神经科护士有关身体约束知识、态度和行为的调查分析

[目的]了解神经科护士对身体约束使用知识、态度和行为的情况,分析神经科护士对身体约束使用知识、态度和行为的相关性.[方法]采用夏春红等设计的身体约束知识、态度和行为问卷对北京市4所三级甲等医院的147名神经科护士进行调查.[结果]神经科护士身体约束知识答对率为71.94％,身体约束态度得分为33.60分±3.01分,身体约束行为得分为49.82分±6.53分;身体约束知识得分与态度得分呈正相关(r=0.174,P＜0.05),而身体约束行为得分与身体约束知识、态度得分之间无相关性(P＞0.05);神经科护士工作年限与身体约束知识得分呈负相关(r=-0.203,P＜0.05).[结论]神经科护士对身体约束知识的掌握有待提高,对身体约束呈中性态度,有较恰当的身体约束行为;身体约束知识得分越高,态度越正向;影响神经科护士身体约束知识、行为的因素为年龄和工龄.     

对神经科护士使用身体约束知识、态度、行为认知情况的调查

目的探讨神经科护士身体约束知识、态度、行为的相关性。方法采用个人情况调查表、神经科护士身体约束知识问卷、神经科护士身体约束态度问卷、神经科护士身体约束行为问卷,便利抽取北京市2所三级甲等医院神经科护士进行调查。结果神经科护士身体约束知识得分为（14．77±2．04）分,总答对率74％,身体约束态度得分为（51．89±4．43）分,身体约束行为得分为（64．35±9．64）分。在校期间是否接受过约束使用相关教育及是否接受过身体约束使用相关知识继续教育的两组护士在身体约束知识、态度上差异无统计学意义（P〉0.05）,在身体约束行为上的得分有差异具有统计学意义（P〈0．01）,教育程度、职称等一般资料不同的护士在身体约束知识、态度及行为上的得分均（P〉0．05）。身体约束知识得分与身体约束态度、行为的得分呈正相关（r=0.40,n27;P〈0．01）,身体约束态度得分与身体约束行为得分呈正相关（r=0.21,P〈0.05）。结论神经科护士对身体约束知识的掌握隋况整体较好。神经科护士对身体约束呈正向态度。神经科护士身体约束行为相对较好。     

ICU护士身体约束实践行为与认知现状及影响因素分析

[目的]调查重症监护室(ICU)护士身体约束实践行为与认知现状并分析其影响因素。[方法]使用自制的ICU护士身体约束实践行为与认知问卷对187名ICU护士进行调查。[结果]ICU护士身体约束实践行为条目总均分为(3.38±0.35)分,身体约束认知条目总均分为(0.63±0.12)分,整体答对率为64.55%;不同学历、工作后是否接受过相关教育或培训的ICU护士身体约束实践行为和认知得分比较差异有统计学意义(P0.05);ICU护士身体约束实践行为与认知呈正相关(r=0.440,P0.01)。[结论]医院管理部门应加快建立切实可行的身体约束使用准则和流程,重视身体约束相关知识的教育和实践行为的培训。     

ICU护士身体约束知识、态度、行为的调查分析

目的 描述监护病房护理人员身体约束知识、态度、行为情况及其相关性.方法 采用便利取样的方法,抽取北京市3所三级甲等医院监护病房的110名护士为研究对象.研究工具包括自行设计的一般资料问卷、身体约束知识问卷、身体约束态度问卷、身体约束行为问卷.结果 监护病房护理人员身体约束知识得分属于中等水平(11.09±2.21),身体约束适用性知识答对率最低(36.4%),身体约束护理知识答对率最高(90.2%).护理人员对身体约束的使用呈中性态度,而身体约束行为得分则较高(47.92±6.37).在ICU工作的年限与身体约束知识得分呈负相关(r=-0.21,P<0.05),而是否参加过身体约束使用相关继续教育的两组护士之间在身体约束知识、态度、行为得分上有显著性差异(P均<0.05).身体约束态度得分与身体约束知识、行为的得分呈正相关(r=0.30、0.27,P<0.01),身体约束知识得分与身体约束行为得分之间无相关性.结论 监护病房护理人员身体约束知识不足,对身体约束呈中性态度,有较为恰当的身体约束行为.     

神经科护士有关身体约束知识、态度和行为的调查分析

[目的]了解神经科护士对身体约束使用知识、态度和行为的情况,分析神经科护士对身体约束使用知识、态度和行为的相关性。[方法]采用夏春红等设计的身体约束知识、态度和行为问卷对北京市4所三级甲等医院的147名神经科护士进行调查。[结果]神经科护士身体约束知识答对率为71．94％,身体约束态度得分为33．60分±3．01分,身体约束行为得分为49．82分±6．53分;身体约束知识得分与态度得分呈正相关（r=0．174,P〈0．05）,而身体约束行为得分与身体约束知识、态度得分之间无相关性（P〉o．05）;神经科护士工作年限与身体约束知识得分呈负相关（r=-0．203,P〈o．05）。[结论]神经科护士对身体约束知识的掌握有待提高,对身体约束呈中性态度,有较恰当的身体约束行为;身体约束知识得分越高,态度越正向;影响神经科护士身体约束知识、行为的因素为年龄和工龄。     

护士对危重患者使用身体约束伦理认知与行为状况的调查

目的 了解护士对使用身体约束伦理的认知与行为状况.方法 采用自行设计的问卷,对147名护士进行危重患者使用身体约束的伦理认知和行为状况调查.结果 护士对危重患者身体约束的伦理行为得分为(28.04±3.85)分,态度得分为(33.41±4.51)分;不同科室护士对执行身体约束的评估行为得分差异具有统计学意义(P＜0.0...     

