硫代硫酸钠标准溶液(0.1 mol/L)标定的不确定度评定方法研究

建立硫代硫酸钠标准溶液(0.1mol/L)标定的不确定度评定方法.以国家标准为依据,建立数学模型,分析不确定度来源,探讨不确定度的评定方法.硫代硫酸钠标准溶液(0.1mol/L)标定的不确定度评定,对产品质量检测结果的可信度表达有重要意义.     

白血病患者Flt-3基因突变及其与白血病发生、预后的关系

背景：Flt3基因是近年来发现的早期造血生长因子受体基因。Flt3与其配体结合后能通过信号传导途径对造血干，祖细胞的增殖和分化起调节作用。Flt3近膜区的内部串联重复（FLT3／ITD）与多种白血病的发生，发展密切相关，且为预后不良的独立指标。目的：探讨Flt-3基因内部串联重复（ITD）突变与急性白血病发生的关系及其预后判断的临床意义。设计：重复测量。单位：沈阳医学院生物化学及分子生物教研室。对象：147例样本均来自于1999—01／2004—12沈阳医学院附属医院住院及门诊收治的白血病患者，均经形态学及骨髓活检确诊。其中男95例，女52例；年龄5—23岁。参照FAB分型标准诊断：急性髓性白血病62例患者分别为AML（M1，M2）33例，AMMOL（M4）3例，AMOL（M5）18例，AMKL（M7）8例，急性淋巴细胞白血病43例，幼年型慢性粒细胞白血病13例，骨髓增生异常综合征29例。纳入对象均对检测项目知情同意。方法：采用聚合酶链反应联合序列检测147例白血病患者中的Flt-3／ITD。主要观察指标：观察伴有Flt-3，ITD急性髓性白血病患者的临床表现及预后，检测各类急性白血病中Flt-3的表达水平及Flt-3／ITD阳性率，发生的区间和长度。结果：①Flt-3／ITD：急性髓性白血病患者62例中有5例除Flt-3表达产物之外，伴有异常扩增产物，其中急性髓性白血病（M1，M2）3例、AM-MOL1例、AMOL1例。测序及Blast比对分析显示，伴有异常产物的患者在外显子11区均有ITD，各例ITD的复制区域不同，长短不等（33—72bp）。43例急性淋巴细胞白血病、29例骨髓增生异常综合征和13例幼年型慢性粒细胞白血病患者中均未检测到Flt-3／ITD。②预后：5例Flt-3，ITD阳性患者确诊后均在短期内死亡，平均生存期10．8个月。结论：①Flt-3／ITD仅发现于急性髓性白血病患者，其存在可能与急性髓性白血病发生及进展有关。②Flt-3／ITD是急性髓性白血病患者预后判断的重要标志。     

多层螺旋CT（MSCT）灌注成像评价梗阻性积水肾肾功能的临床研究

目的：探讨多层螺旋CT（MSCT）灌注成像评价梗阻性积水肾肾功能的价值.方法：对36例单侧梗阻性重度肾积水、对侧肾显影正常的患者,按IVU结果分为显影组和不显影组,在梗阻解除前行MSCT灌注扫描,测量积水肾与对侧肾皮质的血流量（BF）、血容量（BV）值,并对两组间积水肾的BF和BV值进行比较.结果：36例中,显影组20例,MSCT检查显示积水肾皮质BF、BV值分别为（412.58±217.56）ml·100 g-1·min-1,（28.66±10.96）ml/100 g;不显影组16例,积水肾皮质BF、BV值分别为（185.24±189.30）ml·100g-1·min-1、（15.6±11.8）ml/100g.两组间积水肾肾皮质BF、BV值比较差异均有统计学意义（P＜0.01）,组内积水肾与对侧肾肾皮质BF、BV值差异显著（P＜0.01）,组间对侧肾肾皮质BF、BV值差异无显著性（P〉0.05）.结论：MSCT灌注成像较IVU能更准确地反映肾功能,在评价单侧梗阻性积水肾肾功能中具有一定价值.     

导管滑脱评估监控表在鼻胆管护理中的应用与效果评价

【】目的 运用导管滑脱危险因素评估、监控表对经内镜鼻胆导管引流术(ENBD)患者进行评估,落实鼻胆导管滑脱防范措施,改进固定方法,以降低鼻胆管拔管发生率。方法 自2010年开始对行ENBD患者留置的鼻胆管,实施导管滑脱危险因素评估和监控,根据患者实际情况落实防范管理的护理措施,并与2009年ENBD患者比较实施导管滑脱危险因素评估、监控表前后鼻胆管拔管情况。结果 实施导管滑脱危险因素评估、监控表评估后,明显提高了护理人员的安全防范意识,ENBD患者鼻胆管拔管的发生率明显降低(P<0.001)。结论 通过导管滑脱危险因素评估、监控表的全面实施和护理安全措施的切实落实,能有效减少鼻胆管滑脱预防工作的盲目性和被动性,降低ENBD患者鼻胆管滑脱的发生率,使防止导管滑脱护理工作常规化、程序化、规范化。     

运用Delphi法构建军队非现役文职护士职业成熟度的研究

目的研制适合我国国情的军队非现役文职护士职业成熟度自评问卷指标。方法采用德尔斐(Delphi)法两轮专家函询,汇总专家意见,确定各级指标内容,构建军队非现役文职护士职业成熟度问卷。结果确定了由认知、情感、能力和行为3个一级指标,8个二级指标和80个三级指标构成的职业成熟度问卷。结论军队非现役文职护士职业成熟度自评问卷很好地体现了职业领域的特殊性,为军队非现役文职护士职业生涯规划提供了有效的理论依据。     

