重睑成形术后患者人格特质、应对方式及总体幸福感间的相关性研究

目的 探讨重睑成形术后患者人格特质、应对方式及总体幸福感间的关系。方法 选取行重睑成形术患者210例,采用艾森克人格问卷简式量表、医学应对方式问卷、总体幸福感量表进行调查。结果 重睑成形术后患者人格问卷简式量表中精神质(P)得分为(6.34±2.19)分、内外向(E)得分为(7.64±2.52)分、神经质得分(N)为(6.05±2.03)分、掩饰性(L)得分为(5.23±1.94)分。应对方式得分为(45.02±5.39)分,总体幸福感得分为(56.64±7.95)分。应对方式、总体幸福感与患者E呈正相关(P<0.05),与P、N、L呈负相关(P<0.05);应对方式与总体幸福感呈正相关(P<0.05)。人格特质在应对方式与总体幸福感间存在中介效应(P<0.05)。结论 重睑成形术后患者人格特质、应对方式及总体幸福感间三者间密切相关,人格特质在应对方式与总体幸福感间存在中介作用。医护人员应重视人格特质与应对方式对重睑成形术后患者总体幸福感的影响,依据人格分类进行针对性干预,改善其积极应对能力,提高患者总体幸福感。     

少年教养人员人格类型及其与自尊、成就动机、应对方式的调查

目的:选取人格、自尊与成就动机、应对方式作为相关变量,分析少年教养人员不同人格类型的自尊与成就动机、应对方式的特点。方法:调查对象为河南省某少年教养管理所2004-10/2005-02在押的少年教养人员97名,均为男性。运用艾森克人格问卷、自尊量表、成就动机量表和简易应对方式量表测评不同人格类型少年教养人员的自尊、成就动机及应对方式。其中①艾森克人格问卷由88项问题,4个分量表组成,分别为精神质、内外向、神经质、掩饰,每题按自己的实际情况回答“是”和“否”。②自尊量表共10题,4级评分(“非常符合”到“很不符合”),总分范围10～40分,分值越高,自尊程度越高。③成就动机量表由30项问题,2个分量表组成,分别为追求成功动机,避免失败动机,得分越高,追求成功的动机越高,得分越低,成就动机越弱,个体越倾向于避免失败。④简易应对方式量表包括积极应对方式和消极应对方式2个分量表,采用多级评分,“不采用、偶尔采用、有时采用、经常采用”,相应评分0,1,2,3分。结果:共发放问卷97份,有效问卷88份。①少年教养人员人格精神质、神经质和掩饰性得分与相应常模比较,差异具有显著性意义[(9.44±3.78),(6.65±4.36)分;(14.49±4.22),(11.43±4.31)分;(8.69±4.24),(12.47±3.81)分,P<0.01]。②自尊与成就动机、积极应对呈正相关,与避免失败、消极应对呈负相关;成就动机与内外向呈正相关,与稳定性呈负相关;积极应对与自尊、成就动机呈正相关;消极应对与内外向、稳定性、避免失败呈正相关,与自尊呈负相关,差异具有显著性意义(P<0.05)。③通过Q型聚类分析得出3种人格类型:冲动型37名、敌对型32名和稳定型19名。不同人格类型被试精神质、稳定性、掩饰性、自尊和成就动机比较,差异具有显著性意义(P<0.01);应对方式比较,差异无显著性意义(P>0.05)。结论:少年教养人员具有高精神质、低掩饰性和神经质偏高的人格特质;具有冲动型、敌对型和稳定型3种人格类型。不同人格类型具有不同的自尊、成就动机和应对方式。     

