个案护理管理模式对胃癌病人术后自我护理能力和健康行为的影响

[目的]探讨个案护理管理模式对胃癌病人术后自我护理能力和健康行为的影响。[方法]将84例胃癌根治术病人随机分为观察组及对照组各42例,对照组病人围术期间给予常规性护理,观察组围术期间实施个案护理管理,干预前后应用自护能力测定量表(ESCA)、健康行为量表(HPL)对两组病人自我护理能力、健康行为及生活质量进行评价。[结果]观察组干预后自我概念、自护责任感、自护技能、健康知识水平及自护能力评分高于对照组,干预后人际关系、压力调节、心理健康、身体活动、营养、健康责任感及健康行为总分均高于对照组(P0.05)。[结论]个案护理管理模式能提高胃癌病人术后自我护理能力,改善病人健康行为,促进病人术后康复。     

慢性心衰患者自我护理能力的现状调查

目的 探讨慢性心衰患者自我护理能力的现状,为临床上提高慢性心衰患者自我护理能力提供相关的依据。方法 对97名慢性心衰患者采用自我护理能力测定量表(ESCA)进行调查评定,并对其相关因素进行简要分析。 结果 慢性心衰患者的自我护理能力处于中等水平,其中自理能力技能与健康知识的掌握处于中等水平,而自我责任感与自我概念处于高等水平。其中对于中低等自护能力水平的慢性心衰患者与高等自护水平的慢性心衰患者相比较,自护能力与健康知识维度得分差异有统计学意义。结论 慢性心衰患者的自我护理能力仍需不断提高,特别是自我护理技能与健康知识方面的提高,可从其影响因素进行针对性的护理,为今后的临床护理工作提供了相关依据。     

结肠造口病人的适应与自我护理能力相关性研究

[目的]探讨肠造口病人的自我护理能力与适应的关系.[方法]采用方便抽样的方法调查了广州市5所三级甲等医院的129例肠造口病人,采用问卷调查法,使用造口适应量表、自我护理能力测定量表分别调查研究对象的适应、自我护理能力.[结果]肠造口病人自我护理能力总分与其适应总分及适应各维度呈正相关(P＜0.01),自我护理能力中自护技能、自我概念和健康知识3个维度分别与适应总分及适应各维度均呈正相关(P＜0.05). [结论]肠造口病人的适应水平与其自我护理能力密切相关,自我护理技能越好、自我认同感越强及对肠造口的健康知识掌握程度越高的病人其适应程度越好.     

“三联”健康教育法对胸腔置管引流病人自护能力及并发症的影响

[目的]探讨“三联”健康教育法对胸腔置管病人自护能力与并发症的影响.[方法]将120例恶性胸腔积液行中心静脉导管胸腔置管治疗的病人按入院时间分为对照组和观察组各60例,对照组采用口述方式进行自护知识教育,观察组采用“三联”健康教育法进行自护教育,于病人胸腔置管后1周采用自我护理能力测评量表评价其自护能力,观察两组并发症发生情况.[结果]两组病人的自护技能、自护责任感、自我概念、健康知识水平及并发症发生率比较差异有统计学意义(P＜0.01).[结论]“三联”健康教育法可提高胸腔置管病人的自护能力,降低胸腔置管并发症.     

应用健康信念模式对提高老年患者自我护理能力的效果研究

目的 探讨应用健康信念模式对提高老年患者自我护理能力的临床效果.方法 将58例老年患者随机分为研究组和对照组各29例,研究组应用健康信念模式(HBM)的方法,对照组患者接受传统的健康教育方法,采用自我护理能力量表(ESCA)分别评估2组患者的自我护理能力、自我护理技能、自护责任感、自我概念、健康知识水平的变化.结果 研究组患者应用HBM后,自我护理能力、自我护理技能、自护责任感、健康知识水平等方面得分明显高于对照组.结论 健康信念模式是老年患者健康教育中行之有效的指导理论,能够显著提高老年患者自我护理的能力,进而改善患者的生活质量.     

