综合医院住院肿瘤患者自杀特点分析与干预

目的分析综合医院住院肿瘤患者的自杀特点,为预防肿瘤患者自杀提供参考依据。方法对2009年~2013年本院发生的13例住院肿瘤患者自杀事件进行回顾性调查,分析发生自杀行为的住院肿瘤患者的护理安全不良事件登记报告表和病历资料,并对知晓自杀事件的医护人员进行调查和访谈。结果住院肿瘤患者自杀前有明显的抑郁心理或流露出自杀意念,肿瘤患者自杀居全院住院自杀患者的第1位;长期严重的癌痛折磨导致晚期肿瘤患者自杀;经济压力过重的肿瘤患者易产生自杀意念。结论采取自杀行为的肿瘤患者具备一定的特征,可以有针对性地采取积极有效的干预措施,建立自杀高危患者的心理评估体系,及早识别抑郁心理障碍;加强疼痛护理,有效控制癌痛;倡导死亡教育,预防不合理性自杀;加强医院安全管理,预防自杀未遂者再次自杀。这些措施都能减少或防止住院肿瘤患者自杀的发生。     

自杀风险管理方案在综合医院住院患者中的应用

目的 探讨自杀风险管理方案在综合医院住院患者中的应用。方法 分析54例住院患者自杀的原因,从患者、医护人员、组织管理3方面制订并实施综合医院住院患者自杀风险管理方案,包括成立自杀预防小组,分析住院患者自杀原因、开展患者自杀预防教育,加强医护人员自杀知识和心理干预技能的培训,改善住院患者物理环境,制订自杀预防及处理应急预案。结果2016年1月—2017年12月,共举办患者心理护理、自杀预防会议12次,共1 600余例患者及家属参加学习。开设自杀预防健康教育宣传栏12次,开展全院护士心理护理、自杀预防培训8次,共2 000余名医护人员参加。召开全院患者自杀事件案例分析讨论会10次,自杀预防相关知识专题讲座5次,对病房窗户、刀具、药品检查20次,召开高危科室患者自杀事件案例讨论会8次,患者自杀预防多学科协作会议4次。方案实施后,患者自杀行为发生率从5.0/10万下降至2.3/10万,成功预防自杀行为4例。结论 自杀风险管理方案的实施,加强了对患者心理健康、自杀预防的教育,增强了护士对患者自杀防范意识和风险管理能力,制订了系统规范化的自杀预防管理措施,达到了减少患者自杀事件发生和保障患者安全的目的。     

不同年代住院精神病患者自杀的相关因素及护理策略

目的 了解不同年代住院精神病患者自杀的相关因素,探索预防精神病患者自杀的护理策略.方法 回顾性调查1961～2000年住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素.结果 各种精神疾病患者自杀率差异无显著性(P>0.05);自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重、负性生活事件和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势(P<0.01).结论 做好风险评估和实施预见性护理,在控制病情的基础上加强监管等综合护理措施,有利于预防住院精神病患者自杀.     

不同年代住院精神病患者自杀的相关因素及护理策略

目的：了解不同年代住院精神病患者自杀的相关因素,以探索有效的预防精神病患者自杀的护理策略。方法：回顾性调查1961年～2000年32例不同年代住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素。结果：各种精神疾病患者自杀率差异无显著性（P〉0.05）;自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势（P〈0.01）。结论：做好风险评估和实施预见性护理,控制病情,加强监护管理等综合护理措施,有利于预防住院精神病患者自杀行为。     

不同年代住院精神病患者自杀的相关因素及护理策略

目的：了解不同年代住院精神病患者自杀的相关因素,以探索有效的预防精神病患者自杀的护理策略。方法：回顾性调查1961年～2000年32例不同年代住院精神病患者的自杀原因,并采用Logistic回归分析患者自杀的危险因素。结果：各种精神疾病患者自杀率差异无显著性（P〉0.05）;自杀与精神病理症状有关;既往有自杀史、负性生活事件、家庭成员有自杀史、病情严重和社会支持不足,是住院精神病患者发生自杀的危险因素;治疗依从性好是患者自杀的保护因素;各年代自杀率呈下降的趋势（P〈0.01）。结论：做好风险评估和实施预见性护理,控制病情,加强监护管理等综合护理措施,有利于预防住院精神病患者自杀行为。     

