护士工作价值观对专业稳定性的影响

目的了解护士的工作价值观对其专业稳定性影响。方法对368名护士进行工作价值观的问卷调查,主要内容为内部价值、外部价值、工作弹性、人际关系及工作环境5个因素。按年龄、婚姻状况、学历及工作年限进行分组,根据护士对这5个因素的感受评分进行比较,判断护士的离职倾向。数据分析采用方差分析之多元回归分析。结果年龄、婚姻状况、学历及工作年限等对护士工作价值观和离职倾向有显著影响;护士工作价值观与其离职倾向呈显著负向影响。结论重视并满足护士的基本要求,完善绩效考核制度,提升她们的自身价值,可降低护士离职意愿。     

武汉市门诊病人选择就诊医院的影响因素分析

目的 研究影响武汉市门诊病人选择就诊医院的原因，为卫生资源的合理配置提供科学依据。方法 随机选择不同级别的多所医院，对各科门诊病人进行问卷调查，结果 利用Foxpro建立数据库，采用SAS软件进行统计分析。结果 医院吸引病人就诊的原因为就近、医疗水平高、对口单位、医疗设备好、有专家门诊等，不同级别的医院略有差异。结论 服务质量及医疗服务的可及性是影响病人选择就诊医院的主要原因。     

Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome

We have analysed retrospectively the influence of different sources of knee deformity on failure of closing wedge high tibial valgus osteotomy (HTO). Preoperative frontal plane varus deformities of the lower extremity, distal femur and proximal tibia, and medial convergence of the knee joint line were assessed on a standard whole leg radiograph in 76 patients. Using the logistic regression model, the probability of survival for HTO was 77% (SD 4%) at 10-years follow-up. Varus deformity of the lower extremity (< 175°), and medial convergence of the knee joint line (> 3°) were identified as preoperative risk factors for conversion to arthroplasty (P = 0.03 and P = 0.006). We found no evidence that varus inclination of the proximal tibia or distal femur influences long-term survival of HTO.     

The inclination of mandibular incisors revisited

Objective: To reassess the inclination of lower incisors and evaluate possible associations with gender, age, symphyseal parameters, and skeletal pattern.Materials and Methods:Twelve hundred and seventy-two (605 females, 667 males) cephalograms of untreated subjects of a craniofacial growth study (age: 8–16 years) were evaluated. Correlations between the angulation of the lower incisors and age, symphyseal distances (height, width, and depth), symphyseal ratios (height-width, height-depth), and skeletal angles (divergence of the jaws and gonial angle) were investigated for all ages separately and for both sexes independently.Results:The inclination of lower incisors increased over age (8 years: girls  =  93.9° [95% CI, 92.3°–95.7°], boys  =  93.3° [95% CI, 91.8°–94.9°]; 16 years: girls  =  96.1° [95% CI, 94.1°–98.2°], boys  =  97.1° [95% CI, 95.6°–98.6°]). Inclination of lower incisors correlated with the divergence of the jaws for all ages significantly or highly significantly, except for boys and girls 9 years of age and girls 11 and 12 years of age, for which only a tendency was observed. Similarly, a strong correlation to gonial angle could be observed. No correlation could be found between the inclination of lower incisors and any symphyseal parameters (absolute measurements and ratios), except for symphyseal depth.Conclusion:Lower incisor inclination is linked to the subject''s sex, age, and skeletal pattern. It is not associated with symphyseal dimensions, except symphyseal depth. Factors related to natural inclination of lower incisors should be respected when establishing a treatment plan.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

Dynamic control of the lumbopelvic complex; lack of reliability of established test procedures

Impairment of the dynamic control of the lumbopelvic complex in LBP has gained increased focus both clinically and experimentally. The objectives of this study were to determine the reliability of inclinometry as a measure of dynamic lumbopelvic control. Lumbopelvic reposition accuracy during pelvic tilts was measured in 39 healthy subjects using an inclinometer attached to the skin at S2 level. The reposition accuracy was measured in sitting, standing and supported standing. Tests were performed three times with a 20 min recess between tests. Only data from the last two test sequences were used in order to account for learning effects. Intraclass correlation coefficients were low for the sitting (0.54) and supported standing positions (0.36). In the standing position, a significant difference between test and retest was observed (P = 0.003) and further reliability analysis was therefore abandoned. It is concluded that inclinometry is not reliable for measuring the dynamic lumbopelvic control in any of the test positions and prior work utilising inclinometry to evaluate dynamic lumbopelvic control should be interpreted with caution.     

Trunk asymmetry and facial symmetry in young adults

The aim of the present study was to detect possible associations between trunk and cervical asymmetry and facial symmetry. Frontal cephalograms prepared in the natural head position, representing 79 subjects (40 males, 39 females) with mild to moderate trunk asymmetry, were analyzed separately for thoracic humps, lumbar prominences, and cervical inclination by discriminating two groups: right-sided-dominant and left-sided-dominant. The differences between the groups were analyzed using an unpaired 2-group t test. The results showed that location of the thoracic humps and inclination of the cervical spine was predominantly right-sided, while the location of lumbar prominence was predominantly left-sided. Craniofacial morphological variables of the head and face were nearly equal for right-sided and left-sided thoracic humps and lumbar prominences, showing that moderate trunk asymmetry does not affect facial symmetry. Further, it was found that frontal head position in relation to the true vertical (VER/ORB) is stable in that the angle between the supraorbital and vertical lines is constantly maintained close to 90 degrees regardless of moderate trunk asymmetry, indicating that visual perception control is most important in orienting the head in frontal plane. Maintenance of the head position takes place by cervical spine adaptation.     

