N2层级护理人员护士领导力与其工作满意度相关性分析

目的:调查某三级甲等医院N2层级护理人员的护士领导力现状与其工作满意度的相关性,为护理管理者进行前瞻性护理人力资源培养和管理提供参考依据。方法:选取某三级甲等医院N2层级护理人员310名作为研究对象,采用一般资料调查问卷、护士领导力评估量表、护士工作满意度量表(MMSS)进行调查。结果:护士领导力总均分为(4.31±0.787)分,护理专业能力评分最高,自护能力评分最低;护士工作满意度总均分为(3.99±0.805)分,同事之间的关系、工作被称赞和认可、排班满意度、工作自主性/工作责任的平衡得分均高于工作满意度总均分;外部回报与护士领导力无相关性,排班、工作/家庭平衡与护士领导力呈正相关(P0.05),同事关系、专业发展机会、工作被称赞和认可、专业交流机会、控制/责任的平衡与护士领导力呈显著正相关(P0.01)。结论:某三甲医院N2层级护理人员护士领导力处于中等偏上水平,工作满意度总体得分处于中等偏上水平,且护士领导力与工作满意度有一定相关性。提示医院管理者应重视护理人员护士领导力培养,最大限度地发挥护士的能动性,提高工作满意度,降低护士离职率。     

综合性三级甲等医院急危重症护士职业韧性对职业生涯高原影响的研究

目的 :调查综合性三级甲等医院急危重症护士职业韧性和职业生涯高原的现状,并分析职业韧性对职业生涯高原的影响。方法:采用便利抽样法对南京市5家综合性三级甲等医院352名急危重症护士进行问卷调查。结果:综合性三级甲等医院急危重症护士职业韧性总均分为(3.32±0.52)分,职业生涯高原总均分为(3.24±0.75)分;职业韧性与职业生涯高原呈显著负相关(P0.01);控制人口学变量后,职业韧性可独立预测职业生涯高原的27.2%。结论 :综合性三级甲等医院急危重症护士整体处于潜高原状态,职业韧性处于中等水平;职业韧性对职业生涯高原有一定的预测性,护理管理者可通过有效措施提高急危重症护士职业韧性水平来缓解职业生涯高原现状,稳定急危重症护理队伍。     

深圳市三级甲等医院ICU护士职业高原现状及人口学影响因素分析

目的了解深圳市三级甲等医院ICU护士职业高原现状,同时分析其人口学影响因素,为制定降低ICU护士职业高原措施提供依据。方法采用自行设计的ICU护士一般人口学资料问卷及谢宝国等编制的《职业生涯高原问卷》对深圳市4所三级甲等医院205名ICU护士进行问卷调查。结果深圳市4所三级甲等医院ICU护士职业高原总体得分为(3.76±0.74)分,层级高原维度得分为(4.26±0.97)分,中心化高原维度得分为(3.97±0.94)分,内容高原维度得分为(3.22±0.99)分。多重线性回归分析显示,年龄、婚姻、职称、监护室工作年限是职业高原及其中心化高原、内容高原维度的影响因素(P0.05)。结论深圳市三级甲等医院ICU护士处于潜高原状态,在层级高原维度得分最高,内容高原维度得分最低。组织和个人在进行职业高原干预时,应充分考虑年龄、婚姻、职称、监护室工作年限影响因素,有针对性地进行干预。     

三级甲等医院护士工作环境感知与满意度相关性研究

目的调查银川市三级甲等医院护士工作环境状况,分析工作环境感知与满意度相关性,为护理管理者改善护士执业环境提供依据。方法采用问卷调查法对宁夏银川市4所三级甲等医院520名护士进行护理工作环境、满意度调查,并对结果进行分析。结果银川市三级甲等医院工作环境总得分(73.43±8.71)分,护士感知的工作环境各维度中充足的人力和物力、高质量护理服务的基础得分较高,护理管理者的能力及领导方式得分处于中等,护士参与医院事务、医护合作得分较低;工作满意度总得分为(116.05±11.33)分,其中晋升机会、管理者、工作性质均与工作环境各维度及总分显著相关。结论银川市三级甲等医院护士对工作环境的感知度处于高水平,其工作满意度整体处于一般水平;护理工作环境、高质量的护理服务基础及工作年限是护士工作满意度的重要影响因素,应通过改善护理工作环境,提高护士工作满意度水平。     

手术室专科护士工作嵌入与工作满意度现状及其相关性

目的调查手术室专科护士工作嵌入与工作满意度现状,并分析二者之间的相关性。方法选取广西130名手术室专科护士进行问卷调查,采用工作嵌入量表、工作满意度量表进行调查。结果手术室专科护士工作嵌入总均分为(3.63±0.53)分,工作满意度总均分为(3.35±0.58)分;手术室专科护士工作嵌入与工作满意度呈正相关(P0.05)。结论手术室专科护士工作嵌入和工作满意度均处于中等偏上水平,工作嵌入水平越高,其工作满意度越高。护理管理者可以通过提高手术室专科护士工作嵌入的方法,提高其工作满意度。     

