临床护士评判性思维态度倾向性现状与相关因素分析

目的分析临床护士评判性思维态度倾向性现状及相关影响因素,为提高护士评判性思维态度倾向性提供参考依据。方法 2018年3—5月,采用中文版加利福利亚评判性思维态度倾向问卷(CTDI-CV)和一般资料问卷对本院100名临床护士进行调查。结果临床护士CT-DI-CV总分为216～379分,平均(285. 69±33. 47)分;不同年龄、受教育程度、职称、护龄护士CTDI-CV总分比较差异均有统计学意义(P 0.05);多因素Logistic回归分析结果显示,受教育程度、护龄以及职称为影响临床护士评判性思维态度倾向性的独立危险因素(P 0. 05)。结论临床护士评判性思维态度倾向性整体水平处于正性表现,但还需要进一步提升;受教育程度、护龄以及职称为影响临床护士评判性思维态度倾向性的主要危险因素。     

临床护士护理伦理决策能力现状及影响因素研究

目的 了解临床护士护理伦理决策能力的现状及影响因素,为提高临床护士的护理伦理决策能力提供依据.方法 随机抽取四川省5所三级甲等综合性医院的359名临床护士为调查对象,应用2007版护理伦理决策问卷(JAND)进行调查.结果 临床护士的护理伦理决策问卷总分为(267.91±16.62)分;两个维度得分为伦理选择(145.66±9.47)分、伦理行动(122.25±8.84)分.进入多元回归方程,各因素中,获取专业知识的途径对总分的影响最大,其次是学历和护理伦理决策培训.结论 临床护士的护理伦理决策能力有待提高,护理教育者及临床管理者应根据影响因素,通过多种途径提高临床护士的护理伦理决策能力.     

临床护士评判性思维与临床决策能力的相关性研究

目的 了解临床护理人员评判性思维能力与护理决策能力的现状,探讨临床护理人员评判性思维能力与护理决策能力的关系.方法 采用评判性思维倾向性调查表(中文版)和护理临床决策能力调查表,对汕头市3所三甲医院223名临床护理人员进行问卷调查.结果 临床护士评判性思维总分平均为(292.12±24.67),决策能力总平均分为(140.72±11.34);评判性思维与决策能力呈显著正相关(P＜0.01).结论 临床护士评判性思维与护理决策能力呈正相关,评判性思维能力越强,护理临床决策能力越强.     

临床护士评判性思维态度倾向性现状及相关因素分析

目的 了解临床护士评判性思维态度倾向性的现状及相关因素,为提高临床护士的评判性思维能力提供依据.方法 随机抽取四川省5所三级甲等综合性医院的366名临床护士为调查对象,应用中文版加利福利亚评判性思维态度倾向问卷(CTDI-CV)进行调查.结果 临床护士的评判性思维态度倾向总分为(284.85士26.76)分；7个特质得分为寻求真相(36.93士6.12)分、思想开放(40.95土4.74)分、分析能力(43.34士4.74)分、系统化能力(40.33士5.33)分、评判性思维的自信心(39.93士5.39)分、求知欲(43.31土5.84)分、认知成熟度(40.06士7.24)分.学历、年龄、职称、工作年限、获取专业知识的途径、评判性思维培训对总分的差异有显著意义(P＜0.05),进入多元线性回归方程的因素中,学历对总分的影响最大,其次是评判性思维培训和工作年限.结论 临床护士的评判性思维态度倾向有待提高,护理教育者及临床管理者应根据影响因素,通过多种途径提高临床护士的评判性思维态度倾向.     

护理本科实习生评判性思维态度倾向性与护理临床决策能力的现状及相关性

[目的]了解护理学专业本科实习生评判性思维态度倾向性及护理临床决策能力现状及其相关性。[方法]采用评判性思维态度倾向性量表和护理临床决策能力测量工具对重庆市5所三级甲等医院实习的护理专业本科实习生223人进行调查,对其相关性进行分析。[结果]护理专业本科实习生评判性思维态度倾向性总分为(295.92±27.95)分,求知欲得分最高,寻求真相得分最低;护理临床决策能力总分为(77.22±9.24)分,评价反馈能力得分率最高,实施决策能力得分率最低;评判性思维态度倾向性与临床决策能力呈正相关(P<0.01)。[结论]护理本科实习生在整体上具有正性评判性思维态度倾向,临床决策能力水平偏低,批判性思维态度倾向性可影响护生的临床决策能力,在教学过程中应注意促进护生批判性思维的形成,从而提高护生的临床决策能力。     

