急诊科护士工作压力水平及相关因素分析

目的 探讨急诊科护士工作压力水平及其相关因素.方法 采用<护士工作压力源量表>对急诊科的97名护士进行调查.结果 担心工作中出现差错事故;经常倒班;工资及其他的福利待遇低;继续深造的机会太少;护士的工作未被患者及家属承认;护理工作的社会地位太低;患者不合作;护理的患者突然死亡;护士不被患者及家属尊重等压力为急诊科护士主要工作压力源.其中不同岗位、年龄、性别、护龄、学历的急诊科护士工作压力源差异存在统计学意义(P＜0.05,P＜0.01).结论 护理专业及护理工作方面的问题,患者护理方面的问题为急诊科护士的主要工作压力源.其中从事临床岗位的一线的护士、男护士、大专以上学历护士、5～10年护龄的护士工作压力程度较重.护理管理者要根据不同性别、不同岗位、不同学历、不同护龄的护士采取有针对性的减压措施.     

急诊科护士工作压力水平及相关因素分析

目的探讨急诊科护士工作压力水平及其相关因素。方法采用《护士工作压力源量表》对急诊科的97名护士进行调查。结果担心工作中出现差错事故；经常倒班；工资及其他的福利待遇低；继续深造的机会太少；护士的工作未被患者及家属承认；护理工作的社会地位太低；患者不合作；护理的患者突然死亡；护士不被患者及家属尊重等压力为急诊科护士主要工作压力源。其中不同岗位、年龄、性别、护龄、学历的急诊科护士工作压力源差异存在统计学意义（P〈0．05，P〈0．01）。结论护理专业及护理工作方面的问题，患者护理方面的问题为急诊科护士的主要工作压力源。其中从事临床岗位的一线的护士、男护士、大专以上学历护士、5～10年护龄的护士工作压力程度较重。护理管理者要根据不同性别、不同岗位、不同学历、不同护龄的护士采取有针对性的减压措施。     

骨科护士工作压力源及相关因素分析

目的探讨骨科护士工作压力水平及其相关因素。方法采用无记名填涂工作压力源量表的调查方式对本院普通病房27名骨科护士进行调查。结果显示担心工作中出现差错事故、经常倒班、护士工作未被病人及家属认可、护理工作的社会地位太低、病人不合作、护理的病人突然死亡等压力为骨科护士的主要工作压力源；其中不同学历、护龄、岗位的骨科护士工作压力各不相同。结论护理专业及工作方面的问题、病人护理方面问题为骨科护士的主要压力源，其中从事临床护理、大专以上学历、5～10年护龄的护士工作压力程度较重，护理管理者要根据不同岗位、不同学历、不同护龄的护士采取有针对性的减压措施。     

急诊科护士压力源的分析与对策

目的 探讨急诊科护士工作压力水平及其相关因素与减轻压力的对策.方法 采用整体问卷方式,对南阳市4所二级甲等综合医院急诊科的78名在职护士进行调查.结果 护理专业及工作方面的问题、病人护理方面的问题为急诊科护士的主要压力源.其中不同岗位、不同护龄、不同学历的急诊科护士压力源存在统计学差异(P<0.05或P<0.01).结论 急诊科护士压力较高,压力源受多种因素影响,护理管理者要根据不同岗位、不同学历、不同护龄采取有针对性的减压措施.     

56名儿科护士工作压力源的调查分析

目的:了解儿科护士工作主要压力源及不同护龄、职称及学历儿科护士的工作压力源的差别。方法:采用问卷调查法,对天津市两所三级甲等医院56名儿科护士的社会人口学资料和工作压力源进行调查。结果:儿科护士工作压力源由高到低依次为:工作量及时间分配问题,工作环境及资源方面问题,病人护理方面问题,护理专业及工作方面问题,管理及人际关系方面问题。不同护龄、职称及学历的儿科护士压力源差别无统计学意义。结论:建议护理管理者采取综合干预模型减少儿科护士工作压力源,为儿科护士提供减轻工作压力的方法,以提高儿科护士工作的效率及质量。     

