医务人员院内感染防护情况调查分析

目的加强我院医务人员的自身防护意识。方法采用自行设计的医务人员自身防护情况调查表对全院医务人员进行问卷调查。结果共发出调查表196份。收回178份，回收率90．8％。其中，57．3％的人未采取防护措施的原因是认为遇到的传染病人少、思想上没有足够重视；洗手及手消毒正确的仅占25。8％；正确应用擦手工具92.7％；正确掌握消毒剂用途及效能4．5％；有95．5％的医务人员认为有必要加强自身防护知识的学习；88．2％的人认为需加强院内感染控制部门的监控力度。结论加强自身防护知识的宣教；熟练应用防护技术；建立健全自我防护的各项规章制度；加强防护措施应用的监督力度。     

加强院前急救是完善急诊医疗体系的当务之急

院前急救是急诊医疗体系最首要的环节。近年来，我国大城市院前急救有明显改善。但中小城市仍相当薄弱，与当今社会发展很不相适应。因此，进一步加强中小城市院前急救是完善急诊医疗体系的当务之急。现将我院1995～1997年735例院前急救病例资料分析如下。1临床资料1．1一般资料男426人，女309人，1995～1997年各年院前急救人数分别为72人，270人和393人。有年龄资料的709例，其中：60岁以上362人占49．3％。占前六位病种为：脑血管疾病146人占19．9％；创伤113人占15．4％；心血管疾病108人占14．7％；消化道急症75人占10．2％；呼吸道急症…     

养老服务机构护理人员现状调查

[目的]了解养老服务机构护理人员的基本情况和培训需求．为加强和完善养老护理队伍建设提供依据。[方法]自行设计问卷．对杭州市（7个县市区）16所养老服务机构的107名护理人员就护理队伍的基本情况、培训及需求情况进行问卷调查。[结果]40岁以上的58人（54．20％）；学历中专以下的72人（67．29％）；从未参加过养老护理相关知识培训的有9人（8．41％）；培训累计时间在1个月以下的有53人（49．53％）；认为需要养老护理方面知识的培训106人（99．07％）；认为半脱产的培训方式比较适合的54人（50．47％）。[结论]养老机构护理人员知识层次结构不合理，整体素质和水平薄弱．不利于我国养老护理事业的健康发展，应尽快完善养老护理人才队伍建设。     

SARS时期就诊病人及家属心态生活习惯对知识需求调查分析

目的了解SARS时期就诊病人及家属心态、生活习惯及对知识需求。方法采用自行设计的问卷对门诊病人及家属进行了心理健康、生活习惯、SARS知识需求调查。结果41．23％的病人及家属有恐惧、惊慌心理；50％以上病人及家属生活有规律、均衡饮食，个人卫生习惯良好，居室通风好；90．74％不接触动物、禽类；90．16％以上SARS知识迫切需求。结论提示对就诊病人及家属进行防SARS知识宣传的必要性、迫切性，必须加强宣教力度。     

消防部队战士焦虑、抑郁状况调查分析

目的：了解青海高原消防战士心理焦虑、抑郁状况，探索有效缓解战士心理焦虑、抑郁的方法。方法：使用抑郁自评量表（SDS）、焦虑自评量表（SAS）随机对110名战士进行问卷调查。结果：总体评分抑郁发生率22．72％，单项分析，有6人经常忧郁，占5．45％；无价值感（我认为如果我死了，别人会生活得好些）11人，占10％；有13人觉得过得没意思（生活空虚感），占11．82％；无用感（我觉得自己是个有用的人，有人需要我。反向评分）13人，占11．82％；焦虑状况发生率14．54％，单项分析，焦虑感（我觉得比平常容易紧张和着急）12人，占10．9％；发疯感（我觉得我可能将要发疯）5人，占4．54％；有38人有不幸的预感，占34．54％。心理障碍和严重心理问题的发生率与居住地、是否独生子女无密切关系。结论：针对青海高原消防战士实施集体心理健康教育、建立预防监测机制可有效预防意外事故发生，有助于保持部队稳定。     

