护理干预对促进上海市妇女乳腺癌早期筛查信念及行为的效果研究

目的评价护理干预对促进妇女乳腺癌早期筛查信念及行为的效果。方法方便选取上海市4个社区,完全随机将其分为干预组和对照组,每组再次方便选取180名研究对象,共选取739名。干预组接受以健康信念模式为指导的为期一年的护理干预,对照组只接受一般防癌宣教。结果干预后妇女感知的易感性、感知的益处增加(B=0.210,P0.01;B=0.105,P0.01),感知障碍减少(B=-0.086,P0.05);每月1次乳腺自我检查的人数增多,进行乳腺临床检查和乳腺X线摄片的人数增多(OR分别为3.094、2.746)。结论以健康信念模式为指导的护理干预帮助妇女树立了健康信念,提高了早期筛查的参与率,对广泛开展乳腺癌的早期筛查工作具有重要意义。     

健康促进模式在适龄妇女乳腺癌检查项目中的应用

目的:探讨健康促进模式在适龄妇女乳腺癌检查项目中的应用。方法:选择2017年1月至2020年12月全县400例适龄妇女乳腺癌筛查作为观察对象,根据时间点不同分为对照组(n=400,2017年1月至2018年12月)和观察组(n=400,2019年1月至2020年12月)。对照组采用常规方法宣教,观察组联合健康促进模式。比较两组干预后满意度、乳腺癌疾病及筛查评分、乳腺自查率及乳腺癌筛查信念评分。结果:观察组干预满意度97.50%明显高于对照组的93.75%,差异存在统计学意义(P<0.05);干预后,两组乳腺癌疾病及筛查知识均明显改善,且观察组乳腺癌疾病及筛查知识得分明显高于对照组(P<0.05);两组干预2个月后乳腺自查率差异无统计学意义(P>0.05),观察组干预4个月、6个月自查率均高于对照组(P<0.05);干预后,两组乳腺癌筛查信念评分明显提高,且观察组感知到的易感性、感知到的严重性、感知到的益处、感知到的障碍及自我效能评分高于对照组(P<0.05)。结论:健康促进模式用于适龄妇女乳腺癌检查项目中可提高满意度,提高乳腺癌疾病及筛查知识知晓率及乳腺自查率,有效改善适龄妇女乳腺癌筛查信念评分。     

自我效能增强护理干预对乳腺癌患者的负性情绪及生活质量的影响

目的：探讨自我效能增强护理干预对乳腺癌患者的负性情绪及生活质量的影响。方法选择2010年1月至2013年1月我院收治乳腺癌患者300例,随机分为观察组和对照组,每组各150例。对照组给予常规护理干预,观察组在常规干预基础上给予自我效能增强护理干预,干预1个月,对两组患者干预前后SAS、SDS评分及干预后的生活质量进行比较。结果①干预后观察组的SAS评分和SDS评分明显低于干预前（ P＜0．05）;干预后观察组的SAS评分和SDS评分明显低于对照组（ P＜0．05）。②干预后观察组的GSES评分明显低于干预前和对照组（P＜0．05）。③干预后观察组的SF－36各维度评分均明显高于对照组（P＜0．05）。结论实施自我效能增强护理干预可有效地缓解乳腺癌患者的焦虑抑郁的负性情绪,改善患者的生活质量,值得临床推广与应用。     

全程信息化管理联合 PDCA 循环对骨科患者压疮形成的预防效果

目的：探讨全程信息化管理联合PDCA循环对骨科患者压疮形成的预防效果。方法选取我院收治的骨折患者168例,随机分为观察组和对照组,每组84例。观察组患者实施以全程信息化管理并进行PDCA循环管理,对照组患者按护理常规护理。术前和干预后1w评估患者压疮疾病相关知识,干预后1w评估健康信念水平及压疮预防措施执行情况。结果干预后观察组患者压疮疾病相关知识评分显著高于对照组（ P＜0．05）。除障碍外,观察组严重性、易感性、益处、健康动力和自我效能均显著高于对照组（P＜0．05）。观察组预防措施执行情况得分显著高于对照组（P＜0．01）,压疮发生率显著低于对照组（P＜0．05）。结论全程信息化管理结合PDCA循环可有效提高骨折患者压疮疾病相关知识、健康信念水平及预防措施执行情况。     

基于马斯洛需要层次理论的干预对肠造口患者的影响

目的探讨基于马斯洛需要层次理论的干预应用于直肠癌造口患者的影响。方法选择2017年1月至2019年11月宜兴市人民医院收治的直肠癌术后肠造口患者112例，按随机数字表法分为观察组和对照组，各56例。对照组行常规护理干预，观察组行基于马斯洛需要层次理论的干预。对比两组患者干预前后健康信念、自我管理行为的情况。结果观察组患者干预3个月后健康信念总分（感知到的易感性、感知到的严重性、感知到的障碍、感知到的益处、健康行为）均高于对照组，差异有统计学意义（P＜005）；观察组患者干预3个月后自我管理行为总分（饮食管理、用药管理、社交管理、造口周围皮肤管理、自我情绪调整、寻求他人帮助）均高于对照组，差异有统计学意义（P＜0.05）。结论基于马斯洛需要层次理论的干预应用于直肠癌术后肠造口患者可提升其健康信念，改善自我管理行为，值得推广。     

