慢性乙型肝炎患者血清e抗原及病毒载量和肝损伤的相关性研究

目的观察慢性乙型肝炎(CHB)患者不同乙型肝炎e抗原(HBeAg)状态与HBV-DNA载量及肝脏损伤的关系。方法分别采用实时荧光定量PCR法及速率法对258例慢性乙型肝炎进行血清HBV-DNA定量和丙氨酸氨基转移酶(ALT)检测。以ALT水平对肝脏损伤程度进行分型,对不同HBeAg状态、病毒载量、肝损伤程度进行分析。结果 HBeAg阴性组年龄大于HBeAg阳性组,其血清HBV-DNA载量低于HBeAg阳性组(P0.01),肝损伤程度两组比较差异无统计学意义(P0.05)。HBeAg阴性组随血清HBV-DNA载量增加,肝损伤程度明显升高(P0.05),HBeAg阳性组则无相关性。结论 HBeAg阳性是判断HBV复制的良好指标,HBeAg阳性CHB患者体内DNA载量与肝内炎症损伤无关。而HBeAg阴性CHB患者体内HBVDNA与肝脏损伤相关,应重视对HBeAg阴性患者的随访和治疗。     

北京市二级医院护理人员专业自主性现状及影响因素调查

目的：了解北京市二级医院护理人员专业自主性现状,并分析其影响因素。方法于2014年1—3月以中文版护理实践量表（ NAS）为调查工具,对北京市平谷区3家二级医院364名临床科室护理人员的专业自主性进行调查。结果3家二级医院的364名护理人员专业自主性得分为（177．96±18．52）分,处于中高等水平。不同年龄、护龄、职称、职务的护理人员的专业自主性得分比较差异有统计学意义（t值分别为6．284,9．700,5．410,6．435;P＜0．05）。结论管理者应关注自主性较低人群,有针对性的采取措施,提高护理人员整体的专业自主性水平,以提升护理质量。     

疼痛护理专业技术小组在提高疼痛护理质量中的作用

目的：探讨疼痛护理专业技术小组在提高疼痛护理质量中的作用。方法疼痛护理专业技术小组随机选取314名护士进行疼痛知识培训需求调查,并采取分层次的疼痛知识培训,比较培训前后护士疼痛专业知识和专业技能掌握程度、疼痛的护理质量。结果64．01％的护士认为对疼痛知识培训非常有必要;98．72％的护士赞成讲授与实践相结合的形式进行培训。培训后护士疼痛专业知识、专业技能考核得分分别为（83．4±3．1）,（85．4±2．7）分,均优于培训前的（63．8±3．8）,（66．2±5．5）分,差异有统计学意义（t值分别为70．821,19．200;P＜0．01）;培训后疼痛护理质量总分从（58．4±3．4）分提高至（87．1±2．9）分,培训前后比较差异有统计学意义（t＝143．608,P＜0．01）。结论疼痛护理专业技术小组广泛开展疼痛知识培训,可显著提高护士的疼痛护理专业知识、专业技能水平和疼痛护理质量。     

家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响

目的 探讨家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响.方法 选取我院收治的慢性肾功能衰竭患者120例,随机分为观察组和对照组,每组50例.对照组患者采用药物治疗和常规性护理,观察组在此基础上增加家庭关怀护理内容.干预10、30、60d后,对两组患者采用HAMD进行抑郁评分,同时采用自测健康评定量表(SRHMS)对患者的健康状况进行评估.结果 干预后两组患者HAMD评分均较干预前降低(均P＜0.05);与对照组同期比较,观察组患者HAMD评分减少更为明显(P＜0.05).患者在自测健康中生理、心理、社会三个健康维度的自测分和总得分均明显高于对照组(均P＜0.01),患者不良症状发生率均明显低于对照组(均P＜0.05).结论 家庭关怀度对慢性肾功能衰竭患者发生抑郁的影响积极的,能缓解患者的心理压力,减低患者抑郁情绪的产生,同时有利于患者症状的缓解.     

