综合医院低年资护士社会支持与应对方式的相关性分析

目的 了解临床低年资护士的社会支持与应对方式状况及两者的相关性.方法 采用社会支持评定量表和简易应对方式问卷,对183名临床毕业5年以下的低年资护士进行调查.比较不同婚姻状况、不同学历组间社会支持、应对方式得分的差异,分析社会支持与应对方式得分相关性.结果 本组低年资护士社会支持总分为(34.49±6.14)分,积极应对维度分为(2.00±0.58)分,消极应对维度为(1.63±0.49)分;客观支持、主观支持、社会支持总分与消极应对呈一定负相关(r分别是-0.29、-0.33、-0.36,均P<0.01);已婚护士社会支持总分较未婚护士高(P<0.01);大专护士社会支持总分与本科护士问差异不明显(P>0.05).结论 低年资护士社会支持总分与消极应对都处于中下水平,积极应对则处于中等水平,社会支持总分与消极应对呈负相关.护理管理者应重视年轻护士的心理健康状况,引导其学会恰当估计自己的应对能力,争取更多的社会支持,提高心理健康水平.     

低年资护士心理健康与社会支持状况分析

目的探讨低年资护士心理健康状况及其与社会支持状况的关系。方法采用一般情况调查表、症状自评量表、社会支持评定量表,于2015年6月~7月对某三级甲等医院192名低年资护士进行问卷调查,并分析其心理健康与社会支持之间的关系。结果低年资护士心理健康状况良好,未婚护士和已婚护士SCL-90得分在躯体化、恐怖、精神病性、睡眠及饮食因子方面比较,差异有统计学意义(P0.05);专科护士和本科护士在强迫、抑郁因子方面比较,差异有统计学意义(P0.05);不同科室护士的心理健康状况在在强迫、人际关系、抑郁、敌对、恐怖、偏执、精神病性因子方面比较,差异有统计学意义(P0.05);此外,社会支持和心理健康状况具有相关性。结论低年资护士的心理健康受婚姻状况、学历水平和不同科室等因素的影响,社会支持是影响低年资护士心理健康状况的个体内部心理因素。     

儿科护士心理健康状况和应对方式的研究

[目的]探讨儿科护士的心理健康状况及应对方式,以提高护理质量。[方法]采用症状自评量表(SCL-90)、特质应对方式问卷(TCSQ),对福州市58名儿科护士及59名普通科室护士进行心理健康状况和应对方式的调查。[结果]儿科护士SCL-90的强迫、抑郁及焦虑因子分高于普通科室护士因子分,差异有统计学意义(P<0.05);TCSQ的消极应对均分高于普通科室护士均分,差异有统计学意义(P<0.05);其中,儿科护士工作年限≤5年、>20年者多采用消极应对方式。儿科护士的SCL-90总均分及部分因子分与消极应对方式均分呈正相关,差异有统计学意义(P<0.05)。[结论]儿科护士存在一定的心理健康问题,应注重应对方式与心理状态的调整,以提高护理质量。     

护士心理健康状况与应对方式及其相关性的调查研究

目的:了解护士心理健康状况、应对方式及二者之间的相关性,为改善护士群体的心理健康、提高社会适应能力提供科学依据。方法:采用症状自评量表及简易应对方式量表对733名护士进行问卷调查。结果:不同年龄组在焦虑、敌对及偏执症状有统计学差异(P<0.05),30岁以下年龄组焦虑因子得分最高,而40岁以上年龄组焦虑因子得分最低,敌对、偏执因子得分随着年龄的增长而降低;不同年龄、学历及职称护理人员积极应对与消极应对维度得分均无统计学差异,但与全国常模比较,积极应对纬度平均分明显高于全国常模(P<0.05),消极应对纬度平均分明显低于全国常模(P<0.05);积极应对得分与症状自评量表的9个因子呈负相关,而消极应对与症状自评量表所有因子呈正相关,身心症状的反映随着积极应对方式的采取而降低,随着消极应对方式的采取而升高。结论:护士存在一定的心理健康问题,应注重应用积极应对方式提高社会适应能力,促进护士心理健康,从而提高护理质量。     

企业医院护士心理健康状况与应对方式及社会支持的相关研究

目的 探讨改制后企业医院护士心理健康状况及其与应对方式和社会支持的相关性.方法 分别从改制企业医院(A组)和未改制医院(B组)各抽取110名护理人员作为研究对象,用症状自评量表(SCL-90)对A、B两组护士的心理健康状况进行调查,同时用应对方式问卷和社会支持评定量表对A组护士进行调查.结果 A组护士SCL-90总分及9个因子得分均高于B组,除人际关系因子外,其它因子在2组间的得分比较均具有统计学意义(p(0.05);A组SCL-90各因子分与社会支持中的各因子得分呈负相关,与应对方式中的解决问题和求助因子呈负相关,而与其他应对方式呈正相关.结论 改制后的企业医院护士心理健康状况不容乐观,应对其进行心理疏导,鼓励护士采用成熟的应对方式并提高其对社会支持的利用度.     

