注意缺陷多动障碍儿童事件相关电位病例对照研究

目的探讨注意缺陷多动障碍(ADHD)儿童在事件相关电位(ERP)P300检测中的表现特点,为儿童注意缺陷多动障碍的防治提供依据.方法收集符合美国精神障碍诊断与统计手册第4版诊断标准的ADHD儿童37例,精神发育迟滞(MR)儿童24例和品行障碍(CD)儿童22例,正常儿童对照组(NC)30例,并以ADHD为主,与MR和CD进行比较.使用Nicolet Spirit脑电生理仪,以及"听觉靶一非靶刺激序列"为诱发事件,完成P300检测.结果ADHD组、MR组及CD组主成分靶波幅P3变化表现为同一趋势,即潜伏期延迟,波幅降低;在靶潜伏期N2上,ADHD和MR均延迟于NC组和CD组;在靶波幅P3上,ADHD和MR均低于CD组;在非靶波幅P3上MR组又低于ADHD组和CD组.结论ADHD患儿的P3潜伏期和波幅变化反映了ADHD注意力过程缺陷;P300客观反映ADHD,MR和CD认知功能障碍,可以作为ADHD和MR辅助诊断的一个脑电生理学指标.     

夜班对ICU护士心理健康影响及分析

目的分析夜班对ICU护士心理健康的影响，探索促进ICU夜班护士心理健康的有效措施。方法选择我院ICU夜班护士40名作为观察组，正常作息ICU护士22名作为对照组。采用症状自评量表SCL-90对其心理状况进行测评。结果观察组躯体化、强迫、抑郁、人际关系、焦虑、敌对、偏执因子等与对照组比较有显著性差异，差异有统计学意义（P〈0．05）。结论夜班对ICU护士的心理健康有一定的影响。     

夜班对ICU护士心理健康影响及分析

目的分析夜班对ICU护士心理健康的影响,探索促进ICU夜班护士心理健康的有效措施。方法选择我院ICU夜班护士40名作为观察组,正常作息ICU护士22名作为对照组。采用症状自评量表SCL-90对其心理状况进行测评。结果观察组躯体化、强迫、抑郁、人际关系、焦虑、敌对、偏执因子等与对照组比较有显著性差异,差异有统计学意义(P0.05)。结论夜班对ICU护士的心理健康有一定的影响。     

注意缺陷多动障碍儿童事件相关电位的对照研究

【目的】探讨事件相关电位(event related potential,ERP)在儿童注意缺陷多动障碍(attention deficit hy-peractivity disorder,ADHD)诊断中的应用。【方法】应用意大利Amplaid MK-15诱发电位系统,采用听觉Oddball刺激序列测定ADHD儿童与正常儿童P300潜伏期和波幅变化。【结果】病例组靶刺激P300潜伏期为(428.27±19.22)ms,对照组为(341.83±17.72)ms,两组差异有统计学意义(P0.05);病例组靶刺激P300波幅为(12.89±6.10)μV,对照组为(11.75±6.76)μV,两组差异有统计学意义(P0.05);病例组综合反应控制商数和综合注意力商数分别为73.27±13.99和67.93±15.93,对照组分别为104.83±16.11和102.00±15.39,两组差异有非常统计学意义(P0.01);事件相关电位P300潜伏期与综合反应控制商数之间无显著性意义(r=-0.3677,P0.05),但与综合注意力商数之间呈负相关,且具有显著性意义(r=-0.4347,P0.05)。【结论】事件相关电位P300潜伏期测定可协助儿童ADHD的临床诊断。     

事件相关电位在注意缺陷多动障碍儿童综合干预中的应用

目的探讨事件相关电位(ERPs)在注意缺陷多动障碍(ADHD)儿童综合干预中的应用。方法31名ADHD儿童于综合干预6个月前后行ERPsP300测定及Conners量表评估,观察干预前后的变化;比较ADHD儿童P300与36名正常儿童(对照组)的差异。结果干预前ADHD组P300较对照组潜伏期延长,波幅下降(P<0.05)。干预后ADHD组P300较干预前潜伏期缩短,波幅增高;Conners量表分较干预前降低(P<0.01)。ADHD组P300潜伏期与Conners量表分之间成正相关关系(r=0.32,P<0.05)。结论ERPsP300与适当的神经心理学测验联合使用,可为ADHD儿童的严重程度、综合干预效果的动态观察提供客观、灵敏的电生理学指标。     

