河南省某中医药院校本科护生职业价值观、人文关怀能力及同理心的关系

目的:探讨本科护生职业价值观、人文关怀能力及同理心之间的关系,为中医药院校护生的职业价值观教育提供参考。方法:2021年10月—2021年12月,采用一般资料调查表、护士职业价值观量表、人文关怀能力评价量表及同理心量表对河南省某中医药院校811名本科护生进行问卷调查。结果:本科护生的职业价值观总分为(96.64±13.84)分,不同年级、是否曾担任学生干部、家庭对本人所学专业支持程度的护生职业价值观不同(P<0.05);护生职业价值观、人文关怀能力及同理心两两呈正相关(P<0.05);人文关怀能力在本科护生职业价值观与同理心之间起部分中介作用,中介效应占总效应的20.6%。结论:在校护生的职业价值观呈中等水平,需要进一步提升。人文关怀能力在同理心与职业价值观之间起到部分中介作用,增强护生的同理心和人文关怀能力有助于提高其职业价值观水平。     

高职护生人文关怀能力、职业成熟度现状及其相关性研究

目的:了解高职护生人文关怀能力、职业成熟度的现状及其相关性.方法:采用人文关怀能力量表和职业成熟度量表对206名高职护生进行问卷调查.结果:高职护生的人文关怀能力总分为(181.32±20.37)分;职业成熟度量表总分为(111.88±13.01)分.职业成熟度与人文关怀能力呈正相关(r=0.583,P<0.01).结论:高职护生职业成熟度和人文关怀能力处于中低水平,护理教育者应重视两者重要性和相关性,采取针对性的措施提升护理教育质量.     

职业自我效能在本科护生人文关怀能力与职业认同间的中介作用分析

目的：分析职业自我效能在本科护生人文关怀能力与职业认同之间的中介作用，为教育者提高本科护生的职业认同水平提供依据。方法：通过便利抽样法，选取河南科技大学护理学院570名护理本科生为研究对象，通过一般资料问卷、职业自我效能量表、人文关怀量表及职业认同量表进行调查。结果：本科护生职业自我效能得分为（92.74±14.14）分，人文关怀能力得分为（168.53±21.52）分，职业认同得分为（60.41±10.87）分，职业自我效能在人文关怀能力与职业认同间的中介效应值为0.166，占总效应的81.8%。结论：本科护生的职业自我效能在人文关怀能力及职业认同间有部分中介效应，管理者可通过人文关怀能力的培养，增强职业自我效能感，提升其职业认同水平。     

本科实习护生人文关怀能力与职业获益感及主观幸福感的相关性分析

目的 探讨本科实习护生人文关怀能力与职业获益感及主观幸福感相关关系。方法 采用一般资料问卷、关怀能力评价量表、护生职业获益感量表、总体幸福感量表对某三级甲等医院94名本科实习护生进行调查。结果 94名本科护生人文关怀能力总分为(193.79±23.97)分,处于中等水平;职业获益感总分为(125.83±15.00)分;主观幸福感总分为(83.28±13.11)分;本科实习护生人文关怀能力与职业获益感、主观幸福感总分均呈密切正相关(r=0.611~0.711,均P<0.01)。结论 本科实习护生人文关怀能力处于中等水平,人文关怀能力与护生职业获益感、主观幸福感呈密切正相关。护理教育者及管理者应关注实习护生职业获益感与主观幸福感水平,并加以干预,从而间接提高其人文关怀能力。     

手术室本科实习护生人文关怀能力、积极心理资本与主观幸福感之间的关系研究

目的探讨手术室本科实习护生人文关怀能力与积极心理资本及主观幸福感之间的关系。方法选取2015年2月至2016年1月在本院实习的手术室本科护生100名,实习期间采取积极心理资本问卷、关怀能力评价量表、总体幸福感量表对手术室本科实习护生进行调查、评估。结果在本院实习的100名手术室本科实习护生人文关怀总分(193.13±22.44)分,处于较低的水平,其积极心理资本、人文关怀能力、主观幸福感具有正相关性的关联(P<0.05)。结论在对手术室本科实习护生进行培训时,需重视本科护生的心理资本,从提高其主观幸福感入手,以此提升人文关怀水平,提高医护人员的职业素养和服务水平。     

