基于时机理论脊髓损伤患者主要照顾者照护体验的质性研究

目的基于时机理论框架探讨脊髓损伤主要照顾者在不同阶段的照护体验。方法2018年11月至2019年5月,采用目的抽样选取安徽医科大学第一附属医院脊柱外科住院及出院脊髓损伤患者的主要照顾者46名为研究对象,采用现象学研究法,基于时机理论的五个不同时期对其进行非结构访谈,以Colaizzi分析法对资料进行分析。结果按照时机理论的五个不同时期提炼主题。手术前期,害怕面对现实;手术后期,缺乏疾病相关知识;出院准备期,焦虑无助;出院调适期,主动应对,希望提高居家照护能力;出院稳定期,勇敢接受,努力应对。结论脊髓损伤照顾者的照护体验是一个复杂动态的过程,患者处于不同的疾病阶段,照顾者的照护体验与之变化,应给予每阶段针对性指导,帮助脊髓损伤家庭树立重新开始的信心。     

Molecular selectivity in the water flooding heavy oil process from porous rocks

Water flooding increases the recovery factor of crude oil and has been proven to be an economical and viable technique for enhancing the oil recovery of oil fields. The process has been systematically studied previously, in which the oil was considered a substance of constant composition. However, the molecular selectivity during the water flooding process has rarely been addressed, especially for heavy oil. Herein, the properties and compositional changes of heavy oil have been investigated in a simulated water flooding process at 60 °C and 85 °C. The crude oil and produced oils from different water flooding stages were characterized by gas chromatography, gas chromatography-mass spectrometry, and Fourier transform ion cyclotron resonance mass spectrometry. The results show that with the increase in temperature, the content of resins in the produced oils from different water flooding stages decreases, and the content of asphaltenes increases slightly. The viscosity of the produced oils increases at low temperatures and decreases at high temperatures as the water cut increases. The composition of the produced oils from different water flooding stages is different. Compared with the no water cut and high water cut stages, the changes in the produced oils of the low water cut stages are significant at different temperatures. The molecular selectivity of heteroatoms is higher than that of hydrocarbons in the water flooding process. Water flooding preferentially extracts small-molecule low-carbon hydrocarbons and small-molecule heteroatoms with low condensation degrees. The compositional differences between the produced oils were characterized by the double bond equivalent versus carbon number distribution of the S, N, and O-containing compounds. This study can not only provide some explanations on the viscosity-forming mechanism of heavy oil but also explains the watered-out phenomena in the development of oilfields.

The composition of heavy oil changes during the water flooding process. Water flooding preferentially extracts small-molecular components with the increase in temperature.     

以护理结局为导向的腰椎手术患者临床护理路径的构建

目的完善腰椎手术患者临床护理路径,为患者提供规范化、科学化的护理服务模式,培养护士发现问题、思考分析问题及解决问题的能力,建立护士临床护理思维。方法以病历和文献回顾为理论依据,以科室现使用的临床路径为基础,查阅患者在手术不同阶段产生的主要护理问题与干预措施,结合《护理结局分类》形成针对性的腰椎手术患者结局评价指标。经过专家咨询与修改,形成符合腰椎手术患者的临床护理路径。结果构建了以护理结局为导向的腰椎手术患者住院当天、术前日、手术日、术后1~3 d、术后4~10 d不同阶段的临床护理路径。结论以护理结局为导向的腰椎手术患者临床护理路径,集中了临床护理路径与护理程序的优势,实现了从个案管理到群体化护理,在使用过程中能充分反映不同层级护理人员的水平与资质,增加护士间的团队合作精神。     

Evidence-based practice: Part 2: Steps in the process

Evidence-based (EBP) aims for a new distribution of power centered on scientific evidence rather than clinical expertise. The present article describes the operational process of EBP by describing the implementation stages of this type of practise. This stage presentation is essential given that there are many conceptions end models of EBP and that some nurses have a limited knowledge of its rules ans implications. Given that number and formulation of the stages varies by author, the process presented here attempts to integrate the different stages reviewed.     

