安宁疗护从业人员安宁疗护知信行现状及影响因素分析

目的 调查安宁疗护从业人员安宁疗护知信行现状并分析其影响因素,为安宁疗护教育培训提供参考.方法 采用 自行设计的安宁疗护从业者安宁疗护知信行问卷,选取1 743名安宁疗护从业人员进行调查.结果 安宁疗护从业者安宁疗护知信行总分为(74.28±8.12)分;学历、身体状况、月收入、对工作强度满意程度、安宁疗护管理制度为安宁疗护从业人员安宁疗护知信行水平的主要影响因素(P＜0.05,P＜0.01).结论 安宁疗护从业者安宁疗护知信行处于中等水平,均有提升空间,管理者需重视对安宁疗护从业者的培训,健全安宁疗护有关制度,提高从业人员的安宁疗护水平和服务质量.     

医护人员的临终关怀态度和安宁疗护行为调查

目的 了解临床医护人员临终关怀态度与安宁疗护行为现况,探讨安宁疗护行为的影响因素。方法 采用临终关怀态度调查量表和安宁疗护行为测量量表对425名临床医护人员进行调查。结果 临床医护人员安宁疗护行为得分为(48.00±10.14)分,显著低于安宁疗护机构医护人员(P<0.05);临终关怀态度得分为(103.72±10.70)分。临终关怀态度与安宁疗护行为呈正相关(P<0.05)。分层回归分析结果显示,男性、已婚以及接受过临终关怀教育的医护人员安宁疗护行为水平较高;临终关怀态度中以患者及其家属为中心的照顾意识维度能独立解释安宁疗护行为总变异的11.6%。结论 临床医护人员临终关怀态度总体偏正向,安宁疗护行为有待进一步提升,临终关怀态度对安宁疗护行为具有重要的促进作用。医院应通过开展专业培训,提升医护人员安宁疗护行为能力。     

医护人员医疗告知知信行现状及影响因素分析

目的 调查分析医护人员医疗告知知信行现状及影响因素,为促进医疗告知质量,保障患者权利提供参考.方法 应用 自制的医护人员医疗告知知信行问卷对新疆3所三级甲等医院的3 329名医护人员进行调查.结果 医护人员医疗告知知信行问卷总均分(121.45±15.41)分,知识、态度、行为各维度得分为(4.71±0.84)分、(5...     

肿瘤科护士安宁疗护核心能力及影响因素分析

目的 调查肿瘤科护士安宁疗护核心能力现状,分析其影响因素,为制订针对性的干预措施提高肿瘤科护士的安宁疗护核心能力提供参考.方法 采用肿瘤科护士安宁疗护核心能力问卷对辽宁省11所医院的613名肿瘤科护士进行调查.结果 肿瘤科护士安宁疗护核心能力总分为123.30±27.09分,条目均分为3.08,其中教育、协作与专业发展维度及居丧期护理维度水平较低.多元回归分析显示,所在机构安宁疗护护理服务水平、对安宁疗护护理工作的喜爱度、胜任度及是否参加安宁疗护培训讲座是肿瘤科护士安宁疗护核心能力的主要影响因素(均P＜0.01).结论 肿瘤科护士安宁疗护核心能力处于中等水平,护理管理者应重视以核心能力为指导的教育及培训,以提高护士临终照护能力,进而改善临终照护质量.     

肿瘤科护士共享决策知信行现状及影响因素调查

目的 调查肿瘤科护士共享决策知识、态度、行为现状并分析其影响因素,为开展共享决策培训提供支持.方法 采用自制的肿瘤科护士共享决策知信行调查问卷对郑州市三级甲等综合医院和肿瘤专科医院的351名肿瘤科护士进行横断面调查.结果 肿瘤科护士共享决策知识、态度、行为得分分别为(34.76±6.99)分、(21.48±4.00)分、(19.83±5.02)分,总分为(76.07±13.98)分.多元线性逐步回归分析结果显示,职务、是否为肿瘤专科护士是肿瘤科护士共享决策知识和行为的主要影响因素,年龄、是否为肿瘤专科护士是其态度的影响因素(均P＜0.01).结论 肿瘤科护士的共享决策态度较为积极,但知识及行为有待提高.应根据肿瘤科护士的不同特征有针对性地进行共享决策知识培训,以促进内化为积极的行为信念,并自觉外化为行为,提高肿瘤患者的决策质量.     

