急诊科护士工作压力源与心理健康状况的调查研究

目的 了解急诊科护士的工作压力源、心理健康状况及其相关性,以帮助管理层及护士正确认识并减少工作压力,提高急诊科护士急救应急水平及临床护理质量.方法 采用护士工作压力源量表、症状自评量表(SCL-90)对4所三级甲等医院100名急诊科护士进行问卷调查.结果 SCL-90各因子得分均高于常模(P<0.01,P<0.05),表明急诊科护士的心理健康水平处于相对不健康状态.SCL-90总分及各因子得分与工作压力源呈正相关,主要压力源来自护理专业及工作方面的问题、工作量及时间分配问题和病人护理方面的问题.不同学历与压力源得分比较无显著性差异(P>0.05).结论 急诊科护士存在着多种压力源及影响心理健康的因子,应引起医院管理层的关注和重视,采取积极的应对措施,以提高医院急诊科急救应急水平及临床护理质量,为急诊患者提供更优质的护理服务.     

肿瘤科护士压力现状调查与情商培养

[目的]探讨肿瘤科护士心理健康状况与压力源,为预防和降低肿瘤科护士的职业压力提供理论依据。[方法]抽取华中科技大学同济医学院附属同济医院肿瘤科的134名临床护士,选用人口资料调查统计表、护士工作压力源量表(NJSQ)和症状自评量表(SCL-90)进行调查。[结果]肿瘤科护士受自身、病人、工作环境等方面影响,普遍存在如焦虑、强迫症等心理问题。[结论]从深层次看护士心理问题和不良情绪来源于情商的缺乏,提出通过自我修养、团队互助和医院教育等情商培养措施减少护士的不良情绪,保证护士的身心健康和提高临床护理质量。     

手术室护士心理健康情况及精神压力源相关性研究

目的 探讨手术室护士心理健康情况及压力源情况,并研究了两者之间的关系.方法 采用症状自评量表(symptom check list 90,SCL-90)及中国护士工作压力源量表对103名手术室护士进行问卷调查.结果 手术室护士SCL-90各因子得分从高到低顺序为强迫症状(1.99±0.44)分,敌对(1.88±0.36...     

儿科急诊护士心理压力分析及对策

目的了解儿科急诊护士在工作中面对职业压力时对身心健康可能造成的影响.方法采用国际通用症状自评量表(symptom check-list 90,SCL-90),对79名护士进行问卷调查.结果在9个因子中,儿科急诊护士有7个因子均数高于常模,这与儿科急诊紧张、繁忙的工作,嘈杂的环境,缺乏安全感,缺乏社会支持有关.结论儿科急诊护士在工作中存在许多心理压力源,护理管理者应给予足够的重视,合理排班,定期轮换,减轻工作中的疲劳感,建立护理人员支持系统,进行心理健康知识培训,提高护理人员的心理调适能力,创造良好的工作环境和工作氛围.     

某医院护士的心理健康水平及其影响因素

目的了解护士的心理健康状况,探讨影响护士身心健康的相关因素。方法采用SCL-90症状自评量表、护士工作压力源量表及自行设计的个人一般情况调查表,对某医院248名护士进行问卷调查。结果护士心理健康水平与中国常模比较,除人际关系外,其余各类因子得分均高于中国常模,有显著性差异(P<0.05)。本次测评检出248名护士中符合筛查阳性标准者58人,占23.4%;不同科室护士SCL-90各类症状因子分比较,各科室间有显著性差异(P<0.01),尤其外科、儿科、ICU监护室心理健康水平偏低;工作压力源与心理健康因子分呈显著正相关,与心理健康水平呈负相关。结论护理工作的性质及特点决定了护士的心理压力,护士的工作压力和心理健康水平显著相关。目前护士的心理健康水平现状不容乐观,呼吁全社会关心和爱护护士,提高她们的社会地位。     

儿科急诊护士心理压力分析及对策

目的 了解儿科急诊护士在工作中面对职业压力时对身心健康可能造成的影响.方法 采用国际通用症状自评量表（symptom check-list 90,SCL-90）,对79名护士进行问卷调查.结果 在9个因子中,儿科急诊护士有7个因子均数高于常模,这与儿科急诊紧张、繁忙的工作,嘈杂的环境,缺乏安全感,缺乏社会支持有关.结论 儿科急诊护士在工作中存在许多心理压力源,护理管理者应给予足够的重视,合理排班,定期轮换,减轻工作中的疲劳感,建立护理人员支持系统,进行心理健康知识培训,提高护理人员的心理调适能力,创造良好的工作环境和工作氛围.     

