全程无缝隙护理模式在手术室优质护理中的应用

目的:探讨手术室应用全程无缝隙护理模式的临床效果。方法:74例拟手术患者按照随机数字表法分为对照组与干预组,各37例。对照组实施手术室优质护理;干预组于优质护理基础上实施全程无缝隙护理模式。观察2组患者护理前后心理舒适度和手术应激及护理满意度情况。结果:2组患者护理后焦虑自评量表和抑郁自评量表评分均较护理前明显下降(P<0.01),但干预组均较对照组下降更显著(P<0.01)。护理后干预组收缩压和舒张压及心率均明显低于对照组(P<0.01)。2组满意度差异无统计学意义(P>0.05)。结论:手术室中对患者实施优质护理服务时应用全程无缝隙护理模式,可有效改善患者心理舒适度,减少各种手术应激发生,使患者保持良好心态接受手术治疗。     

Linear and nonlinear hearing aid fittings – 2. Patterns of candidature

We studied candidature for linear, slow-acting AVC hearing aids, and fast-acting WDRC hearing aids in a within-subject within-device crossover design of 50 listeners with SNHL. Candidature dimensions include HTLs, ULLs, spectro-temporal and masking abnormalities, cognitive capacity, and self-reports and acoustic measures of auditory ecology. Better performance with linear fittings is associated with flatter audiograms, wider dynamic range, and smaller differences in dynamic range between low and high frequencies, and also with more restricted auditory lifestyles. Better performance with all nonlinear fittings is associated with more sloping audiograms, more restricted dynamic ranges, greater differences in dynamic range between low and high frequencies, and more varied auditory lifestyles. Differential performance between WDRC and AVC fittings is associated with patterns of variation in auditory ecology (rapid versus slow changes) and cognitive (high versus low) capacity. Differential performance between WDRC in two channels, and a hybrid with WDRC in a low-frequency and AVC in a high-frequency channel is associated with psychoacoustic tests of cochlear function (high susceptibility to spectral and temporal smearing, and high susceptibility to upward spread of masking respectively). Patterns of candidature include measures beyond auditory function in the domains of cognitive capacity and auditory ecology.

Sumario

Estudiamos cincuenta sujetos con SNHL buscando criterios de selección para adaptar auxiliares auditivos lineales, con AVC de acción lenta, o con WDRC de acción rápida, en un diseño cruzado que juzgaba variaciones intra-sujeto y con respecto al mismo dispositivo. Los criterios bajo estudio fueron HTL y ULL, anormalidades del espectro temporal y de enmascaramiento, habilidad cognitiva, y auto-reportes y medidas acústicas de ecología auditiva. Se asoció un mejor desempeño al hacer las adaptaciones lineales en sujetos con audiogramas más planos, con rangos dinámicos más amplios y con pequeñas diferencias en el rango dinámico entre frecuencias graves y agudas, así como con estilos de vida auditiva más restringidos. Un mejor desempeño en todas las adaptaciones no lineales se asoció con audiogramas con pendiente, con rangos dinámicos más restringidos, con mayores diferencias en el rango dinámico entre frecuencias graves y agudas, y con estilos auditivos de vida más variados. El desempeño diferencial entre adaptaciones con WDRC y con AVC se asoció con patrones de variación en la ecología auditiva (cambios rápidos vs. lentos), y con habilidad cognitiva (alta vs. baja). El desempeño diferencial entre WDRC en dos canales y un híbrido que utilizaba WDRC en una frecuencia baja, con un AVC en un canal de alta frecuencia se asoció con pruebas psicoacústicas de función coclear (una alta susceptibilidad a la disminución en la nitidez espectral y temporal, y alta susceptibilidad a una diseminación ascendente del enmascaramiento, respectivamente). Los patrones para selección de candidatos incluyen mediciones más allá de la función auditiva en el ámbito de la capacidad cognitiva y de la ecología auditiva.     

