喉癌术后患者基于微信公众平台延续护理的效果观察

目的 探讨基于微信公众平台延续护理在喉癌术后患者中的应用效果.方法 选取在我院头颈外科行喉癌术后出院患者84例,按随机数字表法分为观察组和对照组,各42例.对照组实施常规出院指导及随访,观察组在对照组的基础上给予微信公众平台延续护理.观察比较出院当天和出院后3个月2组患者的抑郁、焦虑、自我效能及生活质量得分情况.结果 出院当天2组患者抑郁、焦虑、自我效能与生活质量得分差异无统计学意义(P>0.05);出院后3个月观察组患者抑郁和焦虑得分低于对照组(P<0.05),自我效能得分高于对照组(P<0.05),社会/家庭状况、情感状况、功能状况、头颈部附加条目得分及生活质量总分均高于对照组(P<0.05).结论 对喉癌术后出院患者,基于微信公众平台延续护理,可改善患者的抑郁和焦虑状况,提高患者的自我效能和生活质量,值得临床借鉴使用.     

人文关怀在癌症手术患者中的应用效果

[目的]探讨人文关怀对癌症手术患者心理状况、希望水平及生活质量的影响.[方法]将100例癌症手术患者随机分为对照组和观察组,每组各50例;对照组给予常规护理,观察组在常规护理基础上由志愿者给予其人文关怀护理.比较两组患者出院前1d及出院后3个月的心理状况、希望水平及生活质量变化.[结果]两组出院前1d的心理状态均处于中度抑郁和焦虑的状态,希望水平处于中等水平,且差异均无统计学意义(P>0.05).出院后3个月对照组汉密尔顿抑郁状态量表(H AMD)得分、焦虑自评量表(SAS)评分及希望水平评分有所改善,但与出院前比较差异无统计学意义(P>0.05);观察组H AMD得分、SAS评分及希望水平显著优于出院前(P<0.05).出院3个月后,观察组生活质量评分为(72.31±9.94)分显著高于对照组的(62.94±10.37)分,差异有统计学意义(P<0.05).[结论]人文关怀对减轻癌症患者焦虑和抑郁情绪、提高患者的希望水平及改善患者的生活质量有重要价值.     

基于医院的延续性护理模式干预对静脉血栓栓塞症患者术后焦虑抑郁情绪及生活质量的影响

目的 基于医院的延续性护理模式干预对静脉血栓栓塞症患者术后焦虑抑郁情绪及生活质量的影响,为建立延续性护理模式及静脉疾病专病数据库提供依据。方法 将90例静脉血栓栓塞症患者按不同干预方法分为研究组和对照组,每组45例。住院期间两组均接受常规抗凝治疗、手术治疗及护理干预,出院后对照组给予常规家庭护理干预,研究组给予基于医院的延续性护理模式干预,观察6个月。比较出院时及出院3个月、6个月两组焦虑自评量表、抑郁自评量表和中文版静脉功能不全患者生活质量/症状问卷子问卷评分,比较出院后6个月两组护理满意度。结果 出院3个月、6个月研究组焦虑自评量表、抑郁自评量表评分均较出院时显著降低(P<0.01),且显著低于对照组(P<0.01),对照组出院6个月焦虑自评量表、抑郁自评量表评分均较出院时显著升高(P<0.01)。研究组仅出院6个月中文版静脉功能不全患者生活质量/症状问卷子问卷评分均较出院时显著降低(P<0.01),但出院3个月、6个月仍显著高于对照组(P<0.01),对照组出院3个月、6个月评分均较出院时显著降低(P<0.01)。出院6个月研究组护理总满意率显...     

以奥马哈系统为理论框架的微信群平台在乳腺癌患者术后延续护理中的应用

目的观察以奥马哈系统为理论框架的微信群平台在乳腺癌患者术后延续护理中的应用效果。方法将64例乳腺癌术后患者按随机数字表法分为对照组和观察组,每组32例。对照组接受常规护理及出院随访,观察组实施以奥马哈系统为理论框架的微信群平台的出院后延续护理干预,干预时间6个月。结果出院后6个月,观察组乳腺癌患者生命质量测定量表各领域评分及总评分均显著高于对照组(P<0.01);观察组患者出院后6个月的焦虑自评量表、抑郁自评量表评分均显著低于对照组(P<0.01)。结论以奥马哈系统为理论框架的微信群平台延续护理模式能够提高乳腺癌术后患者生活质量,能够有效缓解焦虑、抑郁等负面情绪。     

延续性护理对乳腺癌患者生存质量的影响

选取我院2012年4月~2014年3月行乳腺癌手术患者88例,随机分为观察组和对照组各44例。对照组给予常规护理,观察组在对照组基础上给予延续性护理干预。比较两组患者入院和出院后6个月焦虑抑郁水平及生活质量。结果观察组出院6个月SAS及SDS评分明显低于对照组(P<0.05);观察组出院6个月生活质量明显优于对照组(P<0.05)。采用延续性护理可有效提高乳腺癌患者术后生存质量,改善其焦虑忧郁情绪,值得临床推广应用。     

