实习末期护生个人职业生涯规划现状及其影响因素分析

目的:了解实习末期护生的个人职业生涯规划现状及其影响因素。方法:采用自行设计的实习护生一般资料问卷和护生个人职业生涯规划调查问卷对214名某三级甲等医院的2010级实习末期护生进行调查。结果:本组护生职业生涯规划总得分为(100.6±4.1)分,属于"一般"水平。多因素分析结果显示,实习末期护生的个人职业生涯规划得分与护生性别、学历、在校期间是否曾担任班干部、是否曾参加有关职业生涯规划的学习、对目前所学护理专业是否满意、毕业后是否会从事护理工作6个变量存在相关性。结论:实习末期护生的个人职业生涯规划状况一般,且受众多因素影响,护理教育者应有针对性地加强护生的职业生涯规划指导和教育,积极引导护生,提高其职业生涯规划水平。     

本科实习护生实习早期职业生涯规划的现状调查

目的调查本科护生实习早期职业生涯规划的现状及其影响因素。方法采用一般情况调查问卷、职业生涯规划调查量表对144名本科实习护生进行调查。结果本科护生实习早期的职业生涯规划总分为（155．75±23．71）分。不同特征的本科实习护生在“护理专业是否为第一志愿”“专业选择的决策者”及“选择护理专业的依据”3个方面比较差异具有统计学意义（P〈0．01或P〈0．05）。结论学校应加强本科护生的早期职业生涯规划教育,有利于稳定护理人才,提高护理队伍的整体素质水平。     

全日制本科护生实习满意度对个人职业生涯规划的影响

目的 调查全日制本科护生实习满意度和个人职业生涯规划现状,分析实习满意度对个人职业生涯规划的影响.方法 采用方便抽样法,运用一般资料调查表、护生实习满意度量表及护理专业大学生个人职业生涯规划调查问卷,调查233名在南昌市5所三级甲等医院实习的全日制本科护生.结果 233名全日制本科护生的实习满意度总分为(146.54±14.77)分,个人职业生涯规划总分为(87.73±5.71)分.实习满意度与个人职业生涯规划呈正相关(r=0.468,P<0.01).分层回归分析显示,实习满意度中实习计划和临床教学是重要影响因素,共解释个人职业生涯规划19.1％的变异量.结论 全日制本科护生实习满意度处于中等水平以上,个人职业生涯规划处于一般水平.实习满意度中实习计划和临床教学正向影响护生个人职业生涯规划,建议护理管理者采取相关措施规范实习计划和临床教学,促进护生个人职业规划良性发展.     

实习男护生职业生涯规划状况调查分析

目的调查实习男护生职业生涯规划现状,为其职业规划指导提供依据。方法采用一般资料调查表和护理专业大学生个人职业生涯规划问卷对67名临床实习的男护生进行调查。结果 67名实习男护生职业生涯规划总均分为(89.37±13.62)分处于中等偏下水平,其中就业信心因子得分最低为(11.62±1.52)分。学历、学生干部经历、是否第一志愿报考护理专业、职业生涯指导课程经历等因素是实习男护生职业生涯规划的影响因素。结论护理专业学生工作中应该制订针对男护生的职业指导体系,从而帮助男护生科学规划、合理就业和个人在职业生涯中的全面、可持续发展。     

本科护生专业认同与个人职业生涯规划的影响因素及其相关性

目的了解南京中医药大学本科护生的专业认同和个人职业生涯规划情况影响因素及其相关性。方法 2010年12月至2011年1月,采用问卷法对南京中医药大学护理学院的391名本科护生的专业认同与个人职业生涯规划进行调查。结果本科护生专业认同、个人职业生涯规划均处于一般水平,年级、就读原因等是专业认同和个人职业生涯规划的影响因素。专业认同程度与个人职业生涯规划水平呈正相关(r=0.410,P<0.01)。结论本科护生的教育应注重增进专业认同的指导,帮助护生解决个人职业生涯规划中存在的问题,提高护生个人职业生涯规划水平。     

护理本科生实习后期个人职业生涯规划状况调查

[目的]探讨本科护生实习后个人职业生涯规划的状况及相关影响因素.[方法]用自行设计的调查问卷对广州市3所三级甲等医院实习后期的84名护理本科护生进行个人职业生涯规划的调查.[结果]实习后期护理本科护生的个人职业生涯规划均分为3.57分;17.86%的护生认为个人职业生涯规划是很有必要的,仅3.57%和2.38%的护生非常清楚个人职业生涯规划的内容和如何进行个人职业生涯规划;不同志愿选择护理专业、职业规划相关知识学习与否、毕业后从事护理工作不同意愿3个方面护生个人职业生涯规划得分差异均有统计学意义(P<0.05).[结论]实习后期护理本科护生个人职业生涯规划状况呈中等满意程度.志愿选择、职业规划知识的学习、从事护理工作的意愿对实习本科护生个人职业生涯规划状况有一定影响.     

