社区老年糖尿病患者全面康复认知与对医护需求的调查

目的 了解老年糖尿病患者身体、心理、社会、职业上的康复问题和实际生活中面临的困难,探讨老年糖尿病患者对社区医护服务的需要.方法 为老年糖尿病患者建立个人档案,定期通知患者免费体检,对不能按时体检的患者进行家庭随访并强化其家属的健康教育,发放问卷调查对医护服务的需求.结果 糖尿病患者掌握糖尿病相关知识及技能,康复问题主要集中在饮食注意事项,并发症观察处理,自我医疗护理能力,降糖药物的选择.患者对自我认知,回归社会矛盾的认知程度较低,大部分患者对康复的关注还停留在原始的生理需要上.结论 糖尿病患者实际生活中的康复问题值得人们的关注,应根据患者生理、心理、社会、职业上的康复困难采取有效的干预措施,为糖尿病患者建立医院-家庭-社区一体化的康复护理模式,提高生活质量.     

社区老年糖尿病患者全面康复认知与对医护需求的调查

目的了解老年糖尿病患者身体、心理、社会、职业上的康复问题和实际生活中面临的困难，探讨老年糖尿病患者对社区医护服务的需要。方法为老年糖尿病患者建立个人档案，定期通知患者免费体检，对不能按时体检的患者进行家庭随访并强化其家属的健康教育，发放问卷调查对医护服务的需求。结果糖尿病患者掌握糖尿病相关知识及技能，康复问题主要集中在饮食注意事项，并发症观察处理，自我医疗护理能力，降糖药物的选择。患者对自我认知，回归社会矛盾的认知程度较低，大部分患者对康复的关注还停留在原始的生理需要上。结论糖尿病患者实际生活中的康复问题值得人们的关注，应根据患者生理、心理、社会、职业上的康复困难采取有效的干预措施，为糖尿病患者建立医院-家庭-社区一体化的康复护理模式，提高生活质量。     

对直肠癌结肠造口患者全面康复认知与需求的调查分析

目的了解直肠癌结肠造口患者身体、心理、社会、职业上的康复问题和实际生活中面临的困难,寻求实现患者全面康复及回归社会的方法和途径。方法采用自设问卷,调查分析51例直肠癌结肠造口患者的康复情况、对全面康复的认知与康复需求。结果直肠癌结肠造口患者术后的康复问题主要集中在造口局部护理、建立规律排便、造口用品选择、性生活困惑、职业康复方面;患者对全面康复、自我认知、职业康复、回归社会等项的认知程度较低,大部分患者对康复的关注还停留在原始的生理需要上。结论直肠癌结肠造口患者实际生活中的康复问题值得人们关注,康复护理中应根据患者生理、心理、社会、职业上的康复困难采取有效的康复干预措施,为肠造口患者建立医院-家庭-社区一体化的康复护理模式,帮助其实现生理、心理、社会的全面康复,提高生活质量。     

乳腺切除术后病人全面康复认知与需求调查分析

[目的]了解乳腺切除术后病人身体、心理、社会、职业上的康复问题和实际生活中面临的困难,寻求实现病人全面康复及回归社会的方法和途径.[方法]采用自设问卷,调查分析104例乳腺癌切除乳腺术后病人的康复情况及对全面康复的认知与康复需求.[结果]乳腺切除术后病人的康复问题主要集中在术区皮肤护理、并发症观察处理、胸部矫形知识缺乏、性生活困惑、职业康复方面;病人对全面康复、自我认知、职业康复、回归社会等项的认知程度较低,大部分病人对康复的关注还停留在原始的生理需要上.[结论]乳腺切除术后病人实际生活中的康复值得人们关注,康复护理中应根据病人生理、心理、社会、职业上的康复困难采取有效的康复干预措施,为乳腺切除术后病人建立医院、家庭、社区一体化的康复护理模式,帮助其实现生理、心理、社会的全面康复,提高生活质量.     

护理干预对社区糖尿病患者自我管理能力的效果评价

目的研究护理干预对社区老年糖尿病患者在疾病认知、不良生活行为的改变、自我检测能力及对血糖控制等方面的影响。方法建立患者档案,从心理、饮食、运动及服药等方面进行护理干预,并对社区护理干预前后患者的糖尿病知识、自我管理能力等方面进行比较。结果护理干预6个月,患者自我管理能力提高,改善了血糖及其他指标。结论针对性的社区护理干预能有效地促进社区糖尿病患者病情好转。     

