Shikani可视喉镜在清醒危重患者气管插管中的应用

目的 探讨在清醒危重患者急救中使用Shikani喉镜引导气管插管的可行性,并评价其使用效果.方法 选择2008年1月至2009年6月广州中医药大学第二附属医院收治的神志尚清楚的危重呼衰患者48例,男31例,女17例,年龄21～86岁,平均57岁,所有患者均需气管插管行机械辅助通气.采用非随机对照方法,按进入研究的日期单双数分为Shikani喉镜气管插管组(S组,n=25)和Macintosh喉镜气管插管埘照组(M组,n=23).记录每例的气管插管时间、插管次数以及包括心血管反应剧烈、呛咳、屏气、口咽腔损伤等不良反应或并发症的发生情况.统计分析采用x2检验、秩和检验等.结果 S组1次插管成功率(96.0%)较M组1次插管成功率(60.9%)高,插管时间较对照组(M组)缩短,差异均具有统计学意义(P<0.01).S组的心血管反应剧烈、呛咳、屏气的发生率均较M组少,口咽腔黏膜出血创伤的发生率也较M组小,差异均具有统计学意义(P<0.01).结论 在急危重患者救治中,尤其对于神志清楚的患者,Shikani喉镜引导气管插管具有插管迅速、成功率高、心血管反应轻、损伤小、安全性高的优点,是一种安全、有效的气管插管新技术.     

RICU危重患者cTnⅠ水平与APACHEⅢ及预后的相关性研究

【目的】探讨呼吸ICU（RICU）危重患者血清肌钙蛋白I（cTnI）水平与急性生理及慢性健康状况评分Ⅲ（APACHEⅢ）及预后的关系。【方法】选择120例RICU的危重患者,根据患者的预后,出院时是否存活,分为存活组102例与死亡组18例,回顾性分析两组患者血清cTnI水平与APACHEⅢ评分及预后的关系。【结果】存活组cTnI（0．14±0．09）ng／mL、APACHEⅢ评分（37．6±22．2）均显著低于死亡组cTnI（1．72±0．53）ng／mL—APACHEⅢ评分（65．2±29．4）分（P〈0．01）;cTnⅠ水平与APACHEⅢ评分呈正相关（P〈0．01）,随各组血清cTnⅠ水平增高,APACHEⅢ评分亦增高（P〈0．01）,各组死亡率也随之增高（P〈0．01）。【结论】RIcU危重患者cTnⅠ水平和APACHEⅢ评分明显增高,二者相关,其对判断病情及预后有一定的作用。     

以核心能力为导向,循证医学为载体,终身学习为目的的医学人才培养模式研究（一）——医学生批判性思维现状

目的调查分析医学生批判性思维的现状,为探索建立＂核心能力为导向,循证医学为载体,终身学习为目的＂的医学人才培养模式提供依据。方法采用中文版批判性思维能力测量表（Chinese Version of Critical Thinking Disposition Inventory,CTDI-CV）调查分析四川大学617名医学本科生和研究生批判性思维现状。结果该组医学生批判性思维素质平均总分均高于280分,批判性思维呈正性。亚组分析结果显示,平均总分由高到低依次为8年制（309分）、研究生（298分）、7年制（287分）和5年制（286分）。平均总分两两比较,除5年制和7年制之间无明显差异外,其余各组平均相差均≥10分。5年制和7年制医学生＂寻找真相＂、＂系统化能力＂、＂批判性思维自信心＂三项≤40分,其中＂批判性思维自信心＂最低。不同性别和年龄间批判性思维总分和7项特质无差异。结论影响我国学生批判性思维的因素主要包括：教学理念、教学氛围、教学方式和教学评价体系。     

国内部分三甲医院危重疾病患者口腔护理情况调查

目的了解国内三甲医院重症监护室危重疾病患者口腔护理情况,为提高危重疾病患者口腔护理水平提供依据和建议。方法采用信访、向危重病人口腔护理专家咨询和走访等调查方式,获得国内危重疾病患者口腔护理现状信息。结果本次调查共发放调查问卷184份,回收有效问卷79份,有效回收率42.93%。所有回复者均认为口腔护理对于危重疾病患者很重要,有98.7%的重症监护室采取了不同的方式进行护理前评估,包括检查口腔基本情况及口腔分泌物提取,评估实施者主要为床旁责任护士（63.3%）。目前使用最多的口腔护理方式为棉球擦洗法（62.5%）,护理频率每日2～3次,每次平均时间9.1±5.1min,主要使用的口腔护理液有生理盐水（76.0%）、碳酸氢钠（22.8%）、呋喃西林（13.9%）、双氧水（13.9%）等。结论目前国内口腔护理水平相差较大,应加强针对循证口腔护理的培训,有必要建立危重疾病患者口腔护理的全国统一规范。     

