社区医务人员糖尿病干预的知识行为及态度调查

目的了解长沙市社区医务人员关于糖尿病干预的知识（K）、态度（A）、行为（P）的基本情况,为相关部门采取措施更新、提高社区医务人员的知识、技术水平提供参考。方法利用自制的一般资料调查表和KAP调查问卷对长沙市21个社区卫生服务中心的234名社区医务人员进行调查。结果社区医务人员糖尿病干预知识得分26．34±4．78,态度得分18．09±4．74,行为水平得分8．33±3．46。糖尿病干预态度与知识及糖尿病干预行为与知识之间具有正向相关关系（r=0．232、0．162,P〈0．01、P〈0．05）。结论社区医务人员关于糖尿病干预的知识水平较低,态度得分较高,行为水平不能达到理想水平。应通过提高社区医务人员的态度和知识来提高其行为水平。     

糖尿病患者主要照顾者知识、态度和行为调查

目的 了解糖尿病患者主要照顾者的知识(K)、态度(A)和行为(P)现状,分析其影响因素,为有效提高照顾者的照顾水平提供依据.方法 采用自行设计的一般情况调查表和KAP问卷对长沙市3所医院和6个社区的300名糖尿病患者的主要照顾者进行调查.结果 照顾者的KAP总分为（67.92士11.17）,其中知识、态度、行为得分率依...     

社区医护人员预立医疗照护计划知信行的调查

目的了解社区医护人员对预立医疗照护计划的知识态度行为状况,为在社区推广和实施预立医疗照护计划提供依据。方法采用自制的社区医护人员预立医疗照护计划知信行问卷对北京市6所社区医院的114名社区医护人员进行调查。结果社区医护人员预立医疗照护计划的知识问卷回答正确率为53. 87%;态度得分为(4. 06±0. 83)分,处于中等偏上水平,不同职务、工作年限医护人员的态度得分比较,差异有统计学意义(P 0. 05,P 0. 01);行为得分为(3. 35±0. 95)分,处于中等水平,不同学历、职业类型、职务、职称、是否听说过预立医疗照护计划的医护人员其行为得分比较,差异有统计学意义(P 0. 05,P 0. 01)。结论社区医护人员对预立医疗照护计划的态度较积极,但认知和行为水平偏低。应着重加强社区医护人员相关知识全面系统的培训,综合考虑法律、伦理道德等多方面的问题,为预立医疗照护计划在社区的普及和推广做好准备。     

糖尿病患者规范注射知信行状况与生活质量的相关性研究

目的了解接受胰岛素治疗的糖尿病患者对规范注射行为的认知、态度和行为状况及生活质量,为针对性干预提供参考。方法采用自行设计的胰岛素规范注射知信行问卷、中文版"接受胰岛素治疗的患者生活质量量表(ITR-QOL-CV)"对142例接受胰岛素治疗的糖尿病患者进行问卷调查。结果胰岛素规范注射知信行问卷中知识维度得分4.33±1.77,态度维度得分34.72±5.78,行为维度得分14.07±1.65;ITR-QOL-CV得分93.59±18.05。影响患者生活质量的因素是对规范注射的态度、行为、糖化血红蛋白和低血糖知识水平(P0.05,P0.01)。结论糖尿病患者规范注射的知信行水平不高,生活质量呈中等水平,应结合患者的知信行状况及血糖水平实施针对性干预,以提高患者的自护水平及生活质量。     

社区护士自杀相关态度及教育干预研究

目的了解社区护士的自杀态度、自杀预防态度,开展自杀预防教育干预,为自杀预防教育干预实施提供实证依据。方法便利取样法抽取济南市33家社区卫生服务中心的78名社区护士进行横断面调查,并选择其中的36名参加自杀预防教育干预研究。结果社区护士自杀态度得分2.88±0.31、对自杀者态度得分2.53±0.42、对自杀家属态度得分2.60±0.43,均处于中立水平,对自杀行为持排斥、歧视态度,得分3.54±0.51。社区护士自杀预防态度得分38.24±6.00,存在对自杀预防的误解。自杀预防教育干预后,社区护士对自杀态度、自杀行为态度、自杀家属态度、自杀预防态度均有改善且有统计学意义(P0.05,P0.01),但对自杀者态度改变差异无统计学意义(P0.05)。结论社区护士存在对自杀预防的误解和对自杀者的歧视,教育干预能提高社区护士积极的自杀预防态度和对自杀、自杀行为及自杀者家属的正确态度。     