护理人员个人发展计划知信行现状及影响因素分析

目的 调查护理人员个人发展计划知信行现状及影响因素,为开展个人发展计划培训和人力资源管理提供参考.方法 采用自制护理人员一般资料问卷和个人发展计划知信行问卷对3298名护理人员进行调查.结果 护理人员个人发展计划知信行总分为(100.01±15.50)分,知识维度得分(17.82±6.07)分,态度维度得分(52.13±7.06)分,行为维度得分(30.06±7.13)分.多元线性回归分析显示,学历、职称、婚姻状况、岗位及对个人发展计划了解程度是护理人员个人发展计划知信行的影响因素(P＜0.05,P＜0.01).结论 护理人员的个人发展计划知信行水平处于中等水平,受护理人员个人特征的影响.医院管理者可通过开展相关培训以提高护理人员个人发展计划知信行水平.     

护理人员对住院患者自杀预防知信行的调查研究

目的 对护理人员住院患者自杀预防的知识、态度、行为水平进行现况调查,为开展护理人员 自杀预防学习提供参考.方法 采用自制护理人员对住院患者自杀预防知信行调查问卷,对445名护理人员进行调查.结果 护理人员对住院患者自杀预防的知识、态度、行为得分分别为(42.56±6.96)分、(30.02±4.31)分、(52.45±8.02)分,总分为(125.00±15.15)分.是否使用过心理评估量表、是否使用过自杀风险评估工具、是否参与患者自杀预防培训是护理人员 自杀预防知信行的主要影响因素(均P＜0.01).结论 护理人员对住院患者自杀预防知识态度行为总体呈中等偏上水平,管理者应当重视并针对护士开展自杀预防的培训学习.     

青海省护理人员安宁疗护知识及临终关怀态度调查分析

目的了解青海省护理人员安宁疗护知识及临终关怀态度,为推动安宁疗护的发展提供参考。方法采用便利抽样法对青海省3所三级医院、16所二级医院1 833名护士进行安宁疗护知识及临终关怀态度调查。结果护理人员安宁疗护知识得分(11.82±3.74)分;临终关怀态度得分(95.06±10.01)分;安宁疗护知识得分与临终关怀态度得分呈正相关(P0.01)。安宁疗护知识的影响因素为医院级别、性别、职称、是否接受过安宁疗护相关培训、宗教信仰和平均月收入;临终关怀态度的影响因素为医院级别、性别、职称、是否接受过安宁疗护相关培训、职务和学历(P0.05,P0.01)。结论青海省护理人员安宁疗护知识及临终关怀态度处于中等水平,受多种人口学因素的影响;应加强相关知识培训,树立正确的死亡观,以推动安宁疗护的发展。     

急诊科医护人员过度氧疗知信行多中心调查及影响因素分析

目的 调查急诊科医护人员过度氧疗知信行现状,并探索其影响因素,旨在为临床开展氧疗相关培训、规范氧疗行为提供参考。 方法 采用急诊科医护人员过度氧疗知信行问卷,对全国10个省市20所二级及以上综合性医院的急诊科医护人员998人进行调查。 结果 急诊科医护人员过度氧疗知信行总分为（120.76±13.61）分,知识、态度、行为维度得分分别为（29.54±5.45）分、（41.60±4.44）分和（49.62±9.49）分。多元线性回归分析结果显示,急诊科医护人员过度氧疗知信行的主要影响因素为医院级别、近12个月内是否学习过相关文献、职业、是否参加过相关培训、职务等（均P＜0.05）。 结论 急诊科医护人员对过度氧疗知识、态度、行为水平均处于中等水平。医院管理者应针对影响因素对急诊科医护人员进行过度氧疗知识培训,改变氧疗观念,以规范临床用氧,提高氧疗质量。     

临床护士《安宁疗护实践指南》践行行为调查

目的了解临床护士对卫生行业标准《安宁疗护实践指南》的践行行为现状。方法采用便利抽样法,抽取收治疾病末期患者较多科室的216名护士,采用自行设计的调查问卷进行调查。结果临床护士《安宁疗护实践指南》践行行为总分为(119.40±22.03)分,症状控制维度得分最高,心理支持维度得分最低;不同特征护士践行行为得分比较,差异无统计学意义(均P0.05)。结论临床护士《安宁疗护实践指南》总体践行行为处于中等水平,护理管理者要针对薄弱环节,采取针对性措施提高护士践行行为,以提高安宁疗护护理质量。     

