不同职级临床护理人员从事相关护理项目压力情况的调查

目的调查不同年资、学历、职称临床护理人员执行相关护理项目的压力情况。方法采用文献检索和专家会议法，自行设计临床护理人员护理项目压力情况调查表，便利选取3所三级甲等综合性医院450名临床护理人员进行问卷调查。结果调查表的内部一致性Cronbach’s α系数为0．783，因子分析累计贡献率为60．91％；调查对象的学历以大专为主（占57％）、年资以≤5年为主（占63％）、职称以初级为主（占77％）；护士对重大抢救的主观感受压力最大（占20．1％）、压力经常的护理项目为独立当班（占28．1％）、压力一般的为留置胃管（占34．0％）、压力偶尔的为健康教育（占13．7％）、从无压力的为更换液体（占35．8％）；独立当班、留置胃管、重大抢救护理项目的压力在不同职称、年资和学历护士中均有统计学意义（P〈0．01），健康教育在不同年资护士中有统计学意义（P〈0．01），护理会诊在不同职称护士中有统计学意义（P〈0．01）。结论护理管理者应强化5年以内护士临床操作技术的专业化培训，并科学界定不同职级护理人员的护理项目权限，为合理构建临床护理人员能级体系提供科学方法。     

病人入院护理服务现状调查

[目的]了解医院护理人员对病人入院护理服务的现状，分析其存在的问题，以提高病人入院护理服务质量。[方法]采用自行设计的问卷，对3所三级甲等医院和4所二级甲等医院从事临床护理工作的448名护士进行问卷调查。[结果]61．2％护理人员重视入院护理工作，31．0％护士把入院护理服务看成常规的工作内容来完成，7．8％的人不重视，不同护龄的护理人员对其重要性的认识差异有统计学意义（P〈0．01）；就目前的入院护理服务内容和方式，52．6％的护士认为不完善；护士常做入院护理评估的占62．6％；81．8％护士所在科室有自行设计的入院护理评估表，但很少应用；了解和收集心理状况资料的占57．9％。[结论]目前临床入院护理服务工作还处于相对滞后的状态，护理管理者应加强入院护理服务质量控制，入院护理服务的内容、形式应满足病人需要。     

护理人员负性情绪及其相关因素分析

目的：研究市区综合医院和精神病院临床护理人员的负性情绪，探讨对护理工作的热爱与否、护龄长短．是否轮夜班及婚姻状况等方面对情绪的影响。方法：随机抽取三级甲等综合性医院和精神病院从事临床护理工作的护理人员162人．采用焦虑自评量表、抑郁自评量表及一般情况调查表进行评估。结果：护理人员存在不同程度的焦虑、抑郁。其中不热爱本职工作者焦虑、抑郁的发生率高于热爱本职工作者；上夜班护士焦虑、抑郁的发生率高于白班护士；护龄长短对抑郁的发生没有直接影响，但对焦虑有影响；随着护龄的逐渐增长。焦虑发生率反而有所下降。结论：护理人员的负性情绪与轮班制、护龄长短及对现职工作的喜欢与否等有相关性。     

手术室护理人员配置对护士工作满意度影响的相关性分析

目的：探讨手术室护理人员配置对护士工作满意度影响的相关性。方法对1200名手术室护理人员进行问卷调查，调查内容包括护士的一般情况与护理满意度四个指标情况。结果护士对工作负荷不满意占65．0％；感到工作压力不满意占70．0％，主要原因是工作量大、负荷重；对工作不满意度占50．0％，对收入不满意度占66．7％。年龄、配置情况、职称和学历是影响工作满意度的主要因素（P＜0．05），其中人员配置情况是最主要的影响因素（P＜0．01）。结论当前我国护士存在普遍的对工作不满意的情况，护士的合理配置是保证护士满意度提升的基础。     

在职护理人员接受继续教育的思考

对某医院在职护理人员接受继续教育的情况进行统计。结果表明：７０年代中等护士学校毕业护士２１名，接受继续教育者１名，占４．７６％；８０年代至９０年代中等护士学校毕业护士１９０名，接受继续教育者４３名，占２２．６０％。说明在职护理人员接受继续教育人数较少，不能适应护理学科的发展，故各级卫生行政部门应尽快建立健全在职护理人员接受继续教育的相应制度，以强化各类护理人员自觉接受继续教育的意识。     