深圳市护士压力水平及相关因素分析

目的 探讨深圳市护士工作压力水平及相关因素,以采取针对性的心理干预,设法减少工作压力,提高护士的工作效率及护理质量.方法 采用问卷调查法,参照工作压力源量表对深圳特区250名护士进行调查,并对结果进行分析.结果 担心工作中出差错,经常倒班,工资及其他福利低,护理工作的性质及社会地位,深造及进修机会太少,患者、家属及社会认同度低是特区护士的主要工作压力源.不同岗位、护龄、学历护士的工作压力源亦不相同.结论 特区护士心理压力大,建议从管理角度减少或消除护士工作压力源,并对护士进行减轻工作压力训练,针对具体情况进行减压.     

军队医院精神科护士工作压力源分析及应对措施

目的 了解军队医院精神科护士的工作压力状况及影响因素,并制定有针对性的干预措施.方法 对某军队医院56名精神科护士采用护士工作压力源量表和自制一般情况调查表进行测评分析.结果 本组精神科护士在护士工作压力源量表的病人护理方面得分最高,其次是工作环境及资源方面问题,工作量及时间分配问题和护理专业及工作方面的问题得分相对较低.精神科护士的压力与护龄、职务、学历、健康状况、兴趣爱好、家庭经济状况和心理卫生知识知晓状况呈显著相关性（P＜0.05或0.01）.结论 精神科护士存在较大的工作压力,其影响因素较多,应从多方面予以有针对性的干预,以缓解或消除工作压力.     

精神科护士人口学资料与工作压力源和心身耗竭相关性研究

目的探讨精神科护士人口学资料与工作压力源和心身耗竭的相关性,为维护精神科护士的身心健康,提高工作质量提供依据。方法采用中国护士压力源量表和心身耗竭量表对89名精神科护士的压力状况及心身耗竭程度进行测评分析。结果压力源量表排前10位的压力源主要为护理专业方面和患者护理方面的问题;心身耗竭量表测评,精神科护士与Maslach参考值比较情绪的疲倦感有显著性差异（P〈0．01）;年龄、护龄与情绪疲倦感呈显著正相关（R=0．283、0．305,P＜0．01）,文化程度与压力源呈显著正相关（P＜0．05或0．01）,护龄与压力源呈显著负相关（P〈0．05）;不同文化程度和护龄对压力的反应有显著性差异（P〈0．05或0．01）,性别、职称与工作压力源与心身耗竭无关。结论精神科护士心身耗竭和工作压力源与年龄、护龄、文化程度相关,与性别、职称无关,不同文化程度和护龄对压力的反应有显著性差异。医院管理者及护士自身应引起足够的重视。     

护士压力水平及相关因素分析

目的探讨县级医院病房护士工作压力水平及相关因素,为减轻护士的压力提供科学依据。方法采用问卷调查法,参照工作压力源量表,对县级医院350名护士的工作压力源进行调查,并对结果进行分析。结果护士人力配备不足、担心工作中发生差错事故,勤倒夜班,工资及其他福利低,护理工作的性质及社会地位,学习及进修机会太少,患者、家属及社会认同度低是县级医院护士的主要工作压力源。不同岗位、护龄、学历护士的工作压力源亦不相同。结论县级医院护士的心理压力大,建议从管理角度设法减轻护士工作压力源,合理配置护士人力,加强护理表格化记录,加强对护士的人性化管理和关怀。     

精神科护士离职原因调查及其相关因素分析

目的:了解精神科护士不稳定的原因,提高病房护士素质和护理质量.方法:采用问卷调查法,对本院97名精神科病房护士进行问卷调查.结果:护士离职意愿与护士的护龄、性别、学历有显著相关性,离职原因依次为护理专业及工作方面、患者护理方面、工作量及时间分配方面、工作环境方面、护理管理及人际关系方面、社会和医院管理方面的问题.结论:尊重精神科护士,改善护士的工作环境,提高病房护士待遇,加强护患沟通,增加发展机会,争取社会和医院的支持,加强自身素养,来稳定病房护理队伍.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.