妇女乳腺癌及其早期筛查知识、态度、行为的相关性研究

[目的]了解上海市妇女乳腺癌及其早期筛查知识、态度和行为现状以及三者的关系。[方法]采用乳腺癌及其早期筛查知识问卷、乳腺自我检查态度问卷和早期筛查行为调查问卷对上海市739名妇女进行调查。[结果]妇女对于乳腺癌的临床表现和早期筛查方法的知晓率较高,但对于乳腺癌的高危因素不了解;对自我检查的态度评分为3.13分±0.50分,态度较积极;有70.1%的人曾做过乳腺自我检查,但每月做1次的只有3.9%,分别有51.2%和6.5%的人曾做过乳腺临床检查和乳腺X线摄片,但只有11.0%和5.5%的人是1年做1次。乳腺癌及其早期筛查的知识与乳腺自我检查的态度及早期筛查的3种行为之间呈正相关（r分别为0.262、0.072、0.090、0.120）,对于乳腺自我检查的态度也与早期筛查的3种行为呈正相关（r分别为0.272、0.169、0.188）。[结论]护理人员要重视提高妇女对于乳腺癌的认知,帮助她们树立积极的态度,从而改善早期筛查率低的现状。     

规范化自我管理教育对艾滋病患者治疗依从性的作用

目的：探讨规范化自我管理教育对艾滋病患者治疗依从性的影响。方法选取我院收治的艾滋病患者148例,随机分为观察组和对照组,每组74例。对照组患者采取常规的健康教育,观察组在常规的健康教育基础上采取规范化的自我管理教育。比较两组患者干预后的药物知识评分、患者视觉模拟评分法（ VAS）的自评依从性评分以及护士对其的治疗依从性。结果干预后两组患者的药物知识评分均较干预前明显增加（均P＜0．05）,观察组患者的评分明显高于对照组（ P＜0．05）;干预后两组患者VAS评分均较干预前明显提高（均P＜0．05）,观察组患者的VAS评分均明显高于对照组（P＜0．05）;干预后两组护士评价患者的服药依从性均较干预前明显提高（均P＜0．05）,观察组护士评价患者的服药依从性明显高于对照组（P＜0．05）。结论与常规的健康教育比较,规范化的自我管理教育能更有效地提高患者对药物的了解和治疗依从性。     

乳腺癌患者与垂体激素FSH及ACTH相关性分析

目的探讨乳腺增生，乳腺癌患者患者血清中垂体激素FSH（促卵泡激素）及ACTH（促肾上腺皮质激素）含量变化及其与疾病程度的关系。方法采用采用放射免疫（RIA）法检测119例乳腺癌患者（其中73例滤泡期，46例绝经期）、139例乳腺增生患者（其中83例滤泡期，56例绝经期）和66例同期健康人群（对照组）血清FSH和ACTH。结果乳腺增生、乳腺癌患者患者血清中FSH和ACTH的含量明显高于对照组，两组比较差异均有统计学意义（P〈0．01）；在滤泡期乳腺癌组FSH高于乳腺增生组，对比组间差异有统计学意义（P〈0．01），ACTH对比组问无统计学意义（P〉0．05）；在绝经期乳腺癌组ACTH明显高于乳腺增生组，对比组间差异有统计学意义（P〈0．01），TSH对比组间无统计学意义（P〉0．05）。结论乳腺癌组、乳腺增生组和对照组的FSH、ACTH相比较含量均明显增高，且乳腺癌组和乳腺增生组的FSH、ACTH相比较含量显著增高，激素含量变化与病理改变过程呈正相关性。     

小组式健康教育对乳腺癌术后患者康复的影响

目的 探讨小组式健康教育对乳腺癌术后患者康复的影响。方法 2020 年 1 月至 2021 年 6 月我院 86 例乳腺 癌根治手术患者随机分为对照组和干预组。对照组（43 例）选用常规的健康教育;干预组（43 例）选用小组式 健康教育。比较两组的一般自我效能,健康状况,心理状态和护理满意度状况。结果 对照组护理后自我效能和 健康状况评分均低于干预组（P＜0.05）。对照组护理后的 SAS 评分和 SDS 评分均高于干预组（P＜0.05）。对 照组术后满意率（83.72%）低于干预组（97.67%）（P＜0.05）。结论 小组式健康教育可以提高乳腺癌术后患者 的自我效能和生活质量,改善负面情绪,提高满意度。     

血清胱抑素C联合尿微量清蛋白检测在诊断高血压早期肾功能损害中的价值

目的：分析血清胱抑素C（Cys C）联合尿微量清蛋白（mALB）检测在高血压早期肾功能损害中的诊断价值。方法选择2012年1月至2013年12月南京市中西医结合医院320例患者为研究对象,其中高血压组130例,肾功能损害组90例,健康对照组100例。检测每组mALB、肌酐（Scr）、尿素氮（BUN）、Cys C水平,并比较每组Scr、BUN及mALB联合Cys C检测对早期肾功能损害的检出率。结果高血压组mALB、Cys C水平,肾功能损害组mALB、Scr、BUN、Cys C水平均明显高于健康对照组,差异均有统计学意义（P＜0．05）。高血压组Scr、BUN对早期肾功能损害检出率为13．8％、14．6％,均明显低于 mALB联合Cys C （32．3％）,差异均有统计学意（P＜0．05）;肾功能损害组 Scr、BUN 对早期肾功能损害检出率均为53．3％,mALB 联合 Cys C 检出率则为100．0％,差异均有统计学意（P＜0．05）。结论 Cys C联合mALB检测可显著提高高血压早期肾功能损害的检出率,值得临床推广应用。     

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.     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.