医学隔离社区卫生服务人员的心理护理

目的调查武汉市社区抗击新型冠状病毒肺炎疫情过程中我社区卫生服务人员的创伤后心理危机现状。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对56名医学隔离社区卫生服务人员的心理健康状况进行问卷调查。结果56名医学隔离社区卫生服务人员心理护理干预前后的SAS评分和SDS评分比较差异有统计学意义(P<0.05)。结论新型冠状病毒肺炎疫情期间,对隔离社区卫生服务人员加强心理护理,可有效缓解其心理紧张和焦虑情绪,有效改善其心理状态。     

心理疏导应用于新型冠状病毒肺炎隔离病区护士情绪管理的效果研究

目的观察心理疏导应用于新型冠状病毒肺炎隔离病区护士情绪管理的效果。方法选取新型冠状病毒肺炎隔离病区工作的205名护士作为研究对象,对其进行1周的心理疏导,比较干预前后护士焦虑和抑郁情绪。结果干预前护士焦虑自评量表评分为(63.68±8.76)分,抑郁自评量表评分为(60.79±7.11)分,干预1周后护士焦虑自评量表评分为(41.65±7.78)分、抑郁自评量表评分为(42.12±5.77)分,干预前后比较,差异有统计学意义(P<0.05)。结论心理疏导可改善新型冠状病毒肺炎隔离病区护士的焦虑抑郁情绪。     

妊娠剧吐患者心理因素分析及心理护理

目的 探讨妊娠剧吐患者的心理因素及心理护理疗效.方法 61例妊娠剧吐患者,分为观察组34例,对照组33例.入院时分别采用焦虑自评量表(SAS)、抑郁自评量表(SDS)进行评分,所有患者常规药物治疗,同时观察组予心理护理.10 d后两组患者再次进行SAS及SDS评分.结果 入院时SAS评分发现所有患者均存在焦虑症状,SDS评分发现观察组34例患者中28例存在抑郁症状,对照组33例患者中29例存在抑郁症状.经心理护理后观察组患者焦虑及抑郁症状的缓解率分别为82.35%和82.14%,显著高于对照组60.61%和55.17%,同时观察组护理后SAS及SDS评分分别为(42.82±4.73)分和(42.11±5.65)分,显著低于对照组的(48.25±4.61)分和(48.52±5.00)分.结论 妊娠剧吐患者普遍存在焦虑和抑郁症状,心理护理对于改善症状有积极的作用.     

妊娠剧吐患者心理因素分析及心理护理

目的 探讨妊娠剧吐患者的心理因素及心理护理疗效.方法 61例妊娠剧吐患者,分为观察组34例,对照组33例.入院时分别采用焦虑自评量表(SAS)、抑郁自评量表(SDS)进行评分,所有患者常规药物治疗,同时观察组予心理护理.10 d后两组患者再次进行SAS及SDS评分.结果 入院时SAS评分发现所有患者均存在焦虑症状,SDS评分发现观察组34例患者中28例存在抑郁症状,对照组33例患者中29例存在抑郁症状.经心理护理后观察组患者焦虑及抑郁症状的缓解率分别为82.35%和82.14%,显著高于对照组60.61%和55.17%,同时观察组护理后SAS及SDS评分分别为(42.82±4.73)分和(42.11±5.65)分,显著低于对照组的(48.25±4.61)分和(48.52±5.00)分.结论 妊娠剧吐患者普遍存在焦虑和抑郁症状,心理护理对于改善症状有积极的作用.     

新型冠状病毒肺炎普通病房病区及护理人员管理模式探讨——基于首批浙江援鄂医疗队经验总结

总结新型冠状病毒肺炎普通病房病区及护理人员管理模式。病区管理包括严格区域划分,落实消毒隔离工作。护理人员管理包括成立护理管理组,实行三级管理模式,明确各级工作职责,完善人力资源调配,强化专业理论与技能培训。共收治新型冠状病毒肺炎患者293例,其中确诊267例、疑似26例,最终死亡11例,共治愈252例,治愈率为86.01%,30例患者转至其他医疗机构救治,期间医护人员零感染。     

新型冠状病毒肺炎隔离病区护理人员程序化管理实践

目的探索新型冠状病毒肺炎隔离病区护理人员程序化管理的实施效果。方法按照新型冠状病毒肺炎病区护理人员及工作的不同阶段,制定了人力资源调配-多维度防控知识培训-防控管理制度落实-心理疏导-轮休调适的管理实施办法。结果新型冠状病毒肺炎隔离病区内的救护工作顺利有序开展,有助于护理人员快速熟悉工作流程,提升护理人员的自我防护意识,阶段性工作内未发生院内感染。结论实施护理人员程序化管理实现院内医护人员、患者及家属零感染,达到疫情防控下人力资源高效管理,提高工作效率和质量。     

