尿路造口患者自我效能感现状与生存质量相关因素的研究

目的调查尿路造口患者自我效能感与生存质量的现状,探讨两者之间的相关性,并分析尿路造口患者生存质量的影响因素。方法采用Stoma-QOL（S-QOL）量表及自设尿路造13患者自我效能感问卷,通过电话及面对面访谈对36例尿路造口患者进行调查。结果尿路造口患者S-QOL量表平均得分为（57．26±7．23）分,自我效能感问卷实际平均得分为（118．14±18．73）分;尿路造口患者S-QOL得分与自我效能感得分呈显著正相关;经多元回归分析,尿路造口患者各方面自我效能感均影响其生存质量,一般资料中影响尿路造口患者生存质量的因素有：费用支付形式、医疗诊断、手术类型。结论尿路造口患者生存质量有待提高,自我效能感处于中等水平,自我效能感对生存质量有明显影响,可以通过提高尿路造口患者的自我效能感,改善其生存质量。     

尿路造口患者自护能力现状及其影响因素分析

目的调查尿路造口患者出院后自护能力的现状并分析其影响因素,旨在为该类患者自护能力的干预性研究提供依据。方法于2019年6—9月选取门诊就诊的尿路造口患者为调查对象,采用一般资料调查表、造口自我护理量表-早期版（SSCS-ESV）、中文版造口接受度问卷、自尊量表、社会影响量表（SIS）进行调查。结果共收回有效问卷191份,有效回收率为90.95%（191/210）。自护情况:59例（30.89%）完全自己护理造口（完全自护组）,29例（15.18%）需要他人协助护理造口（协助自护组）,103例（53.93%）不是自己护理造口（非自护组）。完全自护、协助自护组造口自护得分分别为（34.71±2.12）分、（26.62±3.82）分,处于中等水平。有序Logistic回归分析显示,造口存在时间、术后开始自护时间、造口接受度、病耻感是影响患者自护情况的主要因素;多元逐步回归分析显示,造口存在时间、造口接受度、自尊水平、病耻感是影响患者出院后自护水平的主要因素。结论尿路造口患者的造口自护能力处于中等水平,以自护情况、自护水平及其影响因素作为干预的切入点,可提高患者造口的自护能力和生活质量。     

临时性回肠造口患者自我护理水平现况及其影响因素分析

目的：调查临时性回肠造口患者造口自我护理水平现况并分析其影响因素，为临床制订针对性护理措施提供参考。方法：采用方便抽样方法，应用一般资料问卷、造口患者自我护理量表对177例临时性回肠造口患者进行调查，采用多元线性回归分析造口患者自我护理水平的影响因素。结果：临时性回肠造口患者造口自我护理能力得分（36.10 ±10.54）分，回归分析结果显示：生活自理能力、婚姻状况、家庭人均月收入、年龄是临时性回肠造口患者自我护理水平的影响因素。结论：临时性回肠造口患者自我护理水平有待提高，护理人员应关注非在婚、生活自理能力低下、家庭人均收入低及高龄的临时性回肠造口患者，并给予相应的措施，改善造口患者自我护理水平。     

肠造口患者互联网诊疗服务使用意愿的影响因素研究

目的 以整合型技术接受模型和双因素模型为理论框架,探究肠造口患者互联网诊疗服务使用意愿的影响因素。方法 采用便利抽样法,选取2021年3月—9月于合肥市3所三级甲等医院就医的310例肠造口患者作为调查对象,使用一般资料调查问卷、电子健康素养量表、肠造口患者互联网诊疗服务使用意愿问卷进行调查,构建结构方程模型,并分析影响因素。结果 肠造口患者互联网诊疗服务使用意愿问卷各维度得分分别为绩效期望（4.08±0.76）分、努力期望（3.11±1.33）分、社会影响（3.66±1.02）分、促成条件（3.80±1.06）分、信任（4.06±0.58）分、抵制变化（3.07±1.29）分、使用意愿（3.37±1.31）分,电子健康素养量表得分为（2.53±1.07）分。结构方程模型分析结果表明,社会影响、努力期望、电子健康素养对使用意愿有正向影响,效应值分别为0.251、0.230、0.082;抵制变化对使用意愿有负向影响,效应值为-0.506,差异均具有统计学意义（均P<0.05）。结论 肠造口患者的互联网诊疗服务使用意愿水平处于中等偏上,其中,抵制变化、社会影响、努力期望和电子健康素养是影响肠造口患者使用意愿的关键因素。     

永久性肠造口患者智谋现状及影响因素分析

目的 了解永久性肠造口患者智谋现状及影响因素,为提高永久性肠造口患者智谋水平提供理论依据。方法 采取便利抽样,使用一般资料调査表、智谋量表（Resourcefulness Scale,RS）、社会影响量表（Social Impact Scale,SIS）,对2020年1月—2021年3月就诊于福建省某三级甲等肿瘤专科医院的260例永久性肠造口患者进行问卷调査。结果 永久性肠造口患者智谋总分为（77.02±14.27）分,其中个人智谋得分为（46.41±9.04）分,社会智谋得分为（30.61±5.79）分。多元线性回归分析结果显示,年龄、文化程度、是否参加过造口组织、有无造口并发症、社会排斥和社会隔离是永久性肠造口患者智谋水平的主要影响因素（P<0.05）,共解释永久性肠造口患者智谋变异的75.7%。结论 永久性肠造口患者智谋处于中等水平,医护人员需加强永久性肠造口患者智谋的提升,尤其是高龄、低学历、未参加过造口组织、有造口并发症的患者;社会影响对永久性肠造口患者智谋有负向影响,尤其是存在社会排斥和社会隔离的患者,以进一步提升其智谋水平,降低患者病耻感水平。     

