护士长领导行为与护士工作满意度的相关性研究

目的 明确护士长领导行为与护士工作满意度之间的相关性。方法 采用分层随机抽样抽取西安交通大学第一、二医院及陕西省人民医院的临床护士，要求其回答3个问卷，包括：一般资料问卷、领导行为描述量表的“定规”和“关怀”亚量表及工作满意度调查问卷。结果 护士长的“定规”与“关怀”领导行为与护士总体工作满意度均有显著的正相关关系。回归分析发现，“定规”领导行为是总体工作满意度的解释变量。结论 优化护士长的各种领导行为，尤其是加强护士长的“定规”领导行为，能提高护士的工作满意度。     

护士长领导行为与护士工作倦怠调查分析

目的:探讨护士长领导行为与护士工作倦怠的状况并分析影响因素.方法:采用一般情况调查表、领导行为描述调查表(LBDQ-Ⅻ)"定规"和"关怀"亚量表、Maslach工作倦怠量表分层随机抽样调查烟台毓璜顶医院、烟台山医院、莱阳中心医院部分护士长及护士(214名).结果:护士长的领导行为更倾向于"定规"领导,科室和护士长的工作年限、职称、学历对领导行为影响大(P＜0.05,P＜0.01);护士的职业倦怠在情绪衰竭、去人性化得分高于常模,成就感低下低于常模(P<0.05).回归分析发现,"定规"领导行为是总体工作倦怠的解释变量,护士工作年限、年龄和学历与职业倦怠存在共线性关系.结论:优化护士长的领导行为,尤其是加强护士长"定规"领导行为,能降低护士工作倦怠.     

护士长领导行为与护士工作倦怠的关系

目的探讨护士长的领导行为与护士工作倦怠水平的关系。方法采用领导行为描述调查表（LBDQ-Ⅻ）和Maslach工作倦怠量表（MBI）对2家医院的214名护士进行调查。结果护士存在较高水平的工作倦怠,护士长关怀得分低于定规,护士长领导行为与护士工作倦怠相关,其中定规维度与情感耗竭、去人格化呈正相关关系,与个人成就感降低呈负相关关系。关怀维度与情感耗竭、去人格化呈负相关关系,与个人成就感降低呈正相关（P〈0．05）。结论护士长在重视定规的同时应当加强对护士的关怀,以降低护士的工作倦怠水平,提高护理工作质量。     

护士长领导行为调查分析

摘要：目的 了解护士长领导行为方式并分析各因素对领导行为的影响。方法 采用一般资料问卷和领导行为描述量表（ＬＢＤＱ-Ⅻ）调查西安市３所三级甲等医院的１２０名临床护士对其护士长领导行为的评价。结果 １２种护士长领导行为中，定规得分最高，显著高于关怀得分（Ｐ＜０.０１）；不同医院、科室及不同学历的护士长，其定规和关怀领导行为比较，差异有显著性意义（Ｐ＜０.０５，Ｐ＜０.０１）。结论 护士长的领导行为以定规为主导，而不同医院文化、科室及护士长学历是其领导行为的影响因素。关键词：护士长；　领导行为；　护士；　数据收集中图分类号：Ｒ４７；Ｃ９３１．３　　文献标识码：Ａ　　文章编号：１００１-４１５２（２００７）０１-０００８-０３     

精神科护士长领导行为与护士工作满意度的关系研究

目的调查精神科护士长领导行为与护士工作满意度之间的关系。方法采用领导行为量表调查精神科护士长的领导行为,采用明尼苏达满意度量表调查护士的工作满意度。结果精神科护士工作满意度得分(65.98±9.66)分;护士长领导行为中,待遇满意、集体精神、绩效规范、心理保健对护士外在工作满意度有影响;性别、工作绩效、工作激励、待遇满意对内在满意度有影响。结论精神科护士工作满意度与护士长领导行为密切相关,改善护士长领导行为有助于提高护士工作满意度。     