临床护士护理伦理决策能力发展现状及影响因素研究

目的调查目前临床护士护理伦理决策能力发展现状及其影响因素．为进一步提高临床护士护理伦理决策能力及护理质量提供依据。方法随机抽取沈阳市4所三级甲等综合性医院的338名临床护士作为调查对象,应用护理伦理决策问卷（JAND）进行调查研究。结果JAND问卷总分为（296．37±14．23）分,伦理行动及伦理选择两个维度得分分别为（162．23±8．02）分和（134．14±6．20）分;多元回归分析提示,诸多因素中以获取专业知识的途径对总分的影响最大,学历及是否经过护理伦理决策能力的培训次之。结论临床护士的护理伦理决策能力应通过专业知识的学习及培训等多种途径加以提高,从而提高临床护理质量。     

贵州省ICU护士评判性思维能力及其影响因素分析

[目的]了解重症监护室(ICU)护士评判性思维能力,探讨其影响因素。[方法]采用一般情况调查表和中文版评判性思维能力测量表(CTDI-CV)对随机选取的贵州省二级、三级医院ICU 124名护士进行调查。[结果]ICU护士CTDI-CV总分为253.39分±43.26分,明显正性倾向占1.6%,正性倾向占25.8%,倾向性较弱占55.6%,明显负性倾向占16.9%。CTDI-CV各维度平均得分由高到低依次为分析能力、求知欲、评判性思维的自信心、开放思想、系统化能力、认知成熟度、寻找真相。ICU护士评判性思维能力与医院性质、第一学历、最高学历呈正相关(P0.05)。[结论]贵州省ICU护士评判性思维能力总体较弱,应加强ICU护士评判性思维能力的培养和提升。     

本科护生评判性思维与临床决策能力的相关性研究

目的探讨四川省护理本科生评判性思维与护理临床决策能力的关系。方法利用评判性思维态度倾向性调查表(中文版)和护理专业大学生临床决策能力测量工具,调查四川省四所大学2008年护理专业毕业实习10～12个月的本科生。结果四川省护理本科生评判性思维能力总平均分为287.37±32.52;四川省护理本科生临床决策能力总平均分为72.86±4.53;评判性思维与临床决策能力总分、确定目标、决断方案、实施决策呈显著正相关(P0.01～0.05)。结论本科护生评判性思维与护理临床决策能力呈正相关,评判性思维能力越强,护理临床决策能力越强。     

护理本科生科研能力与评判性思维态度倾向性的相关性研究

[目的]调查护理本科生科研能力与评判性思维态度倾向性现状,探讨两者之间的相关性,为提高护理本科生科研能力提供理论依据。[方法]采用横断面调查研究,以配额抽样法抽取成都市某校护理学院全日制本科大学一年级~四年级277名学生为研究对象进行问卷调查,问卷由一般资料调查表、护理人员科研能力自评量表、中文版评判性思维态度倾向性问卷构成。[结果]护理本科生的评判性思维态度倾向性总分为(278.06±28.40)分,评判性思维的自信心得分最低,认知成熟度得分最高;护理科研能力总分为(52.96±17.72)分,论文写作能力得分最高,科研设计能力得分最低;护理科研能力与评判性思维态度倾向性总分(r=0.211)及评判性思维自信心(r=0.317)、系统化能力(r=0.294)、求知欲(r=0.238)、分析能力(r=0.187)呈正相关。[结论]护理本科生科研能力水平偏低,评判性思维态度倾向性为倾向不明,科研能力与评判性思维态度倾向性呈正相关,在学校教育中,可以通过加强学生自觉运用评判性思维的能力,即加强护理本科生的评判性思维态度倾向来提高其护理科研能力。     

不同年级护生与临床护士评判性思维能力的比较研究

目的 比较分析不同年级护生与临床护士的评判性思维能力,为护理教育、护理实践的改革提供科学的依据.方法 采用评判性思维倾向测量表中文版(CTDI-CV)对本科一、三年级护生共656名和护士287名进行调查.结果 一年级护生的CTDI-CV总均分为(292.82±26.41)分,护士组(290.58±24.87)分,三年级护生组(284.71±26.20)分,组间比较差异有统计学意义.一、三年级护生的开放思想、求知欲、认知成熟度三特质得分均高于护士,而系统化能力、评判性思维自信心比护士弱.结论 现有的护理教育体制需要优化改革,同时还需促进现代临床护理模式的转变.     

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.