影响临床合理用药因素分析

该文从人为因素、药物因素分别阐述了对合理用药的影响,通过对这些因素的分析,使医务工作者和患者增强对药物使用的认识,尽可能避免或减少不合理用药。     

影响贫困大学生心理健康的因素分析

目的:了解影响高校贫困生心理健康的因素,以便有目的、有针对性开展心理咨询辅导工作。方法:2003-04在某高校1999/2003级共4届在校生6689人中选取436名学生作为调查对象。①观察组218名:入组条件:已接受国家助学贷款的贫困学生。该校接受助学贷款标准为:家庭经济困难(人均收入<200元/月),无力支付学费,且在接受贷款前尚未缴纳学费的学生。对照组:除外观察组学生,随机在4届学生中以班为单位整群抽样218名学生。②使用症状自评量表、抑郁自评量表、焦虑自评量表进行测评。其中症状自评量表分数越高,心理健康水平越低。以焦虑自评量表标准分≥50,抑郁自评量表标准分≥53为有焦虑抑郁症状。结果:观察组收回有效答卷213份,有效回收率为97%,对照组收回有效答卷210份,有效回收率为96%。①观察组症状自评量表总分为124.75±28.37,阳性项目数为28.05±8.64;对照组分别为125.05±27.98,26.19±16.14,两组比较差异无显著性(P>0.05)。②观察组症状自评量表中人际关系因子得分为2.18±0.45,敌对因子得分为1.29±0.35,偏执因子得分为2.04±0.26;对照组分别为1.51±0.45,1.37±0.42,1.44±0.44,两组相比差异均有显著性(P<0.05～0.001)。其他因子得分两组比较,差异无显著性(P>0.05)。③观察组焦虑自评量表粗分为28.43±5.63,标准分为35.29±6.13;抑郁自评量表粗分为29.62±6.26,标准分为37.71±8.04。对照组焦虑自评量表粗分为26.55±5.61,标准分为32.47±6.12;抑郁自评量表粗分为26.78±6.24,标准分为34.92±8.01。两组焦虑自评量表、抑郁自评量表得分均在正常范围,说明无焦虑、抑郁症状。结论:贫困大学生心理健康状况总体属正常范围;忧郁、焦虑不是主要症状;人际关系敏感和偏执是主要症状。     

Factor validation and Rasch analysis of the individual recovery outcomes counter

Objective: The individual recovery outcomes counter is a 12-item personal recovery self-assessment tool for adults with mental health problems. Although widely used across Scotland, limited research into its psychometric properties has been conducted. We tested its’ measurement properties to ascertain the suitability of the tool for continued use in its’ present form.

Materials and methods: Anonymised data from the assessments of 1743 adults using mental health services in Scotland were subject to tests based on principles of Rasch measurement theory, principal components analysis and confirmatory factor analysis.

Results: Rasch analysis revealed that the six-point response structure of the individual recovery outcomes counter (I.ROC) was problematic. Re-scoring on a four-point scale revealed well-ordered items that measure a single, recovery-related construct, and has acceptable fit statistics. Confirmatory factor analysis supported this. Scale items covered around 75% of the recovery continuum; those individuals least far along the continuum were least well addressed.

Conclusions: A modified tool worked well for many, but not all, service users. The study suggests specific developments are required if the I.ROC is to maximise its’ utility for service users and provide meaningful data for service providers.

• Implications for Rehabilitation

• Agencies and services working with people with mental health problems aim to help them with their recovery.

• The individual recovery outcomes counter has been developed and is used widely in Scotland to help service users track their progress to recovery.

• Using a large sample of routinely collected data we have demonstrated that a number of modifications are needed if the tool is to adequately measure recovery.

• This will involve consideration of the scoring system, item content and inclusion, and theoretical basis of the tool.

