北京三级甲等综合医院急诊科护士道德困境与职业倦怠相关性分析

目的 :描述北京市三级甲等综合医院急诊科护士的道德困境、职业倦怠现状,分析两者相关性。方法:用便利抽样法选取北京市六大城区7所三级甲等综合医院的256名急诊科护士为研究对象,采用一般资料问卷、中文版护士道德困境量表、护士职业倦怠问卷进行调查。结果 :急诊科护士的道德困境得分为(60.43±16.07)分,职业倦怠得分为(63.41±16.23)分。不同轮班情况(t=1.917,P=0.018)、学历(F=3.091,P=0.047)的急诊护士道德困境得分差异有统计学意义;不同工作年限(F=4.097,P=0.007)、编制情况(F=4.391,P=0.013)的急诊护士职业倦怠得分差异有统计学意义。道德困境与职业倦怠相关系数为0.323(P0.001)。结论 :北京市三甲综合医院急诊科护士普遍存在道德困境和职业倦怠的困扰且两者之间相互影响。建议护理管理者从多方面入手协助护士降低职业倦怠,促进护理队伍健康持续发展。     

郑州市三甲医院急诊科护士道德困境与职业倦怠的现状及相关性研究

目的 调查郑州市三甲医院急诊科护士的道德困境与职业倦怠的现状,并分析两者之间的相关性。方法 采用便利抽样法选取郑州市5所三甲医院的228名急诊科护士作为研究对象,采用一般资料调查表、中文版护士道德困境量表、护士职业倦怠量表对其进行问卷调查。结果 郑州市三甲医院急诊科护士道德困境总分为(49.41±13.35)分,职业倦怠总分为(63.51±17.25)分。单因素分析显示,不同学历、工作年限的急诊护士的道德困境得分比较,差异均有统计学意义(F=4.830,P=0.015; F=6.302,P=0.001);不同年龄急诊护士的职业倦怠得分比较,差异有统计学意义 (F=8.328,P=0.005),急诊科护士道德困境与职业倦怠呈正关性(r=0.412,P<0.05)。结论 郑州市三甲医院急诊科护士的道德困境与职业倦怠普遍存在,护士的道德困境与职业倦怠呈正相关。     

重症监护病房护士道德困境水平现状及其与医院伦理氛围和心理授权的相关性

目的调查重症监护病房(intensive care unit,ICU)护士道德困境现状,探讨医院伦理氛围、心理授权对护士道德困境水平的影响。方法 2019年1-3月,便利抽取天津市8所三级甲等医院242名ICU护士作为研究对象,采用中文版护士道德困境量表、医院伦理氛围量表和心理授权量表对其进行调查。结果不同工作年限和子女状况的ICU护士,其道德困境水平的差异均有统计学意义(均P0.05);医院伦理氛围和心理授权均与道德困境水平呈负相关(P0.05);回归分析显示,医生、ICU工作年限以及管理者对ICU护士道德困境水平影响较大,三者可共同解释道德困境的19.1%。结论 ICU护士道德困境水平较高,伦理和道德问题对护士身心以及护理团队建设都具有消极影响。管理者应该重视伦理道德问题对ICU护士的影响,创建和谐积极的团队工作氛围,合理配置人力资源与心理授权,以降低护士道德困境水平,稳定护理队伍。     

护士道德困境与同情心疲乏的相关性研究

目的调查护士道德困境与同情心疲乏的现状,并分析二者的关系,为护理管理者有效应对护士道德困境和同情心疲乏提供依据。方法采用护士道德困境量表和专业生活质量量表对湖州市某三级乙等综合医院240名护士进行问卷调查。结果临床护士道德困境评分为(1.61±0.46)分;护士继发性创伤应激(20.76±5.02)分,工作倦怠(24.83±5.73)分,同情心满足(29.68±5.96)分。护士道德困境与同情心疲乏中工作倦怠、继发性创伤应激呈正相关(P0.01或P0.05)。结论护士的道德困境处于轻度水平,有发生同情心疲乏的危险,且护士道德困境与同情心疲乏呈正相关;提示护理管理者应采取针对性教育,克服道德困境,降低护士同情心疲乏的发生,以促进医护人员的身心健康,保证临床护理质量。     

感染科护士道德困境与护理组织氛围相关性研究

目的调查了解感染科护士道德困境与护理组织氛围现状,并分析两者之间的关系。方法研究者于2020年6月—10月采用便利抽样法选取广州市8所医院的286名感染科护士作为研究对象,采用一般人口学资料问卷、中文版护士道德困境量表与护理组织氛围量表进行调查。结果感染科护士中文版护士道德困境量表得分为(53.53±29.60)分;护理组织氛围量表总的条目均分为(3.41±0.47)分;感染科护士的道德困境与护理组织氛围呈负相关(P<0.01)。结论感染科护士的护理组织氛围与道德困境均处于中等水平,护理管理者可以通过提高感染科护士的工作氛围,降低其道德困境水平,从而稳定感染科护士队伍。     