Functions,responsibilities, dedication,payment, organization,and profile of the hospital transplant coordination in Spain in 2002

In Spain, the number of donors per million of population and the activity of transplantation is a direct consequence of the continued work of the hospital transplant coordinators. There are 146 procurement hospitals with approximately 534 transplant coordinators (13.6 coordinators per hospital and 12.7 per million of population). A voluntary survey of 74 Spanish transplant coordinators revealed 67.6% to be men and 32.4% women of average age 43 years with specialization of 75.7%, Intensive Care Medicine; 8.1%, Anesthesiology; 6.7%, Nephrologists; and the rest, General Surgery or without any specialization. Among the group who responded to the injury, 86.5% were doctors and 13.5%, nurses. The overall team is composed of 52% doctors, 27.7% nurses and others with 70.3% working part-time and 27%, full-time. Previous experience was noted to be less than 5 years among 51.4%, and more in the rest of the cases. The 85% work under medical direction by management. Their payment includes salary plus activity in 48.7% of the cases; 21.6%, only salary, and 18.9%, only activity. Each coordinator generates between 3 and 7 organ as well as 3 and 11 of tissue donors. In conclusion, comparing this data with the practice in the United States demonstrates the unique aspects of the Spanish system.     

不同烧伤面积血清、尿、水泡液中Zn、Cu、Fe、Ca、Mg的动态比较

为探讨烧协病人伤后血清、尿和水泡液中 Zn、Cu、Fe、Ca、Mg 的含量,观察了106例烧伤病人(L 组烧伤≥30%,TBSA,57例;S 组烧伤<30%TBSA,49例)伤后1,2,3,7,14,21,28天血清、尿和水泡液中 Zn、Cu、Fe、Ca、Mg 的动态变化。发现除血清 Fe 第1天高于正常值外,其它各元素都减低,L 组比 S 组减低明显。尿 Zn、Cu、Fe 排出明显增多,尿 Ca、Mg 排出减少。水泡液 Zn、Fe、Ca 与血清正常值近似,Cu、Mg 略低于血清正常值。说明烧伤后血 Zn、Cu、Fe、Ca、Mg 的降低与从尿液及创面丢失有关。     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

不同烧伤面积血清、尿、水泡液中Zn、Cu、Fe、Ca、Mg的动态比较

为探讨烧伤病人伤后血清、尿和水泡液中Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的含量，观察了１０６例烧伤病人（Ｌ组烧伤≥３０％ＴＢＳＡ，５７例；Ｓ组烧伤＜３０％ＴＢＳＡ，４９例）伤后１，２，３，７，１４，２１，２８天血清、尿和水泡液中Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的动态变化。发现除血清Ｆｅ第１天高于正常值外，其它各元素都减低，Ｌ组比Ｓ组减低明显。尿Ｚｎ、Ｃｕ、Ｆｅ排出明显增多，尿Ｃａ、Ｍｇ排出减少。水泡液Ｚｎ、Ｆｅ、Ｃａ与血清正常值近似，Ｃｕ、Ｍｇ略低于血清正常值。说明烧伤后血Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的降低与从尿液及创面丢失有关。     

Epidemiology, costs, and burden of osteoporosis in Argentina, 2009

Summary

Osteoporosis is a major public health concern for elderly subjects. Old age is a risk factor for fragility fractures; countries with aging population face a heavy burden of fractures and their consequences.

Introduction

In 2009, the total population of Argentina was 40 million, with 10 million inhabitants aged >50 years. Population will grow 13% by 2050 and reach 53 million, but the elderly population will reach 19.5 million.

Discussion

Local bone mineral density studies reveal that two out of four postmenopausal women have osteopenia, one has osteoporosis, and one has a normal bone mineral density. Around 3.3 million women will suffer from osteopenia in 2025 and 5.24 million in 2050. Although the rate of fragility fractures is higher in patients with osteoporosis, the absolute number of fractures is higher in osteopenic patients. In Argentina, the mean annual rate of hip fractures is 488/100,000 inhabitants aged above 50 years, with a 2.6:1 F/M ratio. Thus, over 34,000 hip fractures occur every year among the aged populationwith an average 90 such fractures per day.

