心理诱导对支气管动脉灌注抗癌药病人应激反应的影响

将１００例肺癌病人随机分为两组，５０例在常规护理的基础上，术前行心理诱导疗法（实验组）；５０例采用常规护理法（对照组）。观察两组病人住院当日、手术前夜焦虑、抑郁、恐惧程度及生命体征变化；术晨及术后１ｈＰａＯ２、ＰａＣＯ２值；术后胃肠道反应情况。结果显示：住院当日两组病人焦虑、抑郁、恐惧分值及生命体征指标无显著性差异（Ｐ＞０．０５），而手术前夜两组间有显著性差异（Ｐ＜０．００１）；ＰａＯ２、ＰａＣＯ２术前两组无差异（Ｐ＞０．０５），术后也有显著性差异（Ｐ＜０．０５）；且术后胃肠道反应发生率对照组明显高于实验组。说明心理诱导可降低支气管动脉灌注化疗药病人应激反应的发生率。     

心理诱导对支气管动脉灌注抗癌药病人应激反应的影响

将１００例肺癌病人随机分为两组，５０例在常规护理的基础上，术前行心理诱导疗法（实验组）５０例采用常规护理法（对照组）。观察两组病人住院当日，手术前夜焦虑，抑制，恐惧程度及生命体征变化。术晨及术后１ｈＰａＯ２，ＰａＣＯ２值，术后胃肠道反应情况。结果显示：住院当日两组病人焦虑，抑郁，恐惧分值及生命体征指标无显著性差异（Ｐ〉０．０５），而手术前夜两组间有显著性差异（Ｐ〈０．００１）；ＰａＯ２，ＰａＣＯ２     

妇科手术病人焦虑程度评估与对策

选择系统化整体护理模式病房和功能制护理病房行子宫，卵巢切除术的病人各３０例。就引起焦虑的原因进行调查，同时采用汉密顿焦虎量表进行焦虑程度比较。     

神经内科实施系统化整体护理效果评价

对神经内科实施系统化整体护理后的１６７例住院病人，从肺部感染的发生率及平均住院日方面与实施系统化整体护理前的１５４例病人进行对照比较。结果显示：对照组发生肺部感染３１例，发生率为２０．１３％；实验组发生肺部感染１０例，发生率为５．９９％，经χ２检验，有显著性差异（Ｐ＜０．００５）。平均住院日实验组也较对照组为短。提示：实施系统化整体护理可提高护理质量     

神经内科实施系统化整体护理效果评价

对神经内科实施系统化整体护理后的１６７例住院病人，从肺部感染的发生率及平均住院日方面与实施系统化整体护理前的１５４例病人进行对照比较，结果显示：对照组发生肺部感染３１例发，生率为２０．１３％，实验组发生肺部感染１０例，发生率为５．９９％，经Ｘ＾２检验，有显著性差异（Ｐ〈０．００５）。平均住院日实验组也较对照组为短，提示：实施系统化整体护理可提高护理质量。     

2种漱口液不同方法含漱预防血液病病人口腔溃疡的效果观察

对１４２例血液病病人采用２种漱口液预防口腔溃疡，Ⅰ组（５７例）单纯采用１∶５０００呋喃西林溶液含漱，Ⅱ组（４１例）单纯采用３％碳酸氢钠溶液含漱，Ⅲ组（４４例）采用上述两种溶液交替含漱。三组均观察３５天，有效率分别为８２．４６％、８５．３７％和９７．７３％，经统计学处理，Ⅰ组与Ⅱ组有效率比较，差异无显著性（Ｐ＞０．０５），Ⅲ组与Ⅰ组有效率比较，差异有显著性（Ｐ＜０．０５），Ⅲ组与Ⅱ组比较，差异亦有显著性（Ｐ＜０．０５）。结果表明，Ⅲ组效果明显优于Ⅰ组与Ⅱ组     

护理干预对糖尿病病人抑郁焦虑心理的影响

为探讨护理干预对糖尿病合并焦虑抑郁病人心理的影响,用Ｚｕｎｇ氏焦虑抑郁自评量表评估糖尿病病人的精神状况,并给予护理干预：包括糖尿病病人教育、心理护理、感觉护理、药物护理、然后比较干预前后的评分值。结果：糖尿病病人存在明显的焦虑抑郁心理,与国内常模相比,有显著性差异（Ｐ〈０．０１）;护理干预后症状明显改善（Ｐ〈０．０５）。建议对糖尿病病人应进行常规的、多层次的护理干预。     

综合医院ICU病人心理状况分析及对策

采用症状自评量表（ＳＣＬ－９０）对初入院的４４例危重病人进行问卷测评，根据测评结果对ＩＣＵ的２４例病人在积极治疗的同时，进行针对性的心理护理（观察组）。１４天后，进行第２次测评，并与入ＣＣＵ和ＲＣＵ的２０例病人进行对照（对照组）。结果显示：心理护理前观察组、对照组各因子分均高于国内常模（Ｐ＜０．００１）。观察组行心理护理两周后，除躯体化、忧郁、焦虑恐怖因子分外，其余因子分与国内常模无差异（Ｐ＞０．０５），对照组无明显变化。说明危重病人存在有不同程度的心理问题。提示应重视危重病人的心理护理     

128例精神分裂症病人配偶心理状况调查

采用症状自评量表（ＳＣＬ９０）对１２８名精神分裂症病人配偶进行评定，并与国内常模进行对比。结果显示，病人配偶的ＳＣＬ９０各因子均分及阳性项目数均明显高于国内常模（Ｐ＜０．０１），且男女病人配偶之间躯体化及人际关系两因子均分也有显著性差异（Ｐ＜０．０１），其余各因子均分及阳性项目数均无显著性差异（Ｐ＞０．０５）。提示，精神病人配偶存在着较严重的心理障碍，尤以焦虑、抑郁突出。     

