2型糖尿病病人服药治疗依从性研究

[目的]了解2型糖尿病病人服药治疗依从性以及影响因素，为有效开展糖尿病教育提供依据。[方法]选择在广州市5家医院就诊的335例2型糖尿病病人，对服药治疗依从性、糖尿病知识、健康信念、自我效能以及服药一般情况等进行问卷调查，用线性逐步回归分析法分析各种因素对服药依从性的影响。[结果]病人服药依从性均分与总分比为0．83；能完全按医嘱长期坚持服药者仅占67．0％。病人服药依从性与糖尿病知识掌握程度、健康信念、自我效能、购药方式、有无药物副反应、是否工作忙或事情多和就医的便利性相关（P〈0．01或P〈0．05）。[结论]医院应强化糖尿病健康教育，确保病人长期坚持服药；重点关注工作忙、记忆力减退、经济困难等因素产生的影响；调动家庭支持力量；政府部门应制定相应治疗优惠政策，合理配置医疗资源。     

2型糖尿病病人足部护理及其影响因素调查

[目的]了解2型糖尿病病人足部护理情况及其影响因素,为针对性开展足部护理教育提供依据。[方法]选择广州市5家医院就诊的349例2型糖尿病病人,对足部护理依从性及有关糖尿病知识、健康信念和自我效能等进行问卷调查,采用线性逐步回归分析法筛选病人足部护理依从性的影响因素。[结果]病人足部护理各项措施执行情况不理想;病人足部护理依从性与其年龄、经济条件、糖尿病知识、健康信念均呈正相关(P<0.01、P<0.05);生活方式呈负相关(P<0.05),与家人同住的病人容易忽视足部护理。[结论]应强化病人对糖尿病足危害的认识,提高足部护理技能;注意对非老年病人、经济条件差的病人进行教育引导;重视对病人家庭成员教育,争取获得家庭支持,以确保病人有效执行足部护理。     

2型糖尿病病人足部护理及其影响因素调查

[目的]了解2型糖尿病病人足部护理情况及其影响因素，为针对性开展足部护理教育提供依据。[方法]选择广州市5家医院就诊的349例2型糖尿病病人，对足部护理依从性及有关糖尿病知识、健康信念和自我效能等进行问卷调查，采用线性逐步回归分析法筛选病人足部护理依从性的影响因素：[结果]病人足部护理各项措施执行情况不理想；病人足部护理依从性与其年龄、经济条件、糖尿病知识、健康信念均呈正相关（P〈0．01、P〈0．05）；生活方式呈负相关（P〈0．05）．与家人同住的病人容易忽视足部护理：[结论]应强化病人对糖尿病足危害的认识，提高足部护理技能；注意对非老年病人、经济条件差的病人进行教育引导；重视对病人家庭成员教育，争取获得家庭支持，以确保病人有效执行足部护理。     

自我效能感对住院精神分裂症病人自我管理的影响

[目的]探讨健康教育路径对住院精神分裂症病人自我效能感的影响。[方法]将60例入组的住院精神分裂症病人分为高自我效能组和低自我效能组,在实施健康教育路径后采用一般自我效能感量表(GSES)、自知力与治疗态度问卷(TIAQ)、自行设计的服药依从性调查表进行评定。[结果]实施健康教育路径后两组病人服药依从性有统计学意义(P<0.05),TIAQ有统计学意义(P<0.05),精神分裂症病人的一般自我效能感(GSES)与国内常模比较有统计学意义(P<0.01)。[结论]健康教育路径是提高精神分裂症病人自我效能感、实行自我管理的有效方法。     

２型糖尿病患者饮食治疗依从性研究

摘要：目的 了解２型糖尿病患者饮食治疗依从性及其影响因素，为进一步有效开展糖尿病患者饮食教育提供依据。方法 对３４９例２型糖尿病患者进行饮食治疗依从性及有关疾病知识、健康信念和自我效能等问卷调查，分析患者饮食治疗依从性的影响因素。结果 患者饮食依从性总分８.５８±２.４４；患者饮食治疗依从性与其年龄、应用技能、健康信念、自我效能呈显著正相关（Ｐ＜０.０５，Ｐ＜０.０１）。结论 提高患者饮食治疗依从性需重视其实际操作技能训练及健康信念、自我效能的影响作用，同时应特别关注非老年患者的饮食治疗依从性。关键词：糖尿病，非胰岛素依赖型；　饮食治疗；　健康信念；　自我效能中图分类号：Ｒ４７３．５　　文献标识码：Ａ　　文章编号：１００１-４１５２（２００７）０５-０００１-０３     

