PICC与伤口造口专科护士多点执业认知及意愿调查

目的了解PICC、伤口造口专科护士多点执业的认知与意愿,为护士多点执业政策的推行提供参考。方法采用整群抽样的方法对新疆303名PICC、伤口造口专科护士进行问卷调查。结果 PICC、伤口造口专科护士多点执业认知得分率59.73%,意愿得分率81.28%;年龄、学历、职称、聘用类型、是否开展专科护理工作是多点执业意愿的影响因素(P0.05,P0.01)。91.75%认为多点执业可以实现护士的自我价值,60.07%认为会增加医院的管理难度,82.18%认为相关法律不完善是多点执业的制约因素,72.61%对多点执业非常乐观和乐观。结论新疆PICC、伤口造口专科护士多点执业认知较低,多点执业意愿强烈且态度乐观,需完善护士多点执业法律法规及制度,以保障护士多点执业的权益。     

苏州市三级医院专科护理门诊护理服务现状调查

目的了解苏州市三级医院专科护理门诊护理服务开展现状,为进一步完善管理提供参考。方法自制调查问卷对苏州市14所三级医院的43个专科护理门诊进行调查。结果专科护理门诊中开展最多的是PICC/静疗门诊(14个,32.6%)、糖尿病护理门诊(9个,20.9%)和围生期保健护理门诊(9个,20.9%);9个(20.9%)门诊开设时间≥10年;出诊护士岗位性质以兼职为主(22个,51.2%);每周开诊时间0.5～7.0 d;7个(16.3%)护理门诊免费。服务内涵包括健康咨询、专科护理技术、专科疑难病例处理、并发症筛查等。工作量以PICC/静疗门诊最多,其次为伤口造口门诊。结论苏州市三级医院专科护理门诊服务模式日趋成熟,服务内涵丰富,患者需求量大。但专科护理门诊的质量评价体系和门诊管理机制还需进一步完善。     

医护人员对专科护士角色及护理门诊认知的现状调查

目的调查医护人员对专科护士角色及护理门诊的认知现状。方法对398名临床医护人员进行专科护士角色及护理门诊认知的现状调查。结果医护人员对专科护士角色重要性认知得分中,顾问者得分最高,为(4.04±0.41)分,医护人员对专科护士角色中顾问者和实践者的重要性认知存在差异(均P0.01)。97.7%的医护人员知道医院开设了专科护理门诊,但仅46.2%知道护理门诊的类别和作用。结论医护人员对专科护士的顾问者角色认可度高,对护理门诊的认知度较低,医院有必要加大护理门诊的建设和宣传力度,以利于专科护士和护理门诊的发展。     

护士多点执业认知的质性研究

目的从护士的角度对开展护士多点执业的意愿与相关问题进行探讨,为护士多点执业政策的推行提供参考。方法采用质性研究的现象学研究方法,对11名护理人员进行半结构式深度访谈,并采用Colaizzi分析法进行资料分析。结果产生了4个主题:护士对多点执业多持观望态度;经验丰富、有专科优势的护士更适合多点执业;护士多点执业具有积极意义;护士多点执业存在较多风险。结论护士对多点执业持褒贬不一的态度,认为多点执业可以提高护士的劳动价值和自我价值,但前提是要有足够的精力和完善的法律保障。我国仍需在多点执业管理、政策、法律法规方面进一步探索。     

专科护士开设护理门诊执业体验的质性研究

目的探讨专科护士在护理门诊工作中的真实感受,为加强护理门诊建设提供参考。方法采用目的抽样法,选取开设护理门诊的10名专科护士进行半结构式访谈,运用Colaizzi 7步分析法对访谈资料进行分析。结果门诊专科护士的执业体验提炼出工作开展被动(认同度低,权限与资源受限,门诊绩效不完善,面临风险)、促进学科发展(专业深度提高,引领专科发展,自我认同感提高)、门诊运行模式多样3个主题及所属的7个亚主题。结论专科护士在开设护理门诊的过程中面临一些障碍和挑战,同时可以促进自身发展。实践过程中需要不断地发现问题、总结经验,以促进护理门诊的长远发展。     

