随州市护士工作倦怠状况及其与工作压力源和控制感的相关性研究

目的 探讨护士的工作倦怠状况及其与工作压力源、控制感的关系.方法 运用护士工作倦怠量表(MBI)、护士工作压力源量表(NJSI)、工作心理控制感问卷(WLCS)对随州市3所医院356名护士进行调查,采用Person相关法分析工作倦怠与工作压力源、控制感的相关性.结果 356名护士工作倦怠量表测评中,高度情绪枯竭者占45.5%,高度去人格化倾向者占31.4%,低度个人成就感者为38.6%.在个人成就感纬度上,中专组护士的得分显著低于大专组护士(P＜0.05);在去人格化倾向纬度上,手术室组得分显著低于其他科室组(P之0.05或P＜0.01).相关分析表明,护士情绪枯竭和去人格化维度得分与工作压力源5个方面因子、控制感均存在显著正相关(P＜0.01或P＜0.001),个人成就感仅与管理及人际关系方面因子、控制感存在显著负相关俨＜0.05或氏0.001).结论 临床护士普遍存在工作倦怠问题,低学历护士工作倦怠情况较严重,手术科室护士相对其他i临床科室护士工作倦怠情况较轻.医院应通过降低护士工作压力源、培养护士内控的性格,以缓解其工作倦怠的情况.     

精神科护士职业应激及效应的调查分析

[目的]了解精神科护士工作紧张及应激效应状况,为改善精神科护士的工作环境和提升身心健康水平提供科学依据.[方法]以江苏省精神专科医院118名精神科护士为研究对象,采用职业紧张因素量表、职业应激反应量表、社会支持量表和焦虑评估量表进行调查,并与181名其他临床科室护士进行职业工作紧张分析比较.[结果]精神科护士的工作紧张因素中的工作控制、工作单调、工作冲突、工作压力、工作危险、工作需求得分高于其他科室护士得分,差异有统计学意义（P〈0.05）;职业应激中心理健康感、工作满意感得分低于其他科室护士得分,每日紧张感及焦虑状态得分高于其他科室护士得分,差异有统计学意义（P〈0.05）;社会支持得分低于其他科室护士得分,差异均有统计学意义（P〈0.05）.[结论]精神科护士职业应激水平、焦虑水平高于其他科室护士,心理健康和工作满意感低于其他科室护士.     

精神科护士职业应激及效应的调查分析

[目的]了解精神科护士工作紧张及应激效应状况,为改善精神科护士的工作环境和提升身心健康水平提供科学依据。[方法]以江苏省精神专科医院118名精神科护士为研究对象,采用职业紧张因素量表、职业应激反应量表、社会支持量表和焦虑评估量表进行调查,并与181名其他临床科室护士进行职业工作紧张分析比较。[结果]精神科护士的工作紧张因素中的工作控制、工作单调、工作冲突、工作压力、工作危险、工作需求得分高于其他科室护士得分,差异有统计学意义(P0.05);职业应激中心理健康感、工作满意感得分低于其他科室护士得分,每日紧张感及焦虑状态得分高于其他科室护士得分,差异有统计学意义(P0.05);社会支持得分低于其他科室护士得分,差异均有统计学意义(P0.05)。[结论]精神科护士职业应激水平、焦虑水平高于其他科室护士,心理健康和工作满意感低于其他科室护士。     

手术室护士职业倦怠现状及干预研究

[目的]探讨手术室护士工作倦怠症现状及干预效果.[方法]选择50名护士作为研究对象,采用疲劳量表-14和职业倦怠量表评价干预前后护士躯体、脑力疲劳得分以及倦怠程度.[结果]干预前后手术室护士躯体疲劳、脑力疲劳得分差异均具有统计学意义（P〈0.05）;手术室护士工作倦怠量表3个维度评分差异均具有统计学意义（P〈0.05或P〈0.01）.[结论]手术室护士面对多重压力,极易产生工作倦怠症,采取有效干预手段可激发他们的工作热情,有效减轻或避免工作倦怠的发生.     

三所军队医院非现役文职护士工作倦怠现状调查研究

目的 调查军队医院非现役文职护士工作倦怠现状.方法 采用Maslach工作倦怠问卷(Maslach Burnout Inventory,MBI),以整群随机取样的方法对某战区3所三级甲等医院的700名非现役文职护士进行问卷调查.结果 共发放问卷700份,收回631份,有效问卷537份,有效回收率85.10%.537份问卷中工作倦怠总体检出率为82.12%,不同维度倦怠检出率分别为情感衰竭83.43%、人格解体77.28%、个人成就感低98.51%;本研究样本个人成就感程度低于M氏样本(P<0.01);已婚者人格解体程度高于未婚者(P<0.05);护龄5年以上者人格解体程度高于护龄5年以下者(P<0.05);在不同科室之间,肿瘤科、急诊科、ICU的护士情感衰竭、人格解体程度明显高于其他科室(P<0.05);门诊、肿瘤科护士个人成就感评分低于其他科室(P<0.05);手术室、ICU护士个人成就感评分高于其他科室(P<0.05).结论 军队医院非现役文职护士是工作倦怠高发人群,医院管理层应有针对性地制定缓解工作倦怠的措施.     