本科护生实习期间心理健康状况与应对方式的相关性研究

目的 了解哈尔滨医科大学护理本科牛在临床实习期间的心理健康状况及与应对方式的相关性.方法 采用症状自评最表(SCL-90)和特质应对方式问卷对67例正在临床实习的护理本科生分期进行测量,并分别与全国青年常模组进行比较.结果 SCL-90 7个因子的得分,护生组与常模组比较差异无统计学意义(P>0.05);护生组与健康成人组积极应对情况分别为(30.00±12.10)分,(21.25±7.14)分,无统计学意义(P>0.05);消极应对情况分别为(31.76±8.61)分,(30.26±8.74)分,有统计学意义(P<0.01);护生组的心理健康状况与消极应对方式的相关性具有统计学意义(P<0.01).结论 护理本科生临床实习期间总体心理健康状况较好.     

低年资儿科护士心理健康状况的调查

目的了解低年资儿科护士的心理健康状况。方法便利抽样法选取上海市儿童医院工作5年以内(含5年)的低年资护士86名为调查对象,采用症状自查量表(symptoms self checking scale 90,SCL-90)问卷对其进行调查,评定其心理健康状况。结果低年资儿科护士SCL-90的总分与全国护士常模评分的差异无统计学意义(P>0.05),其中焦虑因子分和阳性项目数均高于全国护士常模,差异有统计学意义(P<0.05);12.8%的低年资儿科护士存在中度以上的心理问题。结论低年资儿科护士的心理状况较一般人群差,应加强对其心理支持、心理健康教育和行为干预。     

衡水市护士心理健康状况与其应对方式的相关性研究

目的探讨衡水市临床护士心理健康状况及其与应对方式的关系，为采取有效的措施促进护士心理健康提供依据。方法采用症状自评量表（SCL-90）、特质应对方式问卷（TCSQ）对4所医院的171名护士（护士组）及169名医生（医生组）的心理健康状况及应对方式进行了调查。结果护士组的SCL-90各症状因子评分均高于医生组，其中2组在躯体不适、人际关系、抑郁、焦虑得分及总分比较，差异有统计学意义（均P〈0．05）；护士组的积极应对和消极应对得分与医生组比较，差异有统计学意义，其中护士组消极应对得分高于医生组，而积极应对得分则低于医生组（均P〈0．05）。护士的积极应对与SCL-90的总分及人际关系、焦虑、敌对等多个因子呈负相关，而消极应对与SCL-90总分及各个因子均呈正相关。结论护士的心理健康状况较差，管理者应采取有效的措施提高护士的心理健康水平。     

未婚妊娠少女心理健康状况与自我意识的调查

目的探讨未婚妊娠少女心理健康状况与自我和谐及应对方式的关系，为有效开展青少年性健康教育、寻求干预措施提供一定的理论依据。方法采用SCL-90、自我和谐量表和简易应对方式量表，对妇科门诊未婚妊娠少女和其他门诊普通未婚少女各100例进行心理测评。结果未婚妊娠少女的SCL-90自评症状平均分、自我和谐平均分、消极应对平均分均高于普通少女，差异有统计学意义；积极应对平均分低于普通少女，差异有统计学意义；并且未婚妊娠少女的SCL-90自评症状中，躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、偏执7个因子与自我和谐程度呈显著负相关，SCL-90自评症状总分与积极应对方式得分呈负相关，SCL-90自评症状总分与消极应对方式呈正相关。结论未婚妊娠少女心理健康状况较差，其自我和谐程度低，且多采用消极应对方式。应及时进行心理辅导，采取有效的干预手段，提高其心理健康水平。     

低年资护士职业倦怠与社会支持及应对方式的相关性研究

目的 探讨临床低年资护士职业倦怠与社会支持及应对方式的相关关系.方法 抽取内外科各4个病区低年资（工作年限≤5年）护士50人进行职业倦怠量表（MBI）、应对方式问卷（CQS）、社会支持评定量表（SSRS）的调查,并与杭州市常模进行比较.结果 低年资护士职业倦怠中的个人成就感评分低于杭州市常模,差异有统计学意义（t=2.3470,P＜0.05） 职业倦怠与客观支持、支持利用度、社会支持总分、消极应对均存在相关性（P＜0.05或P＜0.01）.结论 低年资护士个人成就感较低,社会支持和应对方式对职业倦怠具有影响作用.护理管理者应消除职业倦怠的压力源、改善组织氛围、增强个体积极应对和社会支持的感知,提高其心理健康水平.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.