慢性乙型病毒性肝炎病人自我效能感和应对方式的相关性研究

[目的]探讨慢性乙型病毒性肝炎病人自我效能感和应对方式的关系。[方法]采用一般自我效能感量表及医学应对方式问卷(MCMQ)对80例慢性乙型病毒性肝炎病人进行调查,并对两者的关系行相关分析。[结果]影响慢性乙型病毒性肝炎病人自我效能感的因素包括性别、文化程度、社会资源利用度;慢性乙型病毒性肝炎病人一般自我效能感得分低于国外常模;病人回避、屈服应对方式与国内常模存在差异(P0.05),面对应对方式则无差异(P0.05);一般自我效能感与面对和回避应对方式呈正相关(P0.01),与屈服应对方式呈负相关(P0.01)。[结论]慢性乙型病毒性肝炎病人一般自我效能感水平较低,且与面对和回避应对方式呈正相关,与屈服应对方式呈负相关,应积极寻求指导方案有效提高病人的一般自我效能感,从而提高病人的应对水平。     

慢性乙型病毒性肝炎病人自我效能感和应对方式的相关性研究

[目的]探讨慢性乙型病毒性肝炎病人自我效能感和应对方式的关系。[方法]采用一般自我效能感量表及医学应对方式问卷（MCMQ）对80例慢性乙型病毒性肝炎病人进行调查,并对两者的关系行相关分析。[结果]影响慢性乙型病毒性肝炎病人自我效能感的因素包括性别、文化程度、社会资源利用度;慢性乙型病毒性肝炎病人一般自我效能感得分低于国外常模;病人回避、屈服应对方式与国内常模存在差异（P〈0.05）,面对应对方式则无差异（P＆gt;0.05）;一般自我效能感与面对和回避应对方式呈正相关（P〈0.01）,与屈服应对方式呈负相关（P〈0.01）。[结论]慢性乙型病毒性肝炎病人一般自我效能感水平较低,且与面对和回避应对方式呈正相关,与屈服应对方式呈负相关,应积极寻求指导方案有效提高病人的一般自我效能感,从而提高病人的应对水平。     

急性心肌梗死病人PCI术后应对方式现状及影响因素分析

[目的]了解急性心肌梗死病人经皮冠状动脉介入治疗(PCI)术后应对方式现状,探讨其影响因素。[方法]采用便利抽样的方法对我市3所三级甲等医院229例住院行PCI术的急性心肌梗死病人应用应对方式问卷、一般自我效能感量表、心理弹性量表进行调查。[结果]急性心肌梗死病人PCI术后面对应对方式得分为(21.48±3.99)分,回避应对方式得分(15.75±3.42)分,屈服应对方式得分(10.45±3.44)分。应对方式在不同年龄、居住情况、月收入、文化程度、居住地及医疗费用支付方式的行PCI术的急性心肌梗死病人间差异均有统计学意义(P0.05)。坚韧性为面对应对方式的积极预测因素,力量、乐观、自我效能影响回避、屈服应对方式。[结论]病人心理弹性和自我效能是其应对方式的主要影响因素。在未来临床工作中,应针对不同影响因素采取相应的有效措施,提高病人医学应对水平,缓解心理压力,促进康复。     

老年高血压病人健康行为自我效能及其影响因素

[目的]了解老年高血压病人的健康行为自我效能及其影响因素.[方法]采用一般资料调查表、健康概念量表、健康行为自我效能量表,对在我院就诊的206例老年高血压病人进行调查.[结果]老年高血压病人健康行为自我效能得分为66.24分±13.95分,46.1%的病人处于中等水平;多元线性回归显示,年龄、教育水平、家庭关系和健康概念是健康行为自我效能的影响因素.[结论]在设计和实施护理干预措施时,应重视老年高血压病人的年龄、教育水平、家庭关系和健康概念.     

腹部手术病人应对方式相关因素及与术后康复的相关性研究

[目的]探讨腹部手术病人的应对方式相关因素及与术后康复的相关性.[方法]采用医学应对问卷(MCMQ)对195例择期腹部手术病人进行调查.[结果]单因素分析显示:①男性、文化程度高、配偶健在、家庭和睦、生活在城镇者更多采用面对方式应对;单身、生活在乡村环境者更多采用回避方式应对;年龄大于50岁、单身、家庭关系差、低收入家庭者更多采用屈服方式应对;②首次排气、排便时间与面对分值呈负相关,首次下床活动时间和排便时间与屈服分值呈正相关.[结论]腹部手术病人的应对方式受个体因素影响,护理人员应指导病人采用积极有效的应对方式,最大限度地改善胃肠功能.     

