健康信念模式在肾移植术后患者自我管理中的应用

目的 探讨运用健康信念模式在肾移植术后患者进行自我管理干预的效果。方法 选择2014年6月—2015年6月在华山医院住院的肾移植术后患者40例,随机分为干预组和对照组,干预组运用健康信念模式对肾移植术后患者进行针对性的健康教育。对照组按肾移植术后护理常规的健康教育内容进行宣教。比较两组肾移植术后患者自我管理干预后3个月的焦虑和抑郁情况、自我效能改变及半年内并发症的发生情况。结果 干预组患者SAS焦虑自评量表及SDS抑郁自评量表得分显著低于对照组（P<0.01）;自我效能评分显著优于对照组（P<0.01）,并发症的发生率低于对照组,但尚未引起统计学差异（P>0.05）。结论 运用健康信念模式对肾移植术后患者进行护理干预,可改善患者的焦虑、抑郁状态,提高患者自我管理能力。     

肾移植受者出院后自我管理行为与自我效能的相关性研究

目的探讨肾移植受者出院后的自我管理行为、自我效能及两者之间的关系。方法应用《慢性病自我管理研究测量表》中的自我管理行为量表、自我效能量表分别调查203名出院后肾移植受者的自我管理行为和自我效能。结果肾移植受者的自我管理行为中耐力锻炼时间较长,体能锻炼、认知性症状管理实践、与医生的交流得分较低,肾移植患者术后的自我效能较稳定,自我管理行为与自我效能呈显著正相关（P〈001）。结论肾移植受者出院后的自我管理行为需要改善,自我管理行为与自我效能关系密切,可通过健康教育提高患者的自我效能,进而改善其自我管理行为。     

监测日记在糖尿病患者自我管理中的作用

目的 探讨监测日记在糖尿病患者自我管理中的作用.方法 将82例糖尿病患者随机分为对照组(41例)和实验组(41例),对照组只给予常规与糖尿病相关的健康教育,实验组除常规健康教育外,还要求坚持记录监测日记.结果 2组自我管理能力和出院3个月后的疗效差异有统计学意义(p＜0.01).结论 坚持监测日记记录的糖尿病患者能主动参与糖尿病的自我管理,预防和延缓糖尿病并发症的发生和发展,全面提高生活质量.     

居家脑卒中患者自我管理能力的影响因素及延续护理对策

目的探讨居家脑卒中患者自我管理能力的影响因素及延续护理对策。方法选择2018年1月至2019年7月我院收治的脑卒中患者90例为研究对象,采用"成人健康自我管理量表"评价患者的自我管理能力,采用多因素logistic回归分析明确居家脑卒中患者自我管理能力的影响因素,据此制定相关的延续护理对策。结果 90例居家脑卒中患者中,24例为自我管理能力低水平,66例为中高水平。患者家庭人均月收入、婚姻状况、文化程度、卒中知识水平、疾病应对方式、日常生活能力、自我效能、社会支持对居家脑卒中患者自我管理能力的影响差异具有统计学意义(P 0. 05);多因素logistic回归分析表明,文化程度、脑卒中知识水平、疾病应对方式、日常生活能力、自我效能、社会支持是居家脑卒中患者自我管理能力的独立危险因素(P 0. 05)。结论居家脑卒中患者自我管理能力高低不一,护理人员要高度关注影响患者自我管理能力的因素,加强延续护理,巩固治疗效果。     

家庭健康评估对社区肾移植术后患者家庭的影响

目的 探讨家庭健康评估对肾移植术后患者家庭的影响.方法 以社区肾移植患者个案的家庭为例,通过3次家庭访视和2次电话访问,进行家庭健康评估,确定护理的重点及计划,并予家庭护理措施.结果 通过家庭护理能提高患者服药、饮食、运动等自我管理能力,从而提高患者的生活质量.结论 家庭健康评估能协助家庭增加自我照顾能力,发挥家庭的最大功能.     