社区老年糖尿病患者的居家护理需求及社会支持特征研究

目的探究社区老年糖尿病患者居家护理需求和社会支持特征。方法 2019年2-5月,采用方便抽样法选取研究对象,在江苏25个社区实施调查。采用社区老年糖尿病患者个体特征情况调查表、居家护理需求问卷和社会支持量表(SSRS)进行调查,分析社区老年糖尿病患者居家护理需求和社会支持特征。结果 287份有效问卷显示,社区老年糖尿病患者居家护理需求总均分为(3.00±0.59)分,在健康指导、康复护理、心理护理、医疗护理和生活护理5个维度需求率分别为67.6%、59.2%、33.8%、24.0%和20.9%。社区老年糖尿病患者社会支持总分为(39.64±7.32)分,客观支持(8.95±2.51)分,主观支持(22.66±4.84)分,对支持的利用度(8.03±2.09)分。居家护理需求受并发症、自理能力影响;年龄、婚姻状况、与谁共同居住、家庭月均收入、并发症、自评健康状况及自理能力是社会支持的影响因素。相关分析结果显示,社区老年糖尿病患者自评健康状况与居家护理服务需求总分及对支持的利用度之间存在相关性(r=0.120,P0.05;-0.249,P0.01);社区老年糖尿病患者生活自理能力与居家护理服务需求总分及对支持的利用度之间存在相关性(r=0.136,P0.05;r=-0.133,P0.05)。结论社区老年糖尿病患者的对健康指导和康复护理需求率较高;社会支持处于中等水平;社区老年糖尿病患者个体特征影响其居家护理需求及对支持的利用度。对自理能力差的社区老年糖尿病患者,要注重提高患者及家属对支持的利用度,从而满足居家护理需求。     

老年糖尿病患者“医院-社区-家庭”互动治疗模式效果初探

目的探讨老年糖尿病患者"医院-社区-家庭"互动治疗模式的效果。方法 2006年2月~2008年2月我科收治诊断明确,病情稳定且需维持治疗,出院后需要跟踪、随访、卫生宣教,而且所属社区服务中心有能力处置的2型糖尿病患者共56例,均采取"医院-社区-家庭"互动模式进行护理。成立糖尿病护理小组,建立个人健康档案,实施三级转诊,社区定期体检。结果 3个月后对56例进行问卷调查,问卷回收率100%,结果显示患者对糖尿病饮食疗法、自测血糖、坚持服药、糖尿病知识及自我护理方法的掌握程度逐渐增高,无一例医疗护理纠纷及投诉发生,降低了患者再住院率和病死率。结论 "医院-社区-家庭"互动模式将护理服务延伸至社区及家庭,是整体护理内涵的延伸和深化,为老年患者提供连续无缝隙的护理服务,对改善患者生活质量起到了较好的促进作用。     

护理干预对老年糖尿病患者自我护理的影响

目的 探讨护理干预对老年糖尿病患者自我护理的影响.方法 对90例老年糖尿病患者采用糖尿病自我效能量表（DSES）及糖尿病自护行为量表（DSCS）评价其自我护理能力信心及自我护理行为执行情况,调查患者自我护理影响因素并进行护理干预,比较干预前后患者自我护理改善程度.结果 干预前后老年糖尿病患者自我护理能力信心及自我护理行为执行情况差异均有统计学意义（P＜0.01）.结论 要提高老年糖尿病患者自我护理能力,可通过对其进行个性化的健康教育、心理疏导、固有观念认知来提高其糖尿病相关知识认知率,改善其心理状况,改变其固有观念.     

上海高等职业院校老年护理专业学生职业决策困难影响因素的质性研究

目的探讨老年护理专业学生职业决策困难的影响因素,为增强老年护理专业人才职业成熟度,帮助其顺利有效地做出职业决策提供帮助。方法 2015年1-6月,运用质性研究方法,采用目的抽样法选取上海某高等职业院校(以下简称高职)老年护理专业18名学生进行深入访谈,将获得的资料进行分析、整理、归纳,提出主题。结果提炼出影响老年护理专业学生职业决策困难的因素包括以下几个方面:自我认知不足、缺乏合理的职业生涯规划、对专业前景缺乏信心、个人意愿及期望与实际相冲突、职业选择焦虑。结论高职教师应积极引导学生转变对老年护理的传统观念,帮助学生提升自我认知,辨明自身优劣势,排除职业决策过程中的不良心理影响,增强职业决策自我效能感;同时,学校应加强就业指导,提升学生的自我职业生涯规划能力。     

社区健康教育提高糖尿病患者自我护理能力的效果

目的观察对糖尿病患者进行社区健康教育的效果。方法对社区280例糖尿病患者根据实际情况通过群体教育、小组教育、随机性教育、家庭访视、电话随访等形式进行健康教育,内容包括基本知识讲解、心理疏导、饮食指导、运动指导、药物指导、血糖自我监测指导、自我足部护理指导、低血糖的观察及处理等。结果经过健康教育,糖尿病患者对疾病的认知、饮食控制、用药的依从性、每天坚持适量运动、自我监测管理、自我足部护理、低血糖的观察及处理等方面有了很大的改善。结论在社区开展深入细致的糖尿病健康教育,改变了糖尿病患者对待疾病的态度,使其能自觉采取健康行为,提高患者自我护理能力,改善机体功能,提高了患者的生活质量。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.