国际认证哺乳顾问发展现状及研究进展

我国母乳喂养现状严峻,为孕产妇提供专业的母乳喂养服务迫在眉睫。本文介绍了国际认证哺乳顾问(IBCLC)认证条件、认证培训、认证考试和资格再认证的情况,归纳了哺乳顾问国外的应用现状,并针对国内存在的问题进行分析,提出推进队伍建设、明确角色定位和借助网络推动哺乳顾问向基层社区和农村地区发展。     

不同视域下围生期母乳喂养需求认知差异的质性研究

目的了解产妇、国际泌乳顾问、产科护士对围生期母乳喂养需求的认知情况, 并分析其差异性, 为制订干预措施提供理论依据。方法采用目的抽样法, 选取2021年2—6月同济大学附属第一妇婴保健院的10名产妇、6名国际泌乳顾问、6名产科护士共22名研究对象, 进行半结构式深入访谈。访谈内容围绕围生期不同阶段的母乳喂养需求展开。结果通过归纳分析, 最终从对产妇和医务人员的访谈中提炼出了3个主题。产前教育认知差异:产妇产前缺乏主动了解母乳喂养意识, 更希望产后及时得到解决, 但是医务人员认为提供产前母乳喂养教育非常必要。住院期间哺乳支持认知异同:产后住院期间产妇和医务人员对加强产后健康教育、关注心理变化意见一致;不同的是, 产妇更希望获得促进泌乳的相关信息和指导, 但医务人员认为重点是提供哺乳技巧指导并加强医务人员专业培训。出院后哺乳支持认知异同:出院后产妇和医务人员都希望获得家庭支持和同伴支持;不同的是, 产妇希望能够和医务人员保持联系反馈问题, 但医务人员认为需要进一步发展社区支持。结论产妇和医务人员对围生期母乳喂养需求的认知不同, 应该针对其不同认知制订针对性的干预措施和个性化的母乳喂养计划,...     

不同职称产科护理人员对妊娠并发症产妇哺乳的认识

目的 了解和比较不同职称产科护理人员对妊娠并发症产妇哺乳的认识.方法 采用自行设计的调查表,对90例护理人员进行问卷调查.结果 产科中级职称和初级职称的护理人员对是否知道妊娠并发症产妇哺乳知识的认识,差异有统计学意义,尤以对肾功能重度损害产妇、糖尿病产妇、艾滋病毒感染产妇哺乳认识差异明显,经统计学检验,P＜0.05;对妊娠并发症产妇能否哺乳的认识方面差异较为明显,尤以对肾功能中度损害产妇、中度高血压产妇、糖尿病产妇、乙肝大三阳产妇、巨细胞病毒感染产妇哺乳的认识.结论 母乳喂养指导是产科护士一项重要的工作,护理人员应加强对妊娠并发症产妇哺乳知识的学习,规范现有的健康教育内容.     

不同职称产科护理人员对妊娠并发症产妇哺乳的认识

目的了解和比较不同职称产科护理人员对妊娠并发症产妇哺乳的认识。方法采用自行设计的调查表,对90例护理人员进行问卷调查。结果产科中级职称和初级职称的护理人员对是否知道妊娠并发症产妇哺乳知识的认识,差异有统计学意义,尤以对肾功能重度损害产妇、糖尿病产妇、艾滋病毒感染产妇哺乳认识差异明显,经统计学检验,P<0.05;对妊娠并发症产妇能否哺乳的认识方面差异较为明显,尤以对肾功能中度损害产妇、中度高血压产妇、糖尿病产妇、乙肝大三阳产妇、巨细胞病毒感染产妇哺乳的认识。结论母乳喂养指导是产科护士一项重要的工作,护理人员应加强对妊娠并发症产妇哺乳知识的学习,规范现有的健康教育内容。     