建设和发展军事护理学科的思考

论述了当前形势下,加强军事护理学科建设的对策。在人才建设方面,要重视军事护理学科带头人的培养、优化军队护理队伍学历结构、提升军队护理队伍整体综合素质;在护理教育方面,要完善军事护理学教学体系、加强军事护理学知识与技能培训、加强军事素质和心理素质培养;在护理研究方面,要加强军事护理学理论与实践研究、加强军事护理技术和装备研究、加强军事护理管理研究,促进军事护理学科快速发展。     

住院精神分裂症患者安全隐患分析及对策

采用回顾性资料分析方法，对40例患者发生自杀、自伤、伤人、逃跑的相关因素进行分析。认为护理管理、护理人员素质、病区设施方面存在易造成自杀、自伤、伤人、逃跑的危险因素。针对精神分裂症患者住院期间安全隐患给予护理对策，严格执行病房安全管理制度，加强分级管理和心理护理，加强护理人员素质培养，加强病区设施管理，可以保证住院患者安全、减少护理纠纷、提高护理质量。     

5M1E分析法在住院患者自杀危险因素分析及预防中的应用

目的：分析影响住院患者自杀的相关危险因素,为减少住院患者自杀、加强医院护理安全管理提供理论依据。方法回顾性分析2009年1月—2013年12月某三甲医院住院患者自杀的相关数据资料,利用描述性统计分析方法,结合5M1E分析法对数据资料从人员、机器、材料、方法、测量与环境6个方面进行分析。结果从人员角度,医务人员自杀认知水平低,患者存在程度不同的人格障碍、认知缺陷或缺乏社会支持等,家属对患者的陪伴不够;从机器角度,医院的门窗等设施存在缺陷;从材料角度,住院患者较易获得自杀工具;从方法角度,医院管理存在薄弱环节,缺乏自杀评估及防御机制;从测量角度,缺乏科学的心理评估及心理干预体系;从环境角度,医院物理和人文环境的管理欠缺。结论通过5 M1 E分析法全面分析住院患者自杀的相关危险因素,并提出有针对性的预防措施,以避免或减少住院患者自杀,提高医院护理安全质量。     

精神病患者住院前后自杀行为分析及护理干预

目的:分析精神病患者自杀的潜在危险因素,探讨如何从护理角度进一步预防住院精神病患者的自杀行为。方法:对2004年1月至2008年12月住院且在住院前后有自杀史的258例患者的临床资料进行回顾性分析。结果:258例患者住院前的自杀方式以服毒、自缢、割腕、跳楼居多,住院后的自杀方式以自缢居多;出院后自杀成功7例,住院期间自杀成功1例。结论:住院精神病患者自杀具有一定的规律性,通过增强护理防范意识,及早对患者实施有针对性的护理干预,可预防、降低患者的自杀成功率。     

精神科住院抑郁症患者自杀预防及护理干预措施专家共识

目的 形成《精神科住院抑郁症患者自杀预防及护理干预措施专家共识》,规范精神科住院抑郁症患者自杀护理干预措施。 方法 运用循证方法及文献分析法提取住院抑郁症患者自杀护理干预措施推荐建议和研究结论,形成共识初稿,通过2轮专家函询及2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。 结果 2轮函询专家积极系数均为100%,专家权威系数均为0.924,各指标重要性赋值均数均>3.5分,且变异系数均<0.25,专家肯德尔和谐系数分别为0.182和0.260（均P<0.01）。最终对精神科住院抑郁症患者自杀护理干预操作性定义、自杀风险评估、干预形式、干预时间、干预理论基础、干预一般原则、自杀意念的干预措施、自杀行为的干预措施、特殊人群自杀护理干预要点、干预效果评价及出院后的健康教育计划共11个部分的内容达成一致意见。 结论 该共识为精神科住院抑郁症患者自杀护理干预措施提供指导依据,使精神科住院抑郁症患者的自杀护理干预更规范。     

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.