我国社区护理研究进展

为了解我国社区护理研究进展,利用《中国生物医学文献光盘数据库》检索2001年—2004年有关社区护理论文507篇,按论文发表时间、内容、发表机构、作者分布地域进行统计分析。社区护理论文数量较2001年前有所增加,且农村社区护理已开展。     

分析论文产出指导护理科研管理思路

目的通过对医院“十、五”期间的护理论文发表情况统计分析,探讨护理部对护理论文撰写管理和指导作用。方法对某院不同职称护理人员2001-2005年公开发表的护理论文数量、质量进行回顾性分析和总结。结果某院护理论文发表数量不多但呈逐年上升趋势,中、高级职称护理人员和护士长发表论文数量相对较多。结论护理部应充分发挥职能作用采取有效管理措施,如成立护理科研领导小组,加大护理科研培训力度,发挥护士长和科研骨干传帮带作用,有效的奖惩方法提高护理人员开展科研积极性,挖掘低年资护士潜力,使科研工作开展更加普遍,以提高护理论文数量和质量。     

国内重症监护护理论文发表情况分析

目的了解2005-2009年重症监护护理科研论文发表情况，为护理科研管理提供依据。方法利用中国期刊全文数据库（CNKI）检索2005-2009年在《中华护理杂志》、《护士进修杂志》、《护理学杂志》等7种护理领域的国家核心期刊发表的重症监护护理类论文的相关信息进行统计分析。结果2005-2009年7种护理领域的期刊共发表重症监护护理论文361篇，沿海发达省份科研实力较强，北京、广东、浙江、上海4个地区的发表论文数量占发表论文总量的60．4％，论文的基金率、合作度、合著度等呈现逐年上升的趋势。结论应加强区域间的交流合作，促进科研水平的整体提高，重视护理人员继续教育，定期组织护理科研培训，提高护理科研工作者的科研能力。     

我院成立护理论文撰写指导小组的实践与效果

目的：通过成立护理论文撰写指导小组，提高护理论文发表的数量和质量。方法：本着合理搭配形成梯队的原则，选择具有护理研究的理论与方法及实践经验、一定的英语阅读能力和写作能力、中级以上职称、曾在国内统计源期刊上发表论文2篇以上或获省级以上优秀论文奖励等条件的护士长为小组成员，负责全院护理人员的护理论文撰写指导工作。结果：2007年发表论文数量和质量明显高于2006年及2005年，差别有统计学意义（P〈0.01）。结论：成立护理论文撰写指导小组，可提高护理人员的撰写水平及其护理论文发表的数量和质量。     

上海市浦东新区社区护士科研状况的调查与分析

目的了解目前浦东新区社区护士的科研状况,为护理科研管理提供参考。方法便利抽样法选择上海市浦东新区45所社区卫生服务中心的466名护士作为调查对象,采用自制调查问卷对其科研现状进行调查。结果 466名社区护士中,近5年中仅有118名护士撰写过论文,65名护士发表过论文(73篇),发表论文的类型以综述为主(占57.5%),且大多为第一作者(87.7%)。社区护士近5年作为项目负责人主持或参与的科研项目中,以院级课题为主,作为负责人主持科研课题30项,参与科研课题72项,同时社区护士所在单位对护理科研工作有一定的支撑。结论社区护士的科研水平较低,各社区对护理科研工作有一定支撑,各级管理者仍需进一步加强对社区护士科研能力的培养和鼓励。     

新疆某三级甲等医院护理人员5年论文发表情况调查

目的了解新疆地区某三级甲等医院近5年来护理人员发表论文的情况，探讨护理人员发表论文的发展动向及存在的问题。方法采用文献计量学方法，对护理人员2007--2011年论文发表情况进行统计分析。结果护理人员近5年共发表论文715篇，由2007年的18．04％上升至2011年的21．26％，发表在国家核心期刊上的论文数为325篇，省级期刊390篇，其中专科护理占33．99％，护理研究占20．42％。不同年龄、不同职称的护理人员发表论文情况有所差异。30～39岁年龄段的护理人员发表论文数量最多，质量也较高；在发表论文的护理人员队伍中，初级职称发表论文217篇，占30．35％；中级职称发表论文297篇，占41．54％；高级职称发表论文201篇，占28．11％。结论护理人员发表论文的质量逐年提高，论文内容日趋丰富。     

护理科研规范管理的成效

目的探索护理科研规范管理的成效。方法建立护理科研管理组织,建立健全护理科研管理制度,建立制度化的教育培训体系,建立有效的激励机制。结果2002—2005年申报省级护理科研课题2项,完成市级科研课题12项,获湖北省科技进步三等奖1项．市科技进步三等奖3项。主编出版《临床护理诊断及措施》《x线摄影位置学》专著2部。2001-2004年每年发表的护理论文分别为9、25、96、108篇,并且在《中华护理杂志》《南方护理学报》等核心期刊上发表的论文,2001-2004年分别为3、12、26、49篇。结论护理科研规范化管理,有效促进护理科研开展,提高护理科研水平和护理质量。     

护理科研论文撰写、发表现状与分析

目的通过对近年护理论文撰写和发表的现状回顾,探析临床护士开展护理科研、护理论文撰写中的问题、难点和应对方法.方法分析2001～2003年刊于国内3种护理核心期刊的571篇护理论著,调查上海第二医科大学各附属医院近3年来护理论文的撰写与发表情况.结果①所发表论文的内容涉及面较广,以专科护理和基础护理为多(46.76%);属前瞻性研究达38.18%,实验性研究占23.99%.②研究样本数较小,其中小于或等于100的达57.44%;有统计学处理和描述的占58.67%.③有科研基金资助的仅为9.98%.④论文撰写数多,但发表率低(20.51%),在护理核心期刊的刊登率更低(5.13%).结论护理学术论文的内涵质量有待提高,应采取多种措施促进护理科研的发展和提高护理学术论文质量.     

老年肺炎38例社区护理

2001年4月－2007年11月，我们对38例老年肺炎患者实施社区护理，取得满意效果。现将社区护理体会报告如下。     

从近年循证护理论文发表情况分析我国循证护理的发展

循证护理(evidence-based nursing,EBN)从20世纪90年代末引入我国后,引起了护理人员的关注,并且作为研究热点问题在护理领域广泛开展。笔者统计了1999年—2006年在相关期刊发表的关于EBN方面的论文,并对其发展状况及存在的问题加以分析。11999年—2006年有关循证护理方面论文的发表情况检索1999年—2006年中国期刊全文数据库收录的有关循证护理论文共690篇,其中1999年1篇,2000年2篇,2001年10篇,2002年48篇,2003年86篇,2004年136篇,2005年179篇,2006年228篇。9种护理核心期刊刊载有关循证护理论文情况见表1。表19种护理核心期刊刊载循证护…     

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.