临床实习护理本科生自我效能感与应对方式的相关研究

[目的]探讨临床实习护理本科生自我效能感与采用应对方式之间的关系。[方法]采用“一般自我效能感量表”及“简易应对方式量表”对哈尔滨医科大学2004级90名护理本科生进行问卷调查。[结果]护理本科生一般自我效能感评分为2.58分±0.40分,处于中等水平,护生临床实习期间较多采用积极应对;一般自我效能感与临床实习期间采取的积极应对方式呈正相关（r=0.313,P〈0.01）。[结论]护理教育应重视提高学生的一般自我效能感,鼓励学生采用积极的应对方式,缓解实习压力,提高实习质量。     

护理本科生自我效能感、应对方式与技能考试成绩的相关性研究

目的了解护理本科生自我效能感水平和应对方式的现状,探讨学生自我效能感、应对方式与技能考试成绩之间的相关性。方法采用一般自我效能感量表与简易应对方式量表调查黑龙江中医药大学2005级82名护理本科生的自我效能感与应对方式情况,同时收集学生的护理学基础技能考试成绩。结果学生一般自我效能感与积极应对方式呈显著正相关（P〈0.01）,技能考试成绩与一般自我效能感和积极应对方式均呈显著正相关（P均〈0.01）。结论护理教育者应重视提高护理本科生的自我效能感,培养学生采用积极的应对方式解决在操作技能学习过程中遇到的困难,从而提高学习效果。目的了解护理本科生自我效能感水平和应对方式的现状,探讨学生自我效能感、应对方式与技能考试成绩之间的相关性。方法采用一般自我效能感量表与简易应对方式量表调查黑龙江中医药大学2005级82名护理本科生的自我效能感与应对方式情况,同时收集学生的护理学基础技能考试成绩。结果学生一般自我效能感与积极应对方式呈显著正相关（P〈0.01）,技能考试成绩与一般自我效能感和积极应对方式均呈显著正相关（P均〈0.01）。结论护理教育者应重视提高护理本科生的自我效能感,培养学生采用积极的应对方式解决在操作技能学习过程中遇到的困难,从而提高学习效果。     

实习护生主观幸福感与一般自我效能感及应对方式的相关性研究

[目的]探讨实习护生的主观幸福感、自我效能感及应对方式的特点及三者之间的关系。[方法]采用幸福感指数量表、一般自我效能量表、特质应对方式量表对135名实习护生进行问卷调查,并运用SPSS 18.0软件进行统计数据分析。[结果]实习护生主观幸福感总分为9.94分±2.45分,处于中低水平;主观幸福感与一般自我效能感、积极应对方式呈正相关(P0.05),与消极应对呈负相关(P0.05)。[结论]一般自我效能感和积极应对方式是实习护生主观幸福感的主要影响因素。     

护理本科生实习早期一般自我效能感与感知应激的相关性研究

目的调查护理本科生实习早期一般自我效能感与感知应激水平现状,并探讨两者的相关性。方法采用一般自我效能感量表及感知应激量表,对两所高校2012级的188名护理本科生进行调查。结果护理本科生实习早期感知应激总分为(55.47±14.31)分,一般自我效能感得分为(24.23±5.13)分,护理本科生实习早期感知应激与一般自我效能感呈负相关(r=-0.285,P<0.01)。结论护理教育者应结合学生自身特点制订切实可行的教学计划,提高学生实习早期一般自我效能感,减轻临床实习压力。     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系。[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查。[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义（P〈0.01）;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大。②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关（r=0.148,P〈0.01）。③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关（r=-0.145,P〈0.05）。[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平。     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系.[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查.[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义(P＜0.01);不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大.②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关(r=0.148,P＜0.01).③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关(r=-0.145,P＜0.05).[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平.     

不同年级护理本科生自我效能与应对方式的相关因素研究

目的调查不同年级护理本科生一般自我效能感与应对方式的情况与相关性,为护理教师有针对性地采取措施提高护生的自我效能感和积极应对方式提供依据。方法应用一般自我效能感量表（GSES）和简易应对方式问卷（SCSQ）对200名护理本科生进行测评。结果不同年级护理本科生的一般自我效能感和积极应对方式均存在显著性差异,自我效能感与积极应对呈显著正相关,与消极应对呈显著负相关。结论提高护理本科生的自我效能感将有助于其积极的应对方式。     

护理本科生自我效能感与临床能力的相关性分析

目的 调查护理本科生临床能力、自我效能感的现状,探讨两者之间的相关性,为临床教师帮助学生提高临床能力提供参考依据.方法 采用一般自我效能感量表及临床能力自评量表对在三级甲等医院实习的128名护理本科生进行问卷调查.结果 护理本科生自我效能感均分为(2.58± 0.85)分,临床能力均分为(4.16±0.53)分.护理本科生临床能力总分及各因子和自我效能感呈显著正相关.结论 了解护理本科生临床能力的现状及与自我效能感的关系,有助于临床带教教师有针对性的采取措施,从而提高学生总体临床能力.     

临床实习前护理本科生自我效能感与专业认同的相关性研究

目的调查临床实习前护理本科生一般自我效能感与专业认同的现状,并分析二者的相关性。方法采用一般自我效能感量表、护理本科生专业认同问卷,对我校即将参加临床实习的403名护理本科生进行问卷调查。结果护理本科生自我效能感得分为（2.38±0.53）分,专业认同总分为（83.52±8.83）分。一般自我效能感与专业情感、专业技能以及专业认同总分呈正相关（P〈0.05或P〈0.01）。结论护理本科生一般自我效能感与专业认同密切相关,护理教育者应采取相关措施,提高护理本科生的自我效能感和专业认同。     

实习护生社会支持、自尊、自我效能感对应对方式影响的路径分析

[目的]探讨实习护生社会支持、自尊和自我效能感对应对方式的影响。[方法]采用社会支持评定量表、自尊量表、一般自我效能感量表和简单应对方式问卷对长沙市3所综合性医院的542名实习护生进行问卷调查,并用LISREL 8.70进行路径分析。[结果]积极应对与社会支持、自尊、自我效能感呈正相关,消极应对与社会支持、自尊、自我效能感呈负相关,自我效能感在社会支持、自尊与应对方式之间起部分中介作用。[结论]实习护生的应对方式受社会支持、自尊和自我效能感的影响。     

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.     

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.