临床护理实习生艾滋病知晓率调查

目的了解临床护理实习生对艾滋病（AIDS）知识的掌握情况及对AIDS患者的态度。方法自行设计调查问卷,对200名临床实习生进行问卷调查。结果护理实验对AIDS基本知识认知普遍较高,但对非传播途径认识不足,大专以上者正确回答率仅66．7％,中专60．1％;93．0％的护生担心接触AIDS患者受感染,39．0％的护生不愿意护理AIDS患者。结论应加强对临床护理实习生AIDS防治专业知识的培训,端正对AIDS患者的态度。     

护理本科生对艾滋病相关知识及态度的调查分析

目的了解护理本科生(护生)对艾滋病(AIDS)相关知识了解情况及对人类免疫缺陷病毒(HIV)感染者/AIDS患者的态度,为学校开展相关健康教育提供参考依据。方法 2011年2月采用问卷调查法,对285名护生进行调查,收回问卷276份,有效问卷257份。结果护生对HIV/AIDS相关知识平均得分为(21.2±3.8)分,对正确使用安全套知识平均得分为(3.7±1.6)分,各年级掌握情况有差异(P<0.001)。257名护生中,82.5%对因输血或注射感染HIV者持同情态度,33.9%和32.3%的护生对因婚前或婚外性行为、性服务者而感染HIV者持歧视态度。结论学校应对护生进行系统正确的HIV/AIDS相关知识的教育,培养护生正确对待HIV感染者/AIDS患者的态度。     

临床护生艾滋病知识、态度与护理意愿的研究

目的了解护理实习学生艾滋病知识、态度、护理意愿度其相关性。方法采用问卷方法对68名护理实习生进行现况调查。结果护生的艾滋病知识均分为13．7分，对职业感染、不可能传播HIV的途径等知识回答正确率低。态度均分为0．89分，86．8％护生的态度分为正分，表示同情和支持艾滋病病人。但对因静脉吸毒、性乱、同性恋染上艾滋病者持歧视态度。护理意愿均分为77．7分，有25％的护生表示不愿意为艾滋病病人提供护理。相关分析表明艾滋病知识、态度、护理意愿之间呈显著性相关关系。结论护生艾滋病知识掌握不够全面。对艾滋病病人护理意愿低。本文为此提出相应对策．     

544名实习护生艾滋病知识及态度的调查

目的了解实习护生对艾滋病相关知识、态度及相关影响因素,为有针对性地在实习护生中开展健康教育,进行艾滋病流行的干预提供依据。方法用整群抽样法,以班级为单位抽取共计558例实习护生,采取不记名自填问卷的方式进行艾滋病认知、态度问卷调查。结果实习护生对艾滋病知识处于中等水平,得分（9.49±3.16）分;对传播途径认识错误方面,62.5%认为感染HIV的孕妇分娩的婴儿也是HIV感染者、55.3%认为共用浴盆、游泳池传染HIV;在对高危行为认识错误中,44.3%认为肛交不传播,40%认为多个性伴侣不易传播;实习护生对待艾滋病的态度不容乐观,呈中等水平,得分（172.11±14.37）分。结论实习护生对艾滋病知识掌握不够,态度有待提高。对实习护生开展健康教育不仅要注重知识水平的提高,态度及高危行为的教育也很重要。     

如何减少和消除护生对HIV／AIDS患者的恐惧心理

分析了护生对HIV／AIDS患者产生恐惧心理的原因，认为对护生在医院实习期间从思想和行为上实施干预，能便护生对HIV／AIDS患者的恐惧心理明显消除，使他们科学地运用护理知识为患者进行恰当的护理。     

临床护生艾滋病知识、态度与护理意愿的研究

目的了解护理实习学生艾滋病知识、态度、护理意愿及其相关性.方法采用问卷方法对68名护理实习生进行现况调查.结果护生的艾滋病知识均分为13.7分,对职业感染、不可能传播HIV的途径等知识回答正确率低.态度均分为0.89分,86.8%护生的态度分为正分,表示同情和支持艾滋病病人,但对因静脉吸毒、性乱、同性恋染上艾滋病者持歧视态度.护理意愿均分为77.7分,有25%的护生表示不愿意为艾滋病病人提供护理.相关分析表明艾滋病知识、态度、护理意愿之间呈显著性相关关系.结论护生艾滋病知识掌握不够全面,对艾滋病病人护理意愿低.本文为此提出相应对策.     

卫生保健护理学

072118护生AIDS知识调查及健康教育效果评价/黄荔萍…//解放军护理杂志.-2007,24(5).-36~38采取整群随机抽样的方法,对护理系大二、大一共400名学生在AIDS系列健康教育活动前后进行问卷调查。结果:被调查护生AIDS知识总知晓率从教育前的75.3%提高到教育后的84.9%(P<0.01);对AIDS高危行为持赞成态度的教育前后差异无显著统计学意义(P>0.05);在对待AIDS/HIV采取“跟普通人一样对待”态度者从教育前的58.5%提高到教育后的66.8%(P<0.05);12.1%的护生曾发生过性行为。提示:在护生中开展全面、系统、深入的AIDS健康教育很有必要;采用…     

对HIV/AIDS恐惧、耻辱和隔离的分析与护理对策

HIV/AIDS能使人恐惧、误解、误传和歧视,极少数护士和施护者会因护理HIV/AIDS患者而被传染上,有些护士和施护者他们本身也是HIV感染者. 护士和施护者所面临的问题分析 (1)情感问题.害怕与HIV患者接触后会生病而死去.HIV/AIDS感染率高的地方,就有相当多的护士和施护者本身被HIV感染.     

对HIV/AIDS恐惧、耻辱和隔离的分析与护理对策

HIV/AIDS能使人恐惧、误解、误传和歧视,极少数护士和施护者会因护理HIV/AIDS患者而被传染上,有些护士和施护者他们本身也是HIV感染者. 护士和施护者所面临的问题分析 (1)情感问题.害怕与HIV患者接触后会生病而死去.HIV/AIDS感染率高的地方,就有相当多的护士和施护者本身被HIV感染.     

对HIV/AIDS恐惧、耻辱和隔离的分析与护理对策

HIV/AIDS能使人恐惧、误解、误传和歧视,极少数护士和施护者会因护理HIV/AIDS患者而被传染上,有些护士和施护者他们本身也是HIV感染者. 护士和施护者所面临的问题分析 (1)情感问题.害怕与HIV患者接触后会生病而死去.HIV/AIDS感染率高的地方,就有相当多的护士和施护者本身被HIV感染.     

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.     

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.     

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.     

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.