脊髓损伤膀胱功能控制训练17例临床护理

目的：探讨心内科住院患者护理需求状况及护理对策。方法：选取心内科住院患者200例，用自行设计的问卷，根据马斯洛人类基本需要理论5个层次30个问题进行调查。结果：心内科住院患者护理需求内容广泛，安全需求得分最高，不同年龄、不同文化程度、不同费用支付方式对护理需求差异有显著性（P〈0．05，P〈0．01）。结论：护理工作需要满足患者各方面的需求，并根据需求进行针对性护理。     

精神病患者陪护亲属认知状况调查及健康教育效果评价

目的探讨精神病住院患者陪护亲属对精神疾病的认知状况，评价健康教育对其认知状况的影响。方法采用自编陪护亲属对精神疾病认知现状调查表，对精神病住院患者100名陪护亲属健康教育前后的精神病认知状况进行评定分析。结果不同文化程度陪护亲属对疾病诊断的认同、对药物剂量的要求、对药物不良反应的态度、系统正规治疗与预后的联系、期望治愈时间及药物维持时间的认知状况均有显著性差异（P〈0．05或0．01）；健康教育后陪护亲属各认知项目的不同认知水平均显著提高，差异均有极显著性（P〈0．01）。结论精神病患者亲属对精神疾病的认知现状较差，不同文化程度认知水平不同，健康教育可显著提高患者家属的认知水平，在对患者进行治疗和健康教育的同时，也应对其亲属进行有针对性地护理健康教育。     

白内障患者手术前后生活质量的调查分析

目的通过住院白内障患者手术前后心理状态和生活质量的调查，探索白内障患者手术前后的护理措施。方法自编一般人口学资料调查表，选用生活质量（quality of life，QOL）问卷和焦虑自评量表（SAS）的调查问卷，对我院住院的白内障患者200例在手术前后进行评定和调查。结果患者术前、术后SAS总分差异有统计学意义（t=6．97，P〈0．01）；QOL因子分和总分的差异有统计学意义（t值〉7．77，P〈0．01），文化程度与QOL总分、术前心理需求总分及SAS的相关性有统计学意义（P〈0．01）。结论复明手术能提高白内障患者的生活质量，及时、有效及高质量的手术前后护理，能使患者安危度过手术过程。     

住院精神病患者配偶心理健康状况调查及护理干预

目的探讨住院精神病患者配偶心理健康状况，为临床护理干预提供依据。方法对30名住院精神病患者配偶，于患者入院时及出院时采用症状自评量表测评其心理健康状况，并与国内成人常模进行对比分析，提出护理干预措施。结果症状自评量表评分，人院时配偶各因子分均显著高于国内成人常模（P〈0.01），除恐怖和精神病性因子外，其余各因子分均显著高于出院时（P〈0．01）；出院时配偶躯体化、强迫、焦虑、抑郁、精神病性因子分仍显著高于国内常模（P〈0．01～0．05），而人际关系因子分显著低于国内常模（P〈0．05）。结论精神病患者配偶存在不同程度的心理问题，应及时给予有效的心理干预，提高其心理健康水平。     

首次住院恢复期精神病患者心理需求调查分析

摘要：目的 探讨首次住院恢复期精神病患者心理需求特点及影响因素，指导临床护理人员有针对性地进行护理。方法 采用自行设计的心理需求调查表，对９６例首次住院恢复期精神病患者进行问卷调查。结果 患者对疾病知识的需求率为５４.１７％，对治疗期望的需求率为６６.６７％，对心理支持的需求率为４８.９１％，对周围环境的需求率为５４.１７％。４个病种在治疗期望和心理支持２个方面差异有显著性意义（Ｐ＜０.０５，Ｐ＜０.０１）；患者对疾病知识的需求与文化程度、婚姻状况，对周围环境的需求与职业呈显著正相关（Ｐ＜０.０５，Ｐ＜０.０１）。结论 首次住院恢复期精神病患者心理需求程度高，需针对患者的需求特点及影响因素，提供针对性的健康教育和心理支持，以提高治愈率和其社会功能。关键词：精神病患者；　恢复期；　心理需求；　护理措施；　数据收集中图分类号：Ｒ４７３．７４；Ｒ３９５．３　　文献标识码：Ｂ　　文章编号：１００１ -４１５２（２００７）０３-００６４-０２     