精神科护士感知自身遭受攻击状况与对患者身体约束态度的相关性研究

目的:调查精神科护士感知自身遭受攻击状况、对患者身体约束态度及其相关性。方法:采用攻击行为发生情况感知量表、对患者身体约束态度问卷对深圳市康宁医院封闭病区110名护士进行调查。结果:护士感知攻击行为发生频率为(33.70±7.51),语言攻击及轻微身体攻击等发生频率高;对患者身体约束态度得分为(38.14±4.60),其中身体约束法律和伦理、对患者身体约束感受和身体约束行为倾向得分分别为(11.75±2.20)、(13.59±2.10)、(13.90±3.02);对患者身体约束感受、身体约束行为倾向和对患者身体约束态度总分与自身感知到的攻击行为呈正相关(r=0.24、0.31、0.20,P=0.036、0.014、0.047)。结论:精神科护士经常遭受轻微攻击,对身体约束的使用呈中性态度,自身感知到的攻击与对患者身体约束态度呈正相关,提示应关注护士的身心健康并对护士进行相应培训,改变护士约束态度,协助护士及早识别攻击行为,及时采取替代性措施,以降低身体约束的使用率。     

重症监护室护士对身体约束相关知识、态度和行为的调查分析

目的了解重症监护室护士对患者身体约束相关知识、态度、行为的状况。方法对北京市某三级甲等医院4个重症监护室的121名护士进行患者身体约束相关知识、态度、行为的调查。结果重症监护室护士身体约束知识得分为(12.69±1.84)分,答对率为79.29%,态度得分为(33.46±3.05)分,行为得分为(49.33±6.46)分。不同性别、科室及监护室工作年限的护士在身体约束知识、态度、行为得分差异具有统计学意义(P0.01或P0.05)。结论重症监护室护士身体约束知识整体呈中等偏上水平,但身体约束适应知识存在不足;对身体约束呈中性态度,且有较恰当的身体约束行为。     

某三级甲等医院护士感知医院伦理氛围与其身体约束知识、态度和行为的相关性研究

目的了解护士对医院伦理氛围感知和身体约束知识、态度和行为的现状,探讨医院伦理氛围和护士身体约束知识、态度和行为的相关性。方法采用方便抽样法于2019年4—5月选取山西省某三级甲等医院临床注册护士400名为研究对象,采用一般资料调查表,医院伦理氛围量表(HECS),身体约束知识、态度、行为问卷进行调查,并分析医院伦理氛围对护士身体约束认知的影响。共发放问卷400份,有效回收387份,有效回收率96.75%。结果387名护士HECS总得分为(89.72±32.78)分,护士身体约束知识得分为(10.86±2.37)分,身体约束态度得分为(30.48±2.94)分,身体约束行为得分为(41.82±7.24)分;不同学历、职称、培训经历的护士身体约束的知识、态度、行为得分差异均有统计学意义(P<0.05);相关性分析结果显示,护士HECS各维度得分及总得分与身体约束知识、态度、行为得分均呈正相关(P<0.05);分层回归分析结果显示,HECS中与医师的关系、与患者的关系、与管理者的关系是护士身体约束知识和态度的影响因素,HECS中与医师的关系、与管理者的关系是护士身体约束行为的影响因素(P<0.05)。结论医院伦理氛围与护士身体约束知识、态度、行为密切相关,营造良好的医院伦理氛围有助于提高护士对身体约束的认知水平,从而规范护士的身体约束行为。     

儿童重症监护室护士身体约束知识-态度-行为调查分析

目的了解儿童重症监护室护士对于患儿身体约束知识、态度和行为现况,探索其相关性及影响因素。方法 2015年8-10月选取我院儿童危重症监护病房(PICU)、心脏监护病房(CCU)、新生儿重症监护病房(NICU)护士,采用ICU儿童身体约束知-信-行量表进行问卷调查并对结果进行分析。结果重症监护室护理人员在儿童身体约束知识得分为(8.32±1.604)分,属较好水平;护理人员对于身体约束的使用呈中性态度,得分为(30.2±5.18)分;身体约束的行为得分较高,得分为(37.05±3.753)分。不同性别、年龄、学历、职称的护士在身体约束知识、态度、行为问卷的得分差异无统计学意义(P0.05);是否接受过培训、护龄及ICU工作年限均对知识、态度、行为问卷得分有所影响,差异有统计学意义(P0.05)。身体约束知识得分与态度得分呈负相关(r=-0.246,P0.05),与行为得分呈正相关(r=0.236,P0.05);身体约束态度与身体约束行为之间无相关关系(r=0.016,P0.05)。结论重症监护室护理人员身体约束知识水平处于中等偏上水平,对身体约束呈中性态度,身体约束行为较为得当。     

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.