Linear and nonlinear hearing aid fittings – 1. Patterns of benefit

We evaluated the benefits of fast-acting WDRC, slow-acting AVC, and linear reference fittings for speech intelligibility and reported disability, in a within-subject within-device masked crossover design on 50 listeners with SNHL. Five hearing aid fittings were implemented having two compression channels and seven frequency bands. Each listener sequentially experienced each fitting for a 10-week period. Outcome measures included speech intelligibility under diverse conditions and self-reported disability. At a group level, each nonlinear fitting was superior to the linear references for benefits in listening comfort, listener satisfaction, reported intelligibility and speech intelligibility. Slow-acting AVC outperformed the fast-acting WDRC fittings for listening comfort, while for reported and measured speech intelligibility the converse was true. For listener satisfaction there were no group differences between the nonlinear fittings. Analysis in terms of fittings for individual listeners revealed subsets with definite divergences from the group data and hence a need for candidature criteria. There are systematic differences between the benefits of nonlinear and linear fittings, and also within nonlinear fittings with fast versus slow time constants. The patterns of benefit and individual optima depend on the domain of outcome being assessed.

Sumario

Evaluamos en cincuenta sujetos con SNHL los beneficios sobre la inteligibilidad del lenguaje de adaptaciones de auxiliares auditivos con WDRC de acción rápida, con AVC de acción lenta y con referencia lineal, así como la discapacidad reportada, con un diseño de enmascaramiento cruzado que permite juzgar las diferencias intra-sujeto y en función del propio dispositivo. Se implementaron cinco adaptaciones con dos canales de compresión y siete bandas de frecuencia. Cada sujeto utilizó secuencialmente las diferentes adaptaciones durante un período de diez semanas. Las medidas de resultado incluyeron inteligibilidad del lenguaje bajo diversas condiciones y la discapacidad auto-reportada. La adaptación con AVC de acción lenta superó la de WDRC de acción rápida en relación con la comodidad para escuchar, aunque para la inteligibilidad del lenguaje, tanto medida como reportada, ocurrió lo contrario. En relación con la satisfacción del sujeto, no existieron diferencias de grupo entre las adaptaciones no lineales. El análisis, en términos en adaptaciones para sujetos individuales, reveló sub-grupos con divergencias definitivas en relación a los datos grupales, y por tanto, la necesidad de establecer criterios para la selección de candidatos. Existen diferencias sistemáticas entre los beneficios de las adaptaciones lineales y no lineales, así como entre las adaptaciones no lineales y las constantes temporales rápidas versus las lentas. El patrón de beneficio y de optimización individual depende del ámbito de resultado bajo escrutinio.     

The Impact of Perceived Closeness on the Differing Roles of Satisfaction,Trust, Commitment,and Comfort on Intention to Remain with a Physician

This study extends previous research by examining perceived closeness as a moderator of traditional relationship measures such as satisfaction, trust, commitment, and psychological comfort, and the impact of each on the intention of the patient to remain with his/her physician. Our findings reveal that in cases where the patient feels close to the physician, psychological comfort with the physician is the most important factor in predicting patient retention. For those who feel less close to the physician, satisfaction is theprimary predictor of patient retention. Therefore, as a close relationship develops between the patient and doctor, the patient's comfort level becomes increasingly important as an exit barrier, even outweighing patient satisfaction.     

对学生标准化病人实施预防压疮的护理研究

目的:将推拿技术应用于学生标准化病人预防压疮的舒适护理中,以探讨优质护理服务内涵建设。方法:选择平凉医学高等专科学校(以下简称平凉医专)2009级护理专业1班为试验组共46名学生,2班为对照组共45名学生,15名学生标准化病人(SSP)和6名考评教师参与实践技能的考核。对学生标准化病人实施推拿治疗;对2组学生和学生标准化病人进行满意度问卷调查。结果:护理学生对护理技术、学生标准化病人对护理效果均满意。结论:应围绕优质护理服务的内涵建设,树立护理服务科研性、内涵性、开放性的理念,综合多学科理论与技术开展预防压疮的舒适护理。     