肺癌患者癌因性疲乏、 负性情绪与社会支持的关系分析

目的 探讨肺癌患者癌因性疲乏、负性情绪与社会支持的关系研究.方法 2015年1月~12月应用癌因性疲乏量表、Zung焦虑量表(SAS)、Zung抑郁量表(SDS)及社会支持量表对120例肺癌患者进行调查研究,应用Pearson单因素分析癌因性疲乏、SAS评分、SDS评分与社会支持的关系.结果 120例肺癌患者中轻度疲乏32例(26.67%),中度疲乏48例(40.00%),重度疲乏40例(33.33%).疲乏总分为(5.98±1.24)分、行为疲乏(4.88±1.02)分、情感疲乏(4.39±1.32)分、认知疲乏(4.02±0.89)分、躯体疲乏(4.69±1.02)分.SAS评分(55.02±5.02)分、SDS评分(57.98±4.69)分,社会支持度总评分为(42.22±5.22)分.经Pearson分析,社会支持度总评分与疲乏总分、行为疲乏、情感疲乏、认知疲乏、SAS评分、SDS评分呈负相关(P<0.05),主观支持评分与疲乏总分、认知疲乏评分及SAS评分、SDS评分呈负相关(P<0.05).结论 肺癌患者癌因性疲乏、负性情绪与社会支持有密切的关系,临床上可通过提高患者社会支持度,从而减轻患者癌因性疲乏及焦虑、抑郁情绪,以改善患者生活质量.     

新型冠状病毒肺炎隔离病区护理人员希望水平、心理健康与影响因素分析

[目的]调查新型冠状病毒肺炎隔离病区护理人员希望水平、心理健康及其影响因素。[方法]采用一般资料调查表、Herth希望量表、领悟社会支持量表和简易应对方式量表调查213名新型冠状病毒肺炎隔离病区护理人员,运用单因素分析及多元线性回归分析探讨其相关影响因素。[结果]新型冠状病毒肺炎隔离病区护理人员希望水平与积极应对、领悟社会支持、文化程度呈正相关(P<0.05);隔离病区护理人员的焦虑与是否积极应对呈正相关(P<0.05);隔离病区护理人员的抑郁与积极应对、性别、管理者有关(P<0.05)。[结论]关注新型冠状病毒肺炎隔离病区护理人员的希望水平、心理健康状态,依据影响因素及时给予心理疏导,引导护理人员积极应对,保持家庭和社会良好支持度,能有效提升护理人员希望水平,做好心理防护,保持战斗力。     

恶性肿瘤患者整体护理中心理状态分析及对策

目的通过调查恶性肿瘤患者的心理状态及相关因素,探讨在恶性肿瘤患者中实施整体护理存在的问题,并提出对策。方法采用心理调查表和自行编制的一般情况调查表,对450例住院患者分别在入院时、进行整体护理后2周,进行心理、焦虑自评量表(SAS),抑郁自评量表(SDS)及一般情况调查,根据调查结果分析整体护理在恶性肿瘤患者护理中存在的问题。结果患者入院经整体护理2周后SAS及SDS评分有明显改善,分别为(47.02±7.45)和(47.68±10.15)分,与入院时SAS和SDS分别为(49.12±9.95)、(51.78±11.35)分相比有显著差异(P<0.01)。结论整体护理能改善恶性肿瘤患者的心理状态,但还存在家庭、社会及医护人员等方面的问题有待进一步改进,以提高整体护理质量。     

FOCUS—PDCA程序在整建制接管新型冠状病毒肺炎重症病区医护人员自我防护中的应用与实践

目的探讨FOCUS-PDCA程序在整建制接管新型冠状病毒肺炎重症病区医护人员自我防护中的应用效果。方法运用FOCUSPDCA程序分析医护人员自我防护的风险问题,成立持续质量改进小组,制定自我防护措施、操作流程及风险预案,并对全体人员行多元化培训、考核并质控。结果 FOCUS-PDCA程序实施后医护人员自我防护知识掌握程度由实施前的43.90%上升至92.07%,经比较差异有统计学意义(P 0.05)。在医院及驻地,医护人员各项防护措施的执行率均提升至100.00%。结论 FOCUS-PDCA程序可提升整建制接管新型冠状病毒肺炎重症病区临时团队医护人员的自我防护能力,降低人员感染风险。     

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.     

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.