The light diffusion technique for estimation of the size of urine particles in patients with type 2 diabetes mellitus in the Tamm-Horsfall protein precipitation

Tamm-Horsfall uroprotein accounts for more than 50% of the urinary proteins in healthy individuals. In abnormalities, it creates a favorable background for detecting smaller-sized uroproteins and for diagnosing pathological processes from the results of native urine tests. In this connection, there is a need for precipitating Tamm-Horsfall glycoprotein while applying laser correlation spectroscopy to analyze the size of urine particles in patients with type 2 diabetes mellitus. Eighty patients with this condition concurrent with different stages of diabetic nephropathy and 23 apparently healthy individuals were examined. The findings suggest that the subfraction urine composition before and after Tamm-Horsfall protein precipitation is different in apparently healthy individuals and patients with type 2 diabetes mellitus concurrent with diabetic nephropathy. This is most likely to be due to the change in the qualitative composition of protein as renal lesion progresses, to the specific features of protein excretion at different stages of a pathological process, and to different concentrations of other low and high molecular-weight proteins.     

Quality assurance for multiplexed assays – how can it be achieved?

Abstract

Multiplexed assays are now a common form of analysis in routine clinical and research laboratories. Assuring the quality of this type of complex, massively-parallel testing poses challenges not encountered in the traditional single-plex assay. A range of quality assurance measures is implemented at different stages in a multiplex assay, beginning in the manufacturing process, and the ensuing analytical and data interpretation stages. This article explores quality issues and the quality assurance measures that have been devised for multiplex assays ranging from simple two-plex assays to the types of assays that involve simultaneous testing on millions of test sites on a single analytical device.     

医疗护理纠纷干预转化趋向的分析

医疗护理纠纷的发生和发展需经历一个过程,各发展阶段都有其特征性表现,并具有普遍规律。因此,认为医疗护理纠纷是可以分期的,并且是可以被干预的。基于医疗护理纠纷分期理论和可干预性,对医疗护理纠纷在干预条件下的转化趋向进行了研究。     

Reworking professional nursing identity

In spite of professional socialization through nursing education programs, new graduates experience stress as they become working professionals. This grounded theory study explores experienced nurses' perceptions of how they became professional. The central problem for nurses was dissonance between expectations and experiences; they addressed this through an iterative, three-stage process of reworking professional identity. The stages of this process are assuming adequacy, realizing practice, and developing a reputation. Iterations of this process occur as new discrepancies are noticed, enhanced awareness dawns, practice changes, learning is undertaken, or experienced nurses become relative novices in another work area. Nurses move through stages more quickly and at different levels with each iteration. Three contextual factors influence the process: expectation; perception of the status accorded by others to nursing; and supportiveness by acceptance, assistance, and advocacy from others in the workplace. These findings expand knowledge about professional socialization and how nurses themselves understand developing professional identity.     

精神科护士夜班经历创伤事件后成长体验的质性研究

目的 探讨精神科护士夜班经历创伤事件后的成长体验,以期为护士不同阶段心理情况进行针对性干预和指导,并为护士职业生涯早期心理建设提供方向。方法 采用扎根理论的研究方法,2020年3月—7月对广东省某三级甲等医院12名夜班经历创伤事件的精神科护士进行深度访谈,采用Strauss和Corbin扎根理论分析资料,分为开放式登录、轴心式登录和选择式登录3个阶段,持续比较分析资料。结果 发现精神科护士夜班经历创伤事件后经历了应激期、调适期、成长期3个不同阶段。结论 精神科护士夜班经历创伤事件后的成长为动态过程,管理者或干预者可根据不同阶段进行针对性干预和指导,并在护士早期培训中促使其提前做好相关知识、技能的储备和必备心理素质的塑造。     

