手术室护士职业倦怠现况与影响因素分析

目的探讨手术室护士职业倦怠现况及影响因素。方法选取2017年12月我院68名手术室护士作为研究对象,采用职业倦怠量表对其职业倦怠情况进行评估,比较不同性别、年龄、护龄、职称及文化程度护士职业倦怠情况,对其影响因素进行分析。结果不同性别的手术室护士的职业倦怠情况比较,差异无统计学意义(P 0. 05)。不同年龄段、护龄、职称及文化程度的职业倦怠情况比较差异有统计学意义(P 0. 05)。结论手术室护士职业倦怠现况显示,出现重度倦怠情况的护理人员较多,主要影响因素为年龄、护龄、职称及文化程度。     

高龄前列腺增生手术患者护理风险因素调查分析

目的：探讨分析高龄前列腺增生手术患者护理风险因素,并研究其对策。方法：选取2010年4月～2013年3月589例高龄前列腺增生手术患者为研究对象,分析其与护理不良情况发生率的相关性。结果：589例患者共发生14例不良情况,发生率为2.38%,主要以穿刺失败发生率最高,明显高于其他不良情况,其中不同时间段、年龄段、疾病知识掌握程度及责任护士护龄、沟通情况与不良情况发生率也较高,经Logistic分析显示,≥80岁、交接班及夜班时、疾病知识掌握较差、责任护士护龄〈5年及沟通较差为高危因素。结论：高龄前列腺增生手术患者护理风险因素包括护理人员与患者两方面的因素,针对这些因素给予相应的处理。     

长沙市省级综合三级甲等医院ICU护士职业倦怠现状及其影响因素分析

目的调查长沙市省级综合三级甲等医院ICU护士职业倦怠现状,并探讨其影响因素。方法采用工作倦怠量表对215名ICU护士进行问卷调查。结果护士的轻、中、重度职业倦怠的检出率分别为30.70%、22.79%、5.58%;性别、班次轮换、自评家庭交流质量和职务是ICU护士职业倦怠的影响因素。结论长沙市省级综合三级甲等医院ICU护士的职业倦怠问题比较严重,家庭交流质量差、夜班多的女性ICU护士应为职业倦怠干预的重点对象。     

外科护士职业倦怠及家庭功能调查分析

目的:调查外科护士职业倦怠现况及其家庭功能水平,探讨外科护士职业倦怠的影响因素及其与家庭功能之间的关系,为缓解外科护士职业倦怠提供依据。方法:2017年1~3月,应用整群抽样方法,选取某三级甲等医院的所有外科护士为研究对象,运用一般情况调查表、职业倦怠量表、家庭关怀度指数问卷3个测评工具进行研究。结果:外科护士职业倦怠处于中重度水平。3个维度的倦怠程度均高于Maslach常模(P0.05),家庭功能处于良好水平,家庭功能与职业倦怠之间呈负相关。社会人口学因素中,性别和工作年限影响外科护士去人格化水平,是否轮转影响外科护士的情感衰竭水平。结论:外科护士的职业倦怠处于中高水平,低个人成就感处于高度倦怠水平,外科护士家庭功能处于健康水平,家庭关怀指数与职业倦怠呈负相关,即家庭关怀指数越高,职业倦怠水平越低。     

福州地区三甲医院护士职业倦怠相关影响因素分析

目的探讨福州地区三甲医院护士职业倦怠相关影响因素。方法采用便利抽样的方法,选取2016年6月~2017年6月福州地区5家省级三甲医院的护士480例作为研究对象。应用一般资料调查问卷和护士职业倦怠量表进行调查评估。应用描述性统计、等级相关系数分析等统计学方法分析护士的职业倦怠程度及相关影响因素。结果年龄、护龄、文化程度、三班倒与职业倦怠有相关关系,差异均有统计学意义(均P<0.05),劳动关系、职称、子女情况、月收入与职业倦怠程度无相关,差异均无统计学意义(均P>0.05)。结论福州地区三甲医院护士职业倦怠程度与年龄、护龄、文化程度、三班倒有关。     

