脊髓损伤病人主要照顾者照顾负担与悲伤情绪的相关性分析

目的:探讨脊髓损伤病人主要照顾者照顾负担与悲伤情绪的相关性。方法:采用照顾负担量表及悲伤情绪量表对103例脊髓损伤病人的主要照顾者进行调查。结果:脊髓损伤病人主要照顾者照顾负担总分(60.50±11.07)分,91.3%为中重度负担;悲伤情绪总分为(61.57±9.77)分,处于较高水平;照顾负担与悲伤情绪总分、各维度得分均呈正相关(r=0.415～0.597,P<0.01)。结论:在不断健全社会支持体系和完善卫生保健政策基础上,护理人员应对主要照顾者进行心理疏导、情感支持及健康指导,提供良好的延续性服务,以减轻照顾者的照顾负担和悲伤情绪。     

脊髓损伤患者照顾者照顾负担与自我效能的调查分析

目的 调查脊髓损伤患者照顾者的照顾负担及自我效能水平并分析其相关关系.方法 通过便利抽样法,采用Zarit护理负担量表、一般自我效能量表,对150例脊髓损伤患者及其照顾者进行调查.结果 脊髓损伤患者照顾者的照顾负担总分为(52.91±11.56)分,照顾者自我效能得分为(19.63±4.85)分,照顾者的照顾负担与自我效能水平显著负相关.结论 应重视提高脊髓损伤患者照顾者的自我效能感,以减轻其照顾负担,提高照顾能力及患者所在家庭的健康水平.     

颅脑损伤患者照顾者照顾负担的现状及其影响因素研究

目的调查颅脑损伤患者照顾者照顾负担的现状及其影响因素。方法采用颅脑损伤患者一般资料调查问卷、主要照顾者一般资料调查问卷、照顾者护理负担量表、照顾者积极感受量表、简易应对方式问卷以及疲劳量表对210例颅脑损伤患者的照顾者进行调查。结果照顾者照顾负担均分(62.78±14.38)分,处于重度负担水平。照顾者积极感受均分为(26.08±14.47)分,躯体疲劳均分为(6.45±1.20)分,脑力疲劳均分为(4.96±1.05)分,积极应对均分为(22.64±11.21)分,消极应对均分为(14.81±7.41)分,照顾时间平均为(17.58±4.31)天。经多元线性回归分析显示,照顾者照顾负担的影响因素为颅脑损伤患者的损伤程度、照顾者躯体疲劳及积极感受,其中损伤程度和躯体疲劳为危险因素,积极感受为保护因素。结论颅脑损伤患者的损伤程度及照顾者躯体疲劳是照顾者照顾负担的正性影响因素,积极感受是颅脑损伤患者照顾者照顾负担的负性影响因素。医护人员应积极治疗颅脑损伤患者的同时,关注照顾者身心健康,鼓励照顾者多表达积极感受,提供高质量的照护。     

老年期痴呆患者照顾者照顾负担与社会支持及相关性研究

目的调查老年期痴呆患者照顾者负担及其与社会支持的相关性.方法采用照顾者负担量表及社会支持评定量表,对153对老年期痴呆患者及其照顾者进行调查.结果照顾者负担处于轻、中度水平,社会支持处于中度水平;照顾者照顾负担总分与患者记忆行为问题总分呈正相关(r=0.336,P<0.01);与社会支持总分呈负相关(r=-0.348,P<0.01).生活部分自理患者的照顾者,家中无人或有1~2人分担照顾的照顾者,市医保患者的照顾者负担高(P<0.05).结论老年期痴呆患者的照顾者承受轻、中度照顾负担,应关注生活部分自理患者的照顾者、少人/无人分担的照顾者、市医保患者的照顾者,提供足够的社会支持有助于减负.提示应加强社会保障建设,完善医疗保障体系,加快建立支持老年期痴呆患者家庭的服务机构,与患者家庭共同承担照顾任务.     

2型糖尿病患者家庭主要照顾者照顾负担与糖尿病知识水平的相关性研究

目的：探讨2型糖尿病患者家庭主要照顾者（以下简称照顾者）照顾负担与糖尿病知识水平的现状及其相关性。方法:采用疾病负担量表和糖尿病知识量表对82例2型糖尿病患者及其照顾者进行问卷调查。结果：照顾者照顾负担及糖尿病知识水平总分中位数分别为7.5和61.5分;照顾负担总分与糖尿病知识总分呈负相关（r=-0.591,P＜0.01）。结论：2型糖尿病患者家庭主要照顾者存在不同程度的照顾负担,照顾者拥有的糖尿病知识水平越高,其感受的照顾负担会越少。医务工作者将照顾者纳入到患者的日常健康教育中,有利于提高其生活质量。     

