医院文化的哲学伦理内核及其在现代医院管理中的重要作用

医院管理不是孤立自存的现象,由于管理者和被管理都生活在一定的医院文化氛围之中,因此,医院文化的哲学内核是现代医院管理知识的精髓,医院组织的价值观念、道德准则和思维方式,深刻地影响和制约着现代医院管理的原则和方法,决定着现代医院管理的实施和成败。     

高中学生自我价值感与应对方式、心理健康的相关研究

关于自我价值感的研究已经从概念、结构的探讨进入更为深入的自我价值感水平、发展特点以及与其他心理成分的关系的研究。国内关于自我价值感的相关研究 ,多数是借助国外的自尊量表作为测查工具 ,且仅仅从总体上考察了其他心理因素与自我价值感的相互关系[1-4] 。自我价值感作为应对的资源[5] ,不同自我价值感的人 ,在面对同一压力源时 ,可能有不同的应对反应 ,由此引起不同的情绪感受 ,因此 ,心理健康可能也存在差异。本研究将应用国内专家编制的有关量表 ,并将自我价值感视为一个较稳定的人格变量 ,考察自我价值感与应对方式、心理健康的…     

ICU心搏骤停患者心肺复苏自主循环恢复的影响因素分析

目的 探讨影响ICU心搏骤停患者心肺复苏后自主循环恢复（ROSC）的相关因素.方法 按照心肺复苏Utstein模式,收集ICU心搏骤停并进行心肺复苏抢救的病例157例,分为ROSC组（n=43）和自主循环未恢复组（non-ROSC组,n=114）.分析可能影响ROSC的相关因素.结果 157例心肺复苏患者中有43例（27.4%）ROSC成功,ROSC组的年龄低于non-ROSC组[（59.7±15.2）岁 vs.（64.8±12.4）岁,P〈0.05].多因素Logistic回归分析显示原发病为脑源性疾病不利于患者ROSC（OR=4.255,P=0.031）,而原发病为心源性疾病（OR=0.133,P=0.009）、可除颤心律（OR=0.292,P=0.001）、心肺复苏持续时间≤15 min（OR=0.062,P=0.000）、肾上腺素使用剂量≤5 mg（OR=0.561,P=0.014）是影响ROSC的有利因素.结论 原发病、首次监测心律、心肺复苏持续时间和肾上腺素使用剂量是影响ICU心搏骤停患者心肺复苏后ROSC的因素.     

唐宋词体式组合规律探赜

唐宋词体式组合规律主要表现在：它是以意群为单位。意群间以收句奇偶的不同呈现三种形式：一为纯奇纯偶收结;一为奇偶交错收结;一为独立意群示拗收结。纯奇纯偶收结。意群间应照应,但可过渡可不过渡,均谐;奇偶交错收结,意群间必须过渡,否则不谐;独立意群示拗收结,意群间不必过渡,仍谐。由纯奇纯偶收结体到奇偶交错收结体再到拗体,反映了词体组合不断复杂优化的创造性发展过程,是唐宋词创调大家名家高度智慧的表现。文中还揭示了照应与多种过渡的方法,及拗体的多种表现形式;并阐明了词体组合规律在节律学与音韵学上的原理。     

The effect of an application-based educational intervention with a social cognitive theory model on pregnant women in Denpasar,Bali, Indonesia: a randomized controlled trial

ObjectivesThe aim of this study was to elucidate the effect of application-based antenatal education based on social cognitive theory (SCT) on Health Promoting Lifestyle Profile II (HPLP II) scores, compliance with iron tablet consumption, and readiness for childbirth and complications among pregnant women in Denpasar, Bali, Indonesia.Methods This randomized controlled trial included 71 pregnant women in the treatment group and 74 pregnant women in the control group. The treatment group application-based antenatal education based on SCT, while the control group attended a conventional pregnancy class. Iron tablet consumption was verified by counting the remaining iron tablets. Information on participants’ lifestyles was collected using the HPLP II questionnaire with the help of an assistant. The collected data were statistically analyzed using IBM SPSS ver. 24.0.Results The antenatal education intervention effectively increased the HPLP II score by 0.32 points (2.62±0.331 before the intervention and 2.94±0.273 after). Meanwhile, the control group had a 0.13-point increase (p=0.001), from 2.67±0.336 to 2.80±0.275. There was no significant difference in iron tablet consumption (p=0.333) or readiness for delivery and complications (p=0.557) between the treatment and control groups.Conclusion Application-based antenatal education with SCT effectively increased the HPLP II scores of pregnant women in Denpasar, Bali. Although there was no significant difference in iron tablet consumption or readiness for delivery and complications, the values increased to a greater extent in the treatment group than in the control group. This education model is more suited to urban pregnant women who employed and have good internet access.     