三级医院护士开展“互联网+护理服务”意愿及需求的质性研究

目的了解三级医院护士开展"互联网+护理服务"意愿及需求,为完善该护理服务模式提供参考。方法自拟提纲对1所三级医院的13名临床护士进行一对一深入访谈,采用Colaizzi现象学研究法分析资料、提炼主题。结果提炼出4个主题:有较强的开展"互联网+护理服务"意愿;人身安全与执业安全保障需求;护理服务医疗风险控制需求;合理收费需求。结论三级医院护士对"互联网+护理服务"有较强的意愿,安全保障、相关规范标准及合理收费是当前主要需求。相关管理部门应尽快加以建设和完善,以促进"互联网+护理服务"良性发展。     

广东省三级医院麻醉科护士工作岗位现状调查

目的 了解广东省三级医院麻醉科护士人力、工作岗位现况,为麻醉护理单元的建设提供参考。方法 采用自制问卷,对广东省76所三级医院麻醉科护士及工作岗位、时长进行调查。结果 76所医院共有麻醉科护士547名,麻醉医护比例为1∶0.25。工作岗位开展中最高为总务工作,开展率96.05%,最低为麻醉诱导室护理（18.42%）。工作周时长最高56 h,最低8 h,中位数37 h。结论 广东省三级医院麻醉科护士工作岗位开展不均,下一步学科建设应以人力配备、工作规范及专科培训为主。     

脑外科专科护理指引临床实践调查

目的探讨神经外科专科护士的临床实践情况,为建立神经外科专科护理指引体系提供参考。方法采用自行设计的调查问卷对中山市5所医院131名神经外科护士及中国护理之声网站的79名神经外科护士进行调查。结果收回有效问卷197份。仅43.7%神经外科护士护理患者时考虑患者病情变化与病理变化之间关系,41.1%的护士在患者发生脑疝相关症状时能立刻想到脑疝部位,7.6%~49.2%的护士自评运用GCS评分、肌力评级标准等病情观察技能高,3.6%~45.7%的护士自评非常熟悉危重患者护理,48.7%的护士未接受过危重患者护理的专项培训。结论神经外科护士理论知识、危重患者护理、观察疾病技能及专科培训较缺乏,有必要建立集理论知识、危重患者护理、专科技能、专科用药指引及疾病动态健康指引为一体的专科指引用书。     

护士对艾滋病患者的护理意愿调查

目的了解护士对艾滋病患者的护理意愿现状,为制定艾滋病培训项目及政策提供参考。方法采用护理意愿问卷,随机抽取湖南省综合医院1206名注册护士进行调查。结果护士护理意愿得分为(99.06±25.46)分,121人(10.03%)表示很愿意提供全部护理操作。护士在13项护理操作项目中最愿意实施的操作是测量生命体征,其次是静脉输液,最不愿意为患者擦浴、清洁大小便及剃胡须;不同年龄、学历、职称护士的护理意愿比较,差异无统计学意义(均P0.05)。护士护理意愿与手套使用情况呈正相关,与针刺伤次数呈负相关(P0.05,P0.01)。结论护士在对艾滋病患者的护理意愿上表现出一定的逃避倾向,护理意愿与针刺次数、手套使用意识有关。应加强艾滋病护理技能的培训,增强护士对艾滋病护理的信心。     

新疆地区不同等级医院对“订单式”护理人才培养模式需求的研究

目的了解新疆地区不同等级医院对订单式护理人才培养模式的需求,为建立新疆地区"订单式"护理人才培养模式提供参考。方法分层随机抽取南北疆一级、二级、三级医院各40所,采用自编问卷对其进行调查,通过邮局和网络发放并回收问卷。结果新疆地区不同等级医院愿意参与订单式护理人才培养模式者占75.83%,三级医院参与订单式护理人才培养模式的意愿最高(P0.01)。一、二、三级医院愿意参与订单式护理人才培养模式的首要原因分别是符合当地居民健康需求、符合医院发展特色、符合医院专科护理人才匮乏的需求,对订单的首位岗位需求分别是全科护士、助产士及重症监护护士。结论不同等级医院对订单式护理人才培养的需求不同,参与培养的原因及需求的岗位均不同。订单式培养模式能够根据不同等级医院的发展定位培养护理人才,是提高护理人员整体水平的新途径。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.