曲靖中心城区养老护理员培训现状、需求及培养对策

目的了解曲靖市养老机构护理员培训现状及需求情况。方法随机选取曲靖市138名养老护理员为调查对象。结果养老护理员40～49岁占60.8%,小学及以下文化程度占54.4%,无医学背景占90.4%,合同工占57.6%,月收入多在1 000～1 999元,周工作时长50～59 h的占44.8%;未持证率达80%,72%的人岗前培训时间<1周,主要是日常生活照护培训;多数原意参加培训,希望能根据内容、护龄分阶段分层以理论+操作形式培训,培训内容需求总分(17.29±7.16)分,其中得分最高的是日常生活照护(2.57±0.90)分,得分最低为急救护理(1.79±0.85)分,不同文化、护龄、职称和月薪的养老护理员对培训内容需求差异有统计学意义(P<0.05)。结论养老护理员年龄偏大,文化偏低,多为合同工,工作强度大,待遇低,持证率低,岗前培训时间短,护理员对培训内容的需求受文化、护龄、职称和月薪的影响,最期待理论结合实践培训。     

职业疲溃感对ICU护士离职倾向的影响研究

目的：调查三级甲等医院重症监护病房(ICU)护士职业疲溃感与离职倾向现状并分析二者的相关性。方法：采用便利抽样法,采用一般资料问卷、职业疲溃感量表、离职意愿量表,对217名三级甲等医院ICU护士进行调查。结果：217名ICU护士职业疲溃感及离职意愿得分分别为(53.75±10.62)、(14.26±2.64)分,处于中等水平。相关分析显示,ICU护士职业疲溃感总分及各维度得分与离职意愿总分及各维度得分均呈正相关关系(r=0.161～0.398,P<0.05)。单因素分析显示,不同工龄、人事关系、月均收入、夜班情况及自评健康状况的ICU护士离职意愿得分差异均具有统计学意义(P<0.01);不同人事关系、工作压力及自评健康状况ICU护士职业疲溃感得分差异均具有统计学意义(P<0.01)。多元回归分析显示,工龄、月均收入、夜班情况、自评健康状况及情绪疲溃感是ICU护士离职意向的主要影响因素(P<0.05),可解释总变异的45.9%。结论：三级甲等医院ICU护士离职意愿水平较高,职业疲溃感是其重要影响因素,二者具有相关性。护理管理者应根据其影响因素,采取针对性干预策略,...     

二级综合医院妇产科医护人员职业倦怠现况分析

目的分析二级综合医院妇产科医护人员职业倦怠和其工作时间强度的关系。方法采用Maslach倦怠量表对471名妇产科医务人员的职业倦怠现况进行问卷调查分析。结果不同年龄组者、不同婚姻状况者、不同文化程度者、不同月收入者、医生与护士、轮值夜班次数不同者、每周工作10h以上的天数不同者的医护人员职业倦怠总分的差异均有统计学意义(P<0.05),其中职业倦怠评分:≤30岁年龄组低于31~44岁年龄组;未婚者高于已婚者;本科及以上文化程度者高于大专及以下文化程度者;月收入高于6000元低于月收入少于6 000元;医生高于护士;轮值夜班次数越多和每周工作10h以上的天数越多,职业倦怠总分越高。结论二级综合医院妇产科医护人员是职业倦怠的高危人群,容易出现职业倦怠,应关注妇产科医护人员的工作状况、思想动态,及时做到职业倦怠的预防和职业倦怠发生后干预工作。     

急诊护士心理韧性在工作压力与职业疲溃感之间的中介效应调查

目的 分析急诊护士心理韧性现状以及与工作压力、职业疲溃感的关系,为从积极心理学的角度进行心理干预提供依据.方法 采用不记名问卷调查方式,运用一般人口学资料、心理韧性量表、工作压力源量表、职业疲溃感量表对352名急诊护士进行调查,采用Pearson相关性分析对数据进行两两之间的关系分析,运用温忠麟的依次检验法、线性回归对心理韧性在工作压力与职业疲溃感之间的中介效应进行分析.结果 急诊护士心理韧性得分为(71.67±16.51)分,工作压力得分为(82.64±26.77)分,职业疲溃感的情感耗竭维度得分为(19.l55±11.46)分;去人格化维度得分为(10.43±6.52)分;个人成就感维度得分为(16.45±9.82)分.心理韧性及各维废与工作压力及各维度得分呈显著负相关(P＜0.01);心理韧性会因职业疲溃感中的情感消耗以及去冬格化的加剧而弱化(P＜0.01),也会因个人成就感的增强而增强(P＜0.01);心理韧性在工作压力与职业疲溃感之间有着中介效应.结论 良好的心理韧性更有可能具有较强的抗压能力,体验较低水平的职业疲溃感.     

