自体真皮复合甲床组织片修复甲床缺损80例分析

目的：探讨利用自体真皮复合伤指剩余甲床组织片移植治疗甲床缺损。方法对80例90指甲床缺损的患者（男性60例,女性20例;年龄18～48岁,平均32岁）,利用自体真皮复合伤指的剩余甲床或趾甲床,取薄层组织片复合移植于甲床缺损处,打包加压包扎,术后2周拆线,观察治疗效果。结果本组80例90指术后自体真皮复合甲床组织片移植均I期成活,3例部分坏死,经换药后愈合。术后随访时间为6～12个月,90指中达到优良87指（占96.7％）,差3指（占3.3％）。结论自体真皮复合甲床组织片移植解决了甲床缺损的修复材料与甲分离、指甲质脆等问题。方法简单,效果理想,易于推广。     

Childhood physical abuse predicts stressor-evoked activity within central visceral control regions

Early life experience differentially shapes later stress reactivity, as evidenced by both animal and human studies. However, early experience-related changes in the function of central visceral neural circuits that control stress responses have not been well characterized, particularly in humans. The paraventricular nucleus of the hypothalamus (PVN), bed nucleus of the stria terminalis (BNST), amygdala (Amyg) and subgenual anterior cingulate cortex (sgACC) form a core visceral stress-responsive circuit. The goal of this study is to examine how childhood emotional and physical abuse relates to adulthood stressor-evoked activity within these visceral brain regions. To evoke acute states of mental stress, participants (n = 155) performed functional magnetic resonance imaging (fMRI)-adapted versions of the multi-source interference task (MSIT) and the Stroop task with simultaneous monitoring of mean arterial pressure (MAP) and heart rate. Regression analyses revealed that childhood physical abuse correlated positively with stressor-evoked changes in MAP, and negatively with unbiased, a priori extractions of fMRI blood-oxygen level-dependent signal change values within the sgACC, BNST, PVN and Amyg (n = 138). Abuse-related changes in the function of visceral neural circuits may reflect neurobiological vulnerability to adverse health outcomes conferred by early adversity.     

肺癌手术患者健康教育提前至候床期实施效果探讨

目的利用入院前候床期实施健康教育,以缩短住院时间和提高健康教育效果。方法将120例肺癌手术患者按时间段分为对照组和实验组60例。对照组按常规待患者入院后实施责任制整体护理,实验组于门诊确定住院手术后即建立档案实施健康教育,包括疾病知识、呼吸功能锻炼、手术相关事项告知等,并与入院后的教育相衡接至患者出院。结果实验组术后肺部并发症发生率显著低于对照组、健康知识掌握程度及满意度显著优于对照组、住院时间显著短于对照组(均P0.01)。结论对肺癌手术患者将健康教育提前至候床期间实施,可提高患者健康知识掌握度、有助于降低手术并发症、缩短住院时间及提高患者满意度。     

按三级学科方向培养手术室专科护士可行性的调查

目的：了解不同等级医院对手术室专科护士的需求,探索能满足不同等级医院手术室护理工作实际需求的专科护士培训方案。方法自行设计调查表,选择在江苏省手术室专科护士培训基地学习的80名手术室护士进行调查。调查内容包括一般资料、所在医院三级学科和亚专业学科细化情况、参加专科护士培训后工作状况、手术室专科护士的培养模式和按照三级学科培养手术室专科护士的实施方案4个方面。结果80名护士均认为有必要开展手术室专科护士培训,80．00％的人认为目前模式属手术室全科护士的培训;72．22％的二级医院的护士认为参加培训学习的理论知识、参加的临床实践技能能满足工作需要,可继续采取目前培养模式;74．19％的三级医院的护士认为培训知识尚能满足工作需要,但针对自己的三级学科方向还不够强、不够细,应该按照三级学科培养手术室专科护士。结论根据不同等级医院手术室护理工作的实际需求,建立统一招生、同步培训、分层培养的统分结合培养模式,能培养适应不同等级医院手术室需求的专科护士。     

