自我管理项目在社区COPD中的应用及对负性情绪、自我管理能力的影响

目的探究自我管理项目在社区COPD患者的应用及对负性情绪、自我管理能力的影响。方法选取治疗的110例COPD患者为试验对象,按随机数字表法分为试验组和对照组各55例。对照组予以常规护理,试验组采用自我管理护理。结果比较两组治疗前后负性情绪变化、自我管理能力,患者满意度情况。护理后,两组负面情绪评分均显著降低(P0.05),且试验组降低幅度大于对照组(P0.05);护理后,试验组自我管理得分较护理前显著升高(P0.05),且显著高于对照组(P0.05);护理后,试验组护理满意率明显高于对照组(P0.05)。结论自我管理项目应用于社区COPD患者效果显著,可明显改善患者负性情绪、提高自我管理能力和满意度。     

呼吸康复护理对老年COPD患者负性情绪的影响

目的:探讨呼吸康复护理对老年COPD患者负性情绪的影响。方法:将84例老年COPD患者随机分为对照组和观察组各42例。对照组给予常规护理干预,观察组给予呼吸康复护理,比较两组患者干预前后的焦虑状态和抑郁状态评分。结果:观察组干预后焦虑状态和抑郁状态评分均低于对照组(P<0.05)。结论:呼吸康复护理能够促进COPD患者的呼吸运动,提高患者生存质量,进而改善其负性情绪,效果显著。     

社区慢性阻塞性肺疾病患者自我管理能力调查研究

目的 :调查社区慢性阻塞性肺疾病(COPD)患者自我管理水平,为社区开展COPD患者自我管理干预提供依据。方法 :采用COPD自我管理问卷,对260名社区COPD病患者进行自我管理水平调查。结果 :社区COPD患者自我管理总分为(156.92±36.47)分。患者文化程度、过去一年内因COPD急性加重住院次数、吸烟状况是患者自我管理水平的影响因素。结论:社区COPD患者自我管理水平不高,影响社区COPD患者自我管理水平的因素有文化程度、吸烟状况、住院次数。     

新冠肺炎防控期间COPD患者心理体验的质性研究

目的：了解于我院慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）(慢阻肺)门诊就诊的患者在新冠肺炎防控期间的心理体验,以期为医院重大突发事件的应急工作和COPD患者疾病自我管理工作提供指导和依据。方法：采用半结构式访谈法,对15名曾就诊于我院COPD门诊的慢阻肺患者进行质性访谈,并基于Colaizzi７步分析法对访谈资料加以分析,归纳出主题。 结果：经过反复分析及思考,提炼出5个主题：COPD患者疫情防控期间的焦虑等情感体验、就医态度和体验、疾病认知、社会支持的感激和认同。结论：COPD患者在突发公共卫生事件面前,产生了害怕、焦虑等负性情绪,并出现了个体依从性下降、就诊体验差的状况,提示了我国卫生系统在应对突发公共卫生事件面前仍有进一步提高的空间,患者在突发事件面前的自我管理能力有待提高。     

护生参与指导社区老年慢性阻塞性肺疾病患者肺功能康复的探索

目的 探讨如何利用护生资源对社区老年慢性阻塞性肺病(COPD)康复期患者进行肺功能康复的指导.方法 在大学三年级护理本科生中选拔学习成绩好,具有爱心和责任心、会用地方语言进行交流的25名优秀护生进行肺功能康复训练相关知识培训,在社区医护人员的带领下,参与指导社区老年COPD患者的肺功能康复训练.结果 社区老年COPD患者通过6-12周的肺功能康复训练,呼吸困难状况改善,呼吸困难分级的平均级数由2.12下降到1.60,下降率达24.5%.结论 利用当地医学院校学生对社区老年COPD缓解期患者进行肺功能康复参与指导,可帮助患者建立自信心,减少患病状态,提高生活质量.同时激发了护生的学习兴趣,提高了人文关怀意识,加深了对专业护士内涵的理解.     

