护理实习生择业效能感的调查与分析

[目的]了解临床护理实习生择业效能感现状及其影响因素,为提高护理实习生整体的择业效能感水平提供参考和依据.[方法]应用职业决策自我效能感量表对160名护理实习生进行调查,并分析其人口学资料对择业效能感影响.[结果]临床护理实习生择业效能感平均得分3.370分,接受职业指导和成绩状况影响实习生的择业总效能及各维度效能（P＜0.05或P＜0.01）,并对其有正向预测作用.[结论]临床护理实习生择业效能感整体水平不高,进行职业指导及努力提高成绩水平,将能提高实习生的择业效能感水平.     

护理本科生专业承诺与职业决策自我效能感现状及相关性分析

[目的]了解护理本科生专业承诺和职业决策自我效能感的现状,并分析两者之间的相关性,为临床护理教学和高校护理教育管理提供依据。[方法]采用大学生专业承诺量表和职业决策自我效能量表,对在校的390名护理本科生进行调查。[结果]护理本科生的专业承诺得分为(88.45±14.13)分;职业决策自我效能感得分为(77.65±11.55)分,二者之间呈正相关。[结论]护生的专业承诺和职业决策自我效能感整体得分不高,高校护理教育工作者应高度重视并采取措施提高护理本科生的专业承诺和职业决策自我效能感水平,以帮助本科生成功就业。     

护理生产实习生应对方式与择业效能感的相关性研究

[目的]了解护理生产实习生应对方式与择业效能感的特征,并探讨二者的相关性。[方法]采用自行设计的一般情况问卷、简易应对方式问卷(SCSQ)、择业效能感量表(CDMSE)对北京市某三级甲等综合医院的200名护理生产实习生进行问卷调查。[结果]护理生产实习生的应对方式以积极应对方式为主。在积极应对倾向中,分值≥1分比1分的择业效能感高(P0.001)。护理生产实习生的择业效能感总分为3.54分±0.85分。护理生产实习生应对方式与择业效能感呈正相关(P0.01),并对择业效能感有预测作用。[结论]护理生产实习生应对方式与择业效能感具有相关性。在积极应对倾向分组中,分值1分的护理生产实习生的择业效能感同样应该受到关注。     

实习护生的专业承诺在心理健康与择业效能感间的中介效应

目的探讨实习护生专业承诺在心理健康与择业效能感间的中介效应。方法采用大学生职业决策自我效能感量表、症状自评量表、大学生专业承诺调查问卷对175名临床实习护生进行问卷调查。结果实习护生择业效能感总分为(132.63±2.44)分;其心理健康、专业承诺、择业效能感两两之间存在相关性(P<0.01);专业承诺在心理健康与择业效能感间的中介效应显著,且中介效应占总效应的45.43%。结论护理教育者通过提高实习护生的心理健康和专业承诺水平,将有利于实习护生择业效能感的提高,从而实现成功就业。     

护理专业实习生时间管理倾向调查

目的调查实习初期护理专业学生时间管理倾向情况。方法应用青少年时间管理倾向量表对福建省某医院的309名护理实习生进行调查。结果护理实习生的时间管理倾向总分为(165.44±16.78)分,总均分为(3.76±0.38)分,时间价值感得分为(4.03±0.51)分,时间效能感得分为(3.79±0.42)分,时间监控观得分为(3.63±0.43)分。98.7%的学生事件管理倾向处于较高水平。结论护理专业实习生的时间管理倾向总体处于较高水平,应根据护理实习生特点加强对其利用和运筹时间观念和能力的培养。     

护理本科生专业承诺与学业自我效能感现状及其相关性

目的调查护理本科生专业承诺与学业自我效能感的现状,并探讨两者的相关性。方法采用大学生专业承诺量表、学业自我效能感量表对258名护理本科生进行调查。结果 258名护理本科生专业承诺总分(89.05±14.92)分;学业自我效能感总分(73.78±10.38)分,护理本科生专业承诺与学业自我效能感呈正相关(P0.01)。结论护理本科生专业承诺与学业自我效能感存在较为密切的关系。护理教育者应帮助护理本科生明确学习目标,并通过多种形式来督促、鼓励护理本科生加强专业的学习,增加其对护理专业更全面的认识及对专业的兴趣,提升专业承诺水平,进而提高学业自我效能感。     