广州两所医院肾移植受者出院后的自我管理行为及其影响因素分析

目的 描述肾移植受者出院后的自我管理行为并探讨其影响因素.方法 采用描述性相关性研究设计,应用慢性病自我管理研究测量表中的自我管理行为量表、自我效能量表、贝克(Beck)抑郁问卷、社会支持评定量表,以及自行设计的一般资料调查表及健康知识掌握和健康行为实施调查表,分别调查213例肾移植受者的自我管理行为及其影响因素.采用SPSS 13.0软件进行统计分析.结果 肾移植受者的自我管理行为中耐力锻炼时间较长,体能锻炼、认知性症状管理实践、与医生的交流得分较低,术后时间为6-12个月组患者的自我管理行为相对较好.主要影响因素包括文化程度、有无得到运动指导、自我效能、抑郁程度、社会支持、健康知识掌握水平和健康行为实施情况等,其中自我效能为最主要的影响因素.结论 肾移植受者出院后的自我管理行为需要改善,并受自我效能等多因素的影响.     

延续护理应用于肾移植术后出院患者自我管理中对口服药漏服率的改善研究

目的 探讨延续护理应用于肾移植术后出院患者自我管理中对口服药漏服率的改善效果.方法 将2019年7月至2021年12月期间于常州市第一人民医院泌尿外科肾移植中心接受肾移植手术治疗的48例患者,依据随机数字表分组法分别纳为对照组和观察组,每组各24例.对照组给予常规护理干预,观察组给予延续护理干预.比较两组护理后的口服药漏服率、自我管理能力水平、生活质量和术后远期并发症发生率.结果 护理后,观察组的口服药漏服率低于对照组,其饮食管理、躯体活动管理、社会心理管理及治疗管理等自我管理能力评分均高于对照组(P＜0.05).护理后,观察组的生理功能、社会功能、心理职能及认知功能评价项目评分均高于对照组(P＜0.05).术后远期并发症总体发生率低于对照组(P＜0.05).结论 肾移植术后出院患者实施延续护理,可明显降低患者的口服药漏服率和术后远期并发症发生率,有提升患者的自我管理能力及生活质量水平.     

代谢综合征老年患者自我健康管理对疾病的影响

目的探讨老年代谢综合征患者自我管理模式对疾病的影响。方法选取2011年1—8月就诊于上海交通大学医学院附属瑞金医院的代谢综合征老年患者200例,随机分为干预组和对照组各100例。经过1年的自我管理干预,比较两组患者在自我效能、自我监测方面的能力及生化指标等方面的改变。结果两组患者干预前后在自我效能、自我监测能力和临床生化指标（舒张压、收缩压、空腹血糖、餐后2h血糖、甘油三酯和高密度脂蛋白胆固醇）比较,差异有统计学意义（P〈0．01）。结论自我管理模式的建立能有效提高代谢综合征患者的自我效能、自我监测能力和治疗效果,在延缓疾病进展及防止并发症的预防方面有重要意义。     

自我管理教育对经皮冠状动脉介入治疗术后患者自我效能的影响

目的:探讨自我管理教育对经皮冠状动脉介入治疗(PCI)术后患者自我效能的影响。方法:将137例PCI患者随机分为实验组71例和对照组66例,实验组进行自我管理教育,对照组给予常规护理,对两组患者出院时和出院后9个月用自我效能测量表分别进行自我效能的评价。结果:实验组9个月后自我效能测量评分与对照组比较差异有统计学意义(P<0.01)。结论:自我管理教育能有效提高PCI术后患者的自我效能,促进患者术后康复。     

两种健康教育模式对肾移植患者术后自我监测依从性的影响

目的观察两种健康教育模式对肾移植患者术后自我监测依从性的效果。方法将62例肾移植术后患者随机分为两组,每组31例。对照组采取传统的健康教育,观察组采取联合家属共同教育、电话随访、同伴教育、网络教育的综合健康教育模式,采用SPSS 11.0统计软件,比较两组患者不同时期（6个月、1 a）自我监测依从性情况。结果观察组肾移植患者术后1 a自我监测依从性高于对照组,差异具有统计学意义（P〈0.01）。结论肾移植患者自我监测的长期依从性与实施健康教育的形式密切相关。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.