网络健康教育方式对康复期COPD患者自我管理的影响

目的:探讨基于网络的健康教育方式对慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者自我管理能力的影响。方法:对天津医科大学第二医院病情处于康复期的出院患者72例进行随机分组,每组36例。干预组接受基于网络的健康教育,对照组接受常规健康教育。干预时间6个月。分别于干预前后采用自我管理能力量表测评自我管理能力。结果:干预6个月后,干预组患者评分优于对照组,差异有统计学意义(P0.05)。结论:基于网路的健康教育方式可以提高康复期COPD患者的自我管理能力。     

自我管理项目改善COPD患者生活需求的定性研究

目的探讨自我管理项目对COPD稳定期患者生活需求的满足情况。方法 2010年4~10月对来自苏州大学附属第一人民医院的11例稳定期COPD患者实施了一项为期8周的自我管理项目,在干预后2个月,应用Marslow层次需要论对11例患者进行半结构式深入访谈,并采用Miles和Huberman的内容分析法,对访谈资料进行整理与分析。结果通过自我管理项目干预,COPD患者的生活自理能力、呼吸困难症状预防及控制能力、急性加重的预防能力、与家人、亲朋好友间的相处能力及情绪自控能力有所提高,同时也增加了患者对疾病治疗的信心。结论对稳定期COPD患者开展自我管理项目具有有效性及可行性。但在开展过程中我们需要综合考虑影响自我管理效果的各种因素,如治疗依从性、负性情绪、家庭社会支持等,并重点采取针对性的,干预措施。     

老年慢性阻塞性肺疾病患者自我管理现状及影响因素分析

目的:调查老年慢性阻塞性肺疾病(COPD)患者自我管理现状,对其影响因素进行多重线性分析,并制定科学预防措施。方法:选取我院收治的老年COPD患者106例作为研究对象,采用COPD自我管理量表对患者自我管理现状进行评估,对影响患者自我管理的因素进行单因素和多重线性分析。结果:老年COPD症状管理评分为(21.39±4.26)分,信息管理评分(23.46±3.35)分,日常生活管理评分(42.65±5.43)分,情绪管理评分(34.21±4.51)分,自我效能管理评分(24.58±4.16)分,自我管理总分(154.68±20.52)分。单因素分析结果显示:年龄、文化程度、病程、付费方式、婚姻状况、疾病严重程度、人均月收入、疾病知识水平、居住状况、患者间自我管理评分差异具有统计学意义(P0.05)。多因素分析结果显示:影响老年COPD患者自我管理因素按照重要性排列依次为疾病严重程度、人均月收入、病程、疾病知识水平、付费方式、文化程度、婚姻状况、居住状况、年龄。结论:年龄、文化程度、病程、付费方式等均是影响老年COPD自我管理的因素,临床应根据患者具体情况制定针对性预防措施。     

社区康复护理对老年慢阻肺患者生活质量的影响

目的:探讨社区康复护理对老年慢性阻塞性肺疾病患者生活质量的影响.方法:选取98例老年慢性阻塞性肺疾病(COPD)稳定期患者作为研究对象,随机分为干预组和对照组各49例,干预组给予包括健康教育在内的全方位的社区康复护理措施,而对照组实施常规的护理,观察并比较两组患者的生活质量.结果:护理干预后,两组患者的心理状况都有不同程度的改善,而干预组的SAS和SDS得分显著低于对照组,两组比较差异有统计学意义(P<0.05).干预前两组在躯体功能、心理功能、社会功能、物质功能和总分等5个方面比较差异均无统计学意义(P>0.05),干预后两组得分均有不同程度的升高,而干预组的升高幅度大于对照组,两组比较差异有统计学意义(P<0.05).结论:对老年慢阻肺患者实施全面、系统的社区康复护理,能够有效提高患者的生活质量,促进患者的康复.     

自我决定理论在老年COPD患者自我管理中的应用研究

目的探讨自我决定理论在老年COPD患者自我管理中的应用及效果。方法将197例老年COPD患者分为对照组和观察组,对照组实施小组工作模式,观察组在此基础上以自我决定理论为指导。6个月后,比较两组患者自我管理水平。结果干预后,观察组老年COPD患者自我管理量表总分和症状管理、日常生活管理、情绪管理、信息管理、自我效能得分均高于对照组,差异有统计学意义(P0.01或P0.05)。结论自我决定理论能有效提高老年COPD患者的自我管理水平和减轻症状。     

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.