园区健身人群一般情况的调查与分析

对保定市区部分园区健身人群４５４人从年龄、性别、从业情况、健康状况、健身方式五方面进行了调查。结果：３６岁以上参与健身者３９７人，占８７．４％，３６岁以下参与健身者５７人，占１２．６％；４５４人中离休人员３１２人，占６８．７％，在职人员１４２人，占３１．３％；健康状况良好２０６人，占４５．４％，健康状况一般２４８人，占５４．６％；健身方式有晨舞、气功、拳剑。以上数据提示，在职职工、年轻人、健康状况较差者参与健身活动的人数较少，望有关部门引起重视。并提出了园区健身活动存在的意义与作用、发展与外延。     

医院感染现患率调查报告

目的：监测医院感染率及医院感染的相关情况，以便发现医院感染管理中存在的问题，并探讨现患率调查优缺点。方法：床旁调查与查阅病历相结合，填写统一的个案调查表，凡于调查期内处于医院感染状态的均计人医院感染。结果：调查住院病人1495人，实查率95．71％，查出医院感染97人，114例次，现患率6．49％，例次现患率7．63％；感染部位依次为下呼吸道、腹腔内、泌尿道；病原学诊断率为51．75％；抗生素使用率66．35％。结论：控制医院感染除加强消毒隔离，无菌技术外，尚需加强对接受侵入性诊疗患者的护理，避免滥用抗菌药物及激素或免疫抑制剂，维持患者微生态平衡；现患率调查省时、省力，但资料连续性较差，需重复进行。     

湛江地区40岁以上人群COPD患病率的城乡差异

目的：分析广东省湛江地区城乡40岁以上人群慢性阻塞性肺疾病（COPD）的患病现状及危险因素。方法：按城乡分层，在广东省湛江地区以整群随机抽样方法，调查40岁以上居民3051人，采用统一的流行病学调查表格，并进行肺功能检测。结果：（1）2435人完成肺功能检测，应答率79．8％。城市1126人，农村1309人；男939人，女1496人；（2）COPD总患病率为6．0％（145／2435），农村患病率为7．0％（92／1309），显著高于城市的4．7％（53／1126），P〈0．05；男性患病率为8．9％（84／939），显著高于女性的4．1％（61／1496），P〈0．001。（3）危险因素调查发现，农村的吸烟、吸旱烟、现吸烟、有呼吸病家族史、使用柴草烹饪、有儿童时期呼吸病感染和文化程度低的比例显著高于城市（P〈0．05）。是农村COPD患病率高于城市的重要原因。结论：COPD正成为重要的疾病负担，应多方位加强COPD的人群防治．尤其在农村。     

贵阳地区疗休养员疾病概况及展望

我院地处贵阳市郊，疗体养员主要来自贵阳地区企事业单位。自１９８９年１月至１９９４年１月共收住院疗休养员２８９１人。其中３０岁以下１１８人，占４．０８％；３１～４０岁３７２人，占１２．８７％；４１～５０岁７８２人，占１５－８０％；５１～６０岁９９０人，占３４．２４％；６１～７０岁４５７人，占１５．８０％；７１岁以上的１７２人，占５．９５％；中老年占８０．０８％。其中男１９０８人，女９８３人。健康疗养２６６人，占９．２０％；慢性病疗养２６３５人，占９０．８０％。各类疾病的发病率依次为运动系统疾病２２…     

精神科住院患者暴力行为分析与防范对策

笔者回顾分析了142例住院精神病患者暴力行为发生情况，总结防范对策。本组病例暴力行为73．9％发生在新人院的第1周，50．7％攻击行为是针对医护人员；攻击的诱因：44．4％因进行治疗、检查，21．8％因语言不当，33．8％无明显诱因。既往暴力史、人院前攻击行为、约束人院、不合作、幻觉或妄想、人格改变、酒精滥用等是暴力危险因素。提出防范对策：加强精神科职业防护，掌握与患者沟通技巧，重视人院患者暴力危险因素的评估，加强对精神病的治疗，及早控制病情，做好心理护理，提高患者心理舒适的需求。     

A measure of organizational effectiveness in nursing management

This paper presents an empirical study of the influences of transactional (TA) and transformational (TF) leadership on organizational effectiveness (OE), measured as the degree of goal attainment and the quality of nursing care (NQ). The study subjects were all head-nurses and assistant head-nurses at a medium-sized hospital in Sweden ( n =23). The methods used were questionnaires and interviews. The multi-leadership questionnaire earlier developed by Bass was modified and named the Leadership-Nursing-Effectiveness Questionnaire (LNEQ), comprising 84 items using Likert-type scales. The study showed low mean scores on OE (2.19) and TA (1.05) but high mean scores on NQ (3.17) and TF (3.84). The results suggest that the degree of TA and TF leadership had a low and insignificant connection with OE in this hospital organization. The study did not support the statement that organizational units exposed to a higher degree of TA and TF leadership at the same time show a high degree of OE, as has been shown in studies in other cultural contexts and organizations.     