Workplace stressors, coping, demographics and job satisfaction in Chinese intensive care nurses

Background: Prior research has suggested that certain workplace stressors, coping strategies and demographic characteristics are related to job satisfaction in nurses. Most of the research in this area has been conducted within western culture countries, with little research being carried out in Asian culture countries, especially China. It remains unclear if the findings of the research conducted in western culture countries are applicable to Chinese nurses, especially intensive care nurses. Aims and objectives: Therefore, the aims of this study were to examine, in Chinese intensive care nurses, the most often occurring workplace stressor; the most frequently used coping strategy; and the relationships among workplace stressors, coping strategies, demographic characteristics and job satisfaction. Design: The study design was a survey using four self‐report questionnaires. Methods: One hundred and two intensive care nurses, from four hospitals located in two major cities in central China, were administered four self‐report questionnaires. Results: Findings suggested that the most frequently cited workplace stressor was workload, while the most commonly used coping strategy was planning. Two hundred and twelve significant positive and negative correlations were found among the various workplace stressors, coping strategies, demographic characteristics and the different factors comprising job satisfaction. Conclusions: These findings identify factors that need to be considered when addressing workplace stress, coping strategies and demographic characteristics as they relate to job satisfaction in Chinese intensive care nurses. Relevance to clinical practice: It is important for both hospital and nursing administrators to address factors contributing to job satisfaction, so that retention of qualified ICU nurses, within the workforce, will be facilitated.     

Evaluating the performance of inpatient attending physicians

OBJECTIVE: Instruments available to evaluate attending physicians fail to address their diverse roles and responsibilities in current inpatient practice. We developed a new instrument to evaluate attending physicians on medical inpatient services and tested its reliability and validity. DESIGN: Analysis of 731 evaluations of 99 attending physicians over a 1-year period. SETTING: Internal medicine residency program at a university-affiliated public teaching hospital. PARTICIPANTS: All medical residents (N= 145) and internal medicine attending physicians (N= 99) on inpatient ward rotations for the study period. MEASUREMENTS: A 32-item questionnaire assessed attending physician performance in 9 domains: evidence-based medicine, bedside teaching, clinical reasoning, patient-based teaching, teaching sessions, patient care, rounding, professionalism, and feedback. A summary score was calculated by averaging scores on all items. RESULTS: Eighty-five percent of eligible evaluations were completed and analyzed. Internal consistency among items in the summary score was 0.95 (Cronbach's alpha). Interrater reliability, using an average of 8 evaluations, was 0.87. The instrument discriminated among attending physicians with statistically significant differences on mean summary score and all 9 domain-specific mean scores (all comparisons, P <.001). The summary score predicted winners of faculty teaching awards (odds ratio [OR], 17; 95% confidence interval [CI], 8 to 36) and was strongly correlated with residents' desire to work with the attending again (r =.79; 95% CI, 0.74 to 0.83). The single item that best predicted the summary score was how frequently the physician made explicit his or her clinical reasoning in making medical decisions (r(2)=.90). CONCLUSION: The new instrument provides a reliable and valid method to evaluate the performance of inpatient teaching attending physicians.     

血液净化治疗毒鼠强中毒的临床研究

目的:探索血液净化对毒鼠强中毒的治疗价值,并评价中毒严重程度评分(thepoisoningseverityscore,PSS)与毒鼠强中毒患者的预后的关系。方法:应用血液净化方法治疗13例毒鼠强中毒患者,与常规治疗的11例患者进行疗效比较,并对所有患者作入院时即刻PSS评分及随访PSS评分。结果:血液净化治疗后患者心肌酶、APACHEⅢ评分及脑电图评分明显低于治疗前(P<0.05),且明显低于常规组治疗后(P<0.05)。入院时PSS评分≥2分的患者死亡率明显高于PSS评分<2分者(P<0.01)。结论:血液净化治疗毒鼠强比常规方法更有效。PSS评分能较准确地判断毒鼠强中毒患者的预后及病情严重程度。     

一种定量评价离体海马脑片缺糖/缺氧损伤的新方法

目的 :建立一种定量评价离体脑片缺糖 /缺氧损伤的简便、快速、灵敏的方法。方法 :离体海马脑片缺糖 /缺氧不同时间后以 2 % 2 ,3,5 -三苯基氯化四氮唑 (TTC)染色 ,用乙醇∶二甲亚砜 (5 0∶ 5 0 )抽提 TTC红色结晶产物 ,分光光度法测定 OD490 值 ,并与 LDH释放率进行比较。结果 :随着缺糖 /缺氧时间的延长 ,TTC染色 (OD490 值 )逐渐下降 ,而 LDH释放率逐渐上升 ,两结果呈负相关 (r=- 0 .933,P<0 .0 1) ,提示脑片缺血性损伤。尼莫地平、地塞米松和氯胺酮可减轻脑片缺血性损伤 ,但 ONO- 10 78无效。结论 :TTC染色法简单易行 ,且客观灵敏 ,可用于离体脑片损伤的评价及药物初筛。     

Problems of conscience and fact: Consulting on medicolegal claims

The physician is not obliged to act as a consultant in medicolegal cases, but if one does, one should consult for either the defense or the plaintiff. I believe that acting as a consultant is of service to one's medical colleagues and to society as a whole. Moreover, a series of cases substantiates the view that it should be an advantage to physicians if more ophthalmologists of stature would accept this task.