永久性肠造口病人自我效能、应对方式与生活质量的相关研究

[目的]调查永久性肠造口病人的自我效能、应对方式及生活质量状况,分析变量间的相关性,探讨应对方式在自我效能与生活质量间的作用机制。[方法]采用医学应对方式问卷、造口病人自我效能量表、造口病人生活质量量表对140例肠造口门诊就诊病人进行调查。[结果]医学应对方式量表中3个维度得分分别为面对(19.20±4.22)分、回避(16.50±3.48)分、屈服(10.70±3.51)分,造口病人自我效能得分为(86.60±12.85)分,造口病人生活质量得分为(41.90±10.54)分;自我效能、应对方式、生活质量间两两相关;永久性肠造口病人自我效能可以通过影响应对方式从而影响生活质量。[结论]护理人员期望在提高永久性肠造口病人生活质量时重视应对方式的中介作用,在进行全面评估的基础上给予针对性的心理干预,帮助病人采取正确的应对方式。     

日间手术病人医学应对方式及影响因素调查

[目的]探讨日间手术病人的应对方式及其影响因素.[方法]应用医学应对方式问卷(MCMQ)和自制的调查问卷对208例日间手术病人的医学应对方式及其影响因素进行调查分析.[结果]日间手术病人的积极应对水平与消极应对水平均比常模低;女性病人在"面对"和"屈服"两个策略分值与男性病人比较差异有统计学意义(P<0.01或P<0.05);回避应对方式和年龄呈负相关;性别、年龄、手术类型、在职与否、家庭关系对病人采取各种应对方式有影响.[结论]日间手术病人应对方式的选择受多种因素影响,护理人员应重视评估日间手术病人的应对方式,根据病人特点,指导并帮助日间手术病人进行积极应对.     

自我效能感、医学应对方式对实施TACE的肝癌病人生活质量影响的路径分析

[目的]探讨实施经皮肝动脉化疗栓塞术(TACE)的肝癌病人的一般自我效能感、医学应对方式对生活质量的影响,并分析其影响路径。[方法]采用便利抽样的方法选取2016年6月—12月在成都市某三级甲等医院实施TACE的肝癌病人112例,应用一般自我效能感量表、医学应对方式问卷、癌症治疗功能评价系统共性模块进行问卷调查,通过SPSS 17.0和AMOS 22.0对生活质量的影响程度进行分析。[结果]实施TACE的肝癌病人生活质量总分为(61.20±14.10)分;病人的一般自我效能感、面对应对方式、屈服应对方式进入生活质量的多元回归方程,其一般自我效能感对生活质量有直接影响也有间接影响,面对应对方式与屈服应对方式对生活质量有直接影响。[结论]实施TACE的肝癌病人的生活质量处于中等水平,一般自我效能感、面对应对方式、屈服应对方式是影响生活质量的重要因素。     

结肠造口病人一般自我效能与应对方式研究

[目的]了解造口病人的一般自我效能及其与应对方式的相关性.[方法]采用自设一般状况调查表、一般自我效能感量表、简易应对方式问卷对64例造口病人进行问卷调查.[结果]造口病人的一般自我效能得分为2.57分±0.66分;造口病人的一般自我效能与积极应对方式、造口自理能力呈正相关.[结论]结肠造口病人的一般效能水平较低,护理人员应鼓励病人更积极地面对造口相关问题,提高病人的造口自理能力,增强其自我效能感.     

宫颈癌病人自我接纳现状及其影响因素分析

目的:调查宫颈癌病人自我接纳现状并分析其影响因素.方法:选取江西省某三级甲等医院确诊的宫颈癌病人140例作为研究对象,采用自制一般资料调查表、自我接纳问卷(SAQ)、医学应对方式问卷(MCMQ)对其进行问卷调查.采用单因素分析、Pearson相关性分析、多重线性回归分析研究宫颈癌病人自我接纳的影响因素.结果:宫颈癌病人自我接纳总分为(37.17±7.95)分,低于国内常模的(42.06±6.63)分,差异有统计学意义(P<0.05).单因素分析结果显示,不同受教育程度、家庭人均月收入的宫颈癌病人自我接纳总分比较差异有统计学意义(P<0.05).Pearson相关性分析结果显示,自我接纳总分及各维度得分均与应对方式面对维度得分呈正相关,均与回避、屈服维度得分呈负相关(P<0.05).多重线性回归分析结果显示,应对方式(面对、回避、屈服)、受教育程度、家庭人均月收入是影响宫颈癌病人自我接纳水平的相关因素(P<0.05).结论:宫颈癌病人自我接纳处于中等偏下水平,注重加强对受教育程度低、家庭人均月收入低病人的健康教育和信息支持,改善病人的应对方式对提高宫颈癌病人自我接纳水平有着重要意义.     

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.