影响ICU护士心理健康状况因素分析与对策

目的:调查ICU护士心理健康状况,探讨影响ICU护士心理健康状况的相关因素及对策。方法:采用症状自评量表(SCL-90)对100例ICU护士进行调查研究。结果:本组ICU护士SCL-90总分及表因子得分均高于常模(P0.05);婚姻状况、护龄、文化程度、经济收入等各因素对其心理健康状况都有很大影响(P0.05)。结论:ICU护士的心理健康状况较差,明显低于一般人群,存在心理健康问题,通过调查、分析找出影响ICU护士心理健康状况的相关因素,并指导护士如何应对压力,从而改善护士心理健康状况,减轻心理压力,提高护理质量。     

东莞市不同护龄的护士生活质量与工作压力的调查

目的 了解不同护龄护士生活质量和工作压力状况.方法 应用WHO生活质量测定量表简表(WHOQOL-BREF)和护士工作压力源表对201名护理专升本学员进行现场问卷测评.结果 不同护龄护士在生活质量的得分差异有统计学意义(P<0.05),不同护龄护士的工作压力源差异没有统计学意义(P>0.05).其中不同护龄护士在"经常倒班"上差异有统计学意义(P<0.05).结论 医院管理者应关心年轻护士,通过职业防护培训和科学合理排班,改善其生活质量,通过管理激励手段,帮助她们适当减压.     

门诊护士职业倦怠及影响因素的调查分析

目的探讨门诊护士职业倦怠现况及其影响因素。方法采取便利抽样的方法,采用Moreno—Jinenez护士职业倦怠量表（NBS）对医院门诊工作1年以上、具有护士执业资格的101名护士（不包括护士长）进行调查问卷。结果门诊护士情绪疲惫感高;“产生更换职业的想法”得分高于躯体症状。不同科室的门诊护士其职业倦怠水平有统计学意义（P〈0,05）,干部门诊护士的职业倦怠水平显著高于其他门诊护士。年龄、婚姻、健康状况、经济状况、爱教育情况对门诊护士职业倦怠的产生影响不大,不同工作情况,包括护龄、职称、门诊工作时间、拖加班情况对倦怠的产生无统计学意义。结论门诊护士的职业倦怠处于中等偏上水平。     

重症监护病房护士职业倦怠原因分析及对策

现在重症监护病房(ICU)护理多元化,要求ICU护士在医疗诊治过程中必须满足职业的各种要求。因此,ICU护士工作压力大,而又不得不常常掩盖和压抑自己的一些真性情,无形中的压力易造成ICU护士职业倦怠。骆宏等[1]报道,国内护士职业倦怠感的发生率在55.1%～59.1%。ICU护士的职业倦怠不仅会影响护士自身健康,而且会影响护士队伍的整体素质和护理队伍的稳定[2]。现分析ICU护士职业倦怠的原因并提出相应的对策。1原因分析职业倦怠是一个动态过程,起始于职业压力,倦怠的出现是由于无法成功应对工作压力。引起护士职业倦怠的压力源包括专业地位、医患关系、专业知识、组织氛围与工作负荷等。1.1工作负荷1.1.1生理倦怠ICU是急、危、重病人的聚集地,工作无规律,夜班仍处在繁忙工作中。护士又需要时刻巡视病人的病情变化,导致ICU护士生理性疲劳。ICU护士实行三班工作制,上班安排是属弹性排班,随时处于待命状态,经常加班加点,影响了人体“生物钟”,使ICU护士产生生理上的倦怠。有研究表明,护士每周工作时间越长,情绪疲惫感越强[3]。1.1.2心理倦怠ICU护士工作单位时间内劳动强度高、紧张度强、风险系数高、工作责任重,对ICU...     

护患关系对临床护士职业倦怠的影响

目的:探讨护患关系对临床护士职业倦怠的影响,并提出相应的对策。方法:采用护士调查问卷和马氏职业倦怠量表(MBI-HSS)调查450名临床护士,分析不同护患关系对临床护士职业倦怠的影响。结果:影响护士职业倦怠检出率的因素是:护士执业环境自评状况、患者信任度、患者尊重度;影响各维度得分因素有:护士执业环境自评状况、患者信任度、患者尊重度、患者服务满意度,其中,执业环境自评好、患者信任度高、患者尊重度高的护士,情感衰竭、去人格化得分较低,职业倦怠程度轻(P0.05);得分越高,其职业倦怠程度越重(P0.05)。结论:护患关系是影响临床护士职业倦怠的重要因素,医院管理者应注重构建良好的护患关系和执业环境,从个体、组织、社会三个层面寻找积极的对策,从而预防和减少护士职业倦怠的发生。     

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.