2008年开始呈现逐年递增的趋势,但近年来增长缓慢,且论文均较为集中在北京、广东、上海等几个具有较强学术研究能力的心脏中心,发表论文也较为集中在7种影响因子较低的心胸外科专业SCI期刊。结论中国大陆地区心血管外科学者应设计更为严谨、科学的研究,提高文章整体水平及引用频率。     

中国期刊全文数据库核心期刊肿瘤护理文献评析

目的分析我国核心期刊肿瘤护理研究现状。方法对1998～2007年中国期刊全文数据库(CNKI)核心期刊中肿瘤护理文献进行检索,并对检索结果进行分析。结果共检出文献682篇,文献数量总体呈逐年上升趋势;质量较低的应用体会类文献452篇(66.28%);研究方向中临床研究631篇(92.52%),教育及管理研究27篇(3.96%),护理理论研究17篇(2.49%)及社区护理7篇(1.03%);633篇文献按人体系统学分为总体、消化、生殖、神经等10个系统,最低为1.74%(泌尿系统11篇),最高为29.07%(总体状态184篇)。结论我国肿瘤护理研究处于发展时期,各学科间研究不均衡。研究设计有待加强,研究途径有待完善,研究面有待推广,肿瘤护理整体研究质量有待提高。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.