二级医院手术室护理风险管理指标体系的构建及信效度分析

目的：构建一套适合二级医院手术室护理风险管理指标体系。方法在护理风险相关概念的基础上,通过文献评阅、Delphi法、系统分析法、层次分析法、问卷调查法,对二级医院手术室护理风险进行系统分析和归类,通过小范围专家讨论认证,建立指标体系初步方案。结果所建评价指标体系总体内部一致性系数为0.801,各要素系数为0.712~0.879,信效度好。结论二级医院手术室护理风险管理指标体系为4个构成要素：系统因素、护理人员因素、患者因素、感染防控。     

腹腔镜手术室CO2浓度对医护人员健康的影响

目的探讨腹腔镜手术室内CO2浓度对医护人员健康的影响.方法本研究将60名手术室护士随机分为开腹手术组和腔镜手术组,分别于术前及术后对2组人员测量生命体征、检测动脉血气、评价疲倦程度,并采用便携式红外线CO2分析仪检测手术室内不同时刻CO2浓度.结果腔镜手术室内CO2浓度于手术30 min时升高,术中维持较高水平,于手术结束时达最高值;与本组术前和开腹手术组相比,腔镜手术组人员手术后心率和呼吸频率明显增快,p H降低,PCO2升高,且疲倦严重度评分显著增加(P<0.05).结论腔镜手术造成手术室内CO2污染,危害医护人员身心健康,应予以重视.     

Hospital care services for digestive diseases in Italy: The first quantitative assessment

The scarcity of human and structural resources for specialized gastroenterology care is a problem in many Western countries. Data regarding the resources for Italian Gastroenterology, so far lacking, have been thus searched and evaluated. Based on an agreement protocol between the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Ministry of Health, national data regarding all Institutions providing gastroenterological care were analysed. Hospital beds in Gastroenterology units are presented by region, regimen of stay and per million inhabitants as of January 2011.Association of Hospital Gastroenterologists and Endoscopists also performed a survey of gastroenterology units in all Italian regions regarding number of ordinary/day hospital beds and the number of staff gastroenterologists.The Ministry data showed a total of 174 Gastronterology Units in Italy, a total of 2062 hospital beds for the discipline, for a proportion of 34.2 beds per million inhabitants.The Association of Hospital Gastroenterologists and Endoscopists survey showed a total of 1425 gastroenterologists in Italy.These data should represent a key reference for appropriate planning of specialized care for digestive diseases.     

Time in bed,sleep quality and associations with cardiometabolic markers in children: the Prevention and Incidence of Asthma and Mite Allergy birth cohort study

We investigated associations of time in bed and multiple sleep quality characteristics with cardiometabolic markers in children. Data from the prevention and incidence of asthma and mite allergy study, a population‐based prospective birth‐cohort study started in 1996–1997 in the Netherlands, were analysed. In total 1481 children aged 11–12 years completed a questionnaire (including questions on sleep) and underwent a medical examination. We measured body mass index, waist circumference, total‐ and high‐density lipoprotein cholesterol, blood pressure and glycated haemoglobin. Results showed that in girls, some sleep characteristics were related to anthropometrics (body mass index, waist circumference) and cholesterol. Girls who had a long time in bed (11–12.5 h) had 0.16 lower body mass index z‐score (95% confidence interval ?0.31; ?0.01) and 0.99 cm smaller waist circumference (95% confidence interval ?2.01; ?0.13) compared with girls who spent 10–10.5 h in bed. Girls who went to bed late and rose early had 0.16 mm higher total cholesterol (95% confidence interval 0.01; 0.31) and 0.08 mm higher high‐density lipoprotein cholesterol (95% confidence interval 0.01; 0.14) than ‘early to bed/early rise’ girls. Girls with night‐time awakenings had 0.14 mm higher total cholesterol (95% confidence interval 0.03; 0.25) than girls without night‐time awakenings. Girls who felt sleepy/tired ≥1 day per week had 0.10 mm lower high‐density lipoprotein cholesterol (95% confidence interval ?0.16; ?0.04) and 0.17 mm higher total cholesterol/high‐density lipoprotein cholesterol ratio (95% confidence interval 0.02; 0.32) than girls who did not feel sleepy. No associations were found for boys. Sleep characteristics were not related to blood pressure and glycated haemoglobin, and effect sizes of the associations in girls were small. Therefore, we consider it premature to propose that improved sleep could reduce cardiovascular risk during childhood.