Study of contact characteristics between a respirator and a headform

This article presents a computational study on contact characteristics of contact pressure and resultant deformation between an N95 filtering facepiece respirator and a newly developed digital headform. The geometry of the headform model is obtained based on computed tomography scanning of a volunteer. The segmentation and reconstruction of the headform model is performed by Mimics v16.0 (Materialise, Leuven, Belgium), which is a medical image processing software. The respirator model is obtained by scanning the surface of a 3M 8210 N95 respirator using a 3D digitizer and then the model is transformed by Geomagic Studio v12.0 (3D system, Rock Hill, SC), a reverse engineering software. The headform model contains a soft tissue layer, a skull layer, and a separate nose. The respirator model contains two layers (an inner face sealing layer and an outer layer) and a nose clip. Both the headform and respirator are modeled as solid elements and are deformable. The commercial software, LS-DYNA (LSTC, Livermore, CA), is used to simulate the contact between the respirator and headform. Contact pressures and resultant deformation of the headform are investigated. Effects of respirator stiffness on contact characteristics are also studied. A Matlab (MathWorks, Natick, MA) program is developed to calculate local gaps between the headform and respirator in the stable wearing state.     

环形弹性加压带在肝癌介入治疗术后的应用及效果

目的 观察自制环形弹性加压带在肝癌介入术后的应用及效果.方法 符合入选标准的100例肝癌行介入治疗患者分为对照组和实验组,每组50例,对照组采用传统的盐袋捆绑的方法压迫穿刺点,实验组采用自制环形弹性加压带(专利号:ZL 2014 2 0680702.4)压迫穿刺点,比较两组穿刺点出血性并发症的发生率及患者的舒适度.资料采用SPSS18.0软件包进行统计学处理,采用Wilcoxon秩和检验、t检验和x2检验.结果 实验组50例,出血性并发症发生2例(4％),对照组50例,穿刺点出血性并发症发生10例(20％),两组相比,差异有统计学意义(x2=6.061,P＜0.05).两组舒适度比较显示实验组有优势(Z值=-5.65,P＜0.05).结论 自制环形弹性加压带可以减少出血并发症的发生率,提高患者的舒适度,值得在血管性介入术后推广及应用.     

不同雾化吸入时间对学龄期哮喘患儿舒适度的影响

目的探讨不同时间雾化吸入对住院治疗的学龄期哮喘患儿舒适度的影响。方法将2011年10月至2012年1月在东阳市人民医院儿科住院期间行雾化吸入的70例学龄期哮喘患儿按住院时间分为观察组(单日)和对照组(双日)各35例,两组患儿均在常规综合治疗的基础上给予雾化吸入2次/d,对照组为8:00-9:00和14:30-15:30,观察组为6:00-7:00和20:00-21:00。比较两组患儿雾化吸入1周后喘息、咳嗽、烦躁、睡眠等方面的舒适度评分。结果观察组患儿在喘息、咳嗽、烦躁、睡眠等方面的舒适度均优于对照组,差异有统计学意义(P<0.05);患儿自评舒适度与护士评估舒适度差异无统计学意义(P>0.05)。结论清晨和夜间给予雾化吸入,能有利于减轻哮喘患儿喘息、咳嗽等不适症状,避免烦躁、改善睡眠,提高患儿的整体舒适度。     

Effects of low humidity and high air velocity in a heated room on physiological responses and thermal comfort after bathing: An experimental study

Objective

In the present study we investigated the effects of low relative humidity (RH) and high air velocity (VA) on physiological and subjective responses after bathing in order to present the evidence for required nursing intervention after bathing.

Methods

Eight healthy male subjects participated in this experiment. There were four thermal conditions which combined RH (20% of 60%) and VA (low: less than 0.2 m/s or high: from 0.5 to 0.7 m/s). After taking a tub bath, subjects sat for 80 min in the test room under each condition. In addition, one condition under which the subjects were exposed to 20% RH and high VA condition for 80 min without bathing condition was conducted.

Results

A decrease in mean skin temperature (), dryness of the skin and eyes were observed, though thermal comfort and warmth retained, due to spending time after bathing in a low RH and high VA environment, compared to the condition without bathing. Moreover, dryness of the skin, a decrease in hydration of the skin and an increase in transepidermal water loss (TEWL) after bathing were significantly affected by RH levels, on the other hand subjective coolness, discomfort and perception of dryness in the eye were significantly affected by VA levels. The decrease in after bathing was significantly affected by both RH and VA.

Conclusion

From our findings we concluded that low RH and high VA have negative effects on humans after bathing, for example a decrease in body temperature and dryness of the skin and eyes. Moreover, it was indicated that the negative effects could be kept to a minimum and thermal comfort remain higher, if RH and VA levels were controlled within the optimum ranges.