烧伤住院患者的心理状态分析及护理干预

目的 了解烧伤患者的心理状态，探讨其相关因素为更好地进行心理护理及行为护理干预提供借鉴。方法 采用症状自评量表（SCL-90）对57例烧伤住院患者进行临床症状、心理状态调查分析。结果 烧伤患者的总均分和多数因子分明显高于国内常模。以躯体不适、抑郁、焦虑、敌对、恐怖、偏执和精神病性为著（P均〈0．05）。不同性别患者各因子差异无显著性意义（P均〉0．05）。不同医疗费用支付方式患者中，工伤、医保患者在躯体不适、敌对、恐怖3个因子上的评分高于自费患者（P均〈0．05）。自费患者在精神病性因子的评分高于工伤、医保患者（P〈0．05）。不同文化程度患者中，高中及中专以上文化组在躯体不适与敌对2个因子上的评分高于初中及以下文化组（P均〈0．05）。而在偏执因子的评分，高中及中专以上文化组低于初中及以下文化组（P均〈0．05）。结论 良好的治疗环境和护患关系是做好护理的前提，针对患者的心理状态及时进行相应的心理护理及行为护理干预是保证烧伤患者身心健康的关键。     

胃癌患者的心理分析及护理

目的：了解胃癌患者的心理状况，同时对其开展心理护理，提高患者生活质量。方法：对55例胃癌患者发放自行设计的心理状况调查表，以及临床精神卫生症状自评量表（SCL-90）调查问卷，同时对其开展耐心细致的心理护理。结果：在对组病人进行心理护理后，病人的焦虑、抑郁因子有了极显著性改变（P〈0．01）。躯体化和精神病性两因子有了显著性变化（P〈0．05）。说明心理护理有效地改善了病人的焦虑、抑郁症状。减轻了躯体化症状和精神病性症状。     

军队离退休人群社区护理需求及相关因素的调查

目的探讨军队离退休人群社区的护理需求。方法采用调查问卷形式对240例军队离退休人员社区护理需求进行统计分析。结果240例被调查者均有不同程度的社区护理需求，其中198例对社区护理需求较为急迫。对社区护理的需求量与月平均收入水平、文化程度呈显著正相关（P〈0．05），与年龄呈显著负相关（P〈0．05）。对社区护理需求的急迫程度与月平均健康消费水平、所患疾病对日常生活的影响呈显著正相关（均P〈0．05）。结论军队离退休人群具有极高的社区护理需求。     

住院精神病患者家属心理状态调查及护理干预

目的探讨住院精神病患者家属的心理状态及心理护理干预效果。方法采用自行设计的调查表对56例住院精神病患者家属进行调查，针对他们的心理状态实施心理护理干预措施1个月，干预前后采用抑郁自评量表（SDS）和焦虑自评量表（SAS）进行评定。结果精神病患者家属的心理状态以抑郁（64％）和焦虑（73％）为主。主要的影响因素为对精神病知识缺乏、外界压力、经济负担等。心理干预后患者家属的SDS、SAS总分显著下降（P〈0．001）。结论精神病患者家属存在不同程度的情绪障碍，心理护理干预对之有效。     

护理人员与患者对护理服务需求认知比较

【目的】探讨护理人员与患者两者之间对护理服务需求的认知。【方法】采用住院病人护理需求调查表,对本院100位护理人员进行护理服务需求认知调查,对109位患者进行护理服务需求认知及护理服务需求满意度调查。【结果】不同性别患者之间护理需求均无显著性差异（P均〉0．005）;文化层次高的病人自尊及自我实现的需要均显著高于文化程度较低者（P〈0.01,P〈0．05）;收入较高者自尊需求得分高于收入较低者（P〈0．05）;不同交费方式的两组各项评分均无显著差异性（P〉0．05）,按照（14～44）岁、（45～64）岁、65岁以上三个不同年龄段病人五个方面的需要比较均无显著性差异（P均〉0．05）;护理需求五大项中与护理提供各子项均有显著性差异（P〈0．01）。【结论】护理人员必须以患者的需求为导向,不断调整工作方法,规范护理服务行为,使护理水平得以全面的提高。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。