改善 ICU夜班护士睡眠质量的干预研究

目的了解ICU夜班护士睡眠质量状况,实施睡眠干预措施,改善ICU夜班护士睡眠质量。方法采用匹兹堡睡眠质量指数（PSQI）量表对20名ICU夜班护士进行实施睡眠干预措施前后的调查并与国内常模进行比较。结果20名ICU夜班护士PSQI平均得分显著高于正常人,且有55％的护士存在睡眠障碍;在干预后,ICU夜班护士的睡眠质量得分低于干预前,具有统计学意义（P〈0．05）。结论ICU夜班护士存在睡眠质量问题,可通过营造良好睡眠环境、合理安排夜班班次以及食物及药物等多种干预措施,来减轻或降低睡眠障碍,提高睡眠质量。     

度洛西汀与氟西汀对首发抑郁症患者P300电位干预效果的比较

目的 比较度洛西汀与氟西汀对首发抑郁症患者疗效及认知功能的影响.方法 首发抑郁症患者74例随机分为度洛西汀组与氟西汀组,对两组在治疗前、治疗12周后进行P300及汉密尔顿抑郁量表的评定.与研究组性别、年龄匹配的正常人作对照,比较P300的变化.结果 与对照组相比,度洛西汀组与氟西汀组P300的P2、N2、P3潜伏期及反应时间明显延长,而P300的P2、N2、P3波幅降低,具有统计学差异;治疗后,度洛西汀组与氟西汀组P300的P2、N2、P3潜伏期及反应时间较治疗前减少且波幅升高,具有统计学差异;度洛西汀组与氟西汀组,P300指标的组间比较,无统计学差异.12周末,疗效比较无差异.治疗前后的P300潜伏期、波幅及反应时间均与其治疗前后HAMD评分无显著性相关性.结论 度洛西汀与氟西汀均能有效治疗首发抑郁患者,且具有改善其认知功能作用.     

学习障碍儿童的事件相关脑电位研究

[目的]探索学习障碍(learning disabilities,LD)儿童的事件相关脑电位(P300)的特点,为临床诊治提供依据.[方法]采用修订版儿童学习障碍筛查量表(PRS)结合韦氏智测量表得分及学习成绩入组LD儿童38例,正常对照组26例.对所有对象进行儿童韦氏量表、P300测试;对LD患儿进行相应学习能力训练治疗并随访其P300.[结果]①LD组与对照组比较:靶P2、N2、P3潜伏期延长,差异有显著性(P＜0.05),P3波幅下降差异有显著性(P＜0.05),②LD组训练前后比较:P300各潜伏期均有显著性缩短(P＜0.01);P3波幅改变差异无显著性.[结论]LD儿童P300潜伏期延长,波幅低,存在脑认知功能缺陷,事件相关脑电位P300可作为临床评价LD患儿听觉认知功能的脑电生理指标.     

注意缺陷多动儿童不同注意状态下事件相关电位的比较研究

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童和正常儿童在主动和被动注意状态下,事件相关电位N1、P2、N2、P3各波的异同.方法采用病例对照方法,对30例ADHD儿童和30例正常儿童,分别在被动和主动注意状态下进行经典的听觉Oddball模式事件相关电位研究.结果①在不同注意状态下,ADHD组靶刺激N2、P3潜伏期显著长于对照组(P＜0.05);波幅差异无显著意义.②两组儿童随注意程度的增加P3波幅也显著升高,但ADHD组Fz点波幅变化不显著.③两次测试的波幅增幅比较,两组儿童间差异无显著意义.④ADHD组的计数成绩显著低于对照组.结论 ADHD儿童存在一定的认知功能损害.     

糖尿病患者事件相关电位P300的变化及相关因素研究

目的探讨2型糖尿病患者事件相关电位P300的改变及其相关危险因素,并评价P300在糖尿病脑病中的诊断价值。方法对50例2型糖尿病患者和30例健康对照者进行事件相关电位P300检测,并分析P300波的潜伏期及波幅与糖尿病的病程、血脂及血压的关系。结果(1)糖尿病患者P300的潜伏期较对照组明显延长(P<0.01);且P300的波幅较对照组明显降低(P<0.05)。(2)糖尿病合并高血压组P300的潜伏期较对照组和糖尿病无高血压合并症组明显延长(P<0.01)。(3)随糖尿病病程的延长P300的潜伏期逐渐延长。(4)P300的潜伏期与糖尿病患者的血脂水平呈正相关。结论糖尿病患者存在明显认知功能障碍,事件相关电位P300可作为一项较客观、有价值的评价糖尿病患者认知功能的指标,并有助于糖尿病慢性脑病的早期诊断。     