某三级甲等医院护理人力资源配置现状的分析

目的对某三级甲等医院护理人员配置情况进行分析，了解护理人员配置中存在的问题，为医院合理配置护理人力资源提供依据。方法根据医院护理人员存档资料，对全院1097名护理人员从年龄、职称、学历、用工性质等方面进行全面分析。结果该院护理人员队伍整体结构以低年龄、初级职称为主，分别占54．2％和49．5％；护理人员学历以大专为主，占54．1％；临床科室以聘用制护士为主，占41．1％，正式编制护士为33．5％。结论该院护理队伍在人员的年龄、学历、职称以及用工性质等方面的配置有待进一步改善。     

基层医院绩效工资改革在护理人员中的作用

目的探讨基层医院护士绩效工资分配改革在护理人员中的作用。方法自2003年以来，全院护理人员试行绩效工资分配改革，即实行二级分配制：全院护士绩效工资首先由总护士长按护士人均教统一发放到各科室，再由科室护士长根据护士工作量量化的分值、护理质量考核分值、护士职称系数按比例综合核算出每个护士的绩效工资。结果4年来护士考试综合成绩逐年上升（p〈0．05）；病陪人对护士工作满意度逐年升高（p〈0．05）；护理工作质量考核综合得分逐年升高（p〈0．05）；差错发生率由15％下降至3．25％、结论绩效工资的分配改革激发了护理人员的工作和学习热情，提高了护理质量及病陪人的满意度，减少了差错事故的发生.     

护理轻度缺陷原因分析及预防对策

目的分析发生护理轻度缺陷的原因，提出防范措施，尽可能杜绝中、重度缺陷发生。方法2007年1～12月本院外科系统132起护理轻度缺陷，对缺陷的内容、原因、缺陷责任人的情况、科室等方面进行分析。结果132例次护理轻度缺陷中人员因素90例次，占68．2％；护龄5年以下的护士14例次，占43．2％；发生护理轻度缺陷最多的科室，患者多，工作量大，普外、妇产科分别占14．4％、14．4％，泌外、眼科占15．9％、12．1％。结论重视护理轻度缺陷管理，加强护理人员职业素质教育，才能有效降低中、重度护理缺陷发生率。     

手指再造病人焦虑抑郁情绪调查分析

[目的]了解手指再造病人焦虑抑郁发生情况，为寻找有效的护理干预措施提供依据。[方法1采用自行设计的一般情况调查表和国际通用的医院焦虑抑郁量表对108倒拟行手指再造的病人进行调查。[结果]108例病人中有焦虑症状者69倒，占63.89％，抑郁症状者55例，占50．93％；焦虑抑郁的发生与病人有无固定职业、文化程度和医疗付费方式有直接关系（P〈0．05）；女性病人抑郁情绪发生率明显高于男性（P〈0．05）；有焦虑抑郁症状的病人血管危象发生率明显高于正常人群（P〈0．05）；出院时与手术前比较抑郁情绪阳性率明显高于焦虑情绪阳性率（P〈0．001）。[结论]手指再造病人焦虑抑郁发生率高；焦虑抑郁情绪可增加再造手指血管危象的发生率；抑郁情绪较焦虑情绪更不宜消除；同时应加强对手指再造病人中无固定职业者、文化程度较低者、自费病人和女性病人的护理干预。     

护理差错的分析与启迪

对医院5年来的护理差错进行了调查分析，结果显示：不同班次、不同护龄的护士护理差错发生率有显性差异，不同来源的护士之间也存在差异。针对上述存在问题，提出以下对策：加强护理法规教育，强化护理人员职业道德；转变观念，合理安排护理班次；改善培训模式，重视各类护士的培养管理；改革人员分配制度，建立深层监控系统，通过建立有效的工作系统，保证护士有更多的时间、精力完成高质量的护理工作，确保工作质量。     

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.     

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.