脊柱结核患者对疾病的认知情况及健康教育需求的调查

目的 探讨脊柱结核患者对疾病的认知情况及患者健康教育需求状况.方法 以2013年1月至2015年6月本院收治的脊柱结核患者80例通过问卷调查的方式,了解患者对脊柱结核的认知状况,并分析患者对健康教育的需求.结果 患者对脊柱结核认知平均为(72.78±13.47)分.单因素分析表明,年龄>60岁、文化程度大专及以上、病史>10年者的疾病认知评分均显著好于其他患者(均P<0.05).脊柱结核患者对基础知识、治疗知识、康复知识、出院指导与随访的需求率分别为91.25%、100.00%、100.00%、97.50%.患者对个性化健康教育需求最高(90%),但是多数患者不认可集中授课模式(83.75%).结论 脊柱结核患者对疾病的认知程度受到年龄、病史、文化程度等因素的影响,对健康教育的需求高,而且更期望获得个性化健康教育.     

初治与复治肺结核患者健康教育需求的比较

目的了解初治与复治的肺结核患者健康教育需求,确定两组患者在认知、精神运动、情感领域的不同需求。方法对62例初治、41例复治的肺结核患者进行自设问卷调查。运用Likert4点评分方法。结果两组患者健康需求有显著差异（P〈0,01）。在认知、精神运动、情感领域都存在差异性（P〈0．05）。认知与精神运动领域需求存在高度正相关（r=0．805,P〈0．01）。情感领域与认知、精神运动领域需求存在中度正相关（r=0．435,P〈0．01;r=0．518,P〈0．01）。结论初治与复治的肺结核患者健康教育需求在整体及各个领域都存在差异,应针对不同特点做好健康教育评估。     

初复治糖尿病患者健康教育需求对比研究

目的:探讨初复治糖尿病患者健康教育需求.方法:对62例初治、41例复治糖尿病患者进行自设问卷调查,问卷包括5个方面,运用Likert4点评分方法.结果:两组患者健康需求有显著差异(P＜0.01);在认知、精神运动、情感领域都存在差异(P＜0.05);认知与精神运动领域需求存在高度正相关(r=0.805,P＜0.01);情感领域与认知、精神运动领域需求存在中度正相关(r=0.435,P＜0.05;r=0.518,P＜0.01).结论:初复治糖尿病患者健康教育需求在整体和各个领域都存在差异,应针对不同特点做好健康教育评估.     

初复治糖尿病患者健康教育需求对比研究

目的：探讨初复治糖尿病患者健康教育需求。方法：对62例初治、41例复治糖尿病患者进行自设问卷调查,问卷包括5个方面,运用Likert4点评分方法。结果：两组患者健康需求有显著差异（P〈0．01）;在认知、精神运动、情感领域都存在差异（P〈0．05）;认知与精神运动领域需求存在高度正相关（r=0．805,P〈0．01）;情感领域与认知、精神运动领域需求存在中度正相关（r=0．435,P〈0．05;r=0．518,P〈0．01）。结论：初复治糖尿病患者健康教育需求在整体和各个领域都存在差异,应针对不同特点做好健康教育评估。     

青少年特发性脊柱侧凸手术患者出院计划健康教育方案的构建

目的构建青少年特发性脊柱侧凸手术患者出院计划相关健康教育方案, 为青少年特发性脊柱侧凸手术患者提供系统、规范的出院计划相关健康教育。方法 2021年1—6月, 通过文献回顾和半结构式访谈, 拟定青少年特发性脊柱侧凸手术患者出院计划相关健康教育方案初稿, 采用德尔菲法对15名专家进行2轮函询, 根据专家函询意见确定最终版出院计划相关健康教育方案。结果 2轮专家函询问卷的有效回收率均为100.0%, 专家权威程度系数分别为0.93、0.94, 专家意见的肯德尔和谐系数分别为0.251、0.273 (P<0.01)。最终根据患者及照顾者入院当日、手术前1 d、手术当日、术后第1天、出院前1 d、出院当日、出院后1周共7个时间段的健康需求构建的健康教育方案包含一级条目7个, 二级条目24个, 三级条目78个。结论本研究构建的青少年特发性脊柱侧凸手术患者出院计划相关健康教育方案设计科学合理, 内容全面、可靠, 临床实用性强, 对青少年特发性脊柱侧凸手术患者有效实施出院计划具有重要意义。     