Conclusion

The Latin American Vertebral Osteoporosis Study found an overall 16.2% prevalence of vertebral fractures in Argentinean women aged 50 years or over. Hospitalization costs of hip and vertebral fractures in Argentina exceed 190 million USD per year. Consequently, the costs of osteoporosis for the public health system are staggering; however, the federal or the provincial governments of Argentina do not give the disease a high priority. To conclude, efforts for the prevention and management of osteoporosis are urgently needed.     

Pharmacokinetics of desflurane, sevoflurane, isoflurane, and halothane in pigs

We tested the prediction that the alveolar washin and washout, tissue time constants, and pulmonary recovery (volume of agent recovered during washout relative to the volume taken up during washin) of desflurane, sevoflurane, isoflurane, and halothane would be defined primarily by their respective solubilities in blood, by their solubilities in tissues, and by their metabolism. We concurrently administered approximately one-third the MAC of each of these anesthetics to five young female swine and determined (separately) their solubilities in pig blood and tissues. The blood/gas partition coefficient of desflurane (0.35 +/- 0.02) was significantly smaller (P less than 0.01) than that of sevoflurane (0.45 +/- 0.02), isoflurane (0.94 +/- 0.05), and halothane (2.54 +/- 0.21). Tissue/blood partition coefficients of desflurane and halothane were smaller than those for the other two anesthetics (P less than 0.05) for all tissue groups. As predicted from their blood solubilities, the order of washin and washout was desflurane, sevoflurane, isoflurane, and halothane (most to least rapid). As predicted from tissue solubilities, the tissue time constants for desflurane were smaller than those for sevoflurane, isoflurane, and halothane. Recovery (normalized to that of isoflurane) of the volume of anesthetic taken up was significantly greater (P less than 0.05) for desflurane (93% +/- 7% [mean +/- SD]) than for halothane (77% +/- 6%), was not different from that of isoflurane (100%), but was less than that for sevoflurane (111% +/- 17%). The lower value for halothane is consistent with its known metabolism, but the lower (than sevoflurane) value for desflurane is at variance with other presently available data for their respective biodegradations.     

Comparison of AlloDerm, fat, fascia, cartilage, and dermal grafts in rabbits

OBJECTIVE: To compare various graft materials in the rabbit model, including autologous cartilage, dermal tissue, fat, and AlloDerm (a cadaver-derived material). METHODS: Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts. RESULTS: The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption. CONCLUSIONS: The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.     

Fractures of the proximal femur in Picardy,France, in 1987

Between 1 January and 31 December 1987, 1178 hip fractures were recorded in the 28 clinical centres, public and private, of the Picardy region (19443 km², 1.8 million inhabitants). Patients under 20 years and those with metastatic cancer and myelomatous fractures were excluded. Women sustained 853 fractures (age mean ± SD: 80.2±10.4 years) and men 325 (age 69.7±16.0 years). The crude incidence rate per 10 000 person years was 13.4 for women and 5.4 for men (female/male ratio 2.6). These incidences are among the lowest recorded in Northern Europe. Women with trochanteric fractures were older than those with cervical ones, but no difference was observed for men. After adjusting for age and sex, the incidence of hip fracture was greater in urban (10.5 per 10 000 person years) and semi-rural areas (8.2) than in rural areas (5.3). The mean bed-days per patient (±SD) was 21.6±16.0 (quartiles: 13–17–26 days); no difference was observed between sex or age classes. The in-hospital mortality rate was 8.7%, it increased with age and was higher in men, whatever their age. We review the data in different countries, mostly European, to compare with the Picardy region.     

Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment

BACKGROUND: Choledochal cysts (CDC) are rare congenital cystic lesions of the biliary tract. In North America the incidence of CDC is estimated as 1/150,000; it is not clear that the disease pattern in North America is similar to that in Asia. METHODS: Retrospective chart review. Statistical analysis was under taken using Fisher's exact test. RESULTS: Presentation, epidemiology, diagnosis, and outcome were evaluated in 51 patients with CDC. Malignant transformation was identified in 4 patients presenting uniformly with jaundice (P = .027). Type 4a cysts (54.9%) were the most common cyst identified. Four (14%) type IVa and two (13%) type I cysts developed postoperative stricture. No patient developed cholangiocarcinoma after complete resection of their cyst. CONCLUSIONS: Types I and IVa cysts can be treated similarly with excellent outcome. However, our observation of a high proportion of type 4a cysts may represent a specific North American pattern of this disease requiring a re-evaluation of the classification system.