护理本科生个人职业生涯规划现状及其影响因素分析

目的 探讨护理本科生个人职业生涯规划现状及其影响因素.方法 在文献调研、访谈、问卷调查的基础上自行设计护理本科生个人职业生涯规划调查问卷并检验了其信效度,问卷的重测信度0.818(P=0.000).Cronbach's α系数为0.872,因子分析证实问卷的结构效度好;用此问卷于2008年5-6月对广州市3所高等医学院校各年级365名护理本科生进行个人职业生涯规划的调查,并在单因素分析的基础上进行逐步回归分析,了解其影响因素.结果 护理本科生的个人职业生涯规划总分为(102.37±12.47)分;逐步回归分析表明"对护理专业总的满意度"、"年级"、"是否参加过职业生涯规划知识的学习"、"是否班干部"对护理专业大学生个人职业生涯规划总分的影响有统计学意义.结论 护理本科生个人职业生涯规划现状呈中等满意程度;护理本科生个人职业生涯规划受多种因素影响,高等护理教育应重视学生的个人职业生涯规划,努力提高学生的专业满意度,针对不同年级给予相应的指导和教育.     

本科实习护生自我职业生涯管理的调查分析

目的调查本科实习护生自我职业生涯管理现状并分析影响因素,为职业生涯辅导提供依据。方法采用一般资料问卷、职业生涯规划问卷和大学生职业成熟度量表对358名本科实习护生进行调查。结果本科实习护生自我职业生涯管理处于中等水平,职业生涯规划总分为（87．02±20．04）分,职业成熟度总分为（108．05±11．38）分。选择护理专业的原因中的适合自己、自己兴趣;选择职业的标准中的发展因素、学生干部经历、毕业后是否从事护理工作及是否自己联系过实习单位是本科实习护生职业生涯管理的影响因素。结论学校与医院应当有效结合,针对本科实习护生的现状及需求对其开展专门性、针对性、多样化的职业生涯辅导。     

临床实习护生职业生涯规划认知与教育需求的调查研究

[目的]了解临床实习护生职业生涯规划认知现状以及对职业生涯规划教育的需求,分析影响临床实习护生职业生涯规划认识的因素。[方法]在文献分析、访谈的基础上自行设计护生职业生涯规划认知及教育需求调查问卷,采用方便抽样的方法,对112名临床实习护生进行调查分析。[结果]临床实习护生职业生涯规划认知程度呈中等水平。不同学历、不同年级的临床实习护生之间的认知程度存在差异（P〈0．05）。影响临床实习护生职业生涯规划认知的因素有年龄、护理专业选择意愿和职业生涯规划教育与否3个因素。临床实习护生对护理职业生涯教育的需求呈现在时间、形式、周期和师资4个方面。[结论]护理教育者和管理者应明确职业生涯规划的意义,重视临床实习护生对职业生涯教育的需求,减少各种因素对其产生的影响,提高临床实习护生对护理职业生涯规划的认知程度。     

临床实习护生职业生涯规划认知与教育需求的调查研究

[目的]了解临床实习护生职业生涯规划认知现状以及对职业生涯规划教育的需求,分析影响临床实习护生职业生涯规划认识的因素. [方法]在文献分析、访谈的基础上自行设计护生职业生涯规划认知及教育需求调查问卷,采用方便抽样的方法,对112名临床实习护生进行调查分析. [结果]临床实习护生职业生涯规划认知程度呈中等水平.不同学历、不同年级的临床实习护生之间的认知程度存在差异(P<0.05).影响临床实习护生职业生涯规划认知的因素有年龄、护理专业选择意愿和职业生涯规划教育与否3个因素.临床实习护生对护理职业生涯教育的需求呈现在时间、形式、周期和师资4个方面. [结论]护理教育者和管理者应明确职业生涯规划的意义,重视临床实习护生对职业生涯教育的需求,减少各种因素对其产生的影响,提高临床实习护生对护理职业生涯规划的认知程度.     

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.     

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.     

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.     

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.