关爱照护对脑卒中患者心理状况的影响

目的:探讨关爱照护对脑卒中患者心理状况的影响。方法:将收治的160例脑卒中患者随机分为对照组和观察组各80例,对照组采用普通照护,观察组实施关爱照护;分别于治疗前、干预后1周、出院后1个月采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)比较两组抑郁、焦虑、心理健康状况。结果:干预后1周、出院后1个月,两组SDS评分、SAS评分均明显低于治疗前(P0.05),且观察组低于对照组(P0.01);干预后1周,对照组躯体化、强迫、焦虑、抑郁、精神病性、其他评分均显著低于治疗前(P0.05);干预后1周、出院后1个月,观察组SCL-90中除敌对、偏执因子外,其余各因子评分显著低于对照组(P0.01),且显著低于治疗前(P0.05)。结论:对脑卒中患者实施关爱照护效果确切,可以明显改善患者心理状况,提高患者生活质量,值得临床推广。     

关爱照护模式对脑卒中康复期患者心理状况的影响

目的:探讨关爱照护模式对脑卒中康复期患者心理状况的影响。方法:将收治的160例脑卒中康复期患者随机分为对照组和观察组各80例,对照组行普通照护模式,观察组行关爱照护模式;分别在治疗前、干预1周后及出院1个月后通过焦虑自评量表(SAS)、抑郁自评量表(SDS)及症状自评量表(SCL-90)比较两组焦虑、抑郁及症状自评状况。结果:干预1周和出院后1个月,观察组SDS、SAS评分均低于同组治疗前和对照组(P0.01),且对照组SDS低于治疗前(P0.05);护理1周后对照组SCL-90中躯体化、强迫、抑郁、焦虑、精神病性及其他评分显著低于治疗前(P0.05);干预1周和出院后1个月,观察组SCL-90中除敌对和偏执外,其余各项与对照组和治疗前比较差异有统计学意义(P0.01,P0.05)。结论:关爱照护模式理念先进,能够显著改善患者的焦虑和抑郁症状,提示患者生活质量,值得临床借鉴使用。     

实施延伸护理对人工肝治疗患者焦虑和生活质量的影响

目的观察延伸护理对人工肝治疗患者焦虑和生活质量的影响。方法按照随机数字表将80例人工肝治疗后病情稳定的出院患者分为对照组与观察组各40例。对照组实施常规出院指导,观察组实施延伸护理。出院6个月后比较两组患者焦虑自评量表、健康问卷调查表得分情况。结果出院6个月后两组患者焦虑自评量表、健康问卷调查表得分均较出院时明显改善,且观察组各项指标改善程度比对照组显著,P0.05。结论实施延伸护理有利于降低人工肝治疗患者的焦虑程度,提高生活质量。     

恶性肿瘤放射治疗患者心理状况调查分析

目的:探讨恶性肿瘤放射治疗(放疗)患者的心理状况,为其心理护理提供理论依据.方法:采用症状自评量表(SCL-9O)、抑郁自评量表(SDS)、焦虑自评量表(SAS)和特质应对方式问卷(TCSQ)对77例肿瘤放疗患者(恶性肿瘤组)和42例健康对照组进行测试,并分析其相关性.结果:恶性肿瘤组SCL-90总分及各因子分均显著高于健康对照组(P<0.05或P<0.01),主要表现在躯体化、抑郁、焦虑和精神病性.恶性肿瘤组SAS、SDS得分及情绪异常率均明显高于健康对照组(P<0.05或P<0.01),显示他们有较多的抑郁、焦虑情绪反应.恶性肿瘤组SAS、SDS得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分呈正相关(P<0.05或P<0.01).恶性肿瘤组积极应对得分与健康对照组无显著差异(P>0.05),而消极应对得分明显高于健康对照组(P<0.05).恶性肿瘤组积极应对得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分、SAS、SDS呈负相关(P<0.05或P<0.01);恶性肿瘤组消极应对得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分、SAS、SDS呈正相关(P<0.05或P<0.01).结论:肿瘤放疗患者存在诸多方面的心理问题,有的放矢地进行护理干预可以缓解其身心压力,对提高其治疗护理依从性和战胜疾病的信心是必要的.     

心理干预对子宫全切术患者心理状态及生活质量的影响

目的 探讨子宫肌瘤行子宫全部切除患者手术前后的心理、生活质量变化,评估心理干预的效果.方法 对照组给予常规护理措施,干预组在此基础上给予有针对性的心理干预.采用焦虑自评量表、抑郁白评量表、世界卫生组织生活质量测定量表-100在患者入院时、术前1 d、术后6个月进行效果测评.结果 (1)入院时两组焦虑、抑郁,生活质量得分的差异无统计学意义(P>0.05);术前、术后半年干预组的焦虑、抑郁评分低于对照组(P<0.01);(2)心理干预半年后,干预组总的健康状况及精力、睡眠、性生活等10项得分显著优于对照组(P<0.01);对照组术后半年与入院时比较,注意力、自尊、性生活、总的健康状况等9个项目得分明显改善(P<0.01),干预组术后半年与入院时比较,疼痛、精力、睡眠等11个项目得分明显改善(P<0.01).结论 子宫全切患者存在异常心理,心理干预有助于减少甚至解除手术引起的焦虑、抑郁,并且对患者术后性生活、自尊、身材与相貌、人际关系、社会支持等生活质量改善有明显的调适作用.     

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.     

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.