口腔癌术后病人心理弹性与自我效能、应对方式的相关性研究

[目的]探讨口腔癌术后病人心理弹性水平,并探讨其与自我效能、应对方式的相关性。[方法]选取医院115例口腔癌术后病人为研究对象,采用一般资料调查表、心理弹性量表(CD-RISC)、一般自我效能感量表(GSES)、简易应对方式量表(SCSQ)进行问卷调查。[结果]口腔癌术后病人心理弹性总分为(59.15±14.42)分;Pearson相关分析显示,一般自我效能感量表、积极应对量表得分与心理弹性量表得分呈正相关(P0.05),消极应对量表得分与心理弹性量表得分呈负相关(P0.05);多元逐步回归分析显示,一般自我效能、消极应对是口腔癌术后病人心理弹性的主要影响因素,可解释总变异的43.0%。[结论]口腔癌术后病人的心理弹性有待提高,在临床护理实践中我们应重视提高病人的自我效能,引导病人采取积极的应对方式,进而促进病人心理弹性水平的提高。     

老年痴呆病人家庭照顾者自我效能感与心理弹性的关系:积极应对的中介作用

[目的]探索积极应对在老年痴呆病人家庭照顾者自我效能感与心理弹性之间的关系。[方法]采用Connor-Davidson韧性量表简易版(CD-RISC10)、一般自我效能感量表(GSES)、简易应对方式问卷(SCSQ)对老年痴呆病人照顾者180人进行问卷调查。[结果]老年痴呆病人家庭照顾者的心理弹性总分为(24.83±7.58)分,自我效能感得分为(2.44±0.63)分,积极应对方式得分为(1.92±0.51)分,消极应对方式得分为(1.27±0.48)分;心理弹性得分与自我效能感及积极应对呈正相关(P0.01);自我效能感对照顾者的心理弹性水平具有正向的预测作用,自我效能感通过积极应对的中介效应影响照顾者的心理弹性水平,中介效应量达33.60%。[结论]老年痴呆病人家庭照顾者的心理弹性处于中等水平,其自我效能感有待提高,照顾者的自我效能感与心理弹性密切相关,积极应对在照顾者自我效能感和心理弹性间起部分中介作用。     

住院保胎孕妇心理弹性水平及影响因素分析

[目的]探讨住院保胎孕妇心理弹性水平及影响因素,为发掘其正性心理提供依据。[方法]采用心理弹性量表(CD-RISC)、自我效能量表(GSES)、医学应对方式量表(MCMQ)对212例保胎孕妇进行问卷调查并分析其影响因素。[结果]住院保胎孕妇心理弹性水平较低,相关分析结果显示住院保胎孕妇心理弹性与自我效能、面对应对和回避应对呈正相关,与屈服应对呈负相关。多元回归分析结果显示,住院保胎孕妇的自我效能感、屈服维度和文化程度和受孕方式是心理弹性的主要影响因素。[结论]住院保胎孕妇的心理弹性水平有待提高,临床护理工作者应重视与提高其心理水平与一般自我效能,指导其采取积极合理的应对方式,从而改善其心理状况。     

慢性乙型病毒性肝炎病人自我效能感和应对方式的相关性研究

[目的]探讨慢性乙型病毒性肝炎病人自我效能感和应对方式的关系。[方法]采用一般自我效能感量表及医学应对方式问卷(MCMQ)对80例慢性乙型病毒性肝炎病人进行调查,并对两者的关系行相关分析。[结果]影响慢性乙型病毒性肝炎病人自我效能感的因素包括性别、文化程度、社会资源利用度;慢性乙型病毒性肝炎病人一般自我效能感得分低于国外常模;病人回避、屈服应对方式与国内常模存在差异(P0.05),面对应对方式则无差异(P0.05);一般自我效能感与面对和回避应对方式呈正相关(P0.01),与屈服应对方式呈负相关(P0.01)。[结论]慢性乙型病毒性肝炎病人一般自我效能感水平较低,且与面对和回避应对方式呈正相关,与屈服应对方式呈负相关,应积极寻求指导方案有效提高病人的一般自我效能感,从而提高病人的应对水平。     

颅内动脉瘤患者心理弹性与一般自我效能感和应对方式的相关性研究

目的 探讨颅内动脉瘤患者心理弹性现状,并分析其心理弹性与一般自我效能感、应对方式的相关性。 方法 选取我院神经外科收治的130例颅内动脉瘤患者,采用一般情况调查表、心理弹性量表(connor-davidson resilience scale, CD-RISC)、一般自我效能感量表(general self-efficacy scale, GSES)、简易应对方式量表(simple coping style scale, SCSQ)进行调查。结果 颅内动脉瘤患者心理弹性得分为(53.02±13.74)分;颅内动脉瘤患者心理弹性水平各维度得分、总分与一般自我效能感、积极应对均呈正相关(P＜0.05),与消极应对呈负相关(P＜0.05)。 结论 颅内动脉瘤患者心理弹性水平较低,临床护理工作者应重视提高患者的一般自我效能感,引导患者采取积极的应对方式,从而改善其心理弹性状况。     

