莱芜市社区居民心肺复苏知信行情况调查分析

目的:调查莱芜市社区居民心肺复苏术知信行(KAP)的掌握情况。方法:采用自设莱芜市社区居民关于心肺复苏的KAP调查表,对723名莱芜市社区居民进行问卷调查。结果:莱芜市社区居民关于心肺复苏干预的知识水平较低,居民知识平均得分为(8.3±6.4)分,态度平均得分为(14.3±4.2)分,行为平均得分为(8.2±9.4)分;Spearman相关分析显示,莱芜市社区居民的知识与态度之间、态度与行为之间、知识与行为之间均存在正相关。结论:莱芜市社区居民心肺复苏知晓率低,缺乏心肺复苏理论知识和急救技能;居民心肺复苏知识来源缺乏专业指导,同时其对专业人员进行莱芜市社区心肺复苏知识讲座和培训有很大需求。     

社区护士家庭访视护理知信行的调查及影响因素分析

目的:了解社区护士家庭访视护理知信行的水平及其影响因素.方法:利用便利抽样法,选取149名社区护士,由经过统一培训的调查员用一般资料调查表、社区护士家庭访视护理知信行调查问卷对社区护士进行调查.结果:社区护士家庭访视护理知信行总分为(201.10±18.73)分,标准分为86.10分;知识得分为(28.64±2.49)分,标准分为86.79分;态度得分为(57.28±6.76)分,标准分为88.12分;行为得分为(115.21±13.53)分,标准分为85.34分;行为维度得分最低.社区护士的职称、社区护理知识的主要来源、过去接受家庭访视护理相关知识和技能培训的频次、过去家庭访视的频次,对社区护士家庭访视护理知信行存在影响(P<0.05).相关性分析显示,知识、态度与行为三者之间均呈正性相关,相关系数r值在0.211～0.617,均P<0.001.结论:社区护士家庭访视护理知信行处于中上水平,可通过增加社区护理知识的来源、丰富社区护士的知识和技能培训形式和增加培训次数、建立规范化和系统化的网络培训课程等来提升社区护士家庭访视护理的知信行水平.     

社区中危以上跌倒风险老年人知信行调查研究

目的：分析社区中危以上跌倒风险老年人跌倒预防知信行现状。方法对上海市南码头街道某居委≥65岁老年人进行跌倒风险评估,从中选取100名中危以上跌倒风险的老年人,采用自编社区老年人跌倒预防知信行问卷进行调查。结果社区中危以上跌倒风险老年人跌倒预防知识得分为（22.21±4.62）分,总知晓率为53.8%;信念得分为（10.23±2.71）分,得分率为68.2%;行为得分为（19.34±3.39）分,得分率为64.5%。社区老年人跌倒预防知信行与老年人跌倒家居环境危险因素评分呈负相关（均 P<0.001）。结论社区中危以上跌倒风险老年人跌倒预防知识、信念、行为较差,社区医护人员应有针对性地实施健康教育,提高其跌倒预防知识知晓率,促进跌倒预防的积极正向态度的形成,纠正不良行为,最终减少老年人跌倒事件的发生。     

278名社区居民CPR知信行及自我效能现况调查

目的 了解社区居民 CPR知信行及自我效能现况.方法 采用便利抽样法,于 2017年 7月抽取洛阳市涧西区2个社区的居民作为研究对象.采用"社区居民CPR知识、态度、行为及自我效能问卷"对其进行调查.结果 社区居民CPR知识得分为(6.05±2.53)分,态度得分为(10.45±2.72)分,行为得分为(15.15±4.16)分,自我效能得分为(7.30±2.32)分,得分均处于较低水平.结论 本组社区居民CPR知识、态度、行为、自我效能得分均总体偏低.建议以社区为单位,探索具有针对性和可行性的社区居民CPR培训模式,加大对社区居民 CPR知识和技能培训,对社区居民 CPR知识、态度、行为和自我效能进行全方位的干预,提高社区居民 CPR知信行及自我效能整体水平,以期促进社区居民院外 CPR实施率的提高.     

甲状腺术后患者对姜夏脐疗的知信行调查研究

目的了解甲状腺术后患者对姜夏脐疗的知信行情况,分析其影响因素,以提高患者的健康意识及依从性,帮助其形成正确的信念和行为,从而促进姜夏脐疗在甲状腺术后患者中的应用和推广。方法采用自行设计的《甲状腺术后患者对姜夏脐疗的知信行调查问卷》对42例甲状腺术后实施姜夏脐疗的患者进行调查。结果甲状腺术后患者对姜夏脐疗的知、信、行的总得分平均分为(9.59±2.88)分,其中知识维度得分为(7.74±2.42)分,得分率51.59%;信念维度得分为(9.88±2.75)分,得分率65.87%;行为维度得分为(11.14±2.42)分,得分率74.29%;知识维度得分率最低。甲状腺术后患者的知识、信念、行为三者呈正相关关系,且具有显著性意义(P0.05)。且一般资料中的"文化程度"对知信行调查单项条目"向他人推荐"得分的影响有统计学差异。结论甲状腺术后患者对姜夏脐疗的知识掌握较差,依从态度和执行行为较好。知信行三者作用相互影响,健康教育要注意姜夏脐疗相关知识的宣教,特别是治疗原理及不良反应方面,以提高患者对姜夏脐疗的知、信、行。     