Estimation of the duration of ventricular fibrillation using ECG single feature analysis

The duration of untreated ventricular fibrillation (VF) is of paramount importance for CPR success. Moreover, therapeutic interventions taking into account the interval between cardiac arrest onset and initiation of CPR improve outcome. This study was performed to investigate whether VF feature analysis could be used to estimate the duration of VF in patients with out-of-hospital cardiac arrest. Demographic data recorded according to the Utstein guidelines and ECG recordings of 376 cardiac arrest patients from three European areas were analysed. Ten features in the time and frequency domain derived from different sub-bands of the initial VF ECG (n=127) were evaluated. The correlation between VF ECG features and cardiac arrest times was investigated using Pearson's correlation coefficient in a subset of 40 patients with reliably estimated downtimes and artefact-free initial VF tracings. No significant correlation (p<.05) between any of the VF ECG features and downtime could be found. The duration of cardiac arrest could not be estimated reliably from human VF ECG single feature analysis.     

保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者的影响观察

目的探讨保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者应对方式及美观效果的影响。 方法选取2017年3月至2019年3月长安医院收治的乳腺癌早期患者140例,根据手术方案分为研究组与对照组,各70例。研究组采取保留乳头乳晕的改良根治术联合假体置入术,对照组采取乳腺癌改良根治术。统计两组手术情况（手术时间、淋巴结清扫数目、术后引流量、住院时间）、并发症（皮下气肿、感染、皮肤坏死、皮下积液、上肢水肿）、美观效果,对比手术前后免疫功能（CD3⁺、CD4⁺、CD4⁺/CD8⁺）、应对方式。 结果研究组术后引流量少于对照组,住院时间短于对照组（t=13.584、8.423,P<0.001、<0.001）。术后1 d研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组（t=6.612、7.057、5.170,均P<0.001）。术后1个月研究组依靠自我、姑息、宿命、逃避评分低于对照组,情感宣泄、寻求支持、乐观、面对评分高于对照组（t=10.821、11.010、7.854、5.952、8.563、9.657、9.223、11.596,均P<0.001）。研究组并发症发生率（5.72%）低于对照组（20.00%）（χ²=6.375,P=0.012）,美观效果优良率（92.86%）高于对照组（81.43%）（χ²=4.080,P=0.043）。 结论保留乳头乳晕的改良根治术联合假体置入术治疗乳腺癌早期患者,可减少并发症,改善应对方式,提高美观效果,且对免疫功能影响较小。     

Prise en charge actuelle de l’hypertension artérielle

Hypertension is a common health problem with serious consequences for individuals and a heavy attributable burden for populations. Reducing this burden requires preventive actions at the population level and early diagnosis at the individual level, followed by proactive interventions with proven benefits. Given the variability of blood pressure measurement, diagnosis is established only after repeated measurements under standardized conditions, if possible outside the clinic. Lifestyle changes can modestly reduce blood pressure; their impact is significant if they can be achieved on a large scale. Hypertension treatment requires a rational pharmacological approach, which can reach the target blood pressure within less than 6 months and three pharmacological classes at most in more than 80% of cases. Specialized consultation is required in the remaining 20% to detect secondary hypertensions, to optimize drug therapy and to discuss, in a minority of cases, non-pharmacological treatments. Recommendations are written by experts who select, interpret, and extrapolate the results of clinical research. As a consequence, they are sometimes unsuitable for primary care practice and frequently inconsistent across guidelines. Efforts are currently made to produce less disputable and more usable guidelines.