青海高原地区产妇产后抑郁症人群分布研究

目的：了解青海高原产妇产后抑郁症在不同人群中的发病情况,为制定干预措施提供依据。方法：采用现况研究的方法对青海高原2009年分娩的2 348名产后4周内的产妇进行产后抑郁症人群分布研究。结果：青海高原产后抑郁症患病率为21.85%。产后抑郁症患病率表现为＂〉30岁＂和＂〈20岁＂的明显高于＂20岁～30岁＂;本科及以上学历者明显高于初中以下文化水平者,而文盲明显高于初小;月收入在2 000元以上者均高于＂〈1 000元＂组,且月收入＂2 000元～＂组高于＂1 000元～＂组;产后抑郁症的患病率汉族最低,干部明显高于农民和无业者。结论：青海高原地区产后抑郁症患病率汉族最低,呈现明显年龄过小及过大者、高学历、高收入者高发势态。     

精神科护士的工作疲溃感及其相关因素分析

目的探讨精神科护士的工作疲溃感及其与工作源、个性和应对方式的关系.方法采用Mashach工作疲溃感量表(MBS)、护士工作压力源量表(NJSQ)、简化的艾森克个性问卷(EPQ)和特质应对方式问卷(TCSQ),对两所医院的98名在职精神科护士进行调查.结果与常模[(7.12±5.22)分,(22.19±9.53)分,(36.54±7.34)分]比较,精神科护士的工作冷漠感[(14.13±4.89)分]为高度,而情绪疲溃感[(16.59±7.93)分]与工作无成就感[(15.09±7.61)分]均为轻度;护士的工作压力与情绪疲溃感和工作无成就感密切相关(r=0.239～0.545,P＜0.05～0.01);个性倾外向且情绪不稳定的护士易于产生情绪疲溃感和工作无成就感;积极应对有助于减轻工作冷漠感与工作无成就感,消极应对则会加重情绪疲溃感.结论精神科护士的工作疲溃感相对较轻,并受工作压力及个性、应对方式的影响.应关注引起精神科护士工作压力的特殊成因,改善他们的工作环境,同时塑造良好的个性,提高其积极应对技巧.     

武汉市养老服务机构护理人员调查与思考

目的:掌握武汉市养老护理人员工作状况及面临的困难,分析养老护理人员状况改善及提高养老护理人员综合素质的途径。方法:以用问卷调查为主,深度访谈为辅的方法来收集资料,对全市养老护理人员的年龄结构、文化程度、收入水平、工作强度、工作满意度、接受职业培训、签订劳动合同及办理社会保险等方面进行调查。结果:目前,武汉市养老床护比为1:5.5,养老护理人员整体素质偏低,初中及初中以下文化程度占61.9%,大专文化程度占3.4%,本科及以上文化程度占1.2%。职业培训情况有待加强,从未接受相关知识培训者占55.2%。经济收入水平偏低,月收入900~1 000元之间者占42.3%。老年护理人员严重不足,90%的养老护理人员认为工作强度大。结论:提高养老护理人员收入水平,改变护理人常规思维方式,明确养老护理在护理领域的重要性,确定养老护理教育培训方案,加强培训力度,提高养老护理人员综合素质对应对日益严峻的社会老龄化进程尤为重要。     

护士工作疲溃的研究进展及应对措施

对护士工作疲溃感的现状、原因、预防及干预措施进行了综述,旨在为我国护士工作疲溃感的进一步研究和发展提供信息与方向,有助于获得预防和降低工作疲溃感的应对策略.     

政府购买护理服务模式下居家养老护理员现状分析

目的 调研政府购买护理服务模式下居家养老护理员工作现状,了解居家养老护理员现状及对工作的认知.方法 用自行设计的调查表,采用整群抽样对全区所有护理员进行调查,调查居家养老护理员的基线情况、接受培训及考核等情况.结果 养老护理员队伍具有较好的稳定性;对其工作能力及工作中存在的困难具备一定的认知,78%的养老护理员能胜任工作,76%的护理员认为有困难,65%的护理员认为困难的原因是社区居民观念.结论 多元文化的培训、再培训和评估是提高居家养老服务的保障;居家养老护理员劳动工资报酬有待进一步提高.本调研为进一步提升居家养老护理服务质量和水平提供了理论依据.     

家庭暴力的社会人口学特征

目的探讨家庭暴力(DV)的社会人口学特征.方法采取多级分层随机抽样方法,用自编DV综合问卷,对300户有暴力家庭,以及按照家庭结构配对选取的300户无暴力家庭有关成员作调查访谈.结果施暴者与受虐者年龄组构成比均以30～39岁最高(分别为40.3%和27.1%),文化程度构成比均以小学以下为最高(分别为32.2%和43.1%).施暴者男性多于女性(70.1% vs 29.9%),受虐者女性多于男性(67.0% vs. 33.0%),两组性别差异有显著性(P <0.001),成年男性施暴的危险度是女性的5.0倍.成年施暴者受教育年限[(8.9±4.7)年]高于受虐者[(7.5±5.2)年](P <0.01),但低于对照组(P <0.05).成年施暴者月经济收入[(709.7±796.4)元]及其占家庭总收入比例[(24.1±32.2)%]均显著高于受虐组[(477.5±489.1)元和(17.3±26.0)%](P <0.05或P <0.01),但低于施暴对照组(P <0.05或P <0.01).男性自评经济状况差、占家庭经济收入比例低是DV的危险因子.结论家庭暴力高发年龄为以30～39岁,施暴者为男性居多,受虐者大多为女性,施暴者与受虐者的文化程度与经济收入均较低,特别是经济收入占家庭总收入比例低者容易受虐.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.