     

Factor analysis of the WeeFIM in children with spastic cerebral palsy

Purpose: Determining the psychometric properties such as reliability and validity of Functional Independence Measure for Children (WeeFIM) instrument would help health professionals to understand the comprehensive assessment of children with spastic cerebral palsy (CP). The purpose of this study was to investigate the factor structure of the WeeFIM in children with spastic CP. Methods: Two hundred seven children (138 boys, 69 girls) with spastic CP were recruited in this cross-sectional study; their mean age (SD) was 9.10 (2.7) years. Data were collected through a questionnaire that included the WeeFIM. Of the 207 children, 57 (27%), 105 (51%), and 45 (22%) were quadriplegic, diplegic, and hemiplegic, respectively. In each of these groups, 49 (24%), 32 (15%), 31 (15%), 19 (9%), and 76 (37%) children were classified as Gross Motor Function Classification System (GMFCS) levels I–V, respectively. The factor structure of the WeeFIM was analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) by using AMOS 20.0. The reliability of WeeFIM was assessed by calculating the internal consistency of Cronbach’s α. Results: The internal consistency of Cronbach’s α was 0.98. The 1- and 2-factor models did not demonstrate adequate fit indices according to CFA. However, the 3-factor structure (i.e. self-care, motor, and cognitive factors) was supported by EFA and CFA, which explained 87.12% of the variance. The self-care factor included 6 items (eating, grooming, dressing upper, dressing lower, bathing, and toileting), the motor factor included 7 items (bladder and bowel management, bed/chair/wheelchair, toilet, tub/shower, walk/wheelchair, and stairs), and the cognitive factor included the same 5 items as the original cognitive domain. Conclusion: In children with spastic CP, 3 factors of the WeeFIM were determined by factor analysis. Therefore, self-care, motor, and cognitive domains should be treated as separate scales in children with spastic CP.

Implications for Rehabilitation

• The reliability and validity of the 3-factor WeeFIM were confirmed with spastic CP.

• Findings suggest that the WeeFIM should not be used as an overall summary score of activity daily living in children with spastic CP.

• It is recommended that those working in the field of rehabilitation assess self-care, motor, and cognitive domains separately and develop an appropriate intervention programs for each domain.

     

百草枯中毒的急救与影响预后的因素分析

目的分析影响百草枯中毒预后的因素，探讨提高生存率的合理治疗方法。方法对28例百草枯中毒患者临床资料进行回顾性分析。结果血液灌流前后血浆百草枯浓度差异有统计学意义（P〈0．01），SOD活力差异有统计学意义（P〈0．05）。服毒剂量越小、就诊时间越早、首次灌流时间越早，预后越好。结论百草枯中毒患者预后受多种因素影响，但影响预后的关键因素是中毒剂量、就诊时间、首次灌流时间。因此，百草枯中毒应强调早期全方位治疗，以争取延长患者生命，为进一步降低死亡率创造必要的条件。     

影响合并糖尿病的精神分裂症患者血糖因素的分析

近年来,精神分裂症、抗精神病药物与糖尿病的关系越来越引起人们的重视,2002年7月～2004年5月,作者共调查住院精神分裂症患者876例,结果有86例符合糖尿病的诊断(均为2型).通过对患者血糖分析发现经降糖药治疗后仅有约40％患者控制较好,对可能的影响因素分析发现糖尿病病期,对疾病的态度、总胆固醇水平、治疗依从性和腰围是影响血糖水平的5个主要因素,从而为我们今后较好控制合并糖尿病的精神分裂症患者的血糖提供了有效的依据.合并糖尿病的精神分裂症患者,由于精神分裂症本身的特点使得提高治疗依从性困难,因此,我们对这部分患者从多方位、多角度开展工作,取得满意效果,现介绍如下.     