海口市社区居民高血压知信行调查与护理对策

目的:调查海口市社区居民对高血压的认知、态度与信念、行为,针对现状分析护理对策,为促进高血压防治提供参考依据。方法:采用分层抽样法随机抽取海口市社区居民180名为调查对象,采用自编的社区居民高血压知信行问卷进行调查。结果:海口市社区居民对高血压的诊断标准(36.6%)、是否可以通过饮食与运动控制血压(47.4%)及规范用药(40.6%)等知识的认知水平较低;在自己是否能控制好血压(39.4%)、高血压控制好是否能预防并发症(42.3%)等方面信念不足;控制高脂饮食(34.9%)与高盐饮食(24.6%)、多食水果(28.6%)及定期监测血压(34.3%)等行为不理想有关。结论:海口市社区居民关于高血压的知识、信念、行为总体情况一般,应针对其知信行的薄弱点进行个体化的健康教育,帮助其树立正确的信念,从而实现社区居民防控高血压由"知"到"信"到"行"的转变。     

重型β-地中海贫血患儿家属认知、信念、行为现状调查

[目的]了解重型β-地中海贫血患儿家属对地中海贫血相关知识认知、信念、行为现状。[方法]采用自行设计的知信行问卷调查表对102例重型β-地中海贫血患儿及家属进行调查。[结果]102例重型β-地中海贫血患儿家属对地中海贫血相关知识平均知晓率为47.66%,健康信念平均持有率为78.01%,健康行为平均形成率为57.03%,家属地中海贫血相关知识知晓率与月收入、患儿输血时间呈正相关。[结论]重型β-地中海贫血患儿家属对β-地中海贫血相关知识知晓率、健康行为形成率均较低,需要进一步采取有效措施提高家属的知信行水平。     

护理实习生职业暴露的知信行调查

目的调查护理实习生职业暴露的知识、信念、行为的现状,以便采取有效措施减少护理实习生的职业暴露。方法采用自行设计的护理实习生职业暴露知信行调查问卷,对286名护理实习生在实习10个月时进行问卷调查。结果护理实习生职业暴露的相关知识30.85%来源于学校教育,87.42%来源于临床带教老师,知识总分为(24.15±7.32)分,标准分为(61.38±15.93)分;态度总分为(37.64±8.35)分,标准分为(90.27±12.63)分;行为总分为(30.46±2.76)分,标准分为(45.89±10.24)分。结论护理实习生职业暴露的相关知识缺乏,态度较为积极,相关行为不容乐观,学校和实习医院都要采取相应措施,以促进护理实习生职业暴露知信行的全面提高。     

社区居民急救知信行现状调查研究

目的 了解社区居民急救知识、信念和行为现况水平。方法 2022年3月—9月,采用便利抽样法选取合肥市非医学背景的居民作为研究对象,采用急救知识、信念、行为问卷进行调查。结果 1 252名社区居民急救知识得分（11.01±2.29）分,急救信念得分（36.36±6.25）分,急救行为得分（19.45±2.70）分。不同年龄、自认为急救知识掌握情况不同者的急救知信行得分差异有统计学意义（P<0.05）;不同急救知识技能培训经历者的急救知识、信念得分差异有统计学意义（P<0.05）,急救行为得分差异无统计学意义（P>0.05）。结论 社区居民急救知识和信念水平处于中等偏高水平,行为处于中等水平,应进一步制订合理的公众急救科普知识及技能演练培训方案,以提高社区居民急救知识和技能水平。     

健康教育对初产妇产褥期相关知信行的影响

目的对初产妇产褥期实施健康教育,并探究分析其对相关知信行的影响。方法选择120例初产妇作为本次的观察对象,均在该院定期做孕检直至分娩,将其平均分为2组,实施常规健康教育的产妇设为对照组,实施知信行模式健康教育的产妇设为试验组,将其产后3d、出院时以及产后21d时产褥期的相关知识、信念、行为进行调查分析。结果产后3d两组产妇的产褥期相关知识、健康信念、行为水平比较差异无统计学意义(P0.05),但在产后21d试验组的母乳喂养知识得分[(5.52±1.14)分]、新生儿护理知识得分[(6.13±1.31)分]、产后一般知识得分[(8.01±1.60)分]均高于对照组[(4.19±1.23)分、(5.09±1.27)分、(6.23±1.47)分],差异有统计学意义(P0.05)。并且在出院时和产后21d试验组健康信念、行为水平的各项目分数均高于对照组的,差异均有统计学意义(P0.05)。结论知信行模式健康教育在初产妇产褥期起着较为重要的角色,可以提高初产妇的相关知识、健康信念及行为水平。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.