Nightshift work and risk of breast cancer and other cancers--a critical review of the epidemiologic evidence

OBJECTIVES: This systematic review concerns the role of nightshift work in the risk of breast cancer or other cancers. METHODS: Studies that specifically included information on nightshift or shift work and reported cancer occurrence were focused upon. A systematic search of Medline and the Science Citation Index was conducted until May 2007. The quality of each paper was discussed with respect to design, exposure and outcome information, bias, confounding, and exposure-response assessment. RESULTS: Thirteen relevant reports were found, and eight reported the relative risk for breast cancer, three for prostate cancer, three for colon cancer, and four for all cancers. Most of the studies had crude information about nightshift work, four register-linked studies had no individual exposure information but relied on exposure probabilities assessed on a group level, and no studies analyzed cancer risk according to the cumulative number of night shifts (however, most of the studies did so according to the number of years of nightshift work). Confounding did not seem to be of major concern. The presentation of the results was not always complete, and it would have been appreciated if the reasons for leaving some findings out had been reported. There were indications of a long-term effect of nightshift work (more than 20-30 years), but the number of positive studies was small. In addition, they were all conducted among nurses, and the risk estimates were only moderately increased. This situation makes the results sensitive to bias, chance, and confounding. CONCLUSIONS: There is limited evidence for a causal association between nightshift work and breast cancer, while there is insufficient evidence for prostate cancer, colon cancer, and overall cancer.     

呼吸机集束化策略预防神经外科术后患者呼吸机相关性肺炎的效果观察

目的:探讨呼吸机集束化策略预防神经外科术后患者呼吸机相关性肺炎的临床效果。方法:研究对象为本院2018年9月~2019年9月72例神经外科手术后机械通气时间超过48h的患者,所有患者均开展气管插管呼吸机辅助呼吸。应用SPSS20.0软件将其分为研究组和对照组,分别给予呼吸机集束化策略和常规策略,对比两组患者的呼吸机相关性肺炎发生率、再插管发生率、机械通气时间和ICU住院时间。结果:研究组和对照组患者呼吸机相关性肺炎发生率分别为11.11%(4例)和27.78%(10例),组间差异显著(P<0.05);研究组和对照组患者再插管发生率分别为5.56%(2例)和8.33%(3例),组间差异不显著(P>0.05);研究组机械通气时间和ICU住院时间分别为(14.94±3.44)h和(10.42±3.02)h,均显著短于对照组患者的(18.57±3.78)h和(16.90±3.60)h(P<0.05)。结论:对神经外科术后患者应用呼吸机集束化策略可以有效降低呼吸机相关性肺炎的发生率,缩短患者的机械通气时间和ICU住院时间。     

呼吸机集束化策略预防神经外科术后患者呼吸机相关性肺炎的效果观察

目的:探讨呼吸机集束化策略预防神经外科术后患者呼吸机相关性肺炎的临床效果。方法:研究对象为本院2018年9月~2019年9月72例神经外科手术后机械通气时间超过48h的患者,所有患者均开展气管插管呼吸机辅助呼吸。应用SPSS20.0软件将其分为研究组和对照组,分别给予呼吸机集束化策略和常规策略,对比两组患者的呼吸机相关性肺炎发生率、再插管发生率、机械通气时间和ICU住院时间。结果:研究组和对照组患者呼吸机相关性肺炎发生率分别为11.11%(4例)和27.78%(10例),组间差异显著(P<0.05);研究组和对照组患者再插管发生率分别为5.56%(2例)和8.33%(3例),组间差异不显著(P>0.05);研究组机械通气时间和ICU住院时间分别为(14.94±3.44)h和(10.42±3.02)h,均显著短于对照组患者的(18.57±3.78)h和(16.90±3.60)h(P<0.05)。结论:对神经外科术后患者应用呼吸机集束化策略可以有效降低呼吸机相关性肺炎的发生率,缩短患者的机械通气时间和ICU住院时间。     

Subjective and objective evaluation of sleep and performance in daytime versus nighttime sleep in extended-hours shift-workers at an underground mine

