护理人员“职业枯竭”的现状与对策

对我院护理人员从业满意度、职业生涯潜在威胁的分析，认为护理管理者在重视护理学科发展的同时，换个角度审视并理性思考护理人员中存在的不可回避的“职业枯竭”问题，以利从容应对，有效规避。提出保持“资源守恒”，个人用正确的方法应对压力，护理管理者全方位介入是解决护理人员“职业枯竭”问题的关键。     

治疗老年重症呼吸衰竭42例临床分析

目的：探讨机械通气联合支气管肺泡灌洗（BAL）在治疗老年重症呼吸衰竭的作用。方法：选择常规治疗后病情无缓解的重症老年呼吸衰竭患者42例。建立人工气道行钡械通气治疗12～24h后，低氧血症纠正不理想，气道压力偏高，痰多者，应用加温至37℃生理盐水加庆大霉素、地塞米松及爱全乐经纤支镜行BAL，吸除呼吸道粘稠分泌物，每日一次，连续3—5天。结果：42例患者中，37例通气24h，经支气管肺泡灌洗后，气道压力下降，临床症状好转，缺氧及二氧化碳滞留得到改善，病原菌得到明确，成功脱机出院。结论：对老年重症呼吸衰竭在机械通气的基础上联合支气管肺泡灌洗是治疗呼吸衰竭安全有效的重要措施，值得临床应用。     

Atypical presentation of NREM arousal parasomnia with repetitive episodes

The case report describes a distinct variant of non-REM (Rapid Eye Movement) arousal parasomnia, sleepwalking type, featuring repetitive abrupt arousals, mostly from slow-wave sleep, and various automatisms and semi-purposeful behaviours. The frequency of events and distribution throughout the night presented as a continuous status of parasomnia (' status parasomnicus '). The patient responded well to treatment typically administered for adult NREM parasomnias, and after careful review of the clinical presentation, objective findings and treatment outcome, sleep-related epilepsy was ruled out in favour of parasomnia.     

Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis

Frozen shoulder is said to be a self-limiting entity but full recovery often takes more than 2 years. For that, most patients are unwilling to tolerate painful restriction while awaiting resolution. We prospectively investigated 30 patients (16 women, 14 men) for the outcome of arthroscopic capsular release in idiopathic frozen shoulder. Results were determined by the assessment of subjective and objective parameters to estimate both shoulder function and general health status. Symptoms persisted without improvement for a minimum of 6 months of conservative treatment. Preoperative average American shoulder and elbow surgeons score (ASES) was 35, visual analog scale (VAS) to measure pain was 7, and simple shoulder test (SST) was 4. Mean scores of the physical component of SF-36 were considerably reduced. Mean forward elevation was 85°, average abduction was 70°, mean internal rotation was 15°, and mean external rotation was 10°. Patients were followed-up at 6 weeks, 3, 6, 12 months and by a mean of 36 months. Range of motion for all planes improved (P < 0.05). Median VAS reduced to 2, average ASES increased to 91, and SST enhanced to a mean of 10 (P < 0.05). We stated improvement of the physical components in the SF-36 questionnaire in particular bodily pain and the role-physical score. There were no significant differences between the measurements in the early postoperative phase compared to the mid-term follow-up (P > 0.05). Our results demonstrate that arthroscopic release of refractory idiopathic frozen shoulder combined with a gentle manipulation provides reliable expectations for improvement in both clinical and general health status for most patients. We recommend the use of a limb-specific and a general-health-status questionnaire to conclude the benefit of the surgical intervention and contribute the optimization of a therapy concept more effectively.     