护理学硕士研究生择业效能感地区差异研究

[目的]探讨148名护理研究生择业效能感在不同地区的差异性,为高校护理研究生的就业指导提供依据.[方法]运用《择业效能感问卷》并结合深度访谈法对2006年北京、太原的148名在读女护理研究生的择业效能感进行调查.[结果]护理研究生择业效能感中自我评价得分为3.345分±0.584分,自我概念得分3.625分±0.606分,社会支持得分3.218分±0.502分,学绩得分3.750分±0.628分,职业信息收集得分3.340分±0.541分,目标设定得分3.460分±0.500分;太原护理研究生的择业效能感得分高于北京护理研究生,差异有统计学意义(P＜0.01);北京护理研究生的择业效能感随年级的增高呈先平缓后降低的变化趋势,各年级间差异有统计学意义(P＜0.01);太原护理研究生的择业效能感随年级的增高呈低-高-低的发展趋势,各年级间差异无统计学意义(P＞0.05).[结论]不同地区护理研究生的择业效能感水平不同;不同年级、不同地区护理研究生的择业效能感发展趋势不同.     

护理学硕士研究生择业效能感年级差异研究

[目的]探讨不同年级护理研究生择业效能感存在的差异,为高校护理研究生的就业指导提供依据。[方法]运用《择业效能感问卷》结合深度访谈法对2006年北京、太原148名在读女护理研究生的择业效能感进行调查。[结果]择业效能感各维度得分:学绩3.750分±0.628分,自我评价3.345分±0.584分,自我概念3.625分±0.606分,社会支持3.218分±0.502分,职业信息收集3.340分±0.541分,目标设定3.460分±0.500分;二年级护理研究生择业效能感得分高于一年级护理研究生,一年级护理研究生择业效能感得分高于三年级护理研究生,差异有统计学意义(P<0.001)。[结论]不同年级护理研究生的择业效能感水平不同;随着年级的升高,护理研究生的择业效能感呈现出低—高—低的发展趋势。     

护理实习生医院关怀氛围感知与临床沟通能力的相关研究

目的调查护理实习生医院关怀氛围感知与临床沟通能力状况,分析二者的相关性。方法采用便利抽样法抽取正在临床实习的654名护理专业学生,采用医院关怀氛围感知量表和临床沟通能力测评量表进行调查。结果护理实习生医院关怀氛围感知量表总均分为(4.07±0.75)分,其中带教教师给予自己的关怀感知维度得分最低为(3.96±0.95)分;临床沟通能力测评量表整体得分为(3.09±0.38)分,护理实习生医院关怀氛围感知与临床沟通能力呈中度正相关(r=0.526,P<0.05)。结论护理实习生的医院关怀氛围感知与临床沟通能力均属于中等偏上水平,应重视对护理实习生的医院关怀,提升护理实习生沟通能力。     

护理本科实习生临床能力与自我效能感的关系研究

目的调查护理本科实习生临床能力与一般自我效能感水平,并分析自我效能感对临床能力的影响。方法采用护理本科生临床能力评价量表和一般自我效能感量表,对295名护理本科实习生进行问卷调查;采用回归分析,探讨一般自我效能对临床能力的影响。结果护理本科生的临床能力总均分为(3.95±0.02),处于中等偏上水平;一般自我效能感总均分为(2.46±0.03)分,处于中等水平。回归分析显示,一般自我效能感对临床能力有正性影响(β=0.247,t=4.365,P<0.01)。结论护理本科实习生临床能力处于中等偏上水平,一般自我效能感处于中等水平,二者相互影响。护理教育者应采取相应的对策,提升护理本科实习生的自我效能感,培养其综合临床能力,使其更快、更好地适应临床护理工作。     

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.     

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.