影响临床护士掌握心电监护知识的相关因素分析

目的 了解临床护士掌握心电监护知识的现状及其影响因素,为合理组织培训,提高护士的心电监护知识水平提供依据.方法 采用方便抽样对296例护士进行心电监护知识问卷调查.结果 到过重症监护室上班的护士心电监护提高知识题得分明显高于未到过重症监护室的护士(P＜0.01);参加过培训的护士的基础知识、提高知识、总分得分均明显高于未培训的护士(P＜0.01);均到过重症监护室及培训的护士提高知识、总分得分明显高于均未到过重症监护室及培训的护士(P＜0.01).护士心电监护知识得分与护士的年龄、工作年限、职称、学历等方面无相关性(P＞0.05).结论 护士对心电监护知识掌握欠缺.参加培训及实践能提高护士心电监护知识水平.     

影响临床护士掌握心电监护知识的相关因素分析

目的了解临床护士掌握心电监护知识的现状及其影响因素,为合理组织培训,提高护士的心电监护知识水平提供依据。方法采用方便抽样对296例护士进行心电监护知识问卷调查。结果到过重症监护室上班的护士心电监护提高知识题得分明显高于未到过重症监护室的护士(P<0.01);参加过培训的护士的基础知识、提高知识、总分得分均明显高于未培训的护士(P<0.01);均到过重症监护室及培训的护士提高知识、总分得分明显高于均未到过重症监护室及培训的护士(P<0.01)。护士心电监护知识得分与护士的年龄、工作年限、职称、学历等方面无相关性(P>0.05)。结论护士对心电监护知识掌握欠缺。参加培训及实践能提高护士心电监护知识水平。     

影响临床护士掌握肺血栓栓塞症知识的相关因素分析

目的了解临床护士掌握肺血栓栓塞症(PTE)知识的现状及其影响因素,为合理组织培训、提高护士的PTE知识水平提供依据。方法采用方便取样对176名护士进行PTE知识问卷调查。结果参加过抢救的护士PTE提高知识题得分明显高于未参加抢救的护士(P<0.01);参加过培训的护士基础知识、提高知识、总分得分均明显高于未培训的护士(P<0.01);均参加过抢救、培训的护士提高知识、总分得分明显高于均未参加抢救、培训护士,差异有统计学意义(P<0.01)。护士PTE知识得分与护士的年龄、工作年限、职称、学历等方面无相关性(P>0.05)。结论护士对PTE知识掌握欠缺。参加培训及实践能提高护士的PTE知识水平。建议为在职护士提供形式多样的PTE知识培训,并将PTE知识课程纳入护理学课程体系。     

社区护士接受尿失禁相关知识培训后的效果评价

目的了解社区护士对老年人发生尿失禁的态度及对尿失禁知识的掌握情况，评价社区护士进行尿失禁相关知识培训的效果。方法对100名社区护士进行尿失禁相关知识的培训，并于培训前后采用自行设计的问卷进行测评，比较培训前后护士对老年人发生尿失禁的态度及对尿失禁知识的掌握情况。结果培训前社区护士均未参与关于尿失禁的继续教育；培训后社区护士对老年人发生尿失禁态度得分高于培训前（P〈0．05）；且培训后，社区护士对发生尿失禁呈正向态度人数明显多于培训前，比较有统计学意义（P〈0．05）。培训后社区护士对尿失禁知识（危险因素、症状因素、影响因素、预防因素、治疗因素、管理因素等6个方面）的答对率都高于培训前（P〈0．01）。结论开展尿失禁知识的培训，加深了社区护士对老年人发生尿失禁的认识，提高了社区护士对尿失禁知识的掌握程度，有助于为患者提供及时正确的健康专业指导和帮助，利于尿失禁的早期诊断、治疗和管理。     

上海市特需护士多元文化护理认知现况的调查

目的探讨上海市特需护士多元文化护理的认知水平及影响因素,为提高多元文化护理水平提供培训课程的依据及管理建议。方珐自行设计特需护士多元文化护理调查问卷（4个维度）,对上海市11家具有特需医疗服务的综合医院从事特需服务的202位护士在同一时间内进行调查,对数据进行统计及分析。结果多元文化护理总体得分为（128．70±14．92）分,其中理论知识维度认知得分最低,为（27．36±6．43）分;大专及以上护士的总体认知水平显著高于中专组（P〈0．01）;通过大学英语3级及以上护士总体认知水平显著高于未通过组（P〈0．01）;不同医院护士的总体认知水平存在显著差异（P〈0．05或P〈0．01）。影响护士多元文化认知水平的因素有护士的学习时间（P〈0．001）、护士所在医院的级别（P〈0．001）及护士的文化程度（P〈0．01）。结论上海市特需护士多元文化护理知识的认知水平亟待提高,必须加强培训及管理。     