协同护理模式改善间质性肺病激素治疗病人自我护理能力的效果观察

[目的]观察协同护理模式改善间质性肺病激素治疗病人自我护理能力的效果。[方法]将43例间质性肺病应用激素治疗的病人随机分为两组,对照组实施常规护理,观察组在此基础上给予协同护理模式,即责任护士、病人及家属共同评估病人的需求和存在的问题,制订护理计划,实施协同护理,干预前后采用自我护理能力测定量表(ESCA)和一般自我效能感量表(GSES)对两组病人进行评价。[结果]干预后观察组病人健康知识水平、自我护理技能、自护责任感、自我概念自我护理能力测定量表4个维度得分较对照组均有明显改善(P0.05),一般自我效能感量表评分明显高于对照组(P0.05)。[结论]协同护理模式能够充分发挥间质性肺病激素治疗病人的自我护理能力,从而提高护理质量。     

社区脑卒中患者的健康行为与自我护理能力的相关性

目的 了解社区脑卒中患者健康行为和自我护理能力情况,并探讨两者的相关性.方法 采用健康促进生活方式量表(HPLP)和自我护理能力量表(ESCA)对120例社区脑卒中患者进行调查分析.结果 脑卒中患者HPLP平均得分为(127.76±18.12)分,各维度得分从高到低依次为:营养、压力管理、人际关系、自我实现、健康责任感、躯体活动;ESCA的平均得分为(105.80±13.71)分,各维度得分从高到低为:自我概念、健康知识水平、自护责任感、自护技能;健康行为和自我护理能力呈中等正相关(r=0.548,P<0.05).结论 设计和实施社区护理干预措施时,应提高脑卒中患者的自我护理能力,以改善其健康行为,提高患者的生活质量.     

协同护理模式对慢性心力衰竭病人自我护理能力的影响

[目的]探讨协同护理模式对慢性心力衰竭病人自我护理能力的影响。[方法]采用随机数字表法将96例慢性心力衰竭病人分为观察组和对照组各48例,对照组予常规的护理模式,包括饮食、休息与运动、用药指导和预防感染等措施,观察组在常规护理的基础上运用协同护理模式,采用自我护理能力测定量表(ESCA)对两组病人干预前后的自我护理能力进行评价并比较。[结果]干预后3个月观察组病人的自我护理技能、自我责任感、自我概念及健康知识水平得分显著高于对照组(P0.01)。[结论]协同护理模式以其独特的理念促进病人及家属共同参与护理,提供优质、高效护理,帮助解决病人的各种健康问题,以达到提高病人自我护理能力的目的。     

协同护理提高血液透析患者自我护理能力的效果

目的:探讨协同护理提高血液透析患者自我护理能力的效果。方法:选取2014年1月至2018年12月在本院就诊的40例血液透析患者,随机分为两组。对照组使用常规护理,观察组使用协同护理。对比两组患者的临床效果。结果:观察组的用药依从性、饮水依从性和透析方案依从性明显高于对照组(P<0.05);护理后,两组的自我护理技能、健康知识水平、自我概念和自护责任感明显升高(P<0.05),观察组的自我护理技能、健康知识水平、自我概念和自护责任感明显高于对照组(P<0.05)。结论:协同护理能提高血液透析患者的依从性和自我护理能力。     

自我护理教育对哮喘病人自我护理能力和生活质量影响的研究

目的探讨自我护理教育对哮喘病人的自我护理能力和生活质量的影响。方法采用实验性研究设计,将80例哮喘病人随机分为干预组41例和对照组39例,对照组病人采用一般性健康教育,干预组病人进行个体化的自我护理教育,主要包括哮喘疾病知识及能改善病人健康知识水平、自我概念、自护责任感和自我护理技能四个方面的自我护理教育;干预时间为两个月,干预后两组均采用哮喘知识问卷、自我护理能力测定量表(ESCA)和支气管哮喘生活质量评分表(AQLQ)进行调查。结果通过自我护理教育后,干预组比对照组明显提高了哮喘病人自我护理能力、哮喘疾病知识及生活质量(均P<0.01或P<0.05)。结论自我护理教育能有效地提高哮喘病人的自我护理能力,进而提高生活质量。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.