本科护生共情能力与人文关怀能力的相关性研究

目的:了解本科护生共情能力现状,分析共情能力与人文关怀能力的相关性。方法:采用一般资料调查问卷、护生共情能力问卷、人文关怀能力问卷对衡阳市某大学245名本科二年级护生进行调查。结果:在校护生共情能力得分(111.98±13.31)分、人文关怀能力得分(167.00±16.71)分;影响护生共情能力的社会学因素包括对护理专业的喜爱程度、护生在校参加社会活动的情况、家庭教育的类型、是否是独生子女;护生共情能力与人文关怀能力总分之间呈相关性(P0.01)。结论:本科护生共情能力与人关怀能力呈正相关关系,护理教育者可以结合二者的共性,在教学中融合人文关怀和共情能力,达到共情能力和人文关怀能力共同提高的效果。     

新升格本科院校护生人文关怀能力现状及影响因素

目的了解新升格本科院校护生人文关怀能力现状及影响因素。方法采用人文关怀能力量表和大学生专业承诺量表对184名护理本科生进行调查。结果护生人文关怀能力得分为(171.01±12.96)分,低于国内常模,并与专业承诺呈正相关;专业承诺作为重要影响因素,可解释人文关怀能力16.60%的变异量。结论新升格本科院校处于特殊的转型时期,护生人文关怀能力总体偏低,应增加人文关怀教育的投入,重视对护生专业态度的引导和专业承诺的提高,促进其人文关怀能力的提升。     

本科及硕士实习护生临床护理职业吸引力与职业期望现状及其相关性

目的解本科及硕士实习护生临床护理职业吸引力与职业期望现状,并探讨二者的相关性。方法采用一般资料调查表、职业吸引力量表、职业期望量表对60名本科实习护生和25名硕士实习护生进行调查。结果本科及硕士实习护生临床护理职业吸引力总分(9.91±2.84)分,其分别得分为(11.77±2.04)分、(7.15±2.33)分;职业期望总分(81.83±12.72),其分别得分为(79.04±12.76)分、(76.39±12.10)分,本科实习护生临床护理职业吸引力与职业期望得分均较硕士实习护生高(P=0.001,P=0.043)。本科及硕士实习护生临床护理职业吸引力与职业期望呈正相关(P0.05)。结论本科及硕士实习护生临床护理职业吸引力处于较低水平;职业期望处于中等偏高水平,其中本科实习护生临床护理职业吸引力与职业期望均较硕士实习护生高;实习护生临床护理职业吸引力与职业期望呈正相关。加强护生职业价值观的引导;注重临床带教和理论教学相对接,以提高护生对临床护理职业的认同感,进而提高其职业期望水平,从而稳定护理队伍。     

"关怀日记"在本科实习护生关怀能力培养中的应用

[目的]探讨"关怀日记"在本科实习护生关怀能力培养中的应用效果。[方法]整群随机抽取在海南省人民医院、海南医学院第一附属医院、海南医学院第二附属医院、海口市人民医院实习的本科实习护生120人,随机分为观察组和对照组,对照组按各自医院要求进行实习,观察组在对照组的基础上在每个科室书写关怀日记,运用护士人文关怀品质测评量表对两组护生进行评价。[结果]干预后观察组护生人文关怀品质总分为(134.37±2.00)分,人文关怀理念得分为(32.50±1.03)分,人文关怀知识得分为(32.62±0.98)分,人文关怀能力得分(32.65±0.95)分,人文关怀感知得分为(36.6±0.98)分,总得分及各维度得分均高于对照组(P0.05)。[结论]在实习期间让护生书写关怀日记可以培养本科护生的人文关怀品质。     

实习中期护生人文关怀能力与同理心的相关性研究

[目的]探讨实习中期护生人文关怀能力与同理心水平,明确两者之间的关系及影响人文关怀能力的因素,为改进临床教学方法,进一步提高实习护生人文关怀能力提供参考资料。[方法]采用实习护生人文关怀能力评价量表(HCANU)、Jefferson同理心量表-中文版(JSE-CV)对98名实习中期护生进行问卷调查。[结果]实习中期护生的人文关怀能力及同理心总体处于中上等水平,得分分别为(70.17±8.04)分和(105.86±13.41)分;其中,同理心与人文关怀能力总分及灌输信念和希望、人道及利他价值观、提供良好环境、促进情感交流4个维度呈正相关(P<0.01),且表现出较强的预测能力(P<0.05)。[结论]提高实习护生的同理心、改善实习环境、培养职业价值感等可有效提高其人文关怀能力,为建立人文关怀能力的临床培养路径提供了参考依据。     

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.