脂肪肝患者合并肾结石的原因分析

目的分析体检人群中脂肪肝患者合并肾结石的原因,提出护理对策。方法分析915份体检资料,统计脂肪肝及合并肾结石的人数,并对相关因素进行Logistic分析。结果单纯脂肪肝患者139例,脂肪肝合并肾结石63例。脂肪肝合并肾结石患者甘油三酯（3．32±1．91）mmol／L,显著高于单纯脂肪肝患者（2．53士1．15）mmol／L;脂肪肝合并肾结石患者胆固醇（5．73士0．98）mmol／L,显著高于单纯脂肪肝患者（5．39±0．76）mmol／L。经Logistic回归分析,男性及体重指数、甘油三酯较高是脂肪肝合并肾结石患者的独立危险因素。结论脂肪肝患者合并肾结石与体重指数、甘油三酯等指标变化及性别相关。因此,对脂肪肝患者加强知识宣教,及时进行降脂治疗及定期复查。     

药物不良反应因素分析与合理用药

药物不良反应,是指药品在使用中出现与用药目的无关或意外的、对人体有害的反应,包括药物副作用、毒性反应、变态反应、特异质反应、继发性反应、后遗效应、停药反应等.不良反应严重时可影响治疗效果,甚至危及生命.药物不良反应越来越受到全社会的关注,面对药品不良反应,人们应正确认识,科学对待,了解药品不良反应产生的原因,增强对药品不良反应的防范意识.药物不良反应的发生频率和严重程度不但与药物本身的性质有关,而且与人体生理、病理状态以及饮食等诸多因素有关.     

水泥机立窑窑喷致高温水泥熟料烧伤因素分析

目的 :为了预防水泥机立窑窑喷所致高温水泥熟料烧伤。方法 :对本省9家医院、58家水泥企业及67名机立窑看火工进行了调整和实地走访。结果 :1985～1996年全省水泥烧伤224例 ,男性青壮年为主 ,平均烧伤面积47 % ,Ⅲ°19% ,伴吸入性损伤50例(22.3 %) ,死亡24例(10.7 %)。5～8月为高发月份。该类烧伤主要与安全教育、生产环境、自我保护意识等因素有关。结论 :3年的预防措施实施有效地遏制了水泥烧伤     

Factor analysis of the Revised Piper Fatigue Scale in a caregiver sample

The Revised Piper Fatigue Scale (R-PFS) is an instrument designed to measure subjective fatigue that was developed in samples with physical illness. Its psychometric properties in nonclinical samples are unknown. The purpose of this study was to examine the psychometric properties of the R-PFS in a sample of caregivers of stroke survivors. The convenience sample of 132 caregivers was primarily women (74%), White (71%), college-educated (73%), and employed (52%), with a mean age of 56.7 years (SD = 13.71). Internal consistency reliabilities for the four R-PFS subscales and the total scale were excellent, ranging from .90 to .97. Principal axis factor analysis with oblique rotation was conducted to examine construct validity of the R-PFS. A three-factor solution explained 75.9% of the common variance. Two factors totally replicated the behavioral/severity and affective meaning subscales of the R-PFS. The third factor incorporated a combination of Piper's sensory and cognitive/mood subscales and appeared to summarize how fatigue makes the caregiver feel. The R-PFS demonstrated strong internal consistency reliability and construct validity in this sample. However, data suggest that caregivers may perceive certain feelings associated with fatigue as conceptually similar when these feelings are conceptually distinct in Piper's breast cancer sample. The study supports the need for psychometric evaluation of instruments developed in clinical populations prior to their use in nonclinical populations.     

服务态度引发护理纠纷的因素分析及对策

对我院2005~2007年60例护理纠纷进行调查、分析。发现护理人员形象不佳、语言沟通不良、表情与非语言动作应用不当、告知不全或未告知、情绪不佳或疲劳是引起护理纠纷的主要原因。加强法律法规知识教育,全面提升护士的个人素质,加强护患有效交流和沟通,建立和谐护患关系是防范护理纠纷的重要举措。     

肝移植后乙肝再感染的因素分析及其防治

肝移植患者由于使用免疫抑制剂以及过多种广谱抗生素,使得肝移植比任何其他腹部手术更易发生感染,国内以肝移植后发生乙肝再感染为主.随着乙型肝炎病毒相关性肝病患者行肝移植后长期存活数目的增加,移植学家们把研究的重点延伸到如何优化肝移植后预防乙型肝炎病毒再感染的治疗方案以降低因乙型肝炎病毒变异导致再感染和减少长期用药、降低治疗费用上来.文章分析了肝移植术后乙肝再感染的因素,介绍了肝移植后用于防治乙肝再感染的药物种类及临床应用,展望了肝移植后药物防治乙肝再感染的新的研究方向.     

