电话回访患者护理不满意因素分析与对策

目的：通过电话回访对导致患者不满意因素进行分析,探讨更好地为患者服务使患者满意的对策。方法：选取2005年和2007年在西安市第一医院住院后出院的患者各1000例,通过电话回访比较患者对护士及护士长工作满意度情况,并分析导致患者不满意诸多因素。结果：2007年患者对护士、护士长的满意度都明显优于2005年,但在不满意的具体内容上两年度无显著性差异。结论：培养护士掌握护患沟通技巧时从患者角度出发,遵从、珍视患者的不同生活经历,使患者身心满意;将热情服务贯穿护理的全过程;加强护士“三基”水平,提高护士技能;开展多种形式健康教育模式,满足不同层次患者需求;加强对实习生的管理;提高护士长管理水平。     

胎盘功能磁共振成像研究进展

胎盘是维持胎儿在子宫内发育的重要器官。MRI越来越多地用于胎儿及胎盘的解剖成像。随着影像技术的发展,功能MRI广泛应用于科研及临床,亦是评估胎盘功能重要的工具。本文对胎盘功能MRI的主要研究进展进行综述。     

移植肾急性排斥血氧水平依赖性成像价值初步研究

目的探讨血氧水平依赖功能磁共振成像(blood oxygen level dependent functional magnetic resonance imaging,BOLD-f MRI)移植肾急性排斥早期诊断价值。材料与方法应用3.0 T BOLD-f MRI序列,扫描专用水模(含氯化锰盐酸混合液小瓶15只)及临床志愿者,临床志愿者扫描包括原位肾51例(A组)、正常移植肾34例(B组)和急性排斥移植肾15例(C组)。应用软件计算水模、肾皮质、髓质(=1000/)值,统计分析水模3次扫描间差异、肾皮质和肾髓质3组间差异、原位肾左右差异、3组肾皮质与髓质间差异。通过受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价BOLD-f MRI成像急性排斥移植肾早期诊断效能及确定最佳阈值。结果水模3次扫描间无统计学差异(P0.05);急性排斥肾髓质为(19.36±3.94)Hz,显著低于原位肾(29.73±2.92)Hz和正常移植肾(29.80±2.75)Hz,P0.05,但A与B组髓质间及3组肾皮质间无统计学意义(P0.05),以病理为标准,髓质=24.67 Hz为界值,BOLD-f MRI诊断急性排斥移植肾ROC曲线下面积为0.975,敏感性和特异度分别为86.7%和98.5%;原位肾左右侧无统计学意义(P0.05);非急性排斥肾皮髓质间有统计学意义(P0.05),髓质明显高于皮质,而急性排斥肾皮髓质间未显示统计学差异(P0.05)。结论 BOLD-f MRI在肾移植急性排斥早期诊断中有重要价值。     

miR-574-5p在乳腺癌患者血清中的水平及与临床病理特征的关系

目的探讨微小RNA-574-5p(miR-574-5p)在乳腺癌患者血清中的水平及与临床病理特征的关系。方法选取2014年12月至2015年9月期间60例乳腺癌患者和60例乳腺纤维腺瘤患者作为研究对象,选择于同期在本院健康检查的60例健康女性作为健康对照组。采用实时荧光定量PCR(qPCR)检测入组对象血清miR-574-5p水平。结果经RT-PCR检测,乳腺癌组血清miR-574-5p水平为55.26±6.71,纤维瘤组血清miR-574-5p水平为14.21±4.11,健康对照组血清miR-574-5p水平为3.39±1.02,乳腺癌组miR-574-5p水平高于纤维腺瘤组和健康对照组,差异有统计学意义(F=68.17,P0.05),纤维腺瘤组miR-574-5p水平高于健康对照组,差异有统计学意义(t=21.08,P0.05)。随着患者病理分期的增加、肿瘤体积的增加、分化程度的降低,乳腺癌组血清miR-574-5p水平呈升高趋势,伴淋巴结转移的乳腺癌患者,血清miR-574-5p水平高于未出现淋巴结转移的乳腺癌患者(P0.05)。手术后,乳腺癌患者血清miR-574-5p水平(46.19±6.15)明显低于治疗前(54.91±6.62),差异有统计学意义(t=16.72,P0.05)。结论乳腺癌血清miR-574-5p水平高于良性乳腺病变及健康人群。血清miR-574-5p水平与乳腺癌的临床病理特征及预后密切相关。乳腺癌根治术可以抑制miR-574-5p的表达,改善患者病情。     

急诊科不同时段护理活动的调查

目的 调查急诊科不同时段的护理活动,为急诊护理人力配备提供参考依据.方法 经过统一培训后的调查人员以连续观察法,用表格记录的方式对急诊科当日在岗护理人员24 h的直接护理时数、间接护理时数、相关护理时数、个人活动时间及等待患者时间进行测算并与现有人力比较.结果 在不同时段急诊护理活动量不同,14:30～17:30及17:30～22:00,每位护士每小时平均工作45 min,是工作最繁忙时段.结论 在17:30～22:00时段护理活动多,具有所需护理时数多的规律,管理人员要用好等待病人时间及所需护理时数较少的时段,合理安排人力.     