Through the looking-glass: mirror reading

At early stages of object identification we process correctly oriented and mirrored versions of an object similarly. However, in letter and word perception, such tolerance to mirror reversals is harmful for efficient reading. Do readers successfully develop blindness mechanisms for mirror-letters and words? We conducted two masked priming experiments while recording participants' electrophysiological brain responses to briefly presented primes including mirror-letters (Experiment 1) or to shortly presented mirror-words (Experiment 2). Results showed that the human visual word recognition system is not totally blind to mirror-letters and mirror-words, since the early stages of processing mirror-letters and mirror-words produced effects on target word recognition that were highly similar to the effects produced by identical primes (N250 component). In a posterior stage of processing (N400 epoch), the effect of mirror-letters and mirror-words was different from the effect of identical primes, even though reversed primes still elicited N400 priming effects different from unrelated primes. These results demonstrate that readers perceive mirror-letters and words as correct at initial stages of word recognition, and that the visual word recognition system's neural representation is grounded on basic principles that govern object perception.     

不同发育阶段胎儿表皮干细胞差异表达基因的研究

目的采用基因芯片技术筛选早期胎儿与晚期胎儿表皮干细胞差异表达基因,分析不同发育阶段胎儿表皮干细胞基因表达变化特征及其可能的生物学意义,为进一步寻找表皮干细胞特异性发育调控基因提供新线索。方法收集胎龄8～12周人胎儿正常皮肤(早期胎儿组)及28～32周人胎儿正常皮肤(晚期胎儿组),采用胰蛋白酶和EDTA联合消化法分离表皮,Ⅳ型胶原快速黏附法分离、纯化人表皮干细胞,分别提取各组细胞总RNA,用基因芯片技术检测2组胎儿表皮干细胞基因表达并筛选差异表达基因。结果基因芯片高通量地揭示了早期胎儿组与晚期胎儿组表皮干细胞的遗传信息。晚期胎儿组与早期胎儿组相比,DNA复制均与表皮干细胞的发育进程密切相关。差异表达基因有805个,其中表达下调的基因有389个,主要是GTP结合蛋白基因、序列特异性DNA结合蛋白基因、MAKP活性蛋白基因等与细胞增殖分化相关基因;表达上调的基因有416个,主要是与细胞成熟相关的细胞骨架结构蛋白基因等。结论体外培养的早期胎儿与晚期胎儿表皮干细胞基因表达谱有明显的不同,其差异可能与不同发育阶段人表皮干细胞的增殖分化能力及皮肤创伤修复能力不同密切相关。     

Career needs, career development programmes, organizational commitment and turnover intention of nurses in Taiwan

AIM: This study divided nursing careers into four stages: exploration, establishment, maintenance and disengagement. Besides exploring whether nurses have different career needs at different career stages, this study also examines the gap between career needs and career development programmes, and its relationship with organizational commitment and turnover intention of nurses in Taiwan. BACKGROUND: Although previous studies have recognized that nurses' careers have different stages, a few studies have identified nurses' career needs or offered programmes to respond to nurses' needs. METHOD: Through a literature review and in-depth interviews, this study developed a scale to measure career needs of nurses at different stages and identify the appropriate career development programmes. Additionally, regression analyses were implemented to explore the relationships objectively. RESULTS: Nurses were found to have different career needs at different career stages, and the gap between career needs and career development programmes influenced turnover intention caused by the decline in nurses' commitment towards the hospital. CONCLUSIONS: If hospitals' administrators can provide career development programmes to satisfy career needs of nurses at different career stages, then nurses' commitment to the hospital may increase and nurses' turnover intention may decrease, which may lead to reciprocity between the hospital and the nurses.     