不同工作环境下护士亚健康状况及相关因素比较

[目的]比较不同工作环境下护士亚健康状况及其相关因素的异同,全面了解护士亚健康状况及相关因素,便于有针对性地采取干预措施.[方法]采用亚健康筛选表、Maslach研制的MBI耗竭问卷、简易应对方式问卷、A型行为量表、艾森克个性问卷、自编一般情况调查表进行调查.[结果]综合医院、肿瘤医院、开放式精神病院、封闭式精神病院护士亚健康发生率分别为62.78％、69.56％、40.82％、56.36％,开放式精神病院护士与综合医院、肿瘤医院护士比较差异有统计学意义(P＜0.05或P＜0.01).综合医院护士亚健康与情绪枯竭、去人格化倾向、精神质、神经质、争强好胜、时间匆忙感、压力有关;肿瘤医院护士与情绪枯竭、去人格化倾向、神经质、消极应对方式有关;开放式精神病院护士与情绪枯竭、内外倾向、压力、消极应对方式、护龄有关;封闭式精神病院护士与情绪枯竭、去人格化倾向、个人成就感、精神质、压力、消极应对方式有关.[结论]预防和改变护士亚健康状况要尽量减轻护士压力,而护士也要正视压力、采取积极应对方式、完善自己性格等措施.     

护士人格特征、工作满意度与主观幸福感的相关性分析

[目的]研究护士人格特征、工作满意度与主观幸福感的相关性,探讨工作满意度在护士人格特质与主观幸福感之间的中介作用。[方法]采用艾森克人格问卷简式量表中国版(EPQ-RSC)、卡劳斯克/米勒满意度量表(MMSS)和总主观幸福感量表(GWB)对大连市某三级甲等医院296名护士进行调查。[结果]护士MMSS得分为(3.36±0.45)分,与工作满意度的最低指数均分3.03分比较差异有统计学意义(P0.01)。护士GWB得分为(78.70±7.44)分。护士婚姻状况、工作性质、学历和职称是MMSS得分和GWB得分的影响因素(P0.01)。护士人格特征的神经质和精神质维度与主观幸福感呈负相关(P0.05),内外向维度与主观幸福感呈正相关(P0.05),工作满意度与主观幸福感呈正相关(P0.05)。在中介效应检验中,工作满意度为神经质、内外向与主观幸福感的中间变量,中介率为17.1%和9.5%。[结论]工作满意度在护士人格特征和主观幸福感中起到部分中介作用。     

深圳市龙岗区急诊护士应对方式的特点分析

目的探讨深圳市某区急诊护士压力应对方式的特点,以指导护理管理工作。方法采用中国护士工作压力源量表及简易应对方式问卷,对在深圳市龙岗区14家医院工作的228名急诊护士进行调查。结果急诊护士积极应对得分高于全国常模（P〈0．01）,而消极应对得分明显低于全国常模（P〈0．01）;不同年龄、职称和学历护士的积极应对得分差异有统计学意义（P〈0．01）,婚否、有无子女和宗教信仰、感觉压力高低的护士消极应对得分差异有统计学意义（P〈0．01）。结论急诊护士多采用积极应对方式,较少采取消极应对方式;年龄≥40岁、学历本科及以上、职称为主管护师的急诊护士较多采用积极应对方式;未婚、无子女、有宗教信仰、工作压力水平高的急诊护士较常采用消极应对方式。建议护理管理者根据急诊护士的特点,引导和教育其采取有效的应对方式缓解压力,减少负性情绪影响。     

社会支持及应对方式在护士人格特征与心理健康间的中介作用

目的探讨社会支持、应对方式在护士人格特征和心理健康关系中的中介作用。方法采用一般资料问卷、症状自评量表、艾森克人格问卷、领悟社会支持量表及特质应对方式问卷,对某三级甲等综合医院1 589名临床护士进行调查。结果护士的心理健康得分为(159.75±55.22)分;家庭结构中的扩大家庭,人格特征中的精神质、外向性、神经质维度,领悟社会支持,应对方式中的积极应对维度是心理健康的影响因素,能解释总变异的36.0%;领悟社会支持和积极应对在人格特征与护士心理健康之间有中介效应。结论护理管理者应根据护士的人格特征,提高护士的社会支持及积极应对水平,从而促进护士的心理健康。     