农民工艾滋病知识、态度、行为及其相关性研究

目的了解农民工艾滋病知识、态度及行为现状,并分析其关系,为实施针对性干预提供参考。方法随机整群抽取西安市9大建筑工地936名农民工进行艾滋病知识、态度、行为调查。结果936名农民工有85.0%听说过艾滋病,知识来源排前三的为电影电视(35.6%)、报纸杂志(27.4%)及广播(16.9%);80.0%愿意接受艾滋病教育;艾滋病知识得分26.8±5.7,态度得分55.3±11.2;2.7%～6.0%有卖血、吸毒等与艾滋病相关的高危行为。农民工艾滋病知识与态度呈显著正相关(P0.01),艾滋病知识、态度与行为之间无明显相关性(均P0.05)。结论农民工艾滋病相关知识缺乏,大部分对艾滋病持害怕、歧视态度;存在一定比率的高危行为,有接受健康教育的意愿。针对性的强化和普及教育,可望提高农民工的艾滋病知识,从而改变错误态度和高危行为。     

护理人员个人发展计划知信行现状及影响因素分析

目的 调查护理人员个人发展计划知信行现状及影响因素,为开展个人发展计划培训和人力资源管理提供参考.方法 采用自制护理人员一般资料问卷和个人发展计划知信行问卷对3298名护理人员进行调查.结果 护理人员个人发展计划知信行总分为(100.01±15.50)分,知识维度得分(17.82±6.07)分,态度维度得分(52.13±7.06)分,行为维度得分(30.06±7.13)分.多元线性回归分析显示,学历、职称、婚姻状况、岗位及对个人发展计划了解程度是护理人员个人发展计划知信行的影响因素(P＜0.05,P＜0.01).结论 护理人员的个人发展计划知信行水平处于中等水平,受护理人员个人特征的影响.医院管理者可通过开展相关培训以提高护理人员个人发展计划知信行水平.     

胰岛素使用访谈工具在社区糖尿病患者同伴教育中的应用

目的探讨胰岛素使用访谈工具在社区糖尿病患者同伴教育者中的应用效果。方法采用方便抽样法选取两个社区的糖尿病患者,将其分为同伴访谈组(35例)和对照组(36例),对照组接受常规胰岛素使用相关知识的健康教育,同伴访谈组在此基础上由经过培训的一名同伴教育者运用胰岛素使用访谈工具对患者进行访谈,干预前和干预5个月末比较两组患者对胰岛素看法及胰岛素使用相关知识、行为得分的差异。结果干预后两组患者对胰岛素使用态度得分及胰岛素使用相关行为得分比较,差异有统计学意义(P0.05,P0.01))。结论同伴教育者运用胰岛素使用访谈工具可有效改善社区糖尿病患者对胰岛素看法、胰岛素使用相关行为,促进患者规范地使用胰岛素,从而有利于控制血糖。     

孝感市社区居民脑卒中防治知信行现况调查分析

目的了解孝感市社区居民脑卒中防治知信行现状及相关影响因素,明确需要干预人群特点及干预重点,为开展社区脑卒中健康教育与健康促进干预提供依据。方法采取整群随机抽样方法,对孝感市6个乡镇社区居民1 420人进行脑卒中防治知信行现状调查。结果社区居民脑卒中防治相关知识总均分为28.43±6.79,总知晓率为39.47%,得分率由高到低依次为基础知识(42.26%)、诱发因素(39.36%)、危险因素识别(37.08%)、发病后急救处置知识(25.50%);脑卒中防治信念总均分为39.49±6.34,总得分率为62.68%,其中得分较低的为对脑卒中发病相关危险因素预防重要性的认识;防治行为总均分为37.46±6.47,总得分率为48.03%,其中相关疾病预防监测与治疗行为得分率不足50%。社区居民脑卒中防治知识、态度、行为互为影响(均P0.01)。结论社区居民脑卒中防治知识普遍缺乏,防治态度总体趋向积极,防治健康行为依从性较低。应针对居民知信行特点加大社区脑卒中健康教育和健康促进工作力度。     

护理人员对住院患者自杀预防知信行的调查研究

目的 对护理人员住院患者自杀预防的知识、态度、行为水平进行现况调查,为开展护理人员 自杀预防学习提供参考.方法 采用自制护理人员对住院患者自杀预防知信行调查问卷,对445名护理人员进行调查.结果 护理人员对住院患者自杀预防的知识、态度、行为得分分别为(42.56±6.96)分、(30.02±4.31)分、(52.45±8.02)分,总分为(125.00±15.15)分.是否使用过心理评估量表、是否使用过自杀风险评估工具、是否参与患者自杀预防培训是护理人员 自杀预防知信行的主要影响因素(均P＜0.01).结论 护理人员对住院患者自杀预防知识态度行为总体呈中等偏上水平,管理者应当重视并针对护士开展自杀预防的培训学习.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.