长沙市三级甲等综合医院护士道德困境现状及其影响因素分析

目的:调查长沙市三级甲等综合医院护士的道德困境现状,并对其影响因素进行分析,旨在为改善护理管理工作,针对性加强道德困境干预,维持护理工作队伍的稳定提供参考。方法:便利选取长沙市3所三级甲等综合医院临床科室的378名护士作为研究对象,采用中文版护士道德困境量表进行调查。结果:护士道德困境总分为(53.42±29.91)分,道德困境频率条目得分(1.44±1.00)分,强度条目得分(1.63±1.16)分,表明护士道德困境处于较低水平。无效护理和为患者提供虚假希望是护士道德困境的主要来源;年龄、职务、所在科室对护士的道德困境水平造成影响(P0.05)。结论:护理管理者应当重视护士所遭遇的道德困境,加强伦理和法律知识教育,及时与护士进行沟通,改善护理人力资源配置,缓解护士的道德困境水平。     

急诊科护士职业倦怠与气质类型相关性调查

目的:调查急诊科护士气质类型及心理现状,分析气质类型与心理现状的相关性,为护理管理者合理调配急诊科护士及新护士入院分科提供借鉴和依据。方法:采用随机整群抽样的方法,抽取三级甲等综合性公立医院急诊科护士102名,进行问卷调查。结果:102名护士均存在工作倦怠。多血质得分与情绪衰竭得分存在负相关(P0.05),抑郁质得分与情绪衰竭得分存在正相关(P0.05)、与玩世不恭得分存在显著正相关(P0.01)、与成就感降低得分存在显著负相关(P0.01)。结论:抑郁质及有抑郁倾向的护士不适合急诊工作,有明显的工作倦怠,而多血质及有多血质倾向的护士较适合急诊工作。     

肿瘤科护士道德困境对职业倦怠的影响

[目的]了解肿瘤科护士职业倦怠与道德困境的现状,分析探究护士道德困境对职业倦怠的影响,为降低肿瘤科护士道德困境与职业倦怠提出建议。[方法]选取5省14所三级医院肿瘤科护士483名,采用一般资料问卷、护士道德困境量表与护士职业倦怠量表进行调查,并对结果进行分析。[结果]护士职业倦怠得分为(52.39±19.45)分,处于较高水平。护士道德困境发生频率和困扰程度得分分别为(1.28±0.66)分和(1.34±0.83)分,处于较高水平;护士道德困境与职业倦怠总分呈正相关(r=0.360,P0.01)。分层回归分析显示年龄、加班次数以及道德困境总分对护士职业倦怠有影响(P0.05)。[结论]肿瘤科护士道德困境与职业倦怠处于较高水平,护士道德困境水平高则其职业倦怠水平也高。     

杭州市三级甲等医院急诊科护士工作嵌入现状及影响因素分析

目的 了解急诊科护士工作嵌入现状并探讨其影响因素,为管理者制订留职策略和培养急诊护理人才提供依据。方法 2021年11月至2022年5月,采用便利抽样法选取杭州市6所三级综合性医院的267名急诊科护士为研究对象,采用工作嵌入量表、护士工作环境量表和心理资本量表等对其调查。结果 急诊科护士工作嵌入总分为(70.52±13.72)分,护士工作环境总分为(92.52±16.10)分,心理资本总分为(87.41±17.45)分。不同年龄、职位、聘用方式、工作年限、平均月收入和每月夜班频次的急诊科护士工作嵌入的得分差异均有统计学意义(均P<0.05)。急诊科护士工作环境总分与工作嵌入总分呈正相关(r=0.866,P<0.01)。护士工作环境、心理资本和平均月收入是影响急诊科护士工作嵌入的主要因素,可解释急诊科护士工作嵌入总变异程度的77.8%。结论 急诊科护士工作嵌入处于中等偏上水平。管理者可从改善护理工作环境、完善薪资收入和不断开发心理资本等方面,提升急诊科护士工作嵌入水平。     

急诊科护士留职意愿与职业承诺、护士长领导方式的相关性

目的探讨急诊科护士留职意愿、职业承诺与护士长领导方式的现状及相关性。方法采用便利取样法选择广州市3所三级甲等综合医院130名急诊科护士进行问卷调查,了解急诊科护士留职意愿、职业承诺与护士长领导方式现状。结果急诊科护士留职意愿、职业承诺总分分别为（20．19±3．74）分、（76．16±12．13）分,均处于中等水平;急诊科护士长领导方式以变革型方式为主,职业承诺、护士长领导方式与护士留职意愿呈正相关（均P〈0．05）;护士急诊工作年限、情感承诺、规范承诺可作为预测急诊科护士留职意愿的主要因素（多重线性回归方程共解释护士留职意愿全部变异的38．7％）。结论急诊科护士留职意愿、职业承诺均处于中等水平;急诊科护士长以变革型领导方式为主;急诊护士工作年限、情感承诺、规范承诺是影响急诊护士留职意愿的主要因素。护理管理者应提高护士职业承诺水平,以提升急诊科护士的留职意愿,进而稳定护士队伍,有助于人才的健康发展。     

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.