产科不同工龄护理人员对妊娠合并症产妇哺乳知识的掌握情况的调查

目的了解产科不同工龄护理人员对妊娠合并症产妇哺乳的认识,进一步规范现有的健康教育内容。方法采用自行设计的调查表,对89例护理人员进行问卷调查。结果工龄≥10年和<10年的护理人员对是否知道妊娠合并症产妇哺乳知识的认识差异有统计学意义,尤以对糖尿病产妇和艾滋病产妇哺乳认识较为明显,经统计学检验,P<0.05;对妊娠合并症产妇能否哺乳的认识上差异较为明显,尤以对肾功能中度损害的产妇、中度高血压产妇、糖尿病产妇、甲亢、甲低产妇、乙肝大三阳产妇、巨细胞病毒感染产妇、梅毒产妇哺乳的认识较明显。结论母乳喂养指导是产科护士一项重要的工作,护理人员应加强对妊娠合并症产妇哺乳知识的学习。     

产后哺乳障碍的原因分析及健康教育

在WHO大力提倡母乳喂养婴儿的情况下，全社会都成了母乳喂养的支持者，越来越多的母亲都采取纯母乳喂养自己的婴儿，但有部分母亲在哺乳过程中遇到各种各样的困难，影响哺乳效果。笔者在多年的妇产科临床工作中，总结了一些产后哺乳障碍的原因及针对原因进行的健康教育，对解除哺乳障碍效果满意，现总结如下。     

产科不同工龄护理人员对妊娠合并症产妇哺乳知识的掌握情况的调查

目的 了解产科不同工龄护理人员对妊娠合并症产妇哺乳的认识,进一步规范现有的健康教育内容.方法 采用自行设计的调查表,对89例护理人员进行问卷调查.结果 工龄≥10年和＜10年的护理人员对是否知道妊娠合并症产妇哺乳知识的认识差异有统计学意义,尤以对糖尿病产妇和艾滋病产妇哺乳认识较为明显,经统计学检验,P＜0.05;对妊娠合并症产妇能否哺乳的认识上差异较为明显,尤以对肾功能中度损害的产妇、中度高血压产妇、糖尿病产妇、甲亢、甲低产妇、乙肝大三阳产妇、巨细胞病毒感染产妇、梅毒产妇哺乳的认识较明显.结论 母乳喂养指导是产科护士一项重要的工作,护理人员应加强对妊娠合并症产妇哺乳知识的学习.     

资质认证管理在临床护理中的应用

专业护士资格认证是一个复杂的过程，它对专业知识、工作经验、实践能力以及职业风险承诺水平的要求，远远高于执业注册的基本要求。我院进行资质认证管理在护理工作中的应用研究，旨在探讨适合国情的资质认证管理途径，并对实施认证管理的效果进行评价，现报道如下。     

儿科专科护士资格认证与工作现状的研究进展

从儿科专科护士的概念、认证机构、认证条件、认证考核、延续认证、工作现状等方面,对国内外儿科专科护士的资格认证和工作现状进行综述,以期为我国建立统一规范的儿科专科护士资格认证考核体系和临床管理方案提供参考。     

国际哺乳顾问在产科工作模式的循证护理实践

目的:探讨国际哺乳顾问(IBCLC)在产科工作模式的循证护理实践效果.方法:将2019年1月—2019年12月收治的孕产妇2981例纳入研究组.另选取2018年1月—2018年12月收治的孕产妇2848例作为对照组.研究组实施IBCLC在产科工作模式的循证护理,对照组实施常规护理.比较两组在院期间、出院时、出院3d后纯母乳喂养率以及每季度产妇满意度.结果:研究组在院期间、出院时及出院3 d后的母乳喂养率分别为83.86％、92.35％、95.40％,均高于对照组的69.73％、77.98％、89.15％,差异有统计学意义(均P<0.05).研究组产妇第1季度以及第4季度满意度高于对照组,差异有统计学意义(P<0.05).结论:IBCLC在产科工作模式的循证护理实践效果明显,有利于提高母乳喂养率以及产妇满意度.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.