护士职业倦怠状况及其与社会支持、工作压力源的相关性研究

目的 探讨护士职业倦怠与工作压力源、社会支持的相关性.方法 对4家综合医院的医生(138人)、护士(162人)分别进行量表测查,其中对护士进行工作倦怠量表(MBI)、领悟社会支持量表(PSSS)、中国护士工作压力源量表的测查,医生仅进行工作倦怠量表的测查,并对结果进行分析.结果 护士的MBI测查结果显示情绪衰竭、非人性化评分显著高于医生,而工作成就感评分则显著低于医生;护士职业倦怠水平明显高于医生,2者比较差异有统计学意义.护士职业倦怠程度高者,其社会支持评分低于职业倦怠程度低者;而其工作压力源评分均显著高于职业倦怠程度低者.护士职业倦怠情绪衰竭、非人性化评分与社会支持、工作压力源呈负相关,而工作成就感评分与社会支持、工作压力源呈正相关.结论 护士职业倦怠状况应引起护理管理者的重视,及时采取相应措施提高其心理健康水平.     

手术室实习护生压力源及心理健康状况的调查分析

[目的]了解手术室实习护生的压力源以及心理健康状况，并提出相应的对策.[方法]对32名手术室实习护生采用访谈法分析其压力源，同时采用问卷调查法，应用症状自评量表(SCL-90)对其进行心理健康状况调查.[结果]手术室实习护生的压力源主要是接触病人血液、分泌物等被感染几率增加、与多科室、多医生合作而工作紧张、注意力高度集中;手术室实习护生的强迫症状、焦虑、恐怖因子评分显著高于全国青年常模＜0.05).[结论]手术室实习护生存在较大的工作压力和一定的心理健康问题，应采取有效措施保障其心理健康.     

武汉与北京地区护理本科毕业生压力源、社会支持及心理健康水平比较

[目的]比较武汉与北京两地护理本科毕业生压力源、社会支持、心理健康水平,从而有利于针对性进行护理本科毕业生的健康促进.[方法]采用问卷对武汉市和北京市共81名护理本科毕业生的压力源、社会支持与心理健康状况进行调查.[结果]武汉、北京两地护理本科毕业生压力源比较差异无统计学意义,但领悟社会支持总分和家庭支持得分比较差异有统计学意义(P＜0.01),其他支持得分北京地区均高于武汉地区;SCL-90中的抑郁、焦虑、恐怖、精神病性、偏执因子得分北京地区均低于武汉地区(P＜0.05).[结论]北京与武汉护理本科毕业生压力源相同,但北京地区护理本科毕业生的领悟社会支持和心理健康水平均高于武汉地区.     

精神科护士工作倦怠与工作压力、应对方式及社会支持的相关性研究

目的 探讨精神科护士的工作倦怠状况及与工作压力、应对方式、社会支持的关系.方法 采用中式工作倦怠量表、护士工作压力源量表、简易应对方式量表、社会支持量表对一所三级精神病专科医院临床护士进行调查.结果 精神科护士的工作倦怠水平为中度,主要问题为情感耗竭[（27.01±5.66）分]和成就感降低[（17.07±5.59）分],情感耗竭与年龄、护龄、职称、工作压力源5维度、消极应对方式、社会支持的利用度密切相关（r=0.527～-0.239,P〈0.01）,成就感降低与年龄、护龄相关（r=0.301,0.318,P〈0.01）.多元线性回归表明,护龄、工作压力源中患者护理方面的问题和社会支持利用度对情感耗竭影响显著.结论 改变精神科护士的年龄结构,合理应对精神疾病患者的护理问题,充分感知和应用社会支持是缓解精神科护士工作倦怠的重要干预措施.     

手术室护士压力源分析及对策

[目的]了解手术室护士的压力源及观察其干预效果.[方法]对手术室护士32名进行压力源调查分析并给予行为干预,采用症状自评量表(SCL-90),对干预前后效果进行评定对比.[结果]手术室护士干预后的心理健康水平明显高于干预前.[结论]手术室护士压力源影响较大,采取有效的应对措施可以减轻手术室护士的心理压力.     

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.