肠造口患者出院后继续健康教育的实施和效果验证

目的 ：对出院后的肠造口患者进行继续健康教育并验证健康教育效果。方法 ：通过方便抽样选取北京市17家医院的215名行肠造口手术的患者为研究对象,在出院后第1、3、7、11、23周对患者实施基于微信小程序的健康教育干预,比较继续健康教育前后患者的肠造口自我护理知识得分及社会心理适应得分。结果 ：干预后患者肠造口自我护理知识得分为（17.77±1.81）分,高于干预前的（14.44±7.02）分,差异具有统计学意义（P<0.001）;干预后造口患者社会心理适应得分为（45.50±7.97）分,高于干预前的（40.70±7.60）分,差异具有统计学意义（P<0.001）。结论 ：基于微信小程序的肠造口患者出院后继续健康教育能够有效地提高患者肠造口自我护理知识水平并改善患者社会心理适应能力,具有良好的应用效果,值得临床推广。     

临时造口患者造口接受度现状及其与自我管理行为的关系研究

目的 了解临时造口患者的造口接受度现状,分析其影响因素及其与自我管理行为的关系。方法 采用便利抽样法,选取2022年3-11月在北京协和医院普外科行临时造口患者126例,采用一般资料调查表、造口自我管理行为问卷、中文版造口接受度问卷进行问卷调查。结果 临时造口患者中文版造口接受度问卷总分为(33.52±2.92)分,条目均分为(2.79±0.73)分,处于中等水平。单因素分析结果显示：不同年龄、文化程度、保留造口时间、主要照顾者及有无合并症对患者造口接受度有影响(P<0.05);Pearson相关性分析结果显示：造口接受度总分与自我管理行为总分及其5个维度均呈正相关(r=0.589、0.617、0.178、0.235、0.416、0.306,P<0.05);多元线性回归分析显示：文化程度、有无合并症及自我管理行为中造口护理维度是造口接受度的影响因素(P<0.01)。结论 临时造口患者回归社会后的心理状态是医护人员亟待关注的问题,其造口接受度处于中等水平,可根据影响因素构建有效干预措施提高患者造口接受度,促进自我管理行为,帮助其顺利适应造口生活。     

上海市肠造口患者自我效能现状的调查

目的了解上海市肠造口患者自我效能的现状。方法2011年12月至2012年11月,方便性抽样选择上海市某三级甲等医院、上海造口协会、造口阳光之家的153例肠造口患者采用患者一般资料问卷、造口患者自我效能量表对其进行调查。结果本组患者的自我效能得分为（66．07±20．34）分,处于中等水平。不同造口时间、是否存在并发症、每月用于造口的费用、婚姻状况、教育程度、年龄、有无宗教信仰、是否有其他疾病、造口类型、职业状态等的造口患者自我效能得分差异均无统计学意义（均P〉0．05）;不同性别及自理程度造口患者的自我效能得分差异有统计学意义（均P〈0．05）。结论应重点关注女性、自理程度低的肠造口患者的自我效能,并给予针对性干预,以提高患者生活质量。     

尿路造口患者自我效能感现状与生存质量相关因素的研究

目的 调查尿路造口患者自我效能感与生存质量的现状,探讨两者之间的相关性,并分析尿路造口患者生存质量的影响因素.方法 采用Stoma-QOL(S-QOL)量表及自设尿路造口患者自我效能感问卷,通过电话及面对面访谈对36例尿路造口患者进行调查.结果 尿路造口患者S-QOL量表平均得分为(57.26±7.23)分,自我效能感问卷实际平均得分为(118.14±18.73)分;尿路造口患者S-QOL得分与自我效能感得分呈显著正相关;经多元回归分析,尿路造口患者各方面自我效能感均影响其生存质量,一般资料中影响尿路造口患者生存质量的因素有:费用支付形式、医疗诊断、手术类型.结论 尿路造口患者生存质量有待提高,自我效能感处于中等水平,自我效能感对生存质量有明显影响,可以通过提高尿路造口患者的自我效能感,改善其生存质量.     

结直肠癌造口患者自我管理现状及影响因素分析

目的探讨结直肠癌造口患者的自我管理现状及影响因素。方法采用便利抽样法, 于2022年6—9月选取天津市某三级甲等医院造口门诊的390例结直肠癌造口患者为研究对象。采用一般资料调查表、肠造口自我管理问卷、心理韧性量表、伤残接受度量表对其进行调查。采用Pearson相关分析探讨结直肠癌造口患者自我管理、心理韧性和造口接受度的相关性。采用多重线性回归分析探讨结直肠癌造口患者自我管理的影响因素。本研究共发放问卷390份, 回收有效问卷386份, 有效回收率为98.97%(386/390)。结果结直肠癌造口患者的自我管理得分为(99.07±12.40)分, 心理韧性得分为(69.43±9.76)分, 造口接受度得分为(82.00±10.56)分。Pearson相关分析结果显示, 结直肠癌造口患者自我管理得分与心理韧性、造口接受度得分呈正相关(r值分别为0.640、0.727, P<0.01)。多重线性回归结果显示, 年龄、造口术后时间、TNM分期、术后放化疗情况、心理韧性和造口接受度是结直肠癌造口患者自我管理的影响因素(P<0.05)。结论结直肠癌造口患者的自我管理水平处于中等水平,...     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."