SARS事件前后护理本科生专业态度的比较与分析

目的 通过对SARS事件前后护理本科生专业态度的比较,探讨提高护理专业学生专业认同感的有效途径.方法 采用问卷调查法对109例护理本科在校生的SARS事件前后的专业态度等进行调查.结果 SARS事件前后学生专业态度有显著性差异(P＜0.01),表现为积极的态度增强,消极的态度减弱;SARS事件前后父母的态度也有一定程度的改变(P＜0.05);父母对护理的态度与学生的专业态度存在一定的相关关系.结论 促进人们对护理的认识是提升护理专业的社会地位,促进护理专业学生专业认同感的重要途径;护理专业自身的完善与发展,是提升护理社会地位,促进护理专业学生专业认同感的根本.     

SARS事件前后护理本科生专业态度的比较与分析

目的通过对SARS事件前后护理本科生专业态度的比较，探讨提高护理专业学生专业认同感的有效途径。方法采用问卷调查法对109例护理本科在校生的SARS事件前后的专业态度等进行调查。结果SARS事件前后学生专业态度有显著性差异（P〈0．01），表现为积极的态度增强，消极的态度减弱；SARS事件前后父母的态度也有一定程度的改变（P〈0．05）；父母对护理的态度与学生的专业态度存在一定的相关关系。结论促进人们对护理的认识是提升护理专业的社会地位，促进护理专业学生专业认同感的重要途径；护理专业自身的完善与发展，是提升护理社会地位，促进护理专业学生专业认同感的根本。     

护理专业学生专业态度与SARS事件的关系探讨

目的:了解与分析SARS事件与护理专业学生专业态度的关系.方法:采用问卷调查法对206名护理专业学生SARS事件后的专业态度及SARS事件对其专业态度、学习兴趣的影响等进行了调查.结果:①SARS事件后多数学生的专业态度是积极的、肯定的;②SARS事件对多数学生的专业态度、学习兴趣产生了不同程度的影响;③父母对护理的态度与学生的专业态度存在一定的相关关系.结论:SARS事件对护理专业学生专业态度的主要影响是积极的,促进了护理专业学生的专业认同感.     

护理本科生入学前专业态度和社会影响因素的探讨

[目的]探讨护理本科生入学前专业态度及其社会影响因素.[方法]采用自制问卷调查175名新入学的护理本科生对护理专业的态度及其社会影响因素.[结果]学生入学前专业态度评分为51.37分±10.06分;就业形势与发展前景得分最高,中位得分为1分;社会地位和社会舆论得分最低,中位得分为-1分.专业态度积极组和消极组相比,除在社会事件、护理工作风险性以及就业形势方面的影响程度差异无统计学意义(P>0.05)外,在其他各社会因素之间的差异均有统计学意义(P<0.001).[结论]护理发展前景、“白衣天使”的职业形象是学生入学前专业态度形成的积极社会因素,护士的历史传统形象、社会地位、社会舆论是学生专业态度形成的主要消极影响因素.     

不同层次护理专业学生职业认同感的调查分析

目的 调查分析不同层次护理专业学生的职业认同感情况.方法 采用自行设计的问卷对不同层次护理专业学生197名进行调查.结果 中专学生职业认同感低于大专、本科学生,差异具有统计学意义(P＜0.05).大专学生与本科学生在自主选择护理专业状况、护理地位的认识条目上比较,差异无统计学意义(P＞0.05);而在从事护理事业的态度条目上比较,差异有统计学意义(P＜0.05).结论 不同层次护理专业学生职业认同感有差异,应采取有针对性的教育方法,提高学生的职业认同感水平.     

