护理干预对子宫肌瘤病人围术期负性情绪及护理满意度的影响

[目的]探讨综合护理干预对子宫肌瘤病人围术期负性情绪及护理满意度的影响。[方法]将2016年8月—2017年8月妇科收治的98例子宫肌瘤病人随机分为对照组和观察组各49例,对照组病人给予常规护理措施,观察组病人给予围术期综合性护理干预。干预前后采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对两组病人负性情绪进行评估,自制问卷调查两组病人护理满意程度。[结果]两组病人干预后HAMA和HAMD评分降低,且观察组低于对照组(P0.05);观察组病人护理总满意率高于对照组(P0.05)。[结论]在围术期给予子宫肌瘤病人综合护理干预可缓解病人的负性情绪、提高病人对护理工作的满意度。     

亲情延续护理干预对胃癌化疗病人负性情绪及生活质量的影响

[目的]探讨亲情延续护理干预对胃癌化疗病人负性情绪及生活质量的影响。[方法]将84例胃癌化疗病人随机分为观察组及对照组各42例,对照组给予常规护理,观察组给予亲情护理干预,分别于干预前后应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及胃癌生活质量量表(QOL-C 30)对两组病人负性情绪及生活质量进行评价。[结果]观察组病人干预后HAMA、HAMD评分分别为11.57分±2.65分、10.24分±2.91分,显著低于对照组(P0.05);观察组病人干预后角色功能、躯体功能、情绪功能、社会功能及认知功能评分显著高于对照组(P0.05),而疲乏、恶心呕吐、疼痛评分低于对照组(P0.05)。[结论]亲情护理干预能有效改善胃癌化疗病人负性情绪,提高病人生活质量。     

全程护理对外科手术病人心理应激反应及负性情绪的影响

[目的]探讨全程护理对外科手术病人心理应激反应及负性情绪的影响。[方法]2012年6月—2014年6月选取本院普外科收治的84例病人为研究对象,根据随机数字表将病人分为观察组及对照组各42例,对照组给予常规性护理,观察组给予全程护理,分别于干预前后应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)对两组病人负性情绪进行评价,测量两组病人干预前后血压及心率的变化,并观察两组病人术后康复效果。[结果]观察组病人干预后HAMA、HAMD、疼痛(VAS)评分显著低于对照组(P0.05),收缩压、舒张压、心率水平显著低于对照组(P0.05),术后睡眠质量及满意度均高于对照组(P0.05),下床活动时间、平均住院时间均少于对照组(P0.05)。[结论]全程护理能有效改善外科手术病人心理应激反应及负性情绪,促进病人术后康复。     

认知行为干预对呼吸内镜治疗病人心理应激反应及治疗依从性的影响

[目的]探讨认知行为干预对呼吸内镜治疗病人的心理应激反应及治疗依从性的影响。[方法]选取行呼吸内镜治疗病人92例,根据随机数字表法将病人分为观察组及对照组各46例,对照组检查期间行常规性护理干预,观察组检查期间行认知行为干预,比较两组干预前后心理应激反应、负性情绪及治疗依从性。[结果]干预后观察组心率(HR)、收缩压(SBP)、舒张压(DBP)显著低于对照组(P0.05)。干预后观察组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均低于对照组(P0.05)。观察组一次检查成功率、治疗依从率、病人满意率高于对照组(P0.05),而并发症发生率低于对照组(P0.05)。[结论]认知行为干预能有效减轻呼吸内镜检查病人应激反应及不良情绪,提高病人检查依从性,降低病人检查并发症,提高病人治疗满意率。     

认知疗法联合放松训练对原发性青光眼手术病人负性情绪及睡眠状况的影响

[目的]探讨认知疗法联合放松训练对原发性青光眼手术病人负性情绪及睡眠状况的影响。[方法]将92例原发性青光眼手术病人随机分为观察组与对照组,每组46例。对照组给予常规护理,观察组在常规护理基础上给予认知疗法联合放松训练。术后5 d采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、睡眠状况自评量表(SRSS)分别评价两组病人负性情绪及睡眠状况,比较两组病人术后并发症发生率。[结果]干预后观察组SAS、SDS评分分别为(40.25±4.16)分、(39.45±3.47)分,低于对照组的(45.49±6.38)分、(44.85±4.34)分(t值分别为-4.667,-6.591,P0.05);观察组SRSS评分为(25.73±6.58)分,低于对照组的(29.41±7.35)分(t=-2.530,P0.05);观察组术后并发症发生率为19.57%,低于对照组的43.48%(χ~2=6.093,P0.05)。[结论]认知疗法联合放松训练可明显缓解原发性青光眼手术病人的负性情绪,改善睡眠状况,有助于减少术后并发症。     

