基于随机森林算法的肿瘤科护士工作倦怠影响因素分析:一项多中心研究

目的 采用随机森林算法探讨肿瘤科护士工作倦怠的影响因素。 方法 于2018年3—8月对广西全区25所三级综合医院和专科医院1253名肿瘤科护士采用一般资料问卷、工作倦怠量表、心理资本量表进行横断面调查,分析其工作倦怠现状及其影响因素,使用随机森林分析对可能影响肿瘤科护士工作倦怠的自变量进行重要性排序,将袋外估算误差率最小的变量集纳入logistic回归模型,分析自变量的作用方向和相对危险度。 结果 逐步随机森林分析显示,变量数为8时的袋外估算误差率最低,重要性排名前8的变量依次为收入状况满意度、护患关系满意度、从事肿瘤科护理工作年限、心理资本、年龄、参加院级以上培训次数、群众认可与尊重程度、夜班频次;Logistic回归分析显示,收入状况满意度为一般（OR=1.228,95%CI:1.019~1.497）和不满意或很不满意（OR=1.276,95%CI:1.005~1.621）、护患关系满意度为一般（OR=1.158,95%CI:1.036~1.295）和不满意或很不满意组（OR=1.196,95%CI:1.020~1.402）、从事肿瘤科护理工作5~10年（OR=1.365,95%CI:1.001~1.860）和>10年（OR=1.702,95%CI:1.222~2.371）、心理资本（OR=0.904,95%CI:0.824~0.991）、年龄25~30岁（OR=1.347, 95%CI:1.010~1.797）和>30岁（OR=1.397,95%CI:1.007~1.937）、参加院级以上培训次数1~2次/年（OR=1.107,95%CI:1.008~1.217）、群众认可与尊重程度为一般（OR=1.105,95%CI:1.008~1.212）和不尊重（OR=1.260,95%CI:1.010~1.572）、夜班频次<1次/周（OR=1.115,95%CI:1.025~1.213）和≥1次/周（OR=1.397,95%CI:1.146~1.702）是肿瘤科护士工作倦怠的独立危险因素（P<0.05）。 结论 影响肿瘤科护士工作倦怠的前8位因素依次为收入状况满意度、护患关系满意度、从事肿瘤科护理工作年限、心理资本、年龄、参加院级以上培训次数、群众认可与尊重程度、夜班频次,建议医院和护理管理者应制定相应策略,减少肿瘤科护士工作倦怠。     

组织干预对西藏高原护士工作倦怠的影响

目的：分析组织公平对护士工作倦怠的影响，并在此基础上制定和实施组织干预措施，为预防和矫治西藏高原地区护士工作倦怠提供理论依据和实践指导。方法：对某军区下属的三所总医院的临床女性护士（均为非管理人员）309例采用马氏倦怠感通用量表和组织公平量表进行调查．以获得工作倦怠与组织公平的相互关系。对西藏军区总医院的临床女性护士（均为非管理人员）108例（含干预组54例、对照组54例）在实施组织干预措施半年后采用马氏倦怠感通用量表和组织公平量表进行调查，以检测组织干预措施对提高组织公平感和改善工作倦怠感的实效性。结果：分配公平会影响护士的情绪衰竭和玩世不恭，程序公平会影响成就感降低。组织干预措施可以提高护十的组织公平感和降低工作倦怠感．结论：通过实施组织干预措施可以预防和降低护士的工作倦怠感。     

Practice improves even the simplest movements

Summary Three subjects practiced accurate, fast elbow flexions of 54° to a 3° wide target. Movements of 36°, 54° and 72° were then tested. Comparison over the three distances showed that the normally monotonic relationship between movement distance and movement time is alterable by specific training. Subjects learn to go faster over the practiced distance by refining their neural commands to the muscles. The benefits of practice only partially transfer to other distances. We conclude that many of the relationships seen among movement variables in simple tasks are plastic in nature and affected by prior experience.     

晚期肿瘤的治疗及其价值

晚期肿瘤是否有治疗意义的讨论越来越受到社会的关注。作者从医学及伦理学两方面论述晚期肿瘤的治疗意义,认为治疗有助于疾病的控制,有利于提高患者的生存质量。指出晚期肿瘤的治疗并非无效治疗,患者能从治疗中得益。     

吸入NO、BiPAP鼻罩式机械通气并水化疗法治疗急性加重期肺心病患者的护理

吸入ＮＯ、ＢｉＰＡＰ鼻罩式机械通气并水化疗法治疗急性加重期肺心病患者,根据病人均较危重的治疗特点,有目的地进行心理护理（病人了解治疗中一些特殊问题,解除病人紧张情绪）,适时调整输液量,观察电解质变化,注意保持呼吸道通畅,预防局部皮肤损伤等措施,使病人抢救成功率明显增加。     

Laryngeal cancer and blood selenium levels

Blood selenium concentrations in 43 patients with laryngeal cancer and 47 normal subjects were determined by atomic absorption spectrophotometry. No significant differences in selenium values were observed in sera from the cancer patients when compared with controls, but there were significant differences between patients with advanced (T4) supraglottic cancers and the normal controls. These results suggest that lower blood selenium levels in this latter group of laryngeal cancer patients may be a consequence of their disease rather than its cause.     