护士对静脉采血检验分析前质量控制知识的现状调查

目的了解护士对静脉采血项目检验分析前质量控制知识的掌握程度。方法采用自行设讣的“静脉采血检验分析前质量控制调查问卷”埘116名在岗护士进行问卷调查。结果静脉采血知识得分为（40．25±4．70）分;不同学历、职称、是否参加过静脉采血相关知识培训的护士得分比较差异无统计学意义（P〉0．05）,但不同年龄、护龄、科室的护士得分比较差异具有统计学意义（P〈0．01或P〈0．05）。结论护士缺乏足够的静脉采血相关知识,应加强临床护士静脉采血的继续教育及在校护生的静脉采血知识基础课程的教育。     

压力管理培训对精神科护士心理健康及压力应对方式的影响

目的探讨压力管理培训对精神科护士心理健康及压力应对方式的影响。方法对北京市某三级甲等精神专科医院92名护士进行压力管理培训,于培训前和培训后1周分别采用症状自评量表（SCL-90）及压力应对方式（CSQ）问卷进行评定。结果压力管理培训前SCL-90中躯体化因子得分为（1．63±0．48）分,高于国内常模（1．37±0．48）分,差异有统计学意义（t=7．58,P〈0．01）,培训后得分为（1．40±0．33）分,与常模比较差异无统计学意义（t=0．96,P〉0．05）,培训前后得分比较差异有统计学意义（t=6．96,P〈0．01）;SCL-90中其他因子在培训前得分除恐怖、偏执因子外均显著高于国内常模（P〈0．05）,培训后得分与国内常模比较差异均无统计学意义（P〉0．05）,培训后各因子得分均低于培训前,差异有统计学意义（P〈0．05）。在应对方式问卷培训前后自身对照,培训后解决问题、求助因子得分均比培训前提高（P〈0．05）,幻想、退避的因子得分均比培训前降低（P〈0．01）。结论对精神科护士进行压力管理培训可提高其心理健康水平,有助于其采取有效的压力应对方式。     

临床一线护士与医生自测健康及幸福感的比较分析

[目的]比较临床一线护士与医生的自测健康状况及幸福感。[方法]采用自测健康评定量表（SRHMS）和总体幸福感量表（GWB）对桐乡市3家医院的临床一线护士和医生作抽样调查，并做对照性分析。[结果]护士组与医生组的SRHMS总分、自测心理健康子量表得分无明显差异（P〉0．05）；自测生理健康得分护士组高于医生组（P〈0．05）；护士组在自测社会健康及相关的多个维度得分上均低于医生组（P〈0．05，P〈0．01）；GWB总分护士组明显低于医生组（P〈0．01）。[结论]临床护士自测社会健康及幸福感比医生差，需注意加强社会支持、提高其总体幸福感。     

新生儿重症监护室护士心理健康状况及影响因素分析

目的调查新生儿重症监护室（NICU）护士心理健康状况及影响因素。方法采用SCL-90症状自评量表对102名NICU护士进行心理健康水平的测评,与中国常模比较,分析其影响因素。结果SCL-90症状自评量表测评显示102名NICU护士在总分（145．13±34．35）分、总均分（1．61±0．38）分、阳性项目数（2．00±2．66）分、高于常模的（129．96±38．76）分、（1．44±0．43）分、（24．92±18．41）分（t分别为4．579,4．608,-86．940;P〈0．01）,其中躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性及睡眠饮食情况等因子得分均高于常模,差异具有统计学意义（P〈0．01或P〈0．05）,仅人际关系一项得分与常模比较差异无统计学意义（P〉0．05）;不同学历的NICU护士在精神病性的因子得分方面,差异有统计学意义（P〈0．05）;是否拥有子女在敌对的因子得分方面,差异有统计学意义（P〈0．05）。结论NICU护士心理健康状况较差,学历程度及有无子女对NICU护士心理健康状况有影响,应采取行之有效的措施,进行心理卫生干预,以促进NICU护士的心理健康。     

首诊护士负责制健康教育模式对护士健康教育能力的影响

目的探讨实施首诊护士负责制健康教育模式对护士健康教育能力的影响。方法随机选取40名产科护士实施健康教育新模式并进行系统的培训,对实施前后护士健康教育认知、理论考试成绩、模拟讲座得分及职业满意度进行比较。结果实施健康教育新模式后,护士对健康教育的认知、理论知识掌握及模拟讲座情况较前均有明显提高,差异有统计学意义（x2分别为6．806,7．440,8．658,P〈0．01）。护士对妊娠期高血压病（HDCP）健康教育技能及知识掌握程度各项知识得分均较实施前有明显提高,差异有统计学意义（t分别为-7．574,-6．746,-8．737,-7．763,-9．256;P〈0．01）。护士的职业满意度也明显提高,差异具有统计学意义（x2分别为6．765,9．600,8．352,9．028,4．266,8．571,P〈0．05）。结论实施首诊护士负责制下的健康教育路径,能有效提高护士的健康教育能力。     

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.     

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.     

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.     

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.