56名儿科护士工作压力源的调查分析

目的:了解儿科护士工作主要压力源及不同护龄、职称及学历儿科护士的工作压力源的差别。方法:采用问卷调查法,对天津市两所三级甲等医院56名儿科护士的社会人口学资料和工作压力源进行调查。结果:儿科护士工作压力源由高到低依次为:工作量及时间分配问题,工作环境及资源方面问题,病人护理方面问题,护理专业及工作方面问题,管理及人际关系方面问题。不同护龄、职称及学历的儿科护士压力源差别无统计学意义。结论:建议护理管理者采取综合干预模型减少儿科护士工作压力源,为儿科护士提供减轻工作压力的方法,以提高儿科护士工作的效率及质量。     

新入职护士规范化培训心理应激的质性研究

目的通过对新入护士职规范化培训心理应激的质性研究,发现培训工作存在的优势和不足,进一步完善培训计划,提高培训效果。方法采用描述性现象学研究方法。结果共访谈了18名新入职护士,共提炼了5个主题,分别为心理变化、压力源、社会支持、收获及需求。结论新入职护士是医院护士队伍的新生力量,其专业决定了医院未来护理队伍的发展水平,医院可通过了解新入职护士心理状态、压力源、社会支持及培训需求等方面的实际情况,完善培训方案,加强护理人文培养,提高新入职护士的培训效果,提升规范化培训内涵。     

骨科护士工作压力源及相关因素分析

目的探讨骨科护士工作压力水平及其相关因素。方法采用无记名填涂工作压力源量表的调查方式对本院普通病房27名骨科护士进行调查。结果显示担心工作中出现差错事故、经常倒班、护士工作未被病人及家属认可、护理工作的社会地位太低、病人不合作、护理的病人突然死亡等压力为骨科护士的主要工作压力源；其中不同学历、护龄、岗位的骨科护士工作压力各不相同。结论护理专业及工作方面的问题、病人护理方面问题为骨科护士的主要压力源，其中从事临床护理、大专以上学历、5～10年护龄的护士工作压力程度较重，护理管理者要根据不同岗位、不同学历、不同护龄的护士采取有针对性的减压措施。     

军队医院护士工作压力源的调查分析与对策

目的:探讨军队医院护士的工作压力源情况。方法:采用护士工作压力源量表,对262名军队医院护士的工作压力源进行调查。结果:军队医院护士工作压力源前三位为护士专业及工作方面、工作量及时间分配、患者护理方面的问题。不同科室护士工作压力源不同。结论:护士的心理压力状况不容忽视,应加强护士的心理素质培训,改善工作环境,配备合理的人力资源,减少护士工作压力,促进其身心健康。     

神经外科手术护士工作压力及工作满意度的调查

目的 了解神经外科手术护士的工作压力、压力程度及压力源状况,分析工作满意度的现状,为医院及护理管理者采取有效应对措施提供参考.方法 选取天坛医院神经外科手术护士71名为调查对象,使用一般资料调查表、护士工作压力源量表、护士工作满意度量表（MMSS）进行调查研究.结果 71名神经外科手术护士平均压力水平（2.47±0.97）分,为中度.首要的工作压力源来自工作量及时间分配问题方面,其次为患者护理方面和护理工作及专业方面问题,护士工作满意度处于一般水平,其中在福利待遇、专业发展机会、家庭-工作的平衡方面工作满意度最低 年龄、职称、学历、护龄、婚姻状况是影响工作压力源的主要因素,而年龄、职称、学历、护龄、婚姻状况、夜班情况有无是影响工作满意度的主要因素 护士工作压力与工作满意度呈负相关.结论 神经外科手术护士护理工作量大、负荷重、满意度低是护理工作中存在的主要问题.面对各种工作压力源,应该积极地进行心周调适,保持身心健康,建立良好文化氛围 医院及护理管理者应采用有效措施,以减轻护士的工作压力,提高工作满意度,促进积极的工作态度,提高工作质量及工作效率.     

胸痛中心核心科室护士胸痛护理培训需求调查北大核心

目的:了解胸痛中心核心科室护士胸痛护理培训内容的需求情况,为制订科学合理的培训计划提供参考。方法:采用自制的胸痛护理知识培训需求调查表对28个省、自治区、直辖市的3 692名胸痛中心核心科室护士进行调查。结果:护士培训内容需求排首位的是胸痛中心的救治流程设置,占79.2%。不同科室、工作年限、学历的护士对胸痛护理培训需求存在差异,急诊科护士对急性冠状动脉综合征(ACS)病人随访内容需求低于其他科室;工作年限>10年护士对ACS病人随访内容需求高于其他护士;硕士及以上学历护士对引发急性胸痛疾病的诊疗指南需求较高(P<0.05)。对胸痛中心核心科室的护士来说,网络视频学习是需求率最高的培训方式,占74.08%,以问题为导向的教学法需求率最低,占26.16%。结论:护士对胸痛护理培训需求在科室、工作年限、学历方面存在差异。不同科室的护士对本专科相关知识需求度较高,工作年限越长的护士更关注病人的延续性护理,硕士学历的护士培训需求更注重在急性胸痛疾病发展前沿;应针对护士的所属科室、工作年限、学历制定培训内容,采取喜闻乐见的培训方式,提高护士岗位胜任力。     