258名护士艾森克(EPQ)人格特质及构成分析

目的 分析护士的人格特质特点,为护理人力资源管理提供依据。方法 选择本市东区5所二级以上医院258名护理人员运用艾森克(EPQ)个性问卷。结果 本组护士人格特质以外倾向稳定型为主,内外向标准T分(57.36±8.73);低龄、低护龄护士内外向和精神质得分高于高龄、高护龄组(P<0.01);已婚护士内外向和精神质得分低于未婚组(P<0.05);急诊、监护室护士精神质方面的得分高于其它科室(P<0.01);而不同文化程度护士的人格特质差异无统计学意义。结论 不同组群护士的人格特质存在差异。护理管理者应重视护士的人格差异,因人适用,有效配置,提高护士的岗位适应能力,稳定护理队伍。     

护士长人格特质及应付方式的调查研究

目的了解当前护士长的人格特质及其行为应付方式特点,为正确评价、科学培养和选拔护士长提供心理学方面的实证数据。方法采用艾森克个性问卷和肖计划编制的应付方式问卷对四川省303名护士长进行调查评定。结果护士长在外倾性方面明显高于常模(P<0.01);在神经质和精神质方面得分低于常模(P<0.01);三个维度的差异均有显著性意义;应付方式以解决问题和求助的成熟型为主(占74.9％);护士长人格特质与应付方式之间存在密切的相关性。结论绝大多数被调查的护士长在神经质和精神质维度方面都优于常模,且明显呈外倾型个性,但也发现有一部分护士长存在着高精神质、高神经质的病态性人格倾向,需进一步加强人格教育和指导。     

不同工作环境下护士亚健康状况及相关因素比较

[目的]比较不同工作环境下护士亚健康状况及其相关因素的异同，全面了解护士亚健康状况及相关因素，便于有针对性地采取干预措施。[方法]采用亚健康筛选表、Maslach研制的MBI耗竭问卷、简易应对方式问卷、A型行为量表、艾森克个性问卷、自编一般情况调查表进行调查。[结果]综合医院、肿瘤医院、开放式精神病院、封闭式精神病院护士亚健康发生率分别为62．78％、69，56％、40．82％、56．36％，开放式精神病院护士与综合医院、肿瘤医院护士比较差异有统计学意义（P〈0．05或P〈0．01）。综合医院护士亚健康与情绪枯竭、去人格化倾向、精神质、神经质、争强好胜、时间匆忙感、压力有关；肿瘤医院护士与情绪枯竭、去人格化倾向、神经质、消极应对方式有关；开放式精神病院护士与情绪枯竭、内外倾向、压力、消极应对方式、护龄有关；封闭式精神病院护士与情绪枯竭、去人格化倾向、个人成就感、精神质、压力、消极应对方式有关。[结论]预防和改变护士亚健康状况要尽量减轻护士压力．而护士也要正视压力、采取积极应对方式、完善自己性格等措施。     

临床护士核心自我评价、积极应对与工作投入的相关性

[目的]探究临床护士核心自我评价、积极应对和工作投入的关系。[方法]采用核心自我评价量表、积极应对量表和工作投入量表对333名临床护士的核心自我评价、积极应对方式和工作投入水平进行调查。[结果]临床护士核心自我评价得分为(3.64±0.52)分,积极应对得分为(1.91±0.44)分,工作投入得分为(3.50±0.49)分。相关分析表明临床护士核心自我评价、积极应对和工作投入三者间均呈正相关(P0.05),回归分析发现护士教育程度对积极应对方式有显著的影响作用(P0.05),在控制年龄、护龄和教育程度后,护士核心自我评价对积极应对方式具有显著影响(P0.05),且积极应对方式在护士核心自我评价和工作投入的关系中起部分中介作用。[结论]核心自我评价作为一种积极的人格特质能够直接影响临床护士工作投入,而且通过积极应对方式对工作投入产生间接作用。     

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.