外科护士预防术后患者下肢深静脉血栓形成的知信行调查

目的：调查外科护士对于预防术后患者下肢深静脉血栓形成（DVT）的知识、信念和行为状况。方法：采用自行设计的外科护士预防术后患者DVT知信行问卷,以便利抽样法调查北京市某医院的40名外科护士,对收集的资料进行统计学分析。结果：1外科护士预防术后患者DVT知识得分为（9.38±1.74）分,占满分的62.5%;信念得分为（33.90±3.80）分,占满分的84.6%;行为得分为（38.78±6.83）分,占满分的77.6%。2外科护士预防术后患者DVT的知识、信念与行为三者之间存在正相关（P〈0.05）。3不同职称、责任护士状态、科室的外科护士预防术后患者DVT知、信、行的得分不同,差异有统计学意义（P〈0.05）。结论：外科护士在预防术后患者DVT的知信行方面,信念水平最高,行为水平次之,而知识水平较低,三者之间存在正相关关系。护理管理者应进一步提高护士预防DVT的知识水平,以促进其信念的转念,进而改进护理措施。     

临床外科护士围术期雾化吸入治疗知信行现状调查

目的:探讨临床外科护士围术期雾化吸入治疗知识、态度、行为现状并分析其影响因素。方法:采用自行设计的《临床外科护士围术期雾化吸入治疗知信行调查问卷》,对山东省13家医院405名临床外科护士进行问卷调查。应用单因素分析、多元线性回归分析围术期雾化吸入治疗知信行的影响因素。结果:临床外科护士围术期雾化吸入治疗知识得分(12.70±3.04)分,态度得分(26.54±3.02)分,行为得分(100.84±10.09)分,知信行总分(140.08±13.35)分,三者存在正相关性。多元线性回归结果显示,围术期雾化吸入治疗知识的影响因素为年龄、医院等级、是否教学护士(P0.05),行为、知信行总分的影响因素为医院等级、是否教学护士(P0.05)。结论:临床外科护士围术期雾化吸入治疗态度较积极,但知识水平偏低,行为尚不规范。三级甲等医院、科室教学护士的知信行总体水平高于其他护士,管理者应根据医院等级及护士情况制定培训策略,建立围术期雾化吸入治疗培训体系,提高临床外科护士围术期雾化吸入治疗的知信行水平。     

手术室护士围术期非计划性低体温防护知信行调查及分析

目的 :调查山西省二、三级综合医院手术室护士围术期非计划性低体温防护知信行现状及影响因素。方法 :采用自制手术室护士围术期非计划性低体温防护知信行问卷,对山西省45所二、三级医院852名手术室护士进行调查。结果 :被调查者围术期非计划性低体温防护知信行得分分别为(9.87±3.77)分、(40.50±5.50)分、(43.29±5.93)分,且两两之间存在正相关关系(P0.001);其影响因素为医院等级、学历、职称、职务、工作年限、涉及相关内容的培训次数,共解释总变异的48.4%。结论 :山西省手术室护士围术期非计划性低体温防护知识、态度、行为水平尚可,仍需要加强。各医院应增加投资力度,完善保温设施配置及保温流程构建,以确保手术患者的安全和舒适。     

泌尿外科护士对膀胱肿瘤根治术患者早期活动知信行调查

目的 探讨泌尿外科护士对膀胱肿瘤根治术患者早期活动知信行现状的调查.方法 使用便利抽样法,选取2018牟12月-2020年12月现场抽取某省220名泌尿外科护士展开研究,使用基础信息调查表、泌尿外科护士早期活动知信行调查问卷进行调查,将调查结果通过多重线性回归分析,了解相关影响因素.结果 220名护士知识得分(3.41±1.24)分,信念得分(30.45±3.14)分,行为得分(10.63±2.14)分.多重线性回归分析结果表明,职称是护士早期活动认知的主要影响因素(P＜0.05);是否接受早期培训、职称、泌尿外科工作年限是护士早期活动信念主要影响因素(P＜0.05);是否接受早期活动培训、科室是否开展ERAS是护士早期活动行为影响因素(P＜0.05).结论 泌尿外科护士对膀胱肿瘤根治术患者早期活动的信念较好,但由于自身知识储备单薄,行为状态不甚理想.应针对护士实际情况开展早期活动知识培训,保证多学科合作,制订早期活动方案,保证早期活动在临床有效、科学的实施.     

手术室护理人员医院感染防控"知信行"水平及影响因素

目的了解该院手术室护理人员医院感染防控"知信行"水平现状,调查分析其影响因素,为手术室开展医院感染防控管理提供依据。方法以聊城市第三人民医院手术室38名护理人员为研究对象,收集护理人员一般资料,调查其医院感染防控知识、态度和行为,并分析其影响因素。结果38名护理人员医院感染防控知识得分平均为(35.62±3.41)分,信念得分平均为(205.41±5.63)分,行为得分平均为(187.56±4.74)分,整体得分处于中等水平,三方面得分均以手卫生得分最高,医疗和病理废弃物管理得分最低;不同性别、学历和人事状况的护理人员其医院感染防控"知信行"得分差异无统计学意义(P>0.05);不同年龄、职称、护龄、带教情况、院感监控任职情况和近1年内接受院感培训次数的护士其医院感染防控"知信行"得分情况差异有统计学意义(P<0.05);知识和信念、知识和行为以及信念和行为之间均呈正相关(P<0.05)。结论该院手术室护士医院感染防控"知信行"水平处于中上水平,不同年龄、护龄、职称、带教情况和接受培训次数的护士其医院感染防控"知信行"水平差异显著,临床中应采取积极措施,提升护士认知,改善护士信念,进而提高其院感防控能力。     