The impact of major occupational injuries on professional reintegration. A Portuguese medico-legal contribution

Occupational injuries represent an enormous economic impact for victims, respective families, involved institutions and all the community due to professional outcomes. Thus, it is of the utmost importance that medico-legal personal injury assessment and the posterior follow-up of these victims, may allow their concrete damage repair, considering the victims' needs fulfilment and professional reintegration, whenever possible. The main objective of this study is to reflect on the role that legal medicine can play in promoting the professional reintegration of victims of major occupational accidents through the analysis of occupational injuries cases considering the medico-legal examinations performed. A retrospective study was conducted using medico-legal major occupational injuries cases (Partial Permanent Disability ≥40%). Data were collected from two medico-legal assessment moments: (a) personal injury assessment homologated by a labour court 4.8 years on average after occupational injury; (b) medico-legal follow-up for needs and/or Partial Permanent Disability adjustments performed 18.9 years on average after occupational injury. The final sample includes 103 cases. The results showed that in major occupational accidents, permanent long-term outcomes were principally associated with neurological (62.1%) and orthopaedic (52.4%) sequelae. Permanent professional damage parameters assigned by the labour court included Partial Permanent Disability (23.3%), Permanent Absolute Disability for Regular Work (41.7%) and Permanent Absolute Disability for Any Work (35%). Three-dimensional methodology is helpful in predicting Partial Permanent Disability and Permanent Absolute Disability for Any Work. However, three-dimensional methodology did not reveal correlations with Permanent Absolute Disability for Regular Work, and currently 65% of the victims who were considered able to work by the labour court are not professionally active. Thus, these major cases deserve a more detailed medico-legal approach based on concrete information about the professional reality of each victim, especially cases with an eventual Permanent Absolute Disability for Regular Work. Medico-legal Injury Assessment must be based on concrete aspects of the victim's professional reality and not only on permanent disability tables. This calls for an articulation between all institutions working with the victim of occupational injuries and legal medicine to promote recovery and the necessary measures to assure professional rehabilitation.     

Experiences of diagnostic radiographers through the Covid-19 pandemic

IntroductionDiagnostic Radiography plays a major role in the diagnosis and management of patients with Covid-19. This has seen an increase in the demand for imaging services, putting pressure on the workforce. Diagnostic radiographers, as with many other healthcare professions, have been on the frontline, dealing with an unprecedented situation. This research aimed to explore the experience of diagnostic radiographers working clinically during the Covid-19 pandemic.MethodsInfluenced by interpretative phenomenology, this study explored the experiences of diagnostic radiographers using virtual focus group interviews as a method of data collection.ResultsData were analysed independently by four researchers and five themes emerged from the data. Adapting to new ways of working, feelings and emotions, support mechanisms, self-protection and resilience, and professional recognition.ConclusionThe adaptability of radiographers came across strongly in this study. Anxieties attributed to the provision of personal protective equipment (PPE), fear of contracting the virus and spreading it to family members were evident. The resilience of radiographers working throughout this pandemic came across strongly throughout this study. A significant factor for coping has been peer support from colleagues within the workplace. The study highlighted the lack of understanding of the role of the radiographer and how the profession is perceived by other health care professionals.Implications for practiceThis study highlights the importance of interprofessional working and that further work is required in the promotion of the profession.     

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE

IntroductionThe radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers’ perspectives, perceptions and hopes for role advancement in the UAE.MethodsA qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysisResults29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change.ConclusionThe study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement.Implications for practiceTo sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.     

健康促进格林模式在教师职业心理健康干预中的应用

目的：提高目前国内教师职业心理健康水平,促进其职业健康,从而对学生的心理健康起到积极的影响作用。方法：尝试以格林模式为理论框架探索有效可行的教师职业心理健康干预模式,运用格林模式促进教师职业心理健康。结果：教师职业心理健康知识缺乏（倾向因素）,目前没有系统的、持续的职业心理健康促进模式（促成因素）和良好的职业心理健康支持系统社会支持系统（强化因素）。结论：应运用格林模式从多个方面对目前教师职业心理健康存在的问题进行解读,然后去分析其发生的根本原因,进而有针对性地制定相应解决的办法。教师职业心理问题的预防应分为三级预防;教师职业心理健康问题的预防与化解可分为个人干预或组织干预。     

Exploring the experiences of EU qualified doctors working in the United Kingdom: A qualitative study

This qualitative study of 23 doctors from other EU member states working in the UK highlights that, contrary to media reports, doctors from other member states working in the UK were well prepared and their main motivation to migrate was to learn new skills and experience a new health care system. Interviewees highlighted some aspects of their employment that work well and others that need improving. Some interviewees reported initially having language problems, but most noted that this was resolved after a few months. These doctors overwhelmingly reported having very positive experiences with patients, enjoying a NHS structure that was less hierarchical structure than in their home systems, and appreciating the emphasis on evidence-based medicine. Interviewees mostly complained about the lack of cleanliness of hospitals and gave some examples of risk to patient safety. Interviewees did not experience discrimination other than some instances of patronising and snobbish behaviour. However, a few believed that their nationality was a block to achieving senior positions. Overall, interviewees reported having enjoyable experiences with patients and appreciating what the NHS had to offer.