全身麻醉手术患者术后转运风险因素评估及对策

目的探讨全身麻醉术复苏后患者转运风险因素评估及对策。方法总结分析本院110例全麻术后患者转运途中存在的风险因素,并采取针对性的对策和交接程序。结果全身麻醉术复苏后患者安全转运风险因素包括意识不清、呼吸抑制、呼吸道梗阻、休克、坠床、管道滑脱等。本组患者给予针对性安全转运措施,患者均安全转运。结论全麻术复苏后患者转运过程中容易发生血压、呼吸、心律的改变或者因为躁动而发生坠床等意外事件。因此,在转运前医务人员应准确对患者转运风险因素进行综合评估,采取针对性措施,及时发现和消除潜在的安全隐患,其对确保患者安全转运具有重要意义。     

Factor analysis as a tool for survey analysis using a professional role orientation inventory as an example

BACKGROUND AND PURPOSE: The purpose of this article is to illustrate how confirmatory factor analysis can be used to extend and clarify a researcher's insight into a survey instrument beyond that afforded through the typical exploratory factor analytic approach. The authors use as an example a survey instrument developed to measure individual differences in professional role orientation among physical therapists, the Professional Role Orientation Inventory for Physical Therapists (PROI-PT). SAMPLE: Five hundred three physical therapists responded to a mail survey instrument that was sent to a random sample of 2,000 American Physical Therapy Association members. METHODS: An adapted version of the Professional Role Orientation Inventory, a 40-item Likert-scale instrument developed to assess professional role orientation on 4 dimensions (authority, responsibility, agency, and autonomy), was used. Exploratory and confirmatory factor analyses were used to examine the factorial validity of the PROI-PT. RESULTS: Exploratory factor analysis served as a starting point for examining the factor structure of the instrument. Confirmatory factor analysis then was used to test the hypothesized factor structure and to suggest refinements to the PROI-PT that would improve a psychometric property (internal consistency). DISCUSSION AND CONCLUSION: Although further refinement of the PROI-PT is needed, an instrument that yields valid and reliable measurements of individual differences in professionalism among physical therapists could further our understanding of the psychosocial aspects of physical therapist practice. Exploratory and confirmatory factor analyses can be used by researchers who study various psychosocial constructs in physical therapy.     

塔里木吉拉克TⅡ储层伤害因素分析及对策

塔里木吉拉克TⅡ储层具有黏土含量高、水敏性强,地露压差小、反凝析伤害严重,气藏出水、储层低渗部位水锁伤害严重等特征,限制了油气井产能发挥。实验表明常规的水基钻井液和压裂液对储层的水敏伤害严重。实验和实际生产动态证实了凝析油的存在会大大降低气体渗透率,从而降低产能。地层水入侵又会对储层低渗部位带来水锁伤害。水敏伤害需通过在入井工作液中加入高效黏土稳定剂来缓解,SA-V黏土稳定剂是效果较好的一种；水锁和反凝析伤害需通过注入高效润湿反转剂来消除,含氟表面活性剂与醇类组合的润湿反转剂体系是有效的选择。     

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis

Background

Factor Xa (FXa) inhibitors, used for stroke prevention in atrial fibrillation and venous thromboembolism treatment and prevention, are the dominant non-Vitamin K oral anticoagulants on the market. While major bleeding may be less common with these agents compared to warfarin, it is always a risk, and little has been published on the most serious bleeding scenarios. This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes.