常用止血药对咯血的疗效评价

为评价止血药对咯血的疗效,将192例咯血患者分为4组：止血药组（73例）,垂体后叶素组（77例）,645-2组（24例）,未用止血药组（18例）,按其用药不同进行治疗后的回顾性分析。结果4组总有效率分别为90.14%、92.21%、91.67%、88.89%,经统计学处理4组间无显著性差异（P＞0.05)。提示咯血病例的治疗关键是针对病因治疗,单纯止血无明显效果。     

Adaptación española de la Escala de Impacto de la Publicidad de Apuestas en adolescentes

Media pressure from gambling advertising has reached worrying levels. It constitutes a risk to the mental health of young people and adolescents by promoting a favourable attitude towards gambling, a higher frequency of gambling and a perception of greater accessibility. Currently, there is no instrument available to assess the impact of gambling advertising.ObjectiveThe present study aims to adapt and validate the Impact of Gambling Advertising Scale (IGAS).DesignThe IGAS scale was translated from English ensuring its linguistic, conceptual and metric equivalence. The psychometric properties were then tested.SiteComunidad Valenciana (España).Participants1724 adolescents with a mean age of 16.52 years (SD = .759).InterventionSelf-administered, paper-based questionnaire in a single measure.Main measurementsAdvertising impact, and gambling intention, severity and availability.ResultsInternal consistency and two-half reliability were good, Cronbach's α = .782 and α = .70, respectively. Confirmatory factor analysis concluded that the Spanish version replicates the original three-dimensional version. Convergent validity analyses showed direct and significant relationships with different aspects of gambling behaviour, and other predictors.ConclusionThe adapted version of the IGAS is a reliable and valid measure for the assessment of the impact of advertising on adolescents. The scale is a useful instrument for the diagnosis of risk level and the evaluation of preventive interventions.     

Taking a patient-oriented approach in exercise interventions for pregnant women: a commentary

Taking a patient-oriented approach to developing lifestyle interventions includes incorporating the patient into the program’s design, delivery, and evaluation. This commentary assumes that a patient-oriented approach has not yet been implemented and tested in exercise-based interventions designed for pregnant women. We outline and define a patient-oriented approach to conduct exercise-based research and review previous physical activity interventions designed for pregnant women to determine whether a patient-oriented approach was applied. In addition, pregnant women living with obesity may have unique barriers to engaging in prenatal exercise interventions that have not been previously addressed, such as having experienced weight stigma before pregnancy in healthcare and fitness settings. We propose suggestions for future trials to effectively take a patient-oriented approach when designing and implementing prenatal exercise interventions to address patient-informed barriers and incorporate suggested facilitators for physical activity. Given that prenatal activity levels are low and pregnant women may have unique barriers to engaging in exercise interventions, a patient-oriented approach may be an effective strategy to improve inclusivity and equity and, as a result, increase uptake and adherence to the intervention.     

陪检方式在胸痛患者诊疗过程中效果评价

目的 探究陪检在胸痛患者诊疗过程中的应用效果。方法 选择2019年江苏某三甲医院急诊科收治的110例胸痛患者为研究对象,依据是患者就诊时是否有专人陪检分为实验组与对照组,进行病例对照研究。实验组由医务人员陪检,完成各项辅助检查,对照组患者依据临床医师的指示自行完成各项检查,患者病情严重程度采用TIMI评分进行评价。统计分析两组患者的医疗安全不良事件发生率、患者对医疗服务满意度差异,评价陪检方式的应用效果。结果 110例研究对象,其中男性53例,女性57例,年龄范围49~80岁,平均年龄（62±6.10）岁。实验组（陪检组）56例,对照组（无陪检组）54例。两组人群平均年龄t=-0.323,P=0.747,性别统计学检验x2=1.295,P=0.255。患者病情严重程度评价TIMI评分两组统计学检验t=1.513,P=0.134。实验组不良事件发生数量5例次（8.92%）明显低于对照组16例次（29.6%）,统计学检验x2=7.62,P=0.006（P<0.05）;患者满意实验组94.64%,对照组81.48%,两组统计学检验x2=4.57,P=0.033(P<0.05)。结论 陪检在胸痛患者诊疗过程中具有较好的应用效果,值得推广运用。     

核辐射损伤患者院内护理救治能力量表的编制及信效度检验

目的 编制核辐射损伤患者院内护理救治能力量表,为提高护士的核辐射损伤患者护理能力提供评价依据。方法 采用文献查阅、组织访谈和专家咨询编制量表方法,随机选取某三甲医院330名临床护士作为研究对象,发放量表,进行条目分析及信效度检验。结果 本量表共分为核辐射损伤基础知识、专科装备使用能力、专科病区管理能力、基础护理能力、专科护理能力、自我能力认可6个维度,51个条目。探索性因子分析后,共分为6个主成分,累计解释方差为70.757%。验证性因子分析的χ²、df、χ²/df、CFI、IFI、TLI、NFI、PNFI、PCFI、RMSEA拟合指标均可接受。Cronbach’s α系数为0.976,重测信度为0.823。全体一致S-CVI（S-CVI/UA）为0.84,评价内容效度S-CVI（S-CVI/Ave）为0.98,条目水平内容效度I-CVI为0.78～1.00;结论 本量表的条目及维度设置经检验,各项指标符合要求,信效度检验结果良好,可作为核辐射损伤患者院内护理能力初步评价量表。     

专科医院住院部各科医疗质量综合评价的初步探讨

目的：探讨专科医院住院各科工作情况综合评价方法,向临床科室提供医疗质量信息,促进医疗质量的提高。方法：以医院工作报表为数据来源,用秩和比法从诊疗质量,工作强度和经济效益三方面量化科室医疗质量考核指标。结果：综合数能更全面、有效、合理地评价住部各科医疗质量优劣等级,提出科室改进的指标。结论：此评价方法简便,实用,有利于深化院内改革,强化行政部门管理。     

酵母重组乙型肝炎疫苗在中小学生中接种效果评价

目的 评价中小学生大规模乙型肝炎疫苗接种效果。方法 随机选取来实行乙型肝炎疫苗计划免疫管理的6－18岁中小学生1829名,采用血清流行病学方法观测大规模酵母重组乙型肝炎疫苗接种效果。结果 对HBsAg、抗－HBs和抗－HBc全阴性者,接种疫苗1年后,抗－HBs阳性率为70．55％,HBsAg和抗-HBc阳性率分别为0．56％和1．96％;该人群接种前HBVM阳性率为63．31％,接种后为85．51％,抗－HBs阳性率显著增高,且以6－12岁低年龄组人群更明显,而HBsAg和抗－HBc阳性率在接种后1年无明显变化。结论 酵母重组乙型肝炎疫苗大规模接种后,在中小学生中形成了乙型肝炎高保护性、低感染状态。     

Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation

ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams.MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects.ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied.ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing.     

Characteristics of pain drawings in the neck-shoulder region among the working population

Objectives: The aim was to study the characteristics of pain drawings in the neck, shoulders, and upper-back regions among the general working population. Methods: Pain drawings of the rear view of the neck, shoulders, and upper back were made by 125 middle-aged subjects from the general working population suffering from symptoms, mainly ache and pain, in the neck or shoulder regions. The locations of the markings in each pain drawing were coded to computer files using a transparent grid (878 pixels). The total area, the number of separate loci, and the left-right symmetry were recorded. Symptoms and signs were assessed at a medical examination. Results: The most frequently marked locations in the resulting aggregated topographical diagram covered two palm-sized areas in the neck-shoulder angles, with a symmetrical and even distribution occurring between the left and right sides. Subjects with more chronic or severe symptoms made pain drawings with larger areas. The presence of tenderness in the neck-trapezius region was associated with larger areas and more bilateral and multiple loci. Larger areas with multiple bilateral loci and a more symmetric distribution characterized pain drawings made by women as compared with those made by men. No substantial difference was noted in connection with age or educational level. Conclusions: Pain drawings of neck and shoulder symptoms among the middle-aged general working population most usually focused on the neck-shoulder angles with a symmetrical left-right distribution. The number of separate symptom loci and their total area, left-right distribution, and symmetry were characteristics associated with symptom chronicity and severity or signs of tenderness in the neck-trapezius region. Received: 16 September 1998 / Accepted: 23 September 1998     

Study to evaluate the effectiveness of stress management workshops on response to general and occupational measures of stress

This study was designed to evaluate the effectiveness of stress management training workshops within Zeneca Pharmaceuticals. The study was of cross-sectional design, comparing groups of workshop attendees and non-attendees. In addition, self-rated well-being scores of attendees were compared with results obtained pre-workshop and 2-3 months after the workshop. Employees participating in the study were drawn from the Manufacturing, Research and Development, Sales and Marketing sites of Zeneca Pharmaceuticals located in Cheshire, United Kingdom. Three hundred and ninety persons who had participated in stress management workshops since 1988 were matched for age, gender and department with an equal number of employees who had not attended stress management workshops. Outcome measures included self-rated well-being (as measured by the 30-question General Health Questionnaire), knowledge of company guidance on the management of stress in staff, and an assessment of coping strategies. Subjects who had not attended a stress management workshop were much more likely to have a poor understanding of the principles of management of stress in staff [odds ratio (OR) = 8.3; 95% confidence interval (CI) = 3.3-21.3] and more likely to have poor coping skills (OR = 2.8; CI = 1.3-6.1). However, mean scores for the two measures were similar in attendees and non-attendees. Self-rating of current well-being was strongly associated with the life-events score, but not related to workshop attendance. The study indicates that stress management training workshops reduce the prevalence of employees with a poor understanding of the principles of the management of stress in staff and with poor coping strategies. An improvement in the self-rated well-being observed shortly after the workshop was not sustained.