128例精神分裂症病人配偶心理状况调查

采用症状自评量表（ＳＣＬ－９０）对１２８名精神分裂症病人配偶进行评定，并与国内常模进行对比，结果显示，病人配偶的ＳＣＬ－９０各因子均分及阳性项目数均明显高于国内常模（Ｐ〈０．０１），且男女病人配伍之间躯体化及人际关系两因子均分也有显著性差异（Ｐ〈０．０１），其余各因子均分及阳性项目数均无显著性差异（Ｐ〉０．０５）。提示，精神病人配伍存在着较严重的心理障碍，尤以焦虑，抑郁突出。     

How to face up to the spectre of redundancy

Primary care trust (PCT) reconfigurations are now in their final phase. Posts have been deleted and staff who have not been slotted into other posts must apply for posts within their organization. Those who are unsuccessful must find posts elsewhere. This article aims to enable you to prepare for interview and to attain a new post.     

Potential impact of interventions to reduce times to thrombolysis

Methods: Data were analysed from a prospective, observational study of all patients transported to hospital by ambulance, who subsequently received intravenous thrombolysis at 20 hospitals and two ambulance services in Victoria, Australia (n = 1147). Regression models estimated the association between predictor variables age, sex, route of referral, symptom onset to call time, ambulance pre-notification of the receiving hospital, emergency department thrombolysis, and the outcome, time to thrombolysis. Further modelling estimated the number needed to treat to save one life by several recommended interventions to reduce time delays.

Results: Presentation via a rural hospital or general practitioner was associated with an approximate doubling of the onset to call time (2.08 and 2.30 respectively). Ambulance-hospital pre-notification and emergency department thrombolysis reduced door to needle times by 21% and 27% respectively. Modelling showed that each of the following interventions would be expected to save one life: 1069 hospital pre-notifications, 714 cases of emergency department thrombolysis, 184 cases of prehospital thrombolysis, 340 cases to bypass their rural hospital, or 50 cases to bypass their general practitioner.

Conclusions: Hospital pre-notification and emergency department thrombolysis reduce time delays, although the mortality impact seems to be modest. Prehospital thrombolysis has the potential to save lives, although validation in real practice is required. Advising patients to call directly for an ambulance, rather than the general practitioner, has the greatest potential to save lives.

     

Selection of growth parameters to define failure to thrive

Failure to thrive (FTT) is a syndrome of growth failure due to undernutrition. Determining whether an infant has FTT is based on the use of an anthropometric indicator and a selected cutoff value for that indicator. These anthropometric indicators include weight for age, weight for length, and length for age, and the cutoff values include the 10th, 5th, and 3rd percentiles. Each indicator and selected cutoff value provide unique information about an infant's growth. However, these parameters are often used interchangeably to explain the same growth phenomenon. The sensitivity and specificity of each anthropometric indicator are a function of the cutoff value selected and dictate which infants will be classified as having FTT and which infants will be classified as healthy. Depending on the sensitivity and specificity of the indicator, some infants with FTT will be classified as healthy, and some healthy infants will be classified as having FTT. A clear rationale for the selection of an anthropometric indicator and a cutoff value for defining FTT are important for increasing the generalizability of research findings and thereby expanding the current knowledge base related to FTT.     

加强学生适应系统化整体护理临床教学探讨

随着医学模式的转变 ,人们深刻认识到护理学是艺术和爱心的结合 ,单纯的疾病护理已不能满足病人的需要。如何培养适应系统化整体护理的合格护士 ,是护理教育者面临的重大课题。在近年来的临床教学中 ,笔者在指导学生进行正确的技术操作及基础护理的同时 ,注重提高学生的综合素质 ,以适应系统化整体护理的要求。1　培养学生树立正确的护理理念　　当前 ,我国还处在经济发展时期 ,经济多元化的出现使人们的思想意识、价值观念发生了较大的变化。加之现在的护生多数是独生子女 ,从小生活较优越 ,缺乏同情心、爱心、责任心。所以 ,进入临床实习…     

不复苏意愿相关因素分析

目的 探讨心肺复苏(CPR)中影响患者亲属提出不复苏(DNAR)意愿的患者自身相关因素.方法按Utstein模式要求登记温州医学院附属第一医院急诊科2005年1月至2008年12月院内心搏骤停(CA)患者522例,其中患者亲属提出DNAR意愿157例,为DNAR意愿组,其余365例为积极复苏意愿组.对患者年龄、性别、婚姻、户籍、CA病因、基础疾病、CA前活动状态、有无呼吸机辅助通气、有无使用升压药物等相关指标进行单因素Logistic回归分析,然后选择有统计学意义的变量进行多因素Logistic回归分析.结果 单因素Logistic回归分析发现性别、婚姻对患者亲属提出DNAR意愿无统计学意义(P>0.05),年龄、户籍、CA病因(心源性、创伤性)、中风、癌症、猝死、CA前活动状态、有无呼吸机辅助通气、有无使用升压药10个指标对亲属提出DNAR意愿有统计学意义(P<0.01).多因素Logistic回归分析发现影响亲属提出DNAR意愿的独立危险因素有年龄(P=0.034)、癌症(P=0.006)、中风(P=0.003)、CA前呼吸机辅助通气(P=0.000),而猝死是保护因素(P<0.01).CA病因中,心源性(P=0.020)和创伤性(P=0.000)也是保护因素.结论在与患者亲属提出DNAR意愿相关的患者自身因素中,年龄≥60岁、癌症、中风、CA前呼吸机辅助通气是肯定的因素,猝死及CA病因中的心源性、创伤性是否定的因素.