新护士自我效能感与焦虑状况的相关性研究

目的了解新护士的自我效能感和焦虑状况,并分析二者之间的相关性,为解决新入职护士焦虑状况,采取针对性干预措施提供依据。方法应用一般自我效能感量表和焦虑自评量表对250名新护士进行自我效能感和焦虑状况调查。结果新护士一般自我效能感得分为(2.30±0.17)分,低于国内成人常模(P0.01),不同学历、是否独生子女、家人支持从事本专业、自我感觉科室关系、脱离行业的想法的新护士自我效能感得分差异具有统计学意义(P0.01或P0.05)。新护士焦虑得分为(55.80±8.32)分,高于国内女性常模(P0.01)。焦虑与自我效能感呈负相关(P0.01)。结论新护士自我效能感低,严重影响其焦虑水平,提高自我效能感可以在一定程度降低其临床焦虑水平。     

轮转护士焦虑状况调查及相关因素分析

目的:调查轮转护士焦虑发生情况,并分析其相关因素。方法:用焦虑自评量表(SAS)对124名轮转护士的焦虑状况进行调查,采用多元线性回归方法分析焦虑发生的相关因素。结果:轮转护士得分为(36.35±11.31)分,明显高于国内常模值(P<0.01);其中中度焦虑发生率为17.8%,重度焦虑发生率为30.6%,经多元线性回归分析,认为价值观和学历对得分影响最大。结论:轮转护士焦虑发生率较高,管理者应采取相关措施帮助轮转护士树立正确价值观,并提供机会提升她们的学历。     

精神科护士心理健康水平及影响因素调查研究

目的　了解精神科护士心理健康状况的影响因素。方法　采用SCL 90症状自评量表对 98名精神科护士、10 4名普通内科护士进行测评 ,并进行对照分析。结果　精神科护士症状自评量表 9个因子分显著高于普通内科护士。除人际关系、敌对因子外均有显著性差异 (P <0 .0 1)或P <0 .0 5 ) ;除人际关系 ,精神科护士各项得分均高于国内常模 ,其中躯体化、抑郁、焦虑因子有极显著性差异 (P <0 .0 1)。普通内科护士得分低于国内常模。结论　精神科护士心理健康状况欠佳 ,建议管理者采取确实有效的措施 ,维护精神科护士的心身健康     

精神科护理人员焦虑抑郁状况与社会支持的调查分析

目的探讨精神科护士抑郁、焦虑状况及社会支持程度。方法采用自评焦虑量表(SAS)、抑郁自评量表(SDS)及领悟社会支持量表(PSSS)对109名精神科护士进行问卷调查。结果精神科护士焦虑、抑郁得分平均分别为(45.06±11.16)分和(42.05±8.10)分,明显高于国内常模,差异有非常显著性(P<0.01);焦虑检出率为31.2%,抑郁检出率为58.1%,中度抑郁情绪占30.3%;社会支持总分及各类支持分均较高,社会支持程度与焦虑水平高低、抑郁情绪严重程度呈负相关。结论精神科护士的焦虑、抑郁状况较严重,而社会支持程度较高,有较好和比较稳定的社会支持。精神科护士焦虑、抑郁状况与社会支持具有相关关系。     

三级医院急诊科护士焦虑现状调查分析

[目的]了解广西壮族自治区三级医院急诊科护士焦虑现状。[方法]采取整体抽样法,应用焦虑自评量表对广西壮族自治区12所三级医院386名急诊科在职护士进行问卷调查。[结果]386名护士SAS得分范围为32分~71分(49.68分±10.07分),高于国内常模(P0.05);不同年龄、不同护龄、不同学历、不同婚姻情况、不同收入的护士SAS得分比较差异有统计学意义(P0.05);年龄、学历和月收入为影响急诊科护士焦虑的主要因素。[结论]急诊科护士焦虑水平较高,应采取积极的干预策略降低护士焦虑水平。     

