应对方式在老年骨质疏松性髋部骨折术后患者自我效能感和生存质量之间的中介效应

目的探讨应对方式在老年骨质疏松性髋部骨折术后患者自我效能感和生存质量之间的中介作用。方法采用简易应对方式问卷、一般自我效能感量表、健康状况调查问卷对200例骨质疏松性髋部骨折术后患者进行问卷调查。结果骨质疏松性髋部骨折术后3个月患者的积极应对方式、自我效能感和生存质量得分均低于国内常模(P<0.01或P<0.05),消极应对方式得分高于国内常模(P<0.01)。两种应对方式在一般自我效能感和生存质量之间具有部分中介作用。结论老年骨质疏松性髋部骨折术后患者的生存质量降低,应采取有针对性的护理干预措施提高术后患者的自我效能感,促使患者采取积极的应对方式,减少消极应对方式的使用,进而提高其生存质量。     

老年骨质疏松性髋部骨折术后患者生活质量现状及其影响因素研究

目的 :调查骨质疏松性髋部骨折术后三个月老年患者的生活质量,分析其影响因素。方法 :采用一般情况问卷、医学应对方式问卷、自我效能感量表、健康状况调查问卷(SF-36)对200例术后患者进行问卷调查。结果 :骨质疏松性髋部骨折术后三个月患者生活质量各维度得分及总分均低于国内常模(P0.01)。多元回归分析表明,年龄、不良生活方式可负向预测患者在躯体健康方面的生活质量,性别、经济状况、合并症、自我效能感、面对应对可正向预测患者在躯体健康方面的生活质量。年龄、家庭关系、屈服应对、回避应对可负向预测精神健康方面的生活质量,婚姻状况、自我效能感可正向预测患者在精神健康方面的生活质量。结论 :骨质疏松性髋部骨折术后三个月患者生活质量较差。应采取有针对性的护理干预措施,引导患者采用积极的应对方式,增强患者的自我效能感,避免不良的生活方式,同时提供必要的社会支持,进而提高其生活质量。     

体外循环心脏瓣膜术后患者应对方式与疾病不确定感的相关性分析

目的分析体外循环心脏瓣膜术后患者应对方式与疾病不确定感及其相关性。方法应用医学应对方式问卷、疾病不确定感问卷对208例体外循环心脏瓣膜术后患者进行调查。结果体外循环心脏瓣膜术后患者面对维度得分低于常模(P0.01),回避和屈服维度得分高于常模(P0.01或P0.05)。患者疾病不确定感得分为(90.33±10.32)分,体外循环心脏瓣膜术后患者面对应对方式与疾病不确定感水平呈负相关,而回避、屈服应对方式与疾病不确定感水平呈正相关(P0.01或P0.05)。结论体外循环心脏瓣膜术后患者多采取回避和屈服的应对方式,患者疾病不确定感处于中等水平,护理管理者应鼓励患者寻求疾病知识与配合治疗,进而降低患者疾病不确定感水平。     

AIDS/HIV阳性患者应对方式研究

目的:探讨AIDS/HIV阳性患者应对方式,准确把握其应对特点。方法:运用一般资料调查表和医学应对方式问卷(MCMQ)对30例住院AIDS/HIV阳性患者进行调查。结果:AIDS/HIV阳性患者面对维度得分显著低于常模(P0.01),而回避和屈服维度得分显著高于常模(P0.01)。结论:AIDS/HIV阳性患者不能正确面对疾病,对待疾病常采用回避和屈服的应对方式,这对提高治疗依从性、延长生存时间、提高生存质量极为不利。     

乳腺癌患者术后2周及3个月抑郁状态及应对方式的研究

目的探讨乳腺癌患者术后抑郁与应对方式之间的关系,为进一步制订干预措施改善其抑郁情绪提供依据。方法采用抑郁自评量表和医学应对问卷对150例乳腺癌患者在术后2周和术后3个月进行问卷调查：结果术后2周和术后3个月抑郁得分均高于常模;术后2周及术后3个月的面对、回避、屈服得分均高于常模（P〈0．01或P〈0．05）;术后3个月时点患者采取回避、屈服应对方式与抑郁呈正相关．结论抑郁症状在术后乳腺癌患者中较为普遍,临床医务人员在此阶段应进行常规的抑郁水平评估,在术后不同阶段采取不同应对方式,有利于改善负性情绪．     