某医院护士的心理健康水平及其影响因素

目的 了解护士的心理健康状况,探讨影响护士身心健康的相关因素.方法 采用SCL-90症状自评量表、护士工作压力源量表及自行设计的个人一般情况调查表,对某医院248名护士进行问卷调查.结果 护士心理健康水平与中国常模比较,除人际关系外,其余各类因子得分均高于中国常模,有显著性差异(P＜0.05).本次测评检出248名护士中符合筛查阳性标准者58人,占23.4%;不同科室护士SCL-90各类症状因子分比较,各科室间有显著性差异(P＜0.01),尤其外科、儿科、ICU监护室心理健康水平偏低;工作压力源与心理健康因子分呈显著正相关,与心理健康水平呈负相关.结论 护理工作的性质及特点决定了护士的心理压力,护士的工作压力和心理健康水平显著相关.目前护士的心理健康水平现状不容乐观,呼吁全社会关心和爱护护士,提高她们的社会地位.     

儿科重症监护室护士压力源的调查分析

目的了解儿科重症监护室(ICU)护士的主要工作压力源,提出相应对策。方法于2012年1—6月,采用一般资料问卷及ICU护士压力源量表,调查复旦大学附属儿科医院ICU护士120名。内容包括护理专业及工作方面问题,工作量及时间分配问题,患儿护理问题,工作环境及仪器设备问题以及管理与人际关系问题。结果护理专业及工作方面的问题压力最大,平均得分(2.97±0.57)分;其次为工作量及时间分配问题,平均得分(2.83±0.38)分;患儿护理方面的问题,平均得分(2.75±0.41)分;工作环境及仪器设备问题,平均得分(2.16±0.16)分;管理及人际关系方面的问题,平均得分(2.04±0.29)分。护士所感知的前5项压力源分别为:工作量太大,经常倒班,护士工作未被患者及家属承认,担心工作中出现差错事故,工资及其他的福利待遇低。结论儿科ICU护士整体压力较大,管理者可通过减轻护理工作强度、实施科学弹性排班、加强护士职业技能训练、改善护士待遇和提高社会支持等措施缓解护士压力,以促进其身心健康,进而提高护士的工作效率及护理质量。     

急诊抢救室护士工作压力源与幸福感的相关性研究

目的 调查三级甲等综合医院急诊抢救室护士工作压力源及幸福感现状，并探讨两者之间的关系。方法 选取北京市6所三级甲等综合医院的201名急诊抢救室护士作为研究对象，采用护士工作压力源量表和幸福感指数量表对其进行调查。结果 急诊抢救室护士的护士工作压力源量表条目均分为(2.59±0.48)分。急诊抢救室护士幸福感指数量表条目均分为(3.90±1.29)分。不同管理模式下急诊抢救室护士在护理专业及工作方面的问题、时间分配及工作量的问题、患者护理方面的问题、管理及人际关系方面的问题等维度上的得分和护士工作压力源量表总分及幸福感指数量表总分差异有统计学意义(P<0.05)。急诊抢救室护士的护士工作压力源量表总分与幸福感指数量表总分呈负相关(r=0.622,P<0.01)。结论 急诊抢救室护士工作压力较大，幸福感较低，护理管理者应针对不同方面采取相应措施来减轻压力，提升其幸福感。     

某医院护士的心理健康水平及其影响因素

目的了解护士的心理健康状况,探讨影响护士身心健康的相关因素。方法采用SCL-90症状自评量表、护士工作压力源量表及自行设计的个人一般情况调查表,对某医院248名护士进行问卷调查。结果护士心理健康水平与中国常模比较,除人际关系外,其余各类因子得分均高于中国常模,有显著性差异（P〈0.05）。本次测评检出248名护士中符合筛查阳性标准者58人,占23.4%;不同科室护士SCL-90各类症状因子分比较,各科室间有显著性差异（P〈0.01）,尤其外科、儿科、ICU监护室心理健康水平偏低;工作压力源与心理健康因子分呈显著正相关,与心理健康水平呈负相关。结论护理工作的性质及特点决定了护士的心理压力,护士的工作压力和心理健康水平显著相关。目前护士的心理健康水平现状不容乐观,呼吁全社会关心和爱护护士,提高她们的社会地位。     

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.