新型冠状病毒肺炎时期规培护士焦虑与情绪调节自我效能感现状分析

目的调查规培护士在"新型冠状病毒肺炎(简称新冠肺炎)"时期的焦虑及情绪调节自我效能感水平。方法采用焦虑自评量表、情绪调节自我效能感量表对成都市某新冠肺炎定点医院的102名规培护士进行问卷调查。结果规培护士焦虑人数为47名(46%),其焦虑评分为(39.72±9.87)分,大于中国常模(29.78±0.46)分,差异具有统计学意义(P<0.05);规培一年级护士焦虑得分(40.78±11.08)高于规培二年级护士(38.74±8.59),差异有统计学意义(P<0.05);情绪调节自我效能感总分及各维度得分依次为(46.27±9.28)分、(16.08±3.39)分、(14.83±3.38)分、(14.36±3.49)分;表达积极情绪及调节沮丧/痛苦情绪效能感得分均小于中国常模,而调节生气/愤怒情绪效能感得分大于中国常模,差异均具有统计学意义(P<0.05);规培护士焦虑程度与情绪自我效能感水平呈负相关(r=-0.265,P<0.01)。结论新冠肺炎时期规培护士焦虑程度明显增高,情绪调节自我效能感属中等偏上水平。可通过认知心理干预,提升个体情绪调节自我效能感水平,改...     

陕西省医学生心理健康状况调查与分析

目的:了解医学生心理健康现状,为其心理健康教育工作提供科学依据。方法:采用症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁状态问卷(DSI)、人际信任量表(ITS)、社交回避及苦恼量表(SAD)抽样调查陕西省共计2 770名医学生。结果:2 770名医学生SCL-90中躯体化、焦虑、恐怖因子得分均高于全国大学生常模和全国青年组常模(P<0.01),而人际关系敏感、抑郁、敌对、偏执、精神病性因子得分低于全国大学生常模、高于全国青年组常模(P<0.01);SAS得分为(34.42±7.42)分,高于中国正常人常模(P<0.01);DSI抑郁评分指数为(0.63±0.43),高于正常值0.50;ITS得分为(78.19±7.76)分,高于理论平均值;SAD得分为(79.13±12.18)分,低于理论平均值。结论:医学生焦虑、抑郁情况严重,心理健康状况不容乐观。     

CCU护理人员心身健康状况的调查

目的 了解CCU护士的心身健康状况,以便采取针对性的保健措施.方法 采用临床症状自评量表SCL-90对22名CCU护士进行问卷调查,将调查结果与国内常模及心内科普通病房护士进行比较.结果 CCU护士及普通病房护士SCL-90总均分及阳性项目数、各因子评分均高于国内常模(P<0.01);CCU护士各因子中躯体化、强迫、抑郁、焦虑、恐怖因子得分高于普通病房护士及国内常模(P<0.05).结论 CCU护士的心身健康状况不容乐观.作为护理管理者,应采取切实可行的措施维护护士的心身健康;护士亦应重视自我心理保健,加强自身心理调节,提高心理健康水平,以提高工作效率及护理质最.     

急诊护士心理压力的分析与对策

目的探讨急诊护士心理压力状况及其缓解压力的对策。方法采用症状自评量表（SCL-90）对本院63名急诊科护士进行测试，并与国内常模比较。结果63例急诊护士在躯体化、强迫、抑郁、焦虑、偏执和人际关系敏感及SCL-90阳性项目数得分显著高于国内常模（P〈0．05）。结论急诊护士存在心理压力，应从社会环境和护士的自我素质等方面进行调整缓解，以提高生活和工作质量.     

女性不孕症患者焦虑抑郁状况及其影响因素的调查研究

目的观察女性不孕症患者焦虑抑郁状况,并对其影响因素进行调查研究。方法本研究为横断面研究,抽取杭州市两所三级甲等医院符合纳入标准的女性不孕症患者为研究对象,共计206例,分别采用自制人口学资料和疾病相关情况调查表、焦虑自评量表、抑郁自评量表、社会支持评定量表和家庭关怀度指数问卷对研究对象进行调查,并使用SPSS 20.0统计软件对数据进行处理分析。结果 206例女性不孕症患者的焦虑得分为(44.61±10.29)分,显著高于国内正常人群常模水平(29.28±10.07)分,经比较,t=27.794,P0.001;抑郁得分为(51.49±9.87)分,显著高于国内正常人群常模水平(33.46±8.55)分,经比较,t=29.746,P0.001。Pearson相关分析显示:焦虑得分与家庭关怀度得分(r=-0.276,P0.01)、社会支持得分(r=-0.284,P0.01)均显著相关;抑郁得分与家庭关怀度得分(r=-0.278,P0.01)、社会支持得分(r=-0.329,P0.01)均显著相关。经多因素逐步回归分析显示,女性不孕症患者的焦虑、抑郁与年龄及丈夫是否为独生子显著相关。结论女性不孕症患者的焦虑抑郁得分均高于国内常模,其影响因素有家庭关怀度、社会支持、年龄、丈夫为独生子等。     

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.     

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.     

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.