健康信念模式对耐多药肺结核病人服药依从性的影响

[目的]观察健康信念模式对耐多药肺结核病人服药依从性的影响。[方法]将80例耐多药肺结核病人随机分为观察组和对照组,观察组采用健康信念模式进行健康教育,对照组采用一般性健康教育,比较两组健康教育效果及服药依从性情况。[结果]观察组健康教育知识掌握率及服药依从性明显高于对照组(P0.05)。[结论]运用健康信念模式能影响病人的主观心理过程,改变病人不利于健康的观念,提高病人的服药依从性。     

健康信念模式教育对高血压脑出血病人的影响

[目的]探讨健康信念模式教育对高血压脑出血病人服药依从性及相关知识认知程度的影响。[方法]将120例高血压脑出血病人随机分为实验组和对照组各60例,实验组在药物治疗的同时根据健康信念模式对病人进行有针对性的健康教育,对照组行常规健康教育。比较健康教育前后两组病人疾病相关知识的认知程度及服药依从性。[结果]健康教育前两组病人疾病相关知识的认知程度及服药依从性比较差异无统计学意义（P均〉0．05）,健康教育后3个月随访观察,两组病人疾病相关知识的认知程度及服药依从性比较差异有统计学意义（P均〈0．05）。[结论]健康信念模式教育能提高高血压脑出血病人对疾病相关知识的认知程度及对药物治疗的依从性,提高病人生活质量。     

健康信念模式教育对高血压脑出血病人的影响

[目的] 探讨健康信念模式教育对高血压脑出血病人服药依从性及相关知识认知程度的影响.[方法]将120例高血压脑出血病人随机分为实验组和对照组各60例,实验组在药物治疗的同时根据健康信念模式对病人进行有针对性的健康教育,对照组行常规健康教育.比较健康教育前后两组病人疾病相关知识的认知程度及服药依从性.[结果]健康教育前两组病人疾病相关知识的认知程度及服药依从性比较差异无统计学意义(P均＞0.05),健康教育后3个月随访观察,两组病人疾病相关知识的认知程度及服药依从性比较差异有统计学意义(P均＜0.05).[结论]健康信念模式教育能提高高血压脑出血病人对疾病相关知识的认知程度及对药物治疗的依从性,提高病人生活质量.     

健康信念模式对耐多药肺结核病人服药依从性的影响

[目的]观察健康信念模式对耐多药肺结核病人服药依从性的影响。[方法]将80例耐多药肺结核病人随机分为观察组和对照组,观察组采用健康信念模式进行健康教育,对照组采用一般性健康教育,比较两组健康教育效果及服药依从性情况。[结果]观察组健康教育知识掌握率及服药依从性明显高于对照组（P〈0．05）。[结论]运用健康信念模式能影响病人的主观心理过程,改变病人不利于健康的观念,提高病人的服药依从性。     

2型糖尿病患者眼部检查依从性影响因素的调查

目的探讨2型糖尿病患者眼部检查依从性的影响因素,为糖尿病教育工作提供参考依据。方法问卷调查在广州市5所医院就诊的349例2型糖尿病患者,包括眼部检查情况以及有关糖尿病知识、健康信念和自我效能等,用Logistic回归法筛选眼部检查依从惟的影响因素。结果眼部检查依从性良好者仅21．4％;单因素分析结果发现,年龄、居住地（城市或乡镇）、文化程度、从事医疗或接触医疗、医疗支付方式（公费或医疗保险、自费）、病程、糖尿病知识、健康信念和自我效能等因素对检查依从性有着影响作用;多测素分析显示,仅患者年龄（OR=1．46,95％C．I、=1．07～1．99,P＜0、05）、糖尿病知识（OR=1．13,9,5％C．I=1．07～1．19,P＜O．01）有统计学意义。结论应重视糖尿病眼病早期防治教育,关注非老年患者的眼部检查依从性。政府应强化健康教育促进职责,利用媒体增加乡镇、偏远地区健康信息的可获得性,并提高医疗检查的便利性。     

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.