乳腺癌患者配偶社会支持与照顾者负担的相关性研究

目的了解乳腺癌患者配偶的社会支持和照顾者负担情况,探讨其相关性。方法 2013年7月至2014年7月,便利抽样选择湖北省襄阳市中心医院肿瘤科收治的116例乳腺癌患者及其配偶为研究对象,采用一般情况调查表、社会支持评定量表和Zarit照顾者负担量表进行调查。结果乳腺癌患者配偶的社会支持总分为(29.14±3.42)分,照顾者负担总分为(37.52±13.85)分,处于中度负担水平;社会支持总分与照顾负担总分及其各维度呈负相关,其中主观社会支持与照顾负担各维度呈负相关,社会支持利用度与个人负担呈负相关(均P0.05),客观社会支持与照顾负担各维度均无相关性(均P0.05)。结论乳腺癌患者配偶的社会支持与照顾者负担具有显著相关性,作为乳腺癌患者的主要照顾者,其配偶的社会支持应给予重视,临床医护人员应了解并关注乳腺癌患者配偶主观社会支持,并提高其对社会支持的利用度,以缓解其照顾者负担,减轻其在照顾过程中产生的不良体验,使患者及配偶能积极应对疾病及后续治疗。     

心理弹性在食管癌患者主要照顾者睡眠质量及照顾负担间的中介作用

目的探讨食管癌患者主要照顾者心理弹性、睡眠质量和照顾负担的现状,以及心理弹性在睡眠质量与照顾负担间的中介作用。方法运用心理弹性量表、匹兹堡睡眠质量指数、照顾者负担问卷对236名食管癌患者主要照顾者进行调查。结果食管癌患者主要照顾者心理弹性总分为(63.96±7.67)分,睡眠质量总分中位数为6分,睡眠障碍检出率为41.53%,照顾者负担总分为(22.73±3.86)分。食管癌患者主要照顾者睡眠质量与心理弹性得分呈负相关(P0.01)。睡眠质量与照顾者负担得分呈正相关(P0.01),照顾者负担量表与心理弹性得分呈负相关(P0.01)。Bootstrap法分析心理弹性在照顾负担和睡眠质量间起到部分中介作用,占总效应的44.73%。结论食管癌患者主要照顾者心理弹性水平较低,睡眠质量较差,照顾负担处于轻中度水平,心理弹性在睡眠质量和照顾负担间发挥部分中介作用,提示护理人员应关注和提高照顾者的心理弹性,从而减轻食管癌患者主要照顾者的照顾负担,改善其睡眠质量。     

积极感受在脑卒中主要照顾者相依关系与照顾负担的中介效果

目的 探讨积极感受在脑卒中主要照顾者照顾负担与相依关系的中介作用,为提高主要照顾者身心健康提供理论参考。方法 采取便利抽样法抽取神经内科病区194例住院脑卒中主要照顾者为研究对象,采用一般资料调查表、积极感受量表、相依关系量表和照顾负担量表对主要照顾者进行调查。结果 主要照顾者照顾负担得分为（36.96±14.56）分、积极感受得分为（31.06±8.73）分、相依关系得分为（32.95±14.47）分。积极感受与相依关系呈正相关（r=0.50,P<0.01）,与照顾负担得分呈负相关（r=-0.20,P<0.01）,相依关系与照顾负担呈负相关（r=-0.59,P<0.01）。Bootstrap法进一步验证了积极感受的中介效应。结论 积极感受是脑卒中照顾者照顾负担与相依关系间的部分中介变量。医护人员对照顾者应多加关注,了解其在照顾过程中的积极感受及与患者的相依关系水平,及时给予干预,进一步缓解其感知的照顾负担,提高照顾者的生活质量,促进脑卒中患者主要照顾者的身心健康。     

居家帕金森患者主要照顾者照顾负担与疲劳状况的相关性分析

目的 调查居家帕金森患者主要照顾者照顾负担与疲劳状况的现状,并探讨照顾负担与疲劳状况的相关性.方法 通过便利抽样法选择136名居家帕金森患者主要照顾者,采用照顾者负担量表和疲劳自评量表调查居家帕金森患者主要照顾者的照顾负担与疲劳状况.结果 居家帕金森患者主要照顾者照顾负担总分为（37.54±8.15）分,疲劳状况总分为（53.18±11.62）分.居家帕金森患者主要照顾者的照顾负担总分与疲劳总分呈正相关（P〈0.05）,个人负担与体力疲劳、脑力疲劳、疲劳总分呈正相关（P〈0.05）,责任负担与动力下降、脑力疲劳呈正相关（P〈0.05）.结论 居家帕金森患者主要照顾者的照顾负担处于中度负担,疲劳状况处于中度疲劳水平.护士应加强对帕金森患者照顾者照顾负担的评估,以缓解其疲劳状况.     

脑卒中患者主要照顾者的负担和应对方式及其相关性分析

目的探讨脑卒中患者的主要照顾者的负担水平与应对方式以及二者的相关性。方法采用Zarit照顾者负担量表和简易应对方式问卷调查120位脑卒中患者的主要照顾者。结果脑卒中患者的主要照顾者的负担总分（39．54±13．88）分,86．7％的照顾者负担处于轻、中度水平;照顾者多采取积极应对方式应对负担,偶尔也采取消极应对方式;负担与积极应对方式呈负相关,与消极应对方式呈正相关,差异均有统计学意义（P〈0．01）。结论脑卒中患者的主要照顾者普遍存在不同程度的照顾负担,脑卒中患者主要照顾者的负担与其应对方式密切相关,护理工作者应正确引导照顾者采取适当的应对方式,减轻照顾负担。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.