Development and validation of an instrument for measuring junior nurses’ recognition and response abilities to clinical deterioration (RRCD)

BackgroundNurses of all levels are expected to be competent in managing clinical deterioration. Given their limited experience and basic-level knowledge, there is a concern about junior nurses' clinical and patient management skills. However, junior nurses’ abilities to recognise and respond to clinical deterioration have not been adequately explored because of the absence of a comprehensive tool.ObjectivesThe aim of this study was to develop a new self-assessment scale to assess the junior nurses’ recognition and response abilities to clinical deterioration and to examine its reliability and validity.MethodsScale items were based on literature reviews and interviews. The preliminary scale was generated through two rounds of expert review. A panel of five experts evaluated content validity. After a pilot study, the questionnaire was distributed to 168 junior nurses via convenience sampling. Subsequent statistical analysis of results included construct validity, internal consistency, and test–retest reliability.ResultsSix factors were included, and 69.310% of the total variance was explained by the 25 items comprising the scale. The Cronbach's alpha coefficient was 0.905 (95% confidence interval [CI]: 0.812–0.979) for the overall scale and 0.655–0.838 for its subscales. The Guttman split-half reliability was 0.856 (95% CI: 0.806–0.894). The test–retest reliability of the scale was 0.878 (95% CI: 0.836–0.911).ConclusionWe developed a scale for measuring the abilities of junior nurses to recognise and respond to clinical deterioration and confirmed its reliability and validity. More experimental studies are needed to further evaluate this instrument.     

重性精神病患者封闭式住院治疗期间心理需求分析

目的了解封闭式管理重性精神病患者住院治疗期间心理需求。方法采用便利抽样法,2017年3月—2018年3月选取四川省精神卫生中心封闭式管理的81例重性精神病患者为研究对象,采用自行设计的重症精神病患者心理需求调查问卷进行调查,调查患者自知力、住院治疗自我归因、希望解决的问题等心理需求状况,分析患者心理需求的影响因素。结果81例患者中33.33%(27/81)的患者认为自己患病,对于本次住院治疗39.51%(32/81)的患者归因于自己性格原因,归因于情感问题占17.28%(14/81);心理需求中,希望有家人的陪伴和探视占79.01%(64/81),有心理治疗需求占62.96%(51/81);最想解决的问题中,35.80%(29/81)的患者希望治好疾病,需要提高自信心的患者只占4.94%(4/81)。不同疾病诊断的患者在希望家人陪伴和探视的需求中差异有统计学意义(P<0.05)。不同性别患者在自身疾病相关知识的需求中差异有统计学意义(P<0.05)。不同文化程度的患者对提升压力应对能力需求的差异有统计学意义(P<0.05)。结论封闭式管理重性精神病患者住院治疗期间有较多心理需求,不同性别、文化程度、疾病诊断患者的需求不同,要有针对性地提供心理干预及护理,促进患者尽快康复。     

阿立哌唑对精神分裂症患者的精神症状及生活质量的影响研究

目的：探讨阿立哌唑对精神分裂症患者精神症状和生活质量的影响。方法：将78例精神分裂症患者随机分为两组，分别给予阿立哌唑和利培酮治疗8周，用阳性症状与阴性症状量表（PANSS）评定精神症状。于治疗开始第0、8周末分别进行评定。结果：两组PANSS总分较治疗前均有显著性差异（P〈0.05），阿立哌唑对阴性症状的改善优于利培酮。结论：阿立哌唑对精神分裂症患者的精神症状和生活质量有改善作用。     

部分脾栓塞在肝癌伴脾亢介入治疗中的应用

目的：对原发性肝癌伴脾功能亢进患者行部分脾栓塞，使其血细胞恢复正常，以便能进一步行肝动脉化疗。方法：对46例不能手术切除、且血细胞明显低于正常的肝癌伴脾亢的患者行部分脾栓塞术，栓塞面积控制在50%～70%。结果：脾栓塞术后血白细胞和血小板均较栓塞前明显升高。结论：部分脾栓塞能治疗脾功能亢进，提高血细胞数量，使肝癌伴脾亢患者的肝动脉化疗能正常进行。     