A Practical Quantification of Blood Glucose Production due to High-level Chronic Stress

Blood glucose (BG) is the primary metabolic fuel for, among others, cancer cell progression, cardiovascular disease and inflammation. Stress is an important contributor to the amount of BG produced especially by the liver. In this paper, we attempt to quantify the BG production due to chronic (in the order of weeks) high‐level psychological stress in a manner that a lay person will understand. Three independent approaches were used. The first approach was based on a literature survey of stress hormone data from healthy individuals and its subsequent mathematical manipulation. The next approach was a deductive process where BG levels could be deduced from published stress data of large cardiovascular clinical trials. The third approach used empirical BG data and a BG simulation model. The three different methods produced an average BG increase of 2.2‐fold above basal for high levels of stress over a period of more than a day. The standard deviation normalized to the average value was 4.5%. Copyright © 2011 John Wiley & Sons, Ltd.     

Outcomes in patients with Gleason score 8-10 prostate cancer: relation to preoperative PSA level

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? High‐grade prostate cancers are associated with poor disease‐specific outcomes. A proportion of these tumours produce little PSA. This study demonstrates that among Gleason 8–10 prostate cancers, some of the worst survival outcomes are associated with the lowest PSA levels.

OBJECTIVE

• ? To assess outcomes of patients with Gleason score 8–10 prostate cancer (CaP) with a low (≤2.5 ng/mL) vs higher preoperative serum PSA levels.

PATIENTS AND METHODS

• ? From 1983 to 2003, 5544 patients underwent open radical prostatectomy, of whom 354 had a Gleason 8–10 tumour in the prostatectomy specimen.
• ? Patients were stratified according to preoperative PSA level into four strata: ≤2.5 ng/mL (n= 31), 2.6–4 ng/mL (n= 31), 4.1–10 ng/mL (n= 174), and >10 ng/mL (n= 118).
• ? We compared biochemical progression‐free survival (PFS), metastasis‐free survival (MFS), and cancer‐specific survival (CSS) as a function of preoperative PSA level.

RESULTS

• ? Patients with PSA level ≤2.5 ng/mL were more likely to have seminal vesicle invasion (P= 0.003).
• ? On Kaplan–Meier survival analysis, patients with a PSA level ≤2.5 ng/mL had proportionately worse outcomes than their counterparts with higher PSA levels.
• ? The 7‐year PFS in the PSA ≤2.5 ng/mL stratum was lower than those of the PSA 2.6–4 ng/mL and 4–10 ng/mL strata (36% vs 50 and 42%, respectively); however, the lowest 7‐year PFS was found in those with a PSA level >10 ng/mL (32%, P= 0.02).
• ? Gleason score 8–10 tumours with a PSA level ≤2.5 ng/mL also tended to have the lowest 7‐year MFS (75, 93, 89 and 92% for PSA level ≤2.5, 2.6–4, 4.1–10 and >10 ng/mL, respectively, P= 0.2) and CSS (81, 100, 94 and 90% for PSA level ≤2.5, 2.6–4, 4.1–10 and >10 ng/mL, respectively, P= 0.3), although these differences were not statistically significant.
• ? In the subset with palpable disease, Gleason grade 8–10 disease with PSA level ≤2.5 ng/mL also was associated with a worse prognosis.

CONCLUSIONS

• ? In patients with Gleason grade 8–10 disease, a proportion of these tumours are so poorly differentiated that they produce relatively little PSA.
• ? Patients with high‐grade, low‐PSA tumours had less favourable outcomes than many of those with higher PSA levels.