Acute Renal Failure after Lung Transplantation: Incidence, Predictors and Impact on Perioperative Morbidity and Mortality

The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up was extended until December 2002. Patients were initially divided into two groups: ARF (doubling of baseline creatinine within 2 weeks after surgery) and NoARF. The ARF group was subdivided into ARFD (dialyzed) and ARFnD (not dialyzed). The incidence of ARF was 56% (166/296), but most cases were ARFnD (n = 143). Independent predictors of ARFD (n = 23) were: baseline GFR (OR 0.98, CI 0.96-0.99, p = 0.012), pulmonary diagnosis other than COPD (OR 6.80, CI 1.5-30.89, p = 0.013), mechanical ventilation > 1 d (OR 6.16, CI 1.70-22.24, p = 0.006) and parenteral amphotericin B use (OR 3.04, CI 1.03-8.98, p = 0.045). Both ARFnD and ARFD were associated with longer duration of mechanical ventilation, increased hospital stay and increased early mortality. One-year patient survival was 92.3%, 81.8% and 21.7% in the NoARF, ARFnD and ARFD groups, respectively (p < 0.0001). After controlling for important covariates, ARFD remained associated with an increased hazard of dying (HR 6.77, CI 4.00-11.44, p < 0.0001). In conclusion, ARF occurs commonly after lung transplantation and affects important clinical outcomes, especially when dialysis is required.     

颈椎颈髓损伤后外科治疗时间对预后的影响

目的:前瞻性比较颈椎颈髓损伤患者在3d内与10~14d内进行外科干预后神经功能恢复的情况。方法:32名急性颈椎颈髓损伤的患者根据入选标准随机分为早期手术组(3d内手术)和择期手术组(10~14d内手术)。分别记录患者术前和术后2年的Frankel分级和感觉、运动评分(依据美国脊髓损伤学会的标准)。结果:与术前相比,两组患者术后的感觉、运动评分均有明显改善(P<0.01),Frankel分级的改善程度早期手术组明显优于择期手术组(P<0.01)。结论:急性颈椎颈髓损伤在3d内进行手术治疗者神经功能恢复的结果优于10~14d内行手术者。因此,颈椎颈髓损伤后应尽可能地早期进行外科干预。     

基层公共卫生人员心身健康状况分析

目的了解基层公共卫生人员心身健康状况及影响因素,为提高其健康水平和工作质量提供科学依据。方法应用中国心身健康量表,采用分层整群抽样的方式,抽取胶州、嘉祥、兖州和邹城疾病预防控制中心及下属防保站的公共卫生人员584名进行问卷调查。结果基层公共卫生人员心身障碍发生率为39.43%,其中最高为骨骼系统14.17%,其次为神经系统12.73%;呼吸系统、心血管系统、焦虑、抑郁、精神病性5项因子评分小于全国常模;运用二分类Logistic逐步回归分析显示,从事本行业年限的增加是引起眼和耳疾病的危险性因素（OR=1.067）,职务的增高是导致心血管系统（OR=1.878）、消化系统（OR=1.675）、精神病性（OR=1.841）疾患的危险性因素;核心家庭（OR=0.136）、扩展家庭（OR=0.143）是降低抑郁发生的保护性因素。结论相关部门应采取综合措施,从工作和家庭环境等方面入手,提高基层公共卫生人员的心身健康水平。     

Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

Delivering syringe exchange services through “satellite exchangers”: the Sacramento Area Needle Exchange, USA

An important operational aspect of Syringe Exchange Programmes (SEPs) is the venue of service delivery. This report describes the programmatic features of the Sacramento Area Needle Exchange (SANE), an illegal SEP operating in California, USA. SANE utilises “satellite exchangers” to distribute the bulk of its syringes and HIV risk reduction supplies. Advantages of relying primarily on Designated Exchangers (DE) for delivery of SEP services are that it: (1) allows for coverage of a large geographical area; (2) keeps operational cost low; (3) provides syringes to clients who may not want to or cannot use fixed site programmes; (4) limits the possibility of detection of programme personnel and clients by law enforcement. Limitations are that: (1) it is not as conducive as fixed sites to providing a wide range of ancillary services; (2) it may not be optimal for drug users who do not want to be reliant on other people for access to syringes; (3) those who receive services from a satellite exchanger may not derive as much counselling and referral services as direct exchangers. The lack of legal status, political support and adequate funding threatens the programme’s existence.