实施病区护士长每日访视管理的效果评价

目的探讨实施病区护士长每日访视管理的效果。方法收集实施病区护士长每日访视管理前后护理部质量检查的相关数据,并进行统计学分析。结果分级护理、病房管理和护理服务质量管理、护理质量考核平均合格率以及患者满意度在实施病区护士长每日访视管理后均有显著提高,与实施前比较差异有统计学意义（P〈0.05）。结论病区护士长每日访视管理对护理质量的提高有着重要的促进作用,有助于鼓励护理人员的工作积极性、加强病房管理、融洽护患关系和提高患者满意度。     

住院结核病患者佩戴口罩现状调查

目的:对住院结核病患者佩戴口罩的比例、口罩种类和来源进行调查,以探讨有效的管理方法。方法:自行设计问卷,对14个省、市20家医院的结核病房护士长或医院护理部主任进行调查。结果:调查范围共涵盖32个病区,其中15个(46.9%)病区患者不佩戴口罩,16个(50.0%)病区部分患者佩戴口罩,1个(3.1%)病区所有患者均佩戴口罩;84.4%的病区患者佩戴普通一次性口罩和纱布口罩,15.6%的病区患者佩戴外科口罩;53.1%的病区口罩由患者自己随意购买;46.9%的病区免费或收费为患者提供;综合医院结核病区为患者提供口罩的比例和患者佩戴率均高于结核病专科医院,差异有统计学意义;为患者提供口罩的病区和患者自己购买口罩病区患者佩戴率没有统计学差异。结论:目前国内医院对肺结核患者佩戴口罩的管理欠规范,佩戴比例较低,口罩种类不尽合理。提示结核病医院应加强对患者佩戴口罩行为的干预管理,降低医院感染风险。     

2238例糖尿病患者高危足现状及相关因素分析

调查糖尿病患者高危足的现状,并分析影响因素。方法：用自制的量表对糖尿病患者进行高危足筛查。Spss20.0分析保护性感觉和足背动脉搏动减弱的影响因素及两者之间的相关性。结果：36.10%的糖尿病患者存在糖尿病足高危因素。保护性感觉减弱16.26%,足背动脉搏动减弱14.03%,两者之间的相关系数 r=0.265,年龄、病程、足部皮肤颜色改变等是两者的影响因素。结论：糖尿病患者高危足较多,以保护性感觉与足背动脉搏动减弱为主,年龄越大、病程越长及足部皮肤颜色改变者保护性感觉与足背动脉搏动减弱越明显,应加强糖尿病患者的高危足预防。     

Phantom pain in bilateral upper limb amputation

Purpose.?To alert health professionals on presence and extent of phantom pain and sensation following bilateral upper limb amputation.

Methods.?Of a total of 140 war-related bilateral upper limb amputees in Iran, 103 subjects were thoroughly examined in this cross-sectional study by a physical medicine specialist. The patients were questioned for the presence of phantom pain and sensations, and frequency and intensity of the feeling were recorded.

Results.?At 17.1 ± 6.1 years after injury, 82.0% of the 103 amputees suffered from phantom sensation, including varying degrees of phantom limb pain in 53.9% of stumps. Phantom phenomena had a higher frequency in the right extremities, but this was not statistically significant (p > 0.01). Of those amputees who had phantom pain or sensation, 51.2% reported that they ‘always’ had phantom limb sensation; and approximately one-fourth of the subjects (24.6%) ‘always’ had phantom pain. Among the stumps who reported phantom pain (N = 112), the pain was excruciating (38.5%), distressing (34.9%) or discomforting (25.6%). A significant statistical relation between phantom limb sensation and level of amputation was observed (p < 0.01).

Conclusion.?At this time there is no healing for phantom pain; medical and surgical modalities only bring temporary relief, and less than 1% of the respondents achieve permanent relief through different treatment methods.     