     

胆红素对HBV DNA定量检测结果的影响

目的探讨高胆红素血清对实时荧光定量聚合酶链反应(PCR)检测乙型肝炎病毒核酸(HBV DNA)的影响,并选择有效减低胆红素对HBV DNA测定干扰的方法。方法将不同浓度的HBV DNA标准品(S1-S4:3.0×10~7、3.0×10~6、3.0×10~5、3.0×10~4IU/ml)按相同比例分别添加到胆红素正常血清和高胆红素血清中,按不同浓度胆红素进行分组来考察不同浓度胆红素血症对HBV DNA测定结果的影响程度大小,然后再分别测定HBV DNA的结果,每个标本重复检测三次,同时观察扩增曲线是否存在差异。对影响测定的血清标本作10、100、1000倍稀释后,进行检测,并收集5例临床高胆红素的乙肝血清标本进行验证。结果血清胆红素浓度介于401~500μmol/L、501~600μmol/L、600μmol/L三个组,HBV DNA定量检测结果高于胆红素正常血清组,差异有统计学意义(P0.05),血清胆红素浓度浓度介于20.6~100μmol/L、101~200μmol/L、201~300μmol/L和301~400μmol/L四个组,与胆红素正常血清组比较,差异无统计学意义(P0.05);血清胆红素浓度高于400μmol/L血清扩增时,扩增曲线先缓慢升高,其基线高于标准品,其阈值线处于拐点之下非S扩增区,之后升高呈现S型曲线;10、100、1000倍稀释后,扩增曲线平行且等间距,结果一致性较好。5例高胆红素血清有4例在定阈值线时,其阈值线处于拐点之下非S扩增区,定值偏高,结果高于稀释后的标本,差异有统计学意义(P0.05);有1例阈值线处于拐点处,其斜率低于标准品,结果低于稀释后的标本,差异有统计学意义(P0.05)。结论总胆红素高于400μmol/L对荧光定量PCR检测HBV DNA结果存在影响,通过稀释一般就可以降低胆红素因素干扰。     

Improvement in Smallholder Farmer Knowledge of Cattle Production,Health and Biosecurity in Southern Cambodia between 2008 and 2010

Farmer knowledge surveys were conducted in 2008 and 2010 in Cambodia to evaluate the impact of a research project studying interventions that can improve cattle production and health, including biosecurity and practices relating to risks of transmission of transboundary diseases. The project hypothesis is that by increasing the value of smallholder‐owned large ruminants through nutritional interventions and improved marketing, knowledge‐based interventions including risk management for infectious diseases such as foot‐and‐mouth disease (FMD) can be implemented into a more sustainable pathway for rural development. Between 2008 and 2010, significant improvements in farmer knowledge and attitudes were recorded in three villages in three provinces of southern Cambodia. This was achieved through participatory ‘applied field research’, ‘on the job’ training plus ‘formal’ training programmes. No cases of FMD were recorded during the study period in the ‘high‐intervention’ (HI) villages despite the common occurrence of the disease in a nearby ‘low‐intervention’ and many other villages in the three provinces. Whilst it is likely that protection of these villages from FMD infection was from increasing the herd immunity by vaccination, it could also have been partly because of a decrease in risk behaviours by farmers as a result of their increasing knowledge of biosecurity. The research indicates that smallholder farmers are motivated by nutritional interventions that improve the value of their cattle ‘bank’ and offer better marketing opportunities. This provides a more receptive environment for introduction of disease risk management for infectious and other production limiting diseases, best implemented for smallholder farmers in Cambodia by intensive training programmes. In lieu of a widespread public awareness programme to deliver mass education of smallholder farmers in disease prevention and biosecurity, livestock development projects in South‐East Asia should be encouraged to include training in disease risk management as an important intervention if the current momentum for trade in large ruminant livestock and large ruminant meat is to continue to progress and contribute to addressing global food security concerns.     

Skeletal muscle BOLD MRI: from underlying physiological concepts to its usefulness in clinical conditions

Blood oxygenation-level dependent (BOLD) MRI has gained particular attention in functional brain imaging studies, where it can be used to localize areas of brain activation with high temporal resolution. To a higher degree than in the brain, skeletal muscles show extensive but transient alterations of blood flow between resting and activation state. Thus, there has been interest in the application of the BOLD effect in studying the physiology of skeletal muscles (healthy and diseased) and its possible application to clinical practice. This review outlines the potential of skeletal muscle BOLD MRI as a diagnostic tool for the evaluation of physiological and pathological alterations in the peripheral limb perfusion, such as in peripheral arterial occlusive disease. Moreover, current knowledge is summarized regarding the complex mechanisms eliciting BOLD effect in skeletal muscle. We describe technical fundaments of the procedure that should be taken into account when performing skeletal muscle BOLD MRI, including the most often applied paradigms to provoke BOLD signal changes and key parameters of the resulting time courses. Possible confounding effects in muscle BOLD imaging studies, like age, muscle fiber type, training state, and drug effects are also reviewed in detail.