应对方式及社会支持对骨折病人自我效能的影响

[目的]了解应对方式及社会支持对骨折病人自我效能的影响,为进行自我效能干预提供依据。[方法]采用应对方式问卷、一般自我效能感量表、社会支持评定量表,应用便利抽样法对405例骨折病人进行调查。[结果]骨折病人一般自我效能水平得分为(2.40±0.51)分,一般自我效能水平与社会支持总分、应对方式中解决问题及求助呈正相关,与应对方式中的自责呈负相关;骨折病人的自我效能水平受应对方式、社会支持的影响。[结论]骨折病人的自我效能水平较低,应对方式和领悟社会支持水平影响骨折病人的自我效能水平,应鼓励病人运用积极的应对方式,调动支持力量,激发病人自我照顾动机和良好的遵医行为,促进后期康复。     

妊娠合并甲状腺功能减退症病人心理弹性、自我效能与应对方式的关系研究

[目的]探讨妊娠合并甲状腺功能减退症(甲减)病人心理弹性、自我效能与应对方式的关系。[方法]2017年1月—2017年12月应用心理弹性量表、自我效能量表及应对方式量表对80例妊娠合并甲减病人及80例正常孕妇进行调查,应用Pearson单因素分析妊娠合并甲减病人心理弹性、自我效能与应对方式的关系。[结果]妊娠合并甲减病人心理弹性评分、自我效能评分及积极应对评分均低于正常孕妇(P0.05)。Pearson单因素分析显示:妊娠合并甲减病人积极应对评分与心理弹性及自我效能评分呈正相关(P0.05),而消极应对方式评分与心理弹性及自我效能评分呈负相关(P0.05)。[结论]妊娠合并甲减病人心理状况较差,容易以消极的态度面对疾病,积极提高病人心理弹性及自我效能有助于增强病人治疗信心,有利于改善病人预后。     

反刍思维与心理弹性在ICU住院病人ICU相关记忆与创伤后应激障碍之间的中介作用

[目的]探讨反刍思维与心理弹性在重症病人重症监护室(ICU)相关记忆与创伤后应激障碍之间的中介作用。[方法]便利抽样法抽取182例重症病人作为对象,采用一般情况量表、ICU相关记忆量表、创伤后应激障碍量表、反刍思维量表和心理弹性量表对病人进行调查。[结果]ICU住院病人ICU相关记忆总分为(64.12±11.43)分、反刍思维总分为(65.84±9.14)分、心理弹性总分为(62.54±9.37)分、创伤后应激障碍总分为(41.28±9.52)分;ICU住院病人ICU相关记忆、反刍思维与创伤后应激障碍呈正相关(P0.01),心理弹性与创伤后应激障碍呈负相关(P0.01),ICU相关记忆、反刍思维与心理弹性呈负相关(P0.01);心理弹性和反刍思维在ICU相关记忆与创伤后应激障碍之间均单纯存在部分中介效应,中介效应占总效应的23.19%和27.54%;心理弹性—自我效能感在ICU相关记忆与创伤后应激障碍之间存在链式中介作用,效应值为0.06,占总效应的8.70%。[结论]通过提高ICU住院病人心理弹性水平,可抑制其反刍思维和ICU相关记忆,减轻其创伤后应激障碍。     

慢性乙型病毒性肝炎病人自我效能感和应对方式的相关性研究

[目的]探讨慢性乙型病毒性肝炎病人自我效能感和应对方式的关系。[方法]采用一般自我效能感量表及医学应对方式问卷（MCMQ）对80例慢性乙型病毒性肝炎病人进行调查,并对两者的关系行相关分析。[结果]影响慢性乙型病毒性肝炎病人自我效能感的因素包括性别、文化程度、社会资源利用度;慢性乙型病毒性肝炎病人一般自我效能感得分低于国外常模;病人回避、屈服应对方式与国内常模存在差异（P〈0.05）,面对应对方式则无差异（P＆gt;0.05）;一般自我效能感与面对和回避应对方式呈正相关（P〈0.01）,与屈服应对方式呈负相关（P〈0.01）。[结论]慢性乙型病毒性肝炎病人一般自我效能感水平较低,且与面对和回避应对方式呈正相关,与屈服应对方式呈负相关,应积极寻求指导方案有效提高病人的一般自我效能感,从而提高病人的应对水平。     

急性心肌梗死病人PCI术后应对方式现状及影响因素分析

[目的]了解急性心肌梗死病人经皮冠状动脉介入治疗(PCI)术后应对方式现状,探讨其影响因素。[方法]采用便利抽样的方法对我市3所三级甲等医院229例住院行PCI术的急性心肌梗死病人应用应对方式问卷、一般自我效能感量表、心理弹性量表进行调查。[结果]急性心肌梗死病人PCI术后面对应对方式得分为(21.48±3.99)分,回避应对方式得分(15.75±3.42)分,屈服应对方式得分(10.45±3.44)分。应对方式在不同年龄、居住情况、月收入、文化程度、居住地及医疗费用支付方式的行PCI术的急性心肌梗死病人间差异均有统计学意义(P0.05)。坚韧性为面对应对方式的积极预测因素,力量、乐观、自我效能影响回避、屈服应对方式。[结论]病人心理弹性和自我效能是其应对方式的主要影响因素。在未来临床工作中,应针对不同影响因素采取相应的有效措施,提高病人医学应对水平,缓解心理压力,促进康复。     

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.