护士长自我效能与行为应付方式的调查研究

目的：了解当前护士长自我效能及行为应付方式的一般状况及其相互关系。方法：采用一般自我效能感量表和肖计划编制的应付方式问卷对太原市某两所三级甲等医院80名护士长进行调查评定。结果：护士长表现出较高的自我效能;应付方式以解决问题和求助的成熟型为主;护士长自我效能与行为应付方式之间存在密切的相关性。结论：护士长表现出中等及中等以上的自我效能,采取较为成熟的行为应付方式,自我效能是影响护士长行为应付方式的一个重要因素,在护士长选拔和管理知识培训中应多重视心理学方面的内容。     

Pain in traumatic upper limb amputees in Sierra Leone

Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary.     

Small- and large-fiber involvement in early diabetic neuropathy: a study with the medial plantar response and sensory thresholds

Small- and large-fiber function in diabetic neuropathy was studied in 68 patients (mean age 45.4 +/- 12.9 yr; 27 type I and 41 type II diabetics) with psychophysical tests of vibration and thermal sensation and neurophysiological measurements, including the medial plantar sensory action potential (MPSAP). Thermal sensitivity at the dorsolateral aspect of the foot (Pfizer thermal tester) correlated significantly with vibration thresholds (Somedic vibrameter) at three sites in the foot and two in the hand. Forty patients had normal sensory thresholds, but 18 of these lacked an MPSAP. Smaller groups had a single abnormal sensory threshold: 12 (18%) had an abnormal vibration threshold, and 24 (35%) had abnormal thermal sensitivity; 8 of the former group and 17 of the latter group lacked an MPSAP response. Only 8 (12%) had both abnormal vibration and thermal sensation (6 without an MPSAP). Fifteen of the 17 symptomatic patients had lost the MPSAP, but there was no consistent pattern of sensory loss. In this relatively young group of diabetics, more patients showed absent MPSAP responses than an abnormality in either sensory test on its own. The MPSAP is frequently absent in patients with no abnormalities in psychophysical tests of peripheral large-fiber function (vibration sensation) and small-fiber function (thermal sensitivity).     

Sensory root level recovery in patients with Frankel A quadriplegia.

This prospective study was designed to demonstrate root level recovery of sensation in the zone of partial preservation in patients with C4 through C8, Frankel A spinal cord injuries. Subjects were evaluated for pin (n = 18) and light touch (n = 17) sensation. All subjects had normal sensation at the level of injury, and decreased or absent sensation at all levels caudal to that level within the zone of partial preservation; they had absent sensation at all levels below the zone of partial preservation. After the initial examination, patients were evaluated weekly for four weeks, and then at 2, 3, 6, 12, 18, and 24 months postinjury. Six of 18 patients recovered pin sensation and five of 17 recovered light touch within three months of injury. Most subjects who recovered had injuries from C5 through C8. Eleven of 12 C4 patients did not recover pin sensation, and 11 of 11 failed to recover light touch. However, five of six C5 to C8 patients recovered both pin and light touch. The p values (Fisher-Exact tests) for the C4 vs C5 to C8 groups were .004 and .001 for pin and light touch, respectively. In conclusion, approximately 30% of the total population improved one sensory root level, with the C5 to C8 injured patients comprising the majority of this improvement.     

The assessment of radiating low back pain by thermal sensory testing

Low back pain radiating into the legs is a common pain syndrome. However, neurological examination, imaging and electromyographic studies are of limited value for prognosis or therapy. The origin of the pain remains unknown. The aim was to evaluate the potential of thermal sensory testing to serve as a diagnostic tool in 24 patients who had low back pain radiating down the S1 dermatome, compared with 26 pain-free controls. The method of limits was used to detect the thresholds of warm sensation, cold sensation, warm pain and cold pain at the L4, L5 and S1 dermatomes of the symptomatic and the non-symptomatic legs. Thresholds on the asymptomatic leg were similar to values obtained in controls. We found a significantly higher threshold for cold sensation in the S1 dermatome of the symptomatic leg of the patients compared with the controls (p< 0.005). In addition, patients who had abnormal neurological examination (50%) had higher thresholds for cold sensation or cold pain in the three dermatomes tested at the symptomatic leg compared with the non-symptomatic leg. No differences in the thresholds of warm sensation or warm pain were detected. We propose that these findings indicate selective damage to the Adelta fibres which are involved in transmission of cold sensation and pain, presumably by root compression. We found no evidence of involvement of C fibres, which transmit warm sensation and pain. Thermal testing should be considered among the testing modalities that are capable of demonstrating objective findings in patients with radiating low back pain.