Glenoid and scapulohumeral characteristics and their influence on preoperative range of motion and patient-determined outcomes

BackgroundIt is not clear if glenoid and scapulohumeral characteristics influence preoperative range of motion (ROM) and patient-determined outcomes. It is important to understand these interactions when planning and performing total shoulder arthroplasty in efforts of improving patient satisfaction and implant longevity.MethodsA retrospective review of patients that had three-dimensional computed tomography imaging for total shoulder arthroplasty was performed. Patients were separated into 2 groups determined by the presence (rotator cuff tear arthropathy [RCTA]) or absence (osteoarthritis [OA]) of an irreparable rotator cuff tear. Using the computed tomography measurements, shoulders were stratified by glenoid version (anteverted, normal, and retroverted), glenoid inclination (inferior, normal, and superior), and scapulohumeral subluxation (anterior, centered, and posterior) based on criteria determined from a review of the orthopedic literature. The Western Ontario Osteoarthritis Scale and the American Shoulder and Elbow Surgeons scores and ROM were determined preoperatively.ResultsIn OA patients (n = 154), version was associated with scapulohumeral subluxation (P < .0001). Retroverted glenoids had less flexion (96° vs. 108°; P = .049) and external rotation (15° vs. 21°; P = .04) compared with normal version. Inferiorly inclined glenoids had greater posterior subluxation (77%) than those with normal (67%; P = .001) and superior inclination (68%; P = .01). There were no relationships between excessive inclination or subluxation on ROM. In RCTA patients (n = 115), retroverted glenoids had greater superior inclination compared with normal glenoids (12.1° vs. 8.4°; P = .049). Version was associated with scapulohumeral subluxation (anteverted = mean 34% subluxation; normal version = 56.4% subluxation; retroverted = 71.2% subluxation; P < .0001). Retroverted glenoids had less flexion compared with normal version (70° vs. 90°; P = .048), less abduction (62°) than normal glenoids (88°; P = .03) and anteverted glenoids (115°; P = .03), and less abduction/internal rotation (7°) than normal (22°; P = .03) and anteverted glenoids (36°; P = .04). Superiorly inclined glenoids have more posterior subluxation than normally inclined glenoids (64% vs. 56.6%; P = .02). There was no relationship between inclination and ROM. Patients with posterior subluxation had less external rotation compared with those with a centered humeral head (10° vs. 22°; P = .009) and less abduction/internal rotation compared with anterior subluxation (12° vs. 35°; P = .02). There was no relationship between version, inclination, or subluxation with preoperative Western Ontario Osteoarthritis Scale or American Shoulder and Elbow Surgeons in patients with OA (P > .17) or RCTA (P > .31).ConclusionsAn interaction between version, inclination, and scapulohumeral subluxation in patients with OA and RCTA was found. Retroverted glenoids had decreased ROM measurements. RCTA shoulders with posterior scapulohumeral subluxation had decreased ROM. There was no relationship between glenoid and scapulohumeral morphology and patient-determined outcome scores.Level of evidenceLevel III; Retrospective Case-Control Prognosis Study     

山东地区不同垂直骨面型成人Ⅱ类患者平面倾斜度的锥形束CT转化分析

目的 应用锥形束CT（CBCT）转化侧位片探究山东地区不同垂直骨面型成人安氏Ⅱ类错患者的前牙、后牙及上颌平面倾斜度特点,比较其与正常患者的差异,为矫正安氏Ⅱ类错提供治疗思路和策略依据。 方法 选取2017年12月～2020年6月青岛大学附属医院口腔正畸科收治的123例正畸患者CBCT头颅造影（CCB）为研究对象,其中89例成年安氏Ⅱ类患者作为实验组,34例为对照组,利用CBCT三维影像转化得到矫正前的头颅侧位片并进行测量,根据FH平面与下颌平面之间的夹角（FH-MP）及SN平面与下颌平面之间的夹角（SN-MP）,将患者分为3个不同垂直骨面型的实验组。选取34例安氏Ⅰ类均角患者作为对照组。将实验组测量结果与对照组测量结果进行对比,分析各测量指标的数据差异。 结果 Ⅱ类高角组前牙平面倾斜度为（14.73±3.76）°,后牙平面倾斜度为（21.42±5.77）°,两者均较Ⅱ类均角组及低角组更大（P<0.05）,与对照组前牙及后牙平面之间同样有明显差异（P<0.05）。上颌第二磨牙的高度从低角组到高角组依次减小,各组间差异显著（P<0.01）。 结论 不同垂直骨面型的安氏Ⅱ类错具有不同的平面倾斜度特征。Ⅱ类高角组前牙及后牙平面较均角组、低角组及对照组陡。其中后牙平面倾斜度的差异主要由上颌第二磨牙的垂直高度不同造成。     

我院工作人员离职倾向现状与对策

目的了解公立医院人员流失的原因和影响因素,为医院管理者进行人员管理提供建议。方法采用通用量表对广州市某三甲医院300名在职人员离职倾向情况进行问卷调查。结果不同的工作岗位和用工形式的员工在离职倾向的感知水平上存在显著差异。护理人员和编制外员工具有较高的离职倾向。结论公立医院在人才的供需市场中长期处于优势地位,长久以来对于人员流失问题的重视不足。此外,现阶段医院人员管理仍处于人事管理阶段,人才管理方面仍缺少人性化,如对于离职员工较少采取离职访谈等人力资源管理方法,即便实施了离职访谈,对于发现的问题也较少及时更正。公立医院应注重对人员流失问题的研究,进一步完善医院人才激励体系,促进公立医院人才管理的合理发展。