5.12汶川8.0级地震伤员的四肢放射学表现分析

目的分析5．12汶川8．0级地震中伤员四肢损伤类型和影像表现。方法回顾分析自2008年5月13日-5月27日在绵阳市中心医院放射科就诊的1121例地震伤员中四肢检查的671伤员的放射学资料，其中平片检查668人，约1200处投照部位，CT检查19人23个部位。结果446例伤员放射学检查为阳性，总阳性率约为66．47％，其中四肢单部位损伤为355例（52．91％），多个四肢损伤为91例（13．56％）。共有558个部位损伤，按发生率高低排列，依次为胫腓骨142例（25．45％），足踝113例（20．25％）、髋关节及股骨112例（20．07％），肘关节及尺桡骨54例（9．68％）、肱骨47例（8．42％），手腕38例（6．81％），肩关节36例（6．45％），锁骨16例（2．87％）；按照骨折类型，粉碎性骨折317例（56．81％），横行骨折102例（18．28％），关节脱位37例（6．63％），斜行骨折37例（6．63％），螺旋形骨折31例（5．56％），线形骨折17例（3．05％），嵌插骨折13例（2．33％），骺分离4例（0．72％）。结论地震造成四肢损害以下肢为主，骨折类型以粉碎性骨折及横行骨折为主。     

心肌肌钙蛋白I和T联合检测在病毒性心肌炎诊断中的应用

目的探讨肌钙蛋I（cTnI）和肌钙蛋白T（cTnT）在病毒性心肌炎（VMC）的诊断及病情观察方面的价值。方法对79例VMC患者进行入院后1、2、3周及2个月cTnT和心肌酶谱的动态监测；cTnT、cTnI与心电图（ECG）及病程关系的研究。结果急性VMC患者在各检测期内血清cTnT的阳性率（73．41％）和cTnI的阳性率（67．08％）显著高于心肌酶谱各项目（P〈0．05）：肌酸激酶47．4d％、肌酸激酶同工酶51．28％、天冬氨酸氨基转移酶42．31％、乳酸脱氢酶42．31％、α-羟丁酸脱氢酶44．87％。cTnT和cTnI阳性组ECG正常率（5．26％、9．62％）明显低于阴性组（71．43％、57．69％）（P〈0．05）。结论在VMC的诊断中，cTnT和cTnI可取代传统的心肌酶谱测定作为判断急性心肌炎的指标；同时cTnT和cTnI在VMC病情进展的观察中也具有重要意义。     

Both Juxtacrine and Paracrine Signaling Indispensable in Spermatogonial Stem Cell Cultures

Objective To prove that juxtacrine and paracrine signaling are essential in the culture of spermatogonial stem cells （SSCs） with Sertoli cell feeder layer in vitro. Methods Mice aged 7 d were chosen to harvest testes. A two-step enzyme digestion method was applied in testis suspension. The SSCs and Sertoli cells were separated by adherence distinguishing methods and biologically identified by immunofluorescence and Oil Red 0 staining methods. Flow cytometry was used to analyze purity of SSCs. Three groups were constructed according to different culture conditions. SSC and Sertoli cell co-culture group, SSC conditional culture group and SSC routine culture group. The conditional medium was collected from supernate of culture Sertoli cell in vitro and double-concentrated with DMEM/F12 and fetal bovine serum in a proportion of 4.5 ： 4.5 ： 1. The routine medium was DMEM/F12 containing 10% fetal bovine serum. Adherence rates were measured by Trypan blue staining. Absorbance of SSCs of each group was measured by MTT assay and proliferation curves shown to demonstrate proliferative features of SSCs. Proliferative features and colony formation were observed by inverted microscope. With 24 h difference in adherence rates, proliferations were compared and analyzed.Results The adherence rate of co-culture group was greater than that in the others（P〈0.05）, with insignificant difference in conditional culture group and routine group （P〉0. 05）. SSCs of co-culture group showed stable proliferation immediately following inoculation..4 stable colony formed within 7-10 d and maintained for 30 d. SSCs in conditional culture group and routine group decreased rapidly following transient proliferation. Conclusion The actions of SSCs in Sertoli cell cultures in vitro depended on both juxtacrine and paracrine signaling, Sertoli cell paraerine signaling was unable to promote SSC adherence and proliferation alone.     

膀胱移行细胞癌中E2F3的表达及意义

目的探讨E2F3在膀胱移行细胞癌中的表达及临床意义。方法采用lit-PCR和免疫组化技术检测32例膀胱移行细胞癌及14例正常膀胱移行上皮组织中E2F3 mRNA及蛋白的表达。结果膀胱移行细胞癌中E2F3m RNA及蛋白的表达明显高于正常膀胱移行上皮组织（P〈0．05）,E2F3 mRNA及蛋白的表达随肿瘤分级、分期增高而相应增高（P〈0．05）。结论E2F3对膀胱移行细胞癌的发生发展发挥重要的作用,并可在一定程度上反映肿瘤的恶性程度。