149名实习护生SARS认知情况及其对职业态度的影响

目的 通过对实习护生进行有关SARS的认知情况和对护理职业再认识的调查,分析SARS疫情的发生对学生职业态度的影响,为今后护理教学提供一定的指导依据。方法 采用自行设计的问卷进行调查,包括基本情况,学生对SARS疫情的认知情况,学生实习初期及经历抗击SARS后对护士职业的认识,应对突发公共卫生事件需增加的教学内容等4个方面共18个问题。结果 通过分析发现,京外医院实习生对SARS恐慌心理高于SARS疫情较重的北京地区(χ~2=11.74,P<0.01);未接触SARS病人的实习生比接触SARS病人者恐惧反应严重(χ~2=11.39,P<0.01)。结论 经历抗击SARS战斗之后,实习护生职业态度的认识得到提高、精神境界得到升华;为了更好地应对突发性公共卫生事件,护理教育应注重培养既有临床护理知识又有疾病预防技能的人才,加强护生心理素质和应变能力培养。     

护理本科生专业认同感、精神压力与自尊的相关性研究

目的分析护理本科生专业认同感、精神压力与自尊三者之间的关系,为专业思想教育提供客观依据。方法采用护理本科生专业认同调查问卷(QBNS)、精神压力量表(PSQ)与自尊量表(SES)对403名护理本科生进行调查。采用多元逐步回归分析法,分析自尊和精神压力对专业认同感的影响。结果以第一志愿录取的学生专业认同感得分高于其他专业调剂的学生(P<0.01),因自己喜欢就读护理专业的学生专业认同感得分高于其他原因就读护理的学生(P<0.01);2008级学生精神压力高于2007级学生(P<0.05);其他志愿录取的学生自尊水平高于第一志愿和其他专业调剂的学生(P<0.05);自尊与专业认同感呈显著正相关(P<0.01),与精神压力呈显著负相关(P<0.01)。回归分析显示,自尊和精神压力是专业认同感的有效预测因子。结论自尊不仅可以影响精神压力,而且与精神压力共同预测专业认同感。     

护理学生专业认同感的阶段性调查与分析

了解在校期间与进入临床实习后,护理学生对本专业的认同变化及其相关因素。设计调查问卷,对某院合作学校2010级本科、2009级大专的护理学生进行实习前、实习后的阶段性调查。采用SPSS 17.0统计软件对数据进行统计分析。前后对比有统计学意义的因素依次为社会地位、同学看法、个人奋斗目标、护理专业前景、家人态度及护理人员在病人接受医疗服务过程中的作用。两阶段比较,教师的影响、课外学习情况、个人兴趣及重选本专业的意愿四个条目的比较差别无统计学意义(P0.05)。对临床阶段调查问卷中增加的10个条目统计结果显示,自我价值的实现感对护理学生专业态度的认同关系很大,构成比为78%。护理学生专业认同的影响因素有诸多方面,应予以重视,并采取相关措施提升护理学生的专业认同感,为护理队伍素质的提高做出贡献。     

临终关怀教育对护理本科生死亡与临终关怀态度的影响研究

目的评价临终关怀教育对老年护理专业学生死亡态度及临终关怀态度的影响。方法设计自身前后对照试验,对老年护理专业45名本科生进行4个月临终关怀教育,通过死亡态度量表、临终关怀态度量表来评估临终关怀教育的有效性。结果临终关怀教育后护理专业学生以养老机构为工作志向及志愿从事临终关怀工作的人数较实施前上升(P<0.01);在死亡态度量表中,自然接受、死亡逃避、死亡恐惧3个维度得分差异有统计学意义(P<0.01);在临终关怀态度量表的总分以及各维度得分差异有统计学意义(P<0.01)。结论对护理本科生进行临终关怀教育,能促使护理专业学生工作志向转变为养老机构;有助于护理专业学生克服对死亡的负性情绪,树立正确的死亡观。     

护理本科生入学前专业态度和社会影响因素的探讨

[目的]探讨护理本科生入学前专业态度及其社会影响因素。[方法]采用自制问卷调查175名新入学的护理本科生对护理专业的态度及其社会影响因素。[结果]学生入学前专业态度评分为51．37分&#177;10．06分;就业形势与发展前景得分最高,中位得分为1分;社会地位和社会舆论得分最低,中位得分为-1分。专业态度积极组和消极组相比,除在社会事件、护理工作风险性以及就业形势方面的影响程度差异无统计学意义（P〉0．05）外,在其他各社会因素之间的差异均有统计学意义（P〈0．001）。[结论]护理发展前景、“白衣天使”的职业形象是学生入学前专业态度形成的积极社会因素,护士的历史传统形象、社会地位、社会舆论是学生专业态度形成的主要消极影响因素。     

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.