Stress among caregivers of chronically ill older adults: implications for nursing practice

Caregiving is a dynamic process involving a series of decisions at different stages of a person's chronic illness trajectory. Research suggests the burdens of caregiving can lead to caregiver stress, the actual or perceived physical or emotional strain experienced by the caregiver. Nurses have a pivotal role in assessing for caregiver stress and providing interventions to assist caregivers. This article defines caregiver stress, discusses the impact that caregiving has on a caregiver, provides assessment principles to identify caregiver stress, and includes evidence-based interventions that can be tailored to individual caregivers to encourage health-promoting behaviors.     

稳定同位素iTRAQ标记联合液相色谱-串联质谱法定量分析药物性肝损伤患者血清氨基酸的变化

目的探索药物性肝损伤(DILI)患者治疗的不同阶段血清氨基酸水平的变化差异,探讨其临床意义及可用于DILI早期诊断及疗效评价的氨基酸类生物标志物。方法收集21例健康志愿者(健康组)及24例DILI患者不同阶段(初诊、治疗、转归)的血清标本,采用稳定同位素iTRAQ标记方法联合液相色谱串联质谱技术检测血清氨基酸进行定量并分析其差异。结果在血清中共定量氨基酸28种,与健康组比较,DILI患者共有14种氨基酸浓度在诊疗不同阶段发生显著性改变;其中异亮氨酸、亮氨酸、苯丙氨酸及丝氨酸的浓度在初诊时显著升高,随治疗进程降低,逐渐接近于正常水平。结论 4种氨基酸中,苯丙氨酸与DILI的相关性更高,可能为DILI早期诊断及治疗效果评价的潜在生物标志物。     

基于时机理论对儿童变应性鼻炎免疫治疗照顾者不同阶段照护体验的质性研究

［］　目的：以时机理论为框架,探讨变应性鼻炎患儿家长在免疫治疗不同阶段的真实治疗体验。方法：采用目的抽样法,对在我院接受变应性鼻炎免治疗患儿家长进行半结构式访谈,应用Ｃolaizzi现象学７步分析法分析资料。结果：归纳出4个主题：确诊期情绪反应强烈、准备期的不确定、调整期治疗依从性的烦恼、适应期的回访需求。结论：家长在患儿变应性鼻炎免疫治疗不同阶段的治疗体验是动态变化的,医护人员应根据患儿家长在治疗不同阶段的体验及需求分阶段、有计划、持续性地提供个性化护理,提高治疗的依从性,有利于患儿身心健康成长。     

MR扩散张量在临床脑梗死运动功能康复评估中的应用

目的使用扩散张量成像（DTI）研究脑梗死不同时期的扩散张量的变化规律，并试图通过扩散张量纤维束成像（DTT）探讨皮质脊髓束（CST）损伤与运动功能恢复的关系。方法26例脑梗死患者行常规MRI及DTI检查，测量各期病灶及对侧相应正常区域脑组织的平均扩散系数（DCavg）、部分各向异性系数（FA）、容积比（1-VR）及相对各向异性系数（RA）值，同时进行统计学分析；并行白质纤维束三维重建。结果各期病灶与对侧各参数值间的差异均有统计学意义（P〈0．01）；各期病灶各参数值间的差异亦有统计学意义（P〈0．01）。DTT可显示脑白质纤维束的破坏、推移或扭曲等征象，CST的损伤情况与运动功能的恢复有良好的相关。结论梗死灶DTI各参数值的变化具有规律性，DTT对观察CST的损害程度、预测恢复程度、指导临床康复治疗具有重要的参考价值。     

