医护群体社会支持系统与职业倦怠的相关性研究

目的研究医护群体社会支持系统与职业倦怠的相关性。方法随机抽取市属医院240名临床医护人员进行职业倦怠量表（MBI）和社会支持评定问卷（SSRS）调查,分析医护群体社会支持系统与职业倦怠之间的关系。结果医护群体职业倦怠中情感耗竭、个人成就感评分分别高于和低于Maslach常模,差异有统计学意义（P均〈0．01）;护士职业倦怠水平明显高于医生,其中情感耗竭、个人成就感2个维度医护差异有统计学意义（P均〈0．01）;社会支持中主观支持、支持总分2个维度医护差异有统计学意义（P均〈0．01）;社会支持的3个维度及总分与医护职业倦怠情感耗竭呈显著负相关,与个人成就感呈显著正相关。结论医护群体职业倦怠特别是护士职业倦怠水平较高,应引起管理者高度重视。建议对医护群体实施合理干预,完善社会支持系统构建,并进行寻求良好社会支持的专业培训。     

突发SARS疫情期间影响护士心理健康的相关因素研究

目的探讨突发SARS(严重急性呼吸综合征)疫情期间影响护士心理健康的相关因素。方法采用社会支持量表、应对方式问卷和SCL-90量表对2所综合医院283名护士进行调查。结果与中国女性常模比较,护士SCL-90总分、强迫、人际关系、抑郁、偏执因子分显著降低(P<0.01);焦虑、敌对因子分降低(P<0.05)。不同职业环境(科室)护士间SCL-90总分、躯体化、强迫、人际关系敏感、抑郁和焦虑因子分存在差异(P<0.05)。护士应对方式的选择与SCL-90各因子间呈选择相关。护士社会支持总分及主观支持分与SCL-90总分及各因子呈显著负相关(P<0.01)。结论突发SARS疫情期间,积极发挥社会支持系统的作用、鼓励护士采取积极的应对方式,有利于护士的心理健康。     

突发SARS疫情期间影响护士心理健康的相关因素研究

目的探讨突发SARS(严重急性呼吸综合征)疫情期间影响护士心理健康的相关因素.方法采用社会支持量表、应对方式问卷和SCL-90量表对2所综合医院283名护士进行调查.结果与中国女性常模比较,护士SCL-90总分、强迫、人际关系、抑郁、偏执因子分显著降低(P＜0.01);焦虑、敌对因子分降低(P＜0.05).不同职业环境(科室)护士间SCL-90总分、躯体化、强迫、人际关系敏感、抑郁和焦虑因子分存在差异(P＜0.05).护士应对方式的选择与SCL-90各因子间呈选择相关.护士社会支持总分及主观支持分与SCL-90总分及各因子呈显著负相关(P＜0.01).结论突发SARS疫情期间,积极发挥社会支持系统的作用、鼓励护士采取积极的应对方式,有利于护士的心理健康.     

护理人员心理健康状况调查分析

目的:探讨我院护理人员的心理健康状况.方法:采用自设问卷和症状自评量表(SCL-90)对240名护士进行心理健康水平的测评,并与全国女性常模比较.结果:护士的年龄、护龄及职称与焦虑、偏执呈负相关(P＜0.05);护士的职称、学历与敌对呈负相关(P＜0.05);除人际关系敏感外,护士在SCL-90的其他因子上均高于全国女性常模(P＜0.01);不同科室护士在强迫症状、人际关系敏感、抑郁、恐怖、精神病性因子分及总分上均存在差异(P＜0.05,P＜0.01).结论:护士的年龄、护龄、职称、学历等人口统计学变量对其心理健康有一定的影响;不同科室护士的心理健康水平存在显著性差异;护士群体的心理健康水平显著低于全国女性常模.     