手术室护士职业生涯高原、知识分享行为现状及其相关性研究

目的:调查综合性三级甲等医院手术室护士职业生涯高原和知识分享行为的现状并分析二者的相关性,分析影响护士知识分享行为的因素,为提高护士知识分享行为提供参考。方法:采用便利抽样法对北京4家综合性三级甲等医院246名手术室护士进行问卷调查。结果:综合性三级甲等医院手术室护士职业生涯高原总均分为(3.22±0.84);知识分享行为总均分为(6.07±0.83);职业生涯高原与知识分享行为呈负相关(P0.01)。其中年龄、工作年限、层级高原、内容高原、中心化高原是影响知识分享行为的因素。结论:综合性三级甲等医院手术室护士整体处于潜高原状态,知识分享行为处于较高水平;职业生涯高原对知识分享行为有一定的预测性,护理管理者可通过有效措施来改善职业生涯高原现状,提高手术室护士的知识分享行为,稳定护理的梯队建设。     

规范化培训护士职业期望对离职意愿的影响

目的:探讨规范化培训护士离职意愿现状并分析职业期望对离职意愿的影响。方法:采取便利取样方法,采用护士一般情况调查问卷、离职意愿量表、职业期望量表、职业生涯量表,对北京市某三级甲等医院接受规范化培训的151名护士进行问卷调查。结果:本组调查对象离职意愿处于中等偏上水平,总分为(2.49±0.57)分;职业期望处于中等偏上水平,评分为(3.48±0.58)分;职业生涯教育水平中等偏上为(2.21±0.39)分。层次回归分析显示,护士职业生涯教育程度的提高,会显著提高其职业发展和名誉地位满足对离职意愿的影响(P0.05,P0.01)。结论:护理管理者应重视年轻护士职业期望的满足,加强职业生涯教育,从而降低离职意愿和离职行为,稳定护理队伍。     

不同层级护士职业认同和职业获益感的差异研究

目的调查某三级甲等医院不同层级护士的职业认同及职业获益感现状及其差异。方法采用护士职业认同评价量表和护士职业获益感问卷对432名护士进行调查。结果护士的职业认同总分为(101.72±19.37)分,职业获益感总分为(111.39±18.96)分;一级护士职业认同及职业获益感总分均高于二级护士和三级护士(P0.05)。结论护士的职业认同和职业获益感处于中等水平,不同层级护士职业认同及职业获益感现状存在差异,应采取针对性的干预措施提高护士的职业获益感和职业认同水平。     

安徽省某三级甲等医院护理人员离职意愿现状及其影响因素分析

目的了解安徽省某三级甲等医院护理人员离职意愿的现状,并分析其影响因素,为人力资源管理提供科学依据。方法采用横断面整群抽样调查方法,对某三级甲等医院632名护理人员应用一般情况调查表及护士离职意愿量表、护士工作环境量表、护士工作压力量表、护士职业倦怠量表、护士工作满意度量表、护士组织承诺量表、护士职业承诺量表、社会支持评定量表进行调查。结果护理人员离职意愿总均分为(2.63±0.53)分,处于较高水平;护理人员离职意愿的影响因素包括年龄、职业倦怠、工作满意度、职业承诺及社会支持(R2=0.412,F=32.447,P=0.000)。结论护理人员离职意愿水平较高,医院管理者应统筹管理人力资源、提升护理人员工作满意度及社会支持,以降低护士的离职意愿,稳定护理队伍。     

三线城市三级甲等医院临床护士工作投入现状的调查分析

目的:了解三线城市三级甲等医院临床护士工作投入现状,分析其影响因素,为管理层提高护士工作投入提供参考.方法:采用一般资料调查表、Utrecht工作投入量表中文版,对邯郸市3所三级甲等医院437名临床护士进行横断面调查.结果:邯郸市三级甲等医院护士工作投入总条目均分为(3.44±1.27)分,3个维度条目均分按由高到低排序为活力(3.53±1.41)分、专注(3.39±1.30)分、奉献(3.38±1.45)分;其中年龄、工作时间、职称、层级、婚姻状况以及科室的护士工作投入得分比较差异有统计学意义(P<0.01或P<0.05).结论:邯郸市三级甲等医院的护士工作投入处于中等偏下水平,有很大提升空间.管理者应关注责任护士所在不同科室的工作特点,采取针对性措施提升护士工作投入水平,从而提高护理服务质量.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.