评判性思维在护理学界的研究现状

21世纪,随着医疗技术的日新月异．护理工作的难度和强度也相应增加,比已往显得更为突出的是护士需要住不同情况中提供复杂的护理措施．有些甚至是不熟悉的或者是新的情境．这对护理人员来说是一个挑战。任当今的医疗保健环境不断变化中,随着信息和技术的发展,患者的健康意识也不断提高,     

脑肿瘤适形调强放疗患者疾病不确定感的护理对策

目的探讨护理干预对脑肿瘤适形调强放疗患者疾病不确定感的影响。方法将62例脑肿瘤行适形调强放疗患者随机分为实验组和对照组各31例,实验组按照整体护理模式进行系统性的护理干预。对照组进行常规的健康教育。结果在入院时、放疗前、出院时,对照组的疾病不确定感分别是95.25±8.87、91.16±9.96和84.21±9.91,实验组的分别是95.30±7.12、82.87±6.32和78.23±6.56,在入院时实验组与对照组在疾病不确定感间差异无统计学意义(P0.05)。而在放疗前和出院时实验组患者的疾病不确定感均明显低于对照组,差异有统计学意义(P0.01),均比入院时疾病不确定感明显下降(P0.01);出院时达到最低。而对照组患者的疾病不确定感在放疗前与入院时比较差异无统计学意义(P0.05),出院前疾病不确定感相对于入院时下降,差异有统计学意义(P0.01)。结论相对于常规的健康教育,应用整体护理对患者进行系统性的护理干预能明显降低患者的疾病不确定感。有助于提高患者有效的应对方式及其生活质量。     

社区护士评判性思维现状及其影响因素分析

目的:明确社区护士评判性思维现状及影响因素。方法:利用一般情况问卷、自我效能感量表GSES及评判性思维能力测量表CTDI-CV对186名社区护士进行调查。结果:社区护士CTDI-CV总分为(304.7±87.3)分;专科及以下学历的社区护士CTDI-CV总分显著低于本科及以上的社区护士,工作年限少于5年的社区护士其总分显著低于工作年限等于或多于5年的社区护士;社区卫生服务中心工作大于或等于5年(β=0.542,P=0.000)、自我效能感(β=0.788,P=0.000)是评判性思维的重要影响因素。结论:社区护士具有正性评判性思维倾向,可以尝试通过提高自我效能感加强专科及以下学历护士、工作年限少于5年的社区护士的评判性思维的培养。     

Morgellons: contested illness,diagnostic compromise and medicalisation

The case of Morgellons illustrates how the emergence of a new medically contested illness intersected with and impacted on the diagnostic processes of an existing uncontested psychiatric condition, Delusional Parasitosis (DP). More specifically, the sociopolitical processes at play in the contested illness, Morgellons, dubiously reflect patient empowerment, as well the resilience and power of medical jurisdiction. This research offers insights into the contested illness and medicalisation literatures, and aims to bridge these two approaches towards the relationship between patient empowerment and medical authority, which I do through the notion of doctor‐patient compromise. The data for this research come from a comprehensive qualitative analysis of Morgellons discourse through four key sources: the pro‐Morgellons website Morgellons.org; the anti‐Morgellons website Morgellonswatch.com; the popular media’s portrayal of Morgellons; and the DP and Morgellons articles published in peer‐reviewed medical journals, as made available on PubMed.     

Negotiating the contested terrain of narrative methods in illness contexts

This paper offers an interpretive account of an ongoing transatlantic debate about illness narratives instigated by the publication in 1997 of Paul Atkinson’s paper Narrative Turn Or Blind Alley? The claims and counter‐claims to be found in this debate about narrative data and narrative analysis are set out sequentially, in an attempt to grasp the debate’s essentials. Matters of theoretical perspective, methodology, ethics, and personal politics are found to be at stake in the writings of the four featured academics: Paul Atkinson, Arthur Bochner, Arthur Frank and Elliot Mishler. The paper moves on to consider the types of sociologies at work in their arguments, and explores the debate’s implications for the author’s own illness narratives research project. The paper’s overall aim is to assist researchers who seek to clarify their own thinking on the use of narrative research methods in illness contexts.     

Agents of their health? How the Swedish welfare state introduces expectations of individual responsibility

In recent years, the notion of individual responsibility for one’s health has been introduced into Swedish medico‐political debate. Formerly expressed as a recommendation, it has now taken on the form of expectations. In a Swedish context, this shift from collective to individual responsibility is novel because it implies a break with well‐established welfare state practice of comprehensive care for their citizens. Using a systems‐theoretical approach, we interpret this shift of expectations as a political solution to the problem of legitimate allocation of scarce resources. A more inclusive medical conception of illness has facilitated the introduction of many new diagnoses that, in turn, have lead to a strong increase in claims for medical treatment and for compensation. This semantic change in medicine aggravates the budgetary situation of the welfare state. The political solution lies in a reorientation of the expectations the medical system can have on citizens as well as a shift of the expectations regarding the rights and obligations citizens can have on the medical system. Individuals are increasingly expected to live healthy lifestyles and to avoid hazardous habits. If they do not live up to these expectations, they have to face low prioritisation or denial of treatment.