临床护士安全输血标准知信行调查研究

[目的]了解临床护士安全输血标准知信行现状及影响因素,为临床护理管理者开展相关培训提供参考。[方法]通过自制的临床护士安全输血标准知信行问卷,对某市356名临床护士进行调查。[结果]356名临床护士安全输血标准知识、态度、行为得分及标准分分别为:(0.70±0.17)分、70.45分;(4.33±0.42)分、86.55分;(3.58±0.76)分、71.58分。职称、所在科室、是否自学是临床护士安全输血知信行的影响因素(R~2=0.110,F=3.238,P=0.000)。[结论]临床护士安全输血标准知信行水平仍需提高,应适当增加输血相关培训的次数,加强科室业务学习,确保病人输血安全。     

广东省护士对脑卒中患者吞咽障碍康复护理的知信行现状调查

目的 调查广东省护士对脑卒中患者吞咽障碍康复护理的知信行现状及影响因素，为制订针对脑卒中患者吞咽障碍康复护理的培训方案提供依据。 方法 于2021年6月至8月期间，采用自制问卷对广东省655名脑卒中吞咽障碍康复相关科室的护士进行吞咽障碍康复护理知信行现状调查。 结果 共回收有效问卷616份。入选护士知识、态度及行为维度得分分别为8分、23分和103.5分。相关性分析结果表明，广东省护士对脑卒中后吞咽障碍康复护理的知识、态度及行为具有两两相关性（P<0.001）。通过多重线性回归分析发现，最高学历、吞咽障碍护理工作年限、职称、医院级别和是否受过吞咽障碍相关培训对知识维度得分具有影响作用，职称、医院级别、是否受过吞咽障碍相关培训对态度维度得分具有影响作用，所在科室、科室开展吞咽障碍康复护理情况、吞咽障碍康复护理工作年限对行为维度得分具有影响作用。 结论 广东省护士对脑卒中患者吞咽障碍康复护理的知识水平较好，但态度及行为实践水平有待提高。护理管理者应建立并完善培训体系，强化护士的态度及行为，提高其对脑卒中患者吞咽障碍的护理水平，改善患者医疗结局。     

河南省10所三级医院胸外科护士肺癌围手术期肺康复的知信行现状调查

目的调查胸外科护士对肺癌围手术期肺康复的知信行现状, 并探索其影响因素, 为推动临床肺康复相关培训提供依据。方法本研究为横断面调查研究。采用便利抽样法, 于2022年5—8月抽取河南省10所三级医院的513名胸外科护士作为调查对象。采用自行编制的胸外科护士肺癌围手术期肺康复知信行问卷对其进行调查, 采用多重线性回归分析护士知信行现状的影响因素。共回收有效问卷485份, 有效回收率为94.54%(485/513)。结果 485名胸外科护士的肺癌围手术期肺康复知信行总分、知识维度、信念维度及行为维度得分分别为(186.25±33.55)、(76.36±16.44)、(43.27±6.39)、(66.62±15.71)分。多重线性回归分析结果显示, 胸外科护士肺癌围手术期肺康复知信行总分的影响因素为职务、是否了解肺康复内容、参加肺康复培训次数、是否为患者实施过肺康复(P<0.05)。结论胸外科护士对肺癌围手术期肺康复信念积极, 但知识及行为水平亟待提高。护理管理者应积极开展围手术期肺康复培训, 鼓励胸外科护士更新自我知识体系, 强化护士肺康复执行能力, 进一步推动肺康复相关工作的开展。     

ICU护士预防呼吸机相关肺炎知信行现况及其影响因素调查

目的 调查分析重症监护病房(ICU)护士预防呼吸机相关肺炎(VAP)护理知识、信念和行为现状及其影响因素.方法 采取方便抽样法选取我市三级甲等医院的150名ICU临床护士作为研究对象,应用自行设计的ICU护士预防VAP护理知信行量表考察护士知信行现状,采用一般资料调查表对影响ICU护士预防VAP知信行进行单因素分析、多元线性回归分析.结果 本研究ICU护士预防VAP知、信和行得分依次为(10.47±3.01)分、(24.13±6.57)分和(36.89±8.14)分;影响ICU护士预防VAP知识得分的主要因素为ICU工作年限和参加培训,影响其信念得分的主要因素为ICU工作年限和婚姻状况,影响其行为得分的主要因素为年龄和职称,结果具有统计学意义(P＜0.05).结论 ICU护士预防VAP知识欠缺,信念和行为有待进一步提高,需要树立正确的循证护理,加强培训和学习,提高ICU护士预防VAP依从性.     

新生儿科护士个人发展计划知信行现状及影响因素分析

目的 了解新生儿科护士个人发展计划知信行现状，并分析其影响因素，为护士个人发展计划培训及人力资源管理提供依据。方法 采用新生儿科护士一般资料问卷、护理人员个人发展计划知信行问卷、医院磁性要素量表对106名新生儿科护士进行横断面调查。结果 新生儿科护士个人发展计划知信行问卷得分为(98.36±13.58)分，与医院磁性水平呈正相关(r=0.752,P<0.05)。线性回归分析结果显示，护士文化程度、职称、婚姻状况以及医院磁性水平是影响其个人发展计划知信行水平的主要因素(P<0.05)。结论 新生儿科护士个人发展计划知信行水平一般，有待进一步提高，且受护士个人特征的影响，护理管理者可以通过相关培训以提高新生儿科护士个人发展计划知信行水平。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.