对护理本科生实施团体辅导及其效果评价

目的:分析团体辅导对本科护生主观职业障碍、职业决策自我效能、职业认同的影响。方法:对某高校一年级、二年级58名本科护生进行团体辅导,比较本科护生团体辅导前后主观职业障碍、职业决策自我效能、职业认同。结果:辅导前后本科护生主观职业障碍、职业决策自我效能、职业认同得分差异有统计学意义(P0.05或P0.001)。结论:团体辅导能有效提高本科护生的职业决策自我效能和职业认同,降低其主观职业障碍。     

护生实习前标准预防认知与职业防护意识调查

目的:调查护生实习前标准预防认知与职业防护意识情况。方法:采用自制调查表对407名即将实习的护生进行标准预防认知及职业防护意识的调查,分析其相关性及影响因素。结果:护生实习前标准预防认知程度及职业防护意识在性别、家庭居住地等方面比较差异有统计学意义(P0.05)。本组护生标准预防认知得分(51.64±3.13)分,职业防护意识得分(83.75±7.59)分,标准预防认知程度与职业防护意识呈正相关(r=0.310,P0.01)。不同性别、家庭居住地、对护理专业态度的护生标准预防认知得分比较差异有统计学意义(P0.05),不同家庭居住地、入学前对护理专业了解、对护理专业态度、临床见习经历的护生职业防护意识得分比较差异有统计学意义(P0.05)。本组护生实习前手部卫生知识与教育因素、主观因素、自我评价因素呈正相关;手套使用知识与主观影响因素呈正相关;锐器处理知识与教育因素、主观影响因素呈正相关;口罩使用知识与主观因素、自我评价因素呈正相关;隔离措施与教育因素、主观因素、自我评价因素呈正相关。结论:护生实习前标准预防认知良好,但职业防护意识欠佳,学校和实习医院应增强护生培训,提高职业防护意识。     

大中专护生职业自我概念及影响因素分析

[目的]了解护理大中专学生职业自我概念水平以及影响因素。[方法]采用一般资料问卷和护士职业自我概念量表对870名某职业院校护理大中专学生进行问卷调查。[结果]大中专护理学生职业自我概念处于一般水平,职业自我概念各维度平均得分由高到低依次为:沟通交流、灵活性、技能、满意度、领导维度;有担任班干部经历、非独生子女、认为学习不困难学生的职业自我概念水平显著高于不担任班干部、独生子女、认为学习困难的学生;回归分析显示,此3个因素进入影响职业自我概念水平的回归方程(F=23.17,P<0.001)。[结论]职业院校大中专护生职业自我概念水平较低,学校和临床护理教师应将有关职业自我概念及职业生涯规划的相关知识纳入教学中,培养护生对护理专业的积极情感,提升护生的职业自我概念。     

实习护生职业获益感现状及其影响因素的研究

目的了解实习护生的职业获益感现状并探讨其影响因素,为提高实习护生职业获益感水平提供参考。方法采用实习护生一般资料调查问卷和职业获益感问卷对389名实习护生进行调查。结果实习护生职业获益感总分为(123.56±13.18)分;实习护生职业获益感的主要影响因素为学历、自愿选择护理专业、曾担任学生干部、对带教老师满意。结论实习护生的职业获益感处于中等偏上水平,护理院校和实习医院应共同努力,根据影响因素有针对性地引导护生感知护理职业获益。     

在校男女护理本科生职业认同感比较

目的:调查在校男女护生对护理职业的认同情况,以期为护生的护理职业教育提供理论依据,提高护生对护理职业的认同感。方法:采用护士职业认同量表和自行设计的影响因素问卷对2所护理学院64名在校护生进行调查,并予以比较分析。结果:女生职业认同评分略高于男生职业认同评分(P<0.05),护生的职业认同感受多个因素的影响,但男女护生的职业认同感影响因素不全相同。结论:护理教育工作者应重视并完善护理职业教育,促进护生形成稳定积极的职业认同感。     

实习护生职业认同感现状及其影响因素

目的 通过了解实习护生的职业认同感现状,并分析其影响其职业认同感的因素,提出相应的对策,为今后培养优秀护理人才提供重要依据。方法 2020年1—12月,选取150名实习护生为调查对象,运用自编的护生一般资料问卷和《护生职业认同感量表》进行调查,采用SPSS 25.0统计学软件,对数据进行归纳整理和分析。结果 所调查的150名实习护生职业认同平均分数为56.12±14.01分,各个维度的结果很不平衡,其中维度得分最高的是社会比较与自我反思平均分为3.47±0.94分,得分最低的是职业选择的自主性平均分为3.15±0.61分。单因素分析显示护生就读护理原因、在班里学习情况对实习护生职业认同有影响（P<0.05）。多因素线性回归分析结果表明就读护理专业原因、在班里学习情况是护生职业认同感的影响因素（P<0.05）。结论 实习护生的职业认同感总体处于偏低水平,就读护理专业原因、在班里学习情况是护生职业认同感得分的影响因素。学校老师应根据学生不同特征进行有计划地宣传教育是护理工作的意义以及价值所在。     

临床实习护生职业认同现状调查及其影响因素研究

目的调查临床实习护生的职业认同现状,并分析其影响因素。方法采用实习护生一般资料调查表和职业认同感问卷对98名实习护生进行调查。结果实习护生职业认同感得分为23～34（28．45±5．44）分。职业认同感的影响因素为报考志愿。结论不同特征的实习护生职业认同感不同,护理管理者应根据实习护生的自身特点对其进行针对性的职业引导。     

实习护生职业认同现状及其影响因素分析

目的：通过调查了解实习护生职业认同现状和医务场所暴力现状,分析实习护生职业认同的影响因素,为提高实习护生职业认同感提供借鉴。方法：便利抽取某三甲医院的120名实习护生,采用职业认同问卷、医务场所暴力量表进行调查。结果：实习护生职业认同得分为（63.2±11.4）分;目睹和遭受医务场所暴力比例分别为26.8%和14.3%;学历、是否为独生子女、是否有宗教信仰、对护理专业的态度以及是否目睹医务场所暴力对实习护生职业认同有影响。结论：实习护生职业认同感低,经历医务场所暴力频繁,同时实习护生职业认同还受多种因素的影响,因此今后可通过增加相关培训,针对不同护生给予针对性的干预措施来提高实习护生的职业认同感,稳定护理团队的发展。     

90名在校男护生职业心态的调查分析

目的:了解男护生职业心态及其影响因素。方法:通过调查问卷,对90名男护生进行调查。结果:男护生职业心态极不稳定,只有17.68%的在校男护生比较坚定自己的选择,52.22%的男护生毕业后会选择转行。影响男性从事护理工作的因素是多方面的,其中最主要的影响因素是观念因素,占43.33%。结论:对选择护理专业的男性而言,考虑更多的不是工作本身的难度,而是该如何树立正确的职业心态及有效地应对方法。     

泰安某高校男护生职业认同现状及影响因素分析

目的:调查泰安某高校男护生职业认同现状,探讨其影响因素。方法:采用一般资料调查表、护生职业认同问卷,通过问卷星平台对泰安某高校242名男护生进行调查,并进行职业认同影响因素的单因素和多元线性回归分析。结果:男护生职业认同总分为(57.58±14.60)分,处于中等水平。多元线性回归分析显示,父亲受教育程度、毕业后就业打算是职业认同的主要影响因素(P<0.05)。结论:男护生职业认同水平有待提高,护理教育者与管理者应重视男护生的职业规划教育,制订有针对性的干预措施,促进其职业认同的发展,以防止护理人才的流失。     

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.