护士职业获益感对职业倦怠的影响研究

[目的]探索护士职业获益感对其职业倦怠的影响,以期为护理教育者、管理者引导护士感受职业获益、减轻职业倦怠、维护身心健康提供参考依据。[方法]运用Maslach倦怠量表和自行研制的护士职业获益感问卷对274名护士的职业获益感及其职业倦怠状况进行调查,并进行相关性分析。[结果]护士职业获益感总分为(138.45±17.25)分;职业倦怠中情感耗竭和去人格化维度得分高于常模,个人成就感维度得分高于常模;职业获益感与其职业倦怠量表中情感耗竭、去人格化维度得分呈负相关,与个人成就感得分呈正相关;职业获益感可解释情感耗竭、去人格化及个人成就感的31.6%、13.1%、9.2%的变异。[结论]引导护士感受职业获益感有助于减轻其职业倦怠程度,维护身心健康。     

基层卫生院护士职业倦怠与社会支持的相关性研究

目的探讨基层卫生院护士职业倦怠现状及其与社会支持的相关性。方法采用问卷调查法,对广州市花都区4家基层卫生院共214名护士进行工作倦怠量表(MBI)和社会支持评定量表(SSRS)调查,并对其结果进行分析。结果基层卫生院护士职业倦怠状况属于中等水平,但个人成就感维度倦怠程度高于国内常模水平,差异具有统计学意义(P0.01);基层卫生院护士职业倦怠与其社会支持程度存在显著负相关(P0.01)。结论基层卫生院护士职业倦怠程度高,尤其缺乏个人成就感;加强社会支持,以改善护士职业倦怠。     

120急救中心护士工作倦怠与社会支持及应对方式的相关性研究

目的 了解120急救中心护士工作倦怠与社会支持及应对方式的关系,为护理管理干预提供依据.方法 抽取衡阳市中心医院120急救中心64名护士作为调查对象,采用工作倦怠量表、社会支持评定量表、应对方式问卷进行调查.结果 本组护士情感衰竭得分较常模高,个人成就感较常模低,差异均有统计学意义;社会支持中的客观支持与工作倦怠各因子呈负相关,支持利用度与工作倦怠中的情感衰竭和个人成就感呈负相关,消极应对方式与工作倦怠各因子呈正相关.结论 急救中心护士工作倦怠程度较高,个人成就感较低,社会支持和应对方式对工作倦怠具有影响作用,应加强护理管理干预.     

中西医结合医院护士职业倦怠与同事支持的相关性研究

目的了解中西医结合医院护士的职业倦怠情况,探讨中西医结合医院护士对同事支持的认可程度。方法采用护士职业倦怠量表和同事支持量表对杭州市某三级甲等中西医结合医院的283名护士进行调查。结果中西医结合医院护士情感耗竭和去人格化得分明显高于杭州市常模(P0.01);同事支持A量表得分为(18.92±7.87)分,B量表总分为(43.05±19.87)分。中西医结合医院护士人口统计学资料中的年龄、性别、工作年限、所在科室与职业倦怠3个因子均有显著相关性(P0.01);同事支持量表中的护士长支持、行动计划、过程管理、合作与职业倦怠3个因子均有显著相关性(P0.01)。结论同事支持水平越好,职业倦怠程度越低,说明建立一个强有力的同事支持系统对中西医结合医院护士非常重要。     

护士工作倦怠的干预策略研究

目的 探讨护士工作倦怠与其自尊、成就动机和社会支持的关系,进而提出护士工作倦怠的干预策略.方法 用工作倦怠问卷、自尊量表、成就动机量表和社会支持评定量表对205名护士进行问卷调查,并对结果进行分析.结果 情感耗竭、人格解体和低成就感与自尊、成就动机存在显著负相关,人格解体和低成就感与社会支持存在显著负相关.自尊对情感耗竭具有负向预测作用,成就动机对情感耗竭、人格解体和低成就感具有负向预测作用,社会支持对低成就感具有负向预测作用.结论 护士的工作倦怠需要社会、医院和个人的努力才能克服.     

护士工作倦怠的干预策略研究

目的探讨护士工作倦怠与其自尊、成就动机和社会支持的关系,进而提出护士工作倦怠的干预策略。方法用工作倦怠问卷、自尊量表、成就动机量表和社会支持评定量表对205名护士进行问卷调查,并对结果进行分析。结果情感耗竭、人格解体和低成就感与自尊、成就动机存在显著负相关,人格解体和低成就感与社会支持存在显著负相关。自尊对情感耗竭具有负向预测作用。成就动机对情感耗竭、人格解体和低成就感具有负向预测作用,社会支持对低成就感具有负向预测作用。结论护士的工作倦怠需要社会、医院和个人的努力才能克服。     

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.     

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.