慢性淋巴细胞白血病患者单个核细胞端粒长度与端粒酶表达活性研究

本研究检测慢性淋巴细胞白血病（CLL）患者端粒、端粒酶表达,探讨二者与CLL预后的关系。用Tel—FISH半定量法分析外周血和／或骨髓单个核细胞的端粒长度;用TRAP—ELISA法定量检测外周血和／或骨髓单个核细胞端粒酶表达活性;用流式细胞术检测ZAPT0及CD38的表达。结果表明：不同分期患者端粒长度进行比较时,端粒长度有随分期增高而增长的趋势,两两间比较时RaiⅢ-Ⅳ期与Rai0期、Ⅰ-Ⅱ期之间,BinetC期与A期、B期之间差异具有统计学意义;Rai0期与Ⅰ-Ⅱ期之间、BinetA期与B期之间差异不具有统计学意义。ZAP70阴性组和阳性组端粒长度近似,CD38阳性组较阴性组端粒长度有缩短的趋势,但其差异不具有统计学意义。不同分期患者进行比较时端粒酶表达活性,有随分期增高而升高的趋势;Rai分期各期间进行比较时,端粒酶表达活性有随分期增高而升高的趋势。有1例CLL患者缓解期无端粒酶表达,复发期端粒酶表达升高,提示端粒酶表达可能与疾病活跃程度相关。结论：端粒长度与Rai和Binet分期相关,晚期患者较早、中期患者端粒长度短;端粒酶表达有随分期增高而升高的趋势。初诊和治疗后CLL患者端粒酶表达无差异,表达稳定,未见治疗对它的影响。     

Integration of psychological management strategies in the treatment course of breast carcinoma

The integration of psychological counselling programmes into the treatment procedures of breast cancer has to overcome specific methodological and contextual difficulties. We present a counselling strategy for breast cancer patients which aims at a reduction of short-term sequelae of the crisis of cancer diagnosis and stress of therapy. Its main features, summarized as follows are based on the relevant literature and the results of a pilot study in our department. Counselling is offered and made available to all patients, since both self- and professional referral lead to a selection bias. Psychological counselling is considered as integral part of the entire diagnostic and therapeutic process. The psychologist acts as a continuous supportive partner at all relevant treatment stages, and is introduced to the patient at the outset of the therapy and is always available as familiar contact person for discussion of all problems. Intensity and structure of counselling closely follow the different stages of somatic treatment. Technically, elements of crisis intervention and Progressive Muscular Relaxation (PME, according to Jacobson) are applied. Aspects of patient/doctor relationship and interdisciplinary cooperation between physicians and psychologists are discussed.     

IDA量表在乳腺癌术后不同阶段患者心理状况调查中的应用研究

目的 了解乳腺癌术后不同阶段患者的激惹、抑郁、焦虑状况,为临床实施心理护理提供指导。 方法 采用激惹、抑郁和焦虑量表(irritability, depression and anxiety scale, IDA),以便利抽样法选取176例处于乳腺癌术后不同阶段的患者进行问卷调查。 结果 乳腺癌术后患者的抑郁得分(5.41±1.08)分,其中临界值71例(40.3%),重度抑郁56例(31.8%);焦虑得分(6.05±1.82)分,其中临界值69例(39.2%),重度焦虑32例(18.2%);内向性激惹得分(2.83±0.76)分,其中临界值54例(30.7%),重度内向性激惹17例(9.7%);外向性激惹得分(3.47±1.04)分,其中临界值58例(33.0%),重度外向性激惹2例(1.1%)。术后2个月到5个月,患者焦虑、抑郁、内向性激惹、外向性激惹都处于较高水平。 结论 应加强对乳腺癌术后,特别是术后2个月至5个月间患者心理状况的关注,对各阶段较为显著的心理问题给予针对性的护理措施,以利于乳腺癌术后患者心理状况有良好的适应过程。     

Atherosclerosis and thrombosis: identification of targets for magnetic resonance imaging

Imaging techniques are needed that will allow earlier and more refined diagnosis, guide targeted treatment in individual patients and monitor response to that treatment. Magnetic resonance imaging is well-suited to these tasks as it can provide anatomical, structural, and functional data on the arterial wall. Its capabilities are further enhanced by the use of a range of increasingly sophisticated contrast agents that target specific molecules, cells, and biological processes. This article will consider the pathogenesis of atherosclerosis and systematically identify biologically relevant targets for imaging at different stages of disease process.