头颈部肿瘤患者生存质量与应对方式及社会支持的相关性研究

目的 探讨头颈部肿瘤患者生存质量与应对方式及社会支持的相关性.方法 采用一般资料问卷、头颈部肿瘤生存质量测定特异性量表、社会支持评定量表、医学应对问卷对73例头颈部肿瘤患者进行调查.相关性分析采用Pearson相关分析.结果 73例头颈部肿瘤患者的生存质量得分为(42.37±28.12)分;社会支持总分高于国内常模(t=10.581,P<0.001);回避应对得分高于国内常模,屈服应对得分和面对应对得分低于国内常模,差异具有统计学意义(P<0.05).相关性分析结果显示:屈服应对方式与性生活(r=0.274,P=0.020)、体质量丢失(r=0.233,P=0.048)呈正相关.社会支持总分与头颈部肿瘤患者的疼痛(r=-0.322,P=0.005)、感觉问题(r=-0.333,P=0.004)、张口困难(r=-0.234,P=0.046)呈负相关.结论 头颈部肿瘤患者生存质量处于中低水平,社会支持程度较国内常模高,应对策略较国内常模差,有效的社会支持系统及应对方式有助于提高头颈部肿瘤患者生存质量.     

浅表性膀胱癌患者医学应对现状及其影响因素分析

目的:探讨浅表性膀胱癌患者医学应对现状及其影响因素。方法:采用一般调查表和医学应对问卷(MCMQ)量表对120例浅表性膀胱癌患者进行调查。结果:浅表性膀胱癌患者面对因子得分低于常模,回避、屈服因子得分高于常模(P0.05);性别、文化程度、化疗阶段和手术方式是影响患者应对方式的主要因素(P0.05)。结论:浅表性膀胱癌术后患者应对方式受多种因素影响,医护人员应根据患者特点指导并帮助患者采取积极应对方式。     

腹膜透析患者应对方式与生存质量状况及其相关性分析

目的探讨持续非卧床腹膜透析患者应对方式和生存质量状况及其相关关系。方法采用医学应对问卷（medical copingmodes questionnaire,MCMQ）及生存质量量表（medical outcomes study 36-item short form survery,SF-36）分别对腹膜透析治疗超过3个月患者进行调查。了解患者应对方式和生存质量状况及其相关关系。结果腹膜透析患者应对方式中的＂面对＂维度得分为（18.28±3.86）分,低于常模,＂回避＂与＂屈服＂维度得分分别为（15.74±2.61）分与（11.10±4.77）分,高于常模,组间比较,差异具有统计学意义（均P〈0.05）。腹膜透析患者生存质量得分低于正常人群,组间比较,差异具有统计学意义（均P〈0.05）。相关性分析表明：生存质量与应对方式中的＂面对＂维度呈正相关,而与＂屈服＂维度呈负相关（均P〈0.05）。结论腹膜透析患者倾向于采取＂屈服＂的应对方式,其生存质量低于正常人群;采用＂面对＂应对方式者,其生存质量较好,采用＂屈服＂应对方式,其生存质量较差。教育患者应采用＂面对＂应对方式,提高其生存质量。     

肝硬化患者医学应对方式与社会支持的相关性

目的探讨肝硬化患者的医学应对方式及其与社会支持之间的相关性。方法选取2006年10月至2008年6月在我院住院的115例肝硬化患者,按肝硬化类型将其分为病毒性肝硬化组和酒精性肝硬化组。以医学应对问卷及社会支持问卷为调查工具,对两组肝硬化患者进行社会支持及应对方式的调查,分析其相关性。结果两组肝硬化患者应对方式有差异性,病毒性肝硬化组与常模比较,面对应对得分低于常模（P〈0．05）,回避屈服应对得分高于常模（P〈0．05）。酒精性肝硬化组与病毒性肝硬化组比较,采用面对应对得分高（P〈0．05）,采用回避应对得分低（P〈0．05）。肝硬化患者社会支持与面对应对呈正相关,与回避屈服呈负相关。结论肝硬化患者医学应对方式与社会支持密切相关,护理人员高度重视为肝硬化患者提供社会支持,寻求干预对策,改善其应对方式,提高他们的远期生存质量。     

中老年类风湿关节炎患者应对方式及其影响因素

目的调查中老年类风湿关节炎患者的应对方式,并探讨其相关影响因素。方法采用目的抽样法收集中老年类风湿关节炎患者172例,利用一般资料调查问卷、医学应对方式问卷(medical coping style questionnaires,MCMQ)、医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)、罗森伯格自尊量表(Rosenberg self-esteem scale,RSES)与社会支持量表(the social support scale,SSRS)对患者进行问卷调查。结果中老年类风湿关节炎患者回避与屈服应对方式得分均高于常模(P0.01),但面对应对方式得分明显低于常模(P0.01);其中面对维度得分与性别、年龄及社会支持有关;回避维度得分与婚龄、焦虑及自尊有关;屈服应对方式的影响因素包括病程、焦虑、抑郁、自尊与社会支持(均P0.05)。结论中老年类风湿关节炎患者更倾向于选择消极的应对方式,临床工作中医护人员应及时评估中老年类风湿关节炎患者的应对方式并给予相应干预措施,帮助患者采取积极的应对方式,提高整体的生活质量。     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.