Extended hours of shift work has the potential for adverse consequences for workers, particularly during the nightshift, such as poorer sleep quality during the day, increased worker fatigue, and fatigue-related accidents and decreased work performance. This study examined subjective and objective measurements of sleep and performance in a group of underground miners before and after the change from a backward-rotating 8-hour to a forward-rotating 10-hour shift schedule. The purpose of this study was to evaluate the short- and long-term impact of a shift schedule change on sleep and performance. The results demonstrated improved subjective and objective measures of sleep and performance on the new 10-hour nightshift schedule. The 10-hour nightshift workers subjectively reported more refreshing sleep, fewer performance impairments and driving difficulties than 8-hour nightshift workers. The results of the objective measures of sleep and performance on the 10-hour nightshifts were overall similar or possibly better than those measured on the 10-hour dayshifts. These are some of the first data to suggest that a nightshift that does not encompass the entire night period could have significant benefits to shift-workers. We suggest that these benefits are mostly the result of the timing of the new nightshift start and end times rather than other shift-schedule factors.     

Applying critical pathways to neurosurgery patients at the University of Michigan Medical Center

Project Overview: In April 1990, The University of Michigan Hospitals began a major, multidisciplinary project to standardize care processes in order to increase efficiency and reduce costs while maintaining the quality of clinical care. A team of nurses began the project by developing critical pathways for two neurosurgery procedures--lumbar laminectomy and transphenoidal pituitary tumor resection. The pathways were reviewed by physicians and other staff from other disciplines and were implemented in January of 1991. Key Findings: Data from the first 14 months show a decrease in patients' average lengths of stay in both the intensive care unit (ICU) and routine care unit. Costs and variance data are being analyzed and further improvements to the pathways are being made. Eleven critical paths are now being used for neurosurgery patients. In retrospect, participants learned that physicians should be involved at the earliest stages of critical pathway development and in the process of implementation.     

临床路径教学法在ICU新进护士前3个月护理带教中的应用效果观察

目的探讨在ICU新进护士的前3个月护理带教中,采取临床路径教学法的效果。方法选取该院2016年1月—2018年1月ICU新进的60名护士为研究对象,将护士分成两组,即研究组与对照组,每组30名,对照组采取一对一的护理带教模式,研究组则采取临床路径教学法的护理带教模式,观察两组带教效果。结果护理带教后,研究组护士在理论与操作考核成绩上均要显著高于对照组(P<0.05);研究组新进护士对临床实践能力、应急能力、工作能力及学习兴趣的认可率均显著高于对照组(P<0.05)。结论针对ICU新进护士,在前3个月的护理带教中,实施临床路径教学法的带教模式,可显著提高护士理论与操作能力,且护士对护理带教模式的认可度也高。     

ICU护士工作压力现状及其影响因素

目的了解ICU护士工作压力现状及其影响因素,为减轻ICU护士工作压力提供科学依据。方法 2013年10月,对唐山市工人医院13个重症监护室的204名护士进行问卷调查。结果护士工作轻度压力41人,占20.1%;中度压力144人,占70.6%;重度压力19人,占9.3%。多元回归分析发现,ICU护士工作压力受医院待遇满意度、对工作环境满意度、社会支持和患者病情的影响（P〈0.05）。结论 ICU护士工作压力呈中度水平,应引起高度重视。     

ICU专科护士资格再认证意愿的质性研究

目的 了解ICU专科护士对资格再认证的认知、意愿,并提出相关建议,为制定科学、合理的ICU专科护士资格再认证制度提供理论依据.方法 通过质性研究的现象学研究方法,对新疆维吾尔自治区乌鲁木齐市某三甲医院的12名ICU专科护士进行深入访谈.结果 经过对ICU护士访谈资料的整理归纳,得出5个主题:ICU专科护士对资格再认证存在误区;资格再认证可以提高自身素质、利于职业发展、脱离繁重临床工作;家庭因素、经济影响、医院对专科护士的管理欠妥、再认证的方式等影响ICU专科护士资格再认证的意愿;ICU专科护士在医患沟通和科研方面有强烈培训意愿;希望增加亲自实践的机会.结论 应增强ICU专科护士对资格再认证的认知,注重其成长需求,制定资格再认证方式时突破传统考核方式,尽快完善ICU专科护士资格再认证培养模式.     

Emergence of resistant staphylococci on the hands of new graduate nurses.

OBJECTIVE: To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time. DESIGN: A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period. SETTING: A 50-bed, level III-IV neonatal ICU in New York City. PARTICIPANTS: Twelve experienced nurses and 9 new graduate nurses working full time in the NICU. INTERVENTION: One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis. RESULTS: At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus. CONCLUSIONS: Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.