儿科专科医院护士长领导作用与护士工作满意度相关性研究

目的调查护士长领导作用与儿科护士工作满意度之间的相关性,从而改善护士长领导行为,提高儿科护士工作满意度。方法采用明尼苏达满意度量表测量儿科护士工作满意度,采用自制问卷进行儿科护士对护士长领导作用的评价并分析其相关性。结果儿科护士满意度的平均分为(3.63±0.546)分,护士对护士长领导作用的评价各个衡量指标之间的均值在3.62~3.80之间,护士长领导作用与护士工作满意度之间呈正相关关系(r=0.556,P0.01)。结论护士长领导作用与儿科护士工作满意度密切相关,重视护士长的领导作用将有利于提高儿科护士工作满意度,从而保证护理质量,保障患儿安全。     

急诊科护士长变革型领导行为与护士工作满意度的相关性

目的调查急诊科护士感知到的护士长变革型领导行为及护士工作满意度的状况,分析二者之间的相关性。方法采用自行设计的一般资料调查表、多元领导行为量表和护士工作满意度量表对广州市4所三级甲等综合医院的168名急诊科护士进行问卷调查。结果急诊科护士感知的护士长变革型领导的领导方式总分(50.60±14.40)分,急诊科护士工作满意度总分(79.80±13.30)分;急诊科护士长变革型领导行为与护士工作满意度呈正相关(P0.01)。结论急诊科护士感知的护士长变革型领导行为处于中等偏高水平,急诊科护士工作满意度处于偏低水平。护理管理者应发挥变革型领导行为的积极作用,以提升急诊科护士的工作满意度。     

基于Bass领导理论的病房护士长领导方式与护士工作满意度的相关性研究

目的 探讨病房护士长领导方式与护士工作满意度的相关关系.方法 采用分层抽样方法抽取2所三甲医院符合纳入标准的护士207名作为研究对象,利用交易型领导方式亚量表、转换型方式亚量表和工作满意度量表调查护士所感知的病房护士长领导方式及其自身对工作的满意度.结果 病房护士长采取交易型领导方式的频率高于转换型领导方式,2种领导方式得分比较存在差异;护士工作满意度的"同事"维度得分最高,"薪酬"维度得分最低;转换型领导方式是护士工作满意度的影响因素之一,与护士总体工作满意度总分、"领导者"、"沟通"呈显著相关性.结论 病房护士长更多地采取转换型领导方式可以提高护士的工作满意度.     

急诊科护士长变革型领导行为对护士工作满意度的影响

[目的]对急诊科护士长变革型领导行为和护士工作满意度进行调查,分析两者的关联性。[方法]选择5所三级甲等医院急诊科的168名护士为调查对象,采用常规资料调查表、护士工作满意度量表以及多元领导行为量表进行问卷调查,并对结果做相关性分析。[结果]急诊科护士长变革型领导行为得分为(50.61±14.41)分,护士工作满意度总分为(79.81±13.31)分;急诊科护士长变革型领导行为与护士工作满意度呈正相关(P0.01)。[结论]急诊科护士认为护士长变革型领导行为水平属于中等偏上,护士工作满意度偏低。急诊科护士长应将变革型领导行为的作用充分发挥出来,从而有效地提高护士对工作的满意度。     

基于Bass领导理论的病房护士长领导方式与护士工作满意度的相关性研究

目的 探讨病房护士长领导方式与护士工作满意度的相关关系.方法 采用分层抽样方法抽取2所三甲医院符合纳入标准的护士207名作为研究对象,利用交易型领导方式亚量表、转换型方式亚量表和工作满意度量表调查护士所感知的病房护士长领导方式及其自身对工作的满意度.结果 病房护士长采取交易型领导方式的频率高于转换型领导方式,2种领导方式得分比较存在差异;护士工作满意度的＂同事＂维度得分最高,＂薪酬＂维度得分最低;转换型领导方式是护士工作满意度的影响因素之一,与护士总体工作满意度总分、＂领导者＂、＂沟通＂呈显著相关性.结论 病房护士长更多地采取转换型领导方式可以提高护士的工作满意度.     

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.     

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.     

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.