Elements of psychological support in nursing care

The paper presents the results of a pilot study which involved 50 nurses from several departments of internal medicine of The State Clinical Hospital of the Collegium Medicum, Jagiellonian University in Cracow. The results are based on the Statement Response Questionnaire. They show that the most common responses of the nurses in the face of anxiety expressed by patients are cheering up the patient, collecting information about the symptom, and offering explanation of the symptom. The least common responses included expressing one's own positive emotions and showing empathy towards the patient.     

Moving beyond empiric continuous positive airway pressure (CPAP) trials for central sleep apnea: a multi-modality titration study

There is no universally accepted method to determine effective therapy for central sleep apnea (CSA). Continuous positive airway pressure (CPAP) applied acutely most often does not eliminate apneas and hypopneas. We hypothesized that the application of two or more therapeutic modalities after the diagnostic phase of polysomnography, a multi-modality titration study (MMTS), would identify a successful CSA treatment more often than a standard split-night study (SNS) and obviate the need for additional polysomnograms to determine a successful therapy. We retrospectively analyzed polysomnograms of patients diagnosed with CSA at our Sleep Disorders Center. We defined a therapy trial that resulted in an apnea–hypopnea index < 10 with at least one treatment modality as a therapeutic success. One hundred fifteen patients with CSA were studied. Sixty-six patients (57.4%) underwent a SNS, and 49 patients (42.6%) underwent a MMTS. SNS yielded only 8/66 (12.1%) successes on the first night, whereas a MMTS yielded 19/49 (38.8%) successes (p = 0.001, two-tailed Fishers exact). Patients who underwent a SNS eventually had similar rate of success as patients studied with MMTS (60.6 vs 63.3%, NS), but required more testing. Adaptive servo-ventilation was the most successful modality tested, yielding 36/46 (78.3%) successes. Trials of additional modalities following a failed trial of CPAP often produce a successful option that may guide therapy in patients with CSA. This approach may lead to establishing the diagnosis and treatment plans faster, while reducing unnecessary testing.     

发展民营医院的思路和建议

论述了发展民营医院的思路,针对目前发展民营医院存在的困难和问题提出了对政策调整的建议。     

同伴支持、父母支持和青少年自我价值感初探

目的：探讨实际的同伴支持、感知到的同伴支持、感知到的父母支持、对同伴支持的重要性评价、对父母支持的重要性评价和自我价值感之间的关系。同时也考察了青少年的同伴接受性。方法：用社会测量法和自我报告法对285名青少年进行集体测试。结果：①社会测量法表明青少年也可以被分为受欢迎的、被拒绝的、被忽略的、和有争议的；②感知到的同伴／父母支持和自我价值感之间存在显著正相关；高低实际同伴支持两组被试在感知到的同伴支持上存在显著差异。但在自我价值感上不存在显著差异；（固在所有被试中，只有对初三学生来说，对同伴／父母支持的重要性评价在感知到的同伴／父母支持和自我价值感之间起到调节作用。结论：感知到的同伴／父母支持可以用来预测青少年的自我价值感：对初三学生来说，对同伴／父母支持的重要性评价可以在感知到的同伴／父母支持和自我价值感之间起到调节作用。     

An Implantable Aortic Valvo-pump for Destination Therapy

To investigate the possibility of a long-term applicable left ventricular assist device, a 23 mm outer diameter and 31 g weight implantable aortic valvo-pump was developed. It consists of a rotor and a stator; the rotor has a driven magnets assemble and an impeller, the stator has a motor coil with iron core and a outflow guide vane. The device locates the position of aortic valve, delivers the blood directly from left ventricle to aorta. Neither connecting conduits nor “bypass” circuits are necessary. Therefore, the device has promisingly better antithrombogenicity than other heart pumps. In hemodynamic testing, the pump can produce a blood flow of 7 l/min volume with 50 mmHg pressure increase at 15,000 rpm rotating speed, and at zero flow rate the pump can maintain a diastolic pressure over 80 mmHg at same rotating speed. For further studies the blood compatibility and the durability of the device are of most importance.     

不同营养支持方式对肠外瘘患者人体组成改善作用之比较

目的观察不同营养支持方式对肠外瘘患者人体组成的改善作用。方法30例肠外瘘患者分成两组各15例,分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN),观察10d前后患者人体组成及血清胰岛素样生长因子-1(IGF-1)的变化。结果10d后所有患者的体重指数(BMI)与体细胞群(BCM)显著改善,而TEN组患者10d前后BCM增加幅度更明显,分别为(27.5±0.8)kg和(29.0±0.6)kg,Day10与Day0相比,P<0.01。两组患者总体水(TBW)与细胞内水(ICW)均增加,尤其ICW,Day10与Day0相比,TEN组P<0.01;TPN组P<0.05。血清IGF-1在两组患者治疗后均有显著上升,TEN组增加幅度更明显,Day0为(175.0±32.9)ng/ml,Day10为(255.5±34.1)ng/ml,与Day0比较,P<0.01;与TPN组比较,P<0.05。IGF-1的变化与BCM的改善显著正相关(r2=0.16,P<0.05)。结论营养支持治疗能显著改善肠外瘘患者的体细胞群,纠正细胞内、外水的异常分布,而EN作用更明显。     

躯干运动和负重时对足底支撑面侧向横移的姿势控制

目的:本研究假设自主运动命令和姿势控制信号间有冲突,因此设计在附加重物和不同自主任务的同时给予足底一个模拟受滑的干扰(横移)来观察姿势变化并分析其是否受冲突命令或者力学参数的影响.方法:受试者在执行各种不同的自主任务时,随机给予足底支撑面一个左侧或右侧的横移干扰.这些不同的自主任务包括不负重静止站立、静止站立单手负重5kg、负重5kg站立并躯干静止侧屈15°、负重5kg动态地提重物和放重物5项任务.测量和分析下列参数:中心压力的侧位移(COP)、躯干和股部在冠状面上的角位移和腹内压(IAP).结果:干扰离开质量(向右)、始反应超射的幅度、达到终平衡的时间和达到平衡前COP位移的次数都增加,这种情况可以看作是为了再获得平衡的姿势反应效率降低,因此,如果质量的重力效果能对抗干扰,则再获得平衡的反应效率甚至可以被增进.结论:提重和负重是危害姿势反应效率的因素,因为提重和负重改变了重力效果,加大了对躯干的干扰.在动态条件下躯干的运动不是被横移干扰增强就是被横移干扰抵消,并没有显著地影响改变最终平衡位置姿势校正的效应.因此附加任务的同时给一个支持面上的横移干扰,姿势控制的效应可以被抵消.这个减低的效应可以引起脊柱周围结构的负荷增加和增加受伤的危险性.但是,在恰当地放置负重的位置时,反而可以增进躯干控制和协助恢复姿势平衡.     

社会支持对考试应激的影响

目的了解社会支持对考试应激的影响。方法采用焦虑自评量表和社会支持量表分别对７２７个学生考试前１个月、考试期间考试焦虑分数及社会支持情况进行调查，比较分析考试焦虑分数与社会支持因素的关系。结果考试焦虑分数与客观支持、来自同学和老师的主观支持以及社会支持的利用度成反比。结论家长和学校给予学生足够的社会支持，以及让学生参加适当的社会活动，培养他们利用社会支持的能力，有助于让学生减缓考试应激的水平