Peplau人际关系理论应用于肺癌病人的干预效果分析

[目的]探讨Peplau人际关系理论应用于肺癌病人的干预效果。[方法]选取2017年2月—2018年2月收治的采用常规干预的72例肺癌病人作为对照组,选取2018年3月—2019年3月收治的以Peplau人际关系理论进行干预的72例肺癌病人作为观察组。比较两组病人并发症发生率,干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、世界卫生组织(WHO)生活质量评估量表(WHOQOL-100)评价两组病人负性情绪、生活质量。[结果]观察组病人并发症发生率低于对照组,差异有统计学意义(P0.05);观察组病人干预1个月后焦虑、抑郁评分均低于对照组,差异有统计学意义(P0.05);观察组干预1个月后生活质量评分高于对照组,差异有统计学意义(P0.05)。[结论]Peplau人际关系理论应用于肺癌病人可有效减少其术后并发症,改善病人负性情绪及生活质量。     

穴位按摩对乳腺癌围术期病人睡眠质量和负性情绪的影响

[目的]探讨穴位按摩对乳腺癌围术期病人睡眠质量和负性情绪的影响。[方法]选择乳腺癌围术期病人80例随机分为对照组和干预组各40例,对照组采用乳腺癌围术期常规护理及健康指导,干预组在此基础上给予穴位按摩,比较两组病人干预前后阿森斯失眠量表(AIS)、焦虑自评量表(SAS)和抑郁自评量表(SDS)的评分。[结果]干预后,干预组SAS、SDS、AIS评分低于对照组(P<0.01)。[结论]穴位按摩能有效改善乳腺癌围术期病人的焦虑、抑郁等负性情绪,提高病人睡眠质量。     

质量反馈理论对食管癌病人围术期负性情绪及康复效果的影响

[目的]探讨质量反馈理论对食管癌病人围术期负性情绪、术后并发症及生存质量的影响。[方法]将84例行手术治疗的食管癌病人根据随机数字表法随机分为观察组及对照组各42例,对照组术后给予常规护理,观察组在常规性护理基础上应用质量反馈理论指导围术期护理。干预前后应用焦虑自评表（SAS）、抑郁自评表（SDS）及肿瘤生存质量量表（QOL）对两组病人负性情绪及生存质量进行评价。[结果]观察组干预后 SAS、SDS评分低于对照组（P〈0.05）,QOL 生存质量总评分及各维度评分高于对照组（P〈0.05）;观察组术后并发症发生率为16.67%,对照术后并发症发生率为40.48%,两组并发症发生率比较,差异有统计学意义（P〈0.05）。[结论]质量反馈理论可有效改善食管癌围术期病人负性情绪、降低病人术后并发症发生率、提高病人术后生存质量。     

认知行为疗法对乳腺癌根治术患者心理状态及生活质量的影响

目的探讨认知行为疗法对乳腺癌根治术后患者心理状态及生活质量的影响。方法 2010年10月至2014年10月选取本院肿瘤科收治的92例乳腺癌根治手术患者为研究对象,根据随机数字表将患者分为观察组及对照组各46例,对照组围手术期应用常规性护理,观察组围手术期应用认知行为疗法,干预前后应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、WHO生存质量测定量表(WHO QOL-BREF)对两组患者负性情绪及生活质量进行评价。结果观察组患者干预后HAMA、HAMD评分显著低于对照组(P0.05)。观察组术后睡眠质量及满意度均高于对照组(P0.05),下床活动时间、平均住院时间均短于对照组(P0.05),疼痛评分(VAS)低于对照组(P0.05)。观察组干预后生理领域、心理领域、社会领域、环境领域及总生存质量评分高于对照组,差异有统计学意义(P0.05)。结论认知行为疗法能有效改善乳腺癌根治手术患者焦虑、抑郁情绪,促使患者术后康复,提高患者生活质量。     

综合护理对膀胱全切回肠代膀胱术病人及配偶负性情绪和生活质量的影响

[目的]探讨综合护理对膀胱全切回肠代膀胱术病人及配偶的负性情绪和生活质量的影响。[方法]选取我院泌尿外科行膀胱全切回肠代膀胱术病人及配偶,采用随机分组法分为干预组和对照组,对照组给予常规护理,干预组在常规护理的基础上采取心理干预、行为干预和治疗性干预,于术后第6周运用汉密尔顿焦虑量表、汉密尔顿抑郁量表和世界卫生组织生存质量测定量表对两组病人及配偶的负性情绪和生活质量进行调查。[结果]干预后,干预组病人及配偶焦虑、抑郁评分低于对照组,生活质量得分高于对照组,差异有统计学意义(P0.05)。[结论]综合护理干预措施可有效缓解膀胱全切回肠代膀胱术后病人及配偶的负性情绪,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.