健康教育路径在脊柱结核手术患者中的应用

目的 探讨健康教育路径在脊柱结核手术患者中的作用.方法 将128例脊柱结核手术患者随机分为2组,实验组与对照组各64例.实验组制订住院期间健康教育路径图,按健康教育路径实施健康教育.对照组采用传统方法实施健康教育.结果 实验组对健康教育内容的掌握情况以及护理工作满意度明显高于对照组(p＜0.05).结论 应用健康教育路径对脊柱结核手术患者实施健康教育,对提高教育效果,使患者更好地掌握健康教育知识、密切护患关系、提高护理满意度起到了积极的作用.     

家属赋能模式在脊柱结核外科中的应用

目的:探讨家属赋能模式在脊柱结核外科患者及其家属中的应用效果。方法:将80例脊柱结核外科患者随机分为对照组和实验组各40例,对照组采用传统方法进行健康教育,实验组应用家属赋能模式实施健康教育。应用焦虑自评量表、治疗依从性问卷、家属疾病认知及陪护技能调查表对两组患者及家属进行评价。结果:实验组患者及其家属焦虑程度明显低于对照组(P<0.05),患者治疗依从性、家属陪护技能及疾病认知水平均明显高于对照组(P<0.05)。结论:应用家属赋能模式进行健康教育,可显著提高脊柱结核外科患者治疗依从性及家属对疾病的认知水平及护理能力。     

脊柱微调手法联合传统功法治疗腰椎间盘突出症方案的专家调查研究

目的:对脊柱微调手法联合传统功法治疗腰椎间盘突出症技术流程进行优化,形成规范化的干预方案.方法:根据文献等编制专家问卷调查表,采用Delphi(德尔菲)法从专家积极系数、条目频数分析、专家意见集中、协调、权威程度等指标评价分析2轮调查问卷.结果:明确脊柱微调手法治疗腰椎间盘突出症的操作流程和使用规范,筛选出云手牵伸脊柱...     

基于加速康复外科理念的AIS手术患者健康教育内容构建

目的:构建基于加速康复外科理念的青少年特发性脊柱侧凸手术患者健康教育内容。方法:基于加速康复外科理念,查阅文献并采用半结构式访谈,拟定青少年特发性脊柱侧凸手术患者健康教育内容初稿后,采用德尔菲法对脊柱外科16名医护专家行两轮咨询后修改定稿。结果:两轮专家咨询问卷回收率分别为93.75%和100.00%,两轮专家权威系数分别为0.813和0.894,构建的健康教育内容包括4个一级指标、11个二级指标、47个三级指标。第2轮咨询中,一级指标的满分率为100.00%,二、三级指标的专家协调系数W分别为0.231和0.195,差异有统计学意义(P0.01)。结论:基于加速康复外科构建的青少年特发性脊柱侧凸手术患者健康教育内容科学、可靠、实用性强,有较好的指导意义。     

高原部队官兵健康知识需求调查问卷的编制

目的编制适合高原部队官兵特点的健康教育需求调查问卷。方法以《军队健康教育方案》规定的内容为理论基础,采用健康教育及部队健康教育课程文献回顾、基层高原部队健康教育者工作认知情况的调研、专家访谈的方法拟订高原部队健康知识需求调查问卷。结果专家咨询的权威程度系数为0.81,判断系数为0.88,熟悉系数为0.74;最终编制完成的高原部队官兵健康知识需求调查问卷包括Ⅰ级指标9条、Ⅱ级指标47条,Ⅰ、Ⅱ级指标的协调系数分别为0.991、0.476(P0.01)。结论专家咨询结果表明,本研究编制的高原部队健康知识需求调查问卷可为开展高原部队官兵的健康需求调查及高原部队健康需求调查研究提供依据。     

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.