275名三级医院手术室护士科研压力源现状及影响因素分析

目的调查三级医院手术室护士科研压力源现状,分析其影响因素。方法采用便利抽样方法 ,2016年1月—2018年1月抽取济南市4家三级甲等医院和4家三级乙等手术室护士作为研究对象。采用科研压力源量表、护理人员科研能力自评量表、科研焦虑量表及组织创新氛围,对275名手术室护士进行调查。采用多元线性回归分析科研压力源的影响因素。结果三级医院手术室护士阻碍性科研压力源得分为(21.36±3.24)分,挑战性科研压力源得分为(20.32±3.01)分。多元线性回归分析结果显示:学历、职称、已发表论文数、主持课题情况、参与课题情况、参加过科研培训、科研能力和组织创新氛围进入回归方程(P0.05),共解释挑战性科研压力源总变异的56.2%;学历、职称、子女个数、离异、平均收入、科研在其医院职称评定权重、参加过科研培训、科研焦虑和组织创新氛围进入回归方程(P0.05),共解释阻碍性科研压力源总变异的67.4%。结论三级医院手术室护士阻碍性科研压力源处于较高水平,学历、职称、已发表论文数、主持课题情况、参与课题情况、参加过科研培训、科研能力和组织创新氛围是其主要影响因素;三级医院手术室护士挑战性压力源处于较低水平,学历、职称、子女个数、离异、个人平均月收入、科研在其医院职称评定权重、参加过科研培训、科研焦虑和组织创新氛围是其主要影响因素。建议医院和手术室护理管理者建立全面护士科研培训体系、护理科研管理体制和高效的护理科研激励制度,营造浓厚科研创新学术氛围,增加护士个人收入和关心多子女及离异家庭护士生活,帮助其平衡好家庭、临床工作和科研工作,为其从事护理科研扫清障碍。     

新入职硕士学历护士工作压力源的研究

目的了解新入职硕士学历护士的工作压力来源,为护理管理者进行针对性的培训提供依据。方法对11名新入职硕士学历护士进行半结构式深入访谈,运用现象学分析方法对访谈资料进行分析。结果共提取出4个主题:超负荷的工作量、自身经验及临床带教不足、科研压力和价值感缺失。结论护理管理者应重视新入职硕士学历护士的工作压力,并采取相应措施减缓其工作压力。     

精神科护士工作压力源及相关因素的分析

目的探讨精神科护士工作压力水平及其相关因素.方法采用工作压力源量表对北京安定医院普通病房的97名精神科护士进行调查.结果担心工作中出现差错事故、经常倒班、工资及其他的福利待遇低、继续深造的机会太少、护士工作未被病人及家属承认、护理工作的社会地位太低、晋升的机会太少、病人不合作、护理的病人突然死亡等压力为精神科护士的主要工作压力源.其中不同岗位、不同性别、不同护龄、不同学历的精神科护士工作压力源差异存在统计学意义(P＜0.05或0.01).结论护理专业及工作方面的问题、病人护理方面的问题为精神科护士的主要工作压力源,其中从事临床岗位的护士、男护士、大专以上学历护士、5～10年护龄的护士工作压力程度较重,护理管理者要根据不同性别、不同岗位、不同学历、不同护龄采取有针对性的减压措施.     

肿瘤科护士工作压力及应对方式的调查

目的调查肿瘤科护士工作压力来源和应对方式。方法对48名肿瘤科护士采用护士压力源量表、压力应对方式问卷调查。结果肿瘤科护士总体压力水平为中度,压力主要来源于“工作量及时间分配”、“病人护理”、“工作环境及仪器设备”方面：在“工作量及时间分配”方面,中高级职称及较高学历护士压力高于初级职称及低学历护士,在“护理专业及工作方面”,高学历护士压力高于低学历护士;78．72％的肿瘤科护士采用积极的成熟型应对方式应对压力,21．28％采用消极的或中间型方式应对压力。结论制定有效措施降低肿瘤科护士压力源水平,减轻应激程度,对确保护士身心健康和良好的护理质量是必要的。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.