Preliminary evaluation of pelvic vascular bed isolation chemotherapy in the treatment of advanced cervical carcinoma

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A factor analytic study of teaching in off-campus general practice clerkships

The Preceptor-evaluation questionnaire (PEQ) was developed at the University of Mississippi Medical Center to evaluate the clinical teaching behaviour of general practice doctors in private practice who have one or more third-year medical students per year in their offices for a required general practice clerkship. The PEQ was designed to provide feedback to these doctors and the sponsoring department in an effort to improve teaching in this setting. Developed from the input of family practice doctors who have supervised students in their offices and from a review of related literature, the instrument was given to students to determine the level of importance they attributed to each teaching characteristic. A principle components factor analysis and subsequent varimax rotation produced six significant teaching factors in this setting. These six factors were:

• 1 demonstrates a humanistic orientation toward patients and staff;
• 2 demonstrates a humanistic orientation toward student;
• 3 provides opportunity for practice;
• 4 motivates and stimulates student's thinking;
• 5 communicates effectively with student; and
• 6 demonstrates comfort and confidence in the roles of doctor and teacher.

The factor relating to the humanistic orientation toward student has not appeared as a separate factor in other studies of clinical teaching. This may be due to the unique aspects of the relationship between student and doctor in this setting which may not occur in other settings. The PEQ and similar reliable and valid instruments can provide valuable information for the doctors in these off-campus teaching situations as well as provide useful programme planning information for the sponsoring academic departments. This information may also be valuable for off-campus residency training.     

GnRH analogues as an adjuvant therapy for ovarian cancer patients.

OBJECTIVES: Lowering gonadotropin levels with gonadotropin-releasing hormone (GnRH) analogues in patients with ovarian cancer remains open to debate. The aim of this study was to assess the results of treatment in stage III and stage IV ovarian cancer patients who had surgery supplemented with chemotherapy, radiotherapy, and GnRH analogues. Gonadotropin levels were monitored during treatment. METHODS: The study group comprised 69 patients aged 27-70 years, stratified according to the type of treatment. The overall disease-free, 5-year survival rates and the frequency of remissions were analyzed. Hormonal tests [follicle-stimulating hormone (FSH) and luteinizing hormone (LH)] were performed in 58 patients. Associations were checked between gonadotropin levels, clinical findings, and survival. The results were statistically compared. RESULTS: Statistically significant differences were noted when chemotherapy was supplemented with GnRH analogues and/or radiotherapy. Administration of GnRH analogues resulted in significantly lower levels of LH than of FSH. Levels of FSH were significantly lower in patients surviving at least 5 years or in complete remission at the time of this study. CONCLUSIONS: Combined therapy can produce favorable results in late-stage ovarian cancer, and GnRH analogues have an important role in treatment strategy.     

FOLFOX方案治疗30例晚期胃癌疗效观察

目的：观察每二周高剂量亚叶酸钙（CF）／氟脲嘧啶（5－FU）与草酸铂（L－OHP）方案（FOLFOX方案）治疗晚期胃癌的临床疗效和毒副反应。方法：采用高剂量CF／5－FU／L－OHP深静脉输注方案（CF200mg.m^2-1.d^-1，静滴2小时，第1、2天；5-FU400mg.m^2-1.d^-1,静推，第1天，5－FU1600mg.m^2-1.d^-1，静滴22小时，第1、2天；L－OHP130mg.m^2-1.d^-1，静脉输注4小时，第1天），化疗方案以14天为1周期，重复4周期后间隔1个月评定疗效。结果：全组30例，总有效率为53．3％，18例初治组的有效率为61．11％，其中CR1例。12例复治组的有效率为41．7％，初治组中位缓解期为5个月。复治组的中位缓解期为3个月。Ⅱ、Ⅲ度口腔炎发生率为26．7％，7例出现手足综合征，血液学毒性轻微。结论：每二周高剂量CF／5－FU／L－OHP方案是治疗晚期胃癌有效安全的化疗方案。