实验室检验失血与医源性贫血——ICU的潜在危机

所有的住院患者均需采血进行实验室检测,而ICU中的危重患者则更为频繁.有很多原因促使医生开立检验单,以明确疾病的诊断和治疗,但由此而产生的失血却往往易被忽视.病情的危重程度和器官功能障碍程度是检验失血量的主要影响因素,但同时采血技术、检验分析仪性能以及医生开立检验单的目标和规范性等欠佳会增加血液标本的浪费.积极地进行规范的医疗管理和实验室仪器设备的改进等,在满足患者病情治疗需要的前提下尽量降低检验性失血,需要全社会的努力.     

ICU的形成与发展

危重病医学从简单的监测与护理到当今发展成为较系统的危重病医学理论、一系列先进的监测手段和救治技术,经过了半个多世纪几代人的努力。ICU的建立和发展是现代医学进步的显著标志之一。危重病医学的贡献在于,在积极治疗原发病的基础上,通过先进的生命支持手段,使许多过去认为已无法救治的危重患者得以存活或延长其生存时间。从ICU的形成、危重病医学学科建设、我国ICU队伍的建设到现阶段ICU的发展过程作简要阐述,并着重指出今后ICU发展中面临的任务与挑战,如ICU收治标准、住院费用、病人安全性,旨在促进我国乃至世界范围内ICU可持续健康的发展。     

ICU的形成与发展

危重病医学从简单的监测与护理到当今发展成为较系统的危重病医学理论、一系列先进的监测手段和救治技术,经过了半个多世纪几代人的努力.ICU的建立和发展是现代医学进步的显著标志之一.危重病医学的贡献在于,在积极治疗原发病的基础上,通过先进的生命支持手段,使许多过去认为已无法救治的危重患者得以存活或延长其生存时间.从ICU的形成、危重病医学学科建设、我国ICU队伍的建设到现阶段ICU的发展过程作简要阐述,并着重指出今后ICU发展中面临的任务与挑战,如ICU收治标准、住院费用、病人安全性,旨在促进我国乃至世界范围内ICU可持续健康的发展.     

如何降低ICU费用——规范ICU的建设和管理

ICU收费高的主要症结在于ICU的建设和管理需要规范化,包括在中国制定ICU的收治和转出指征规范,减少过度医疗和延迟医疗;积极配备ICU人力资源,提高监护质量,培训ICU专业医师上岗,掌握并运用专业知识施救,保证治疗的恰当性。允许恰当的家属陪护,对患者给予情感支持,或可降低镇静药物等的使用,缩短住院日;对于脑死亡、植物状态以及癌症晚期或其他晚期疾病的临终患者,提倡放弃治疗,避免无益救治造成卫生资源的浪费,对家属造成巨大的精神压力和经济负担。但是医生主动放弃治疗的决定尚需要政策的支持和法律的保障。     

再生障碍性贫血发病机制认识的发展与启示

再生障碍性贫血的发病机制已经突破了“种子”、“土壤”、“虫子”学说,并沿着“免疫异常”理论进入“自身免疫病”理论。同时这是一个科学思维付诸实践不断探索的过程。大量证据表明再生障碍性贫血是一种自身免疫病,它应该符合自身免疫病的共性,这一认识开阔了人们的视野,使人们能在更高的层面上考察原来的事物。     

再生障碍性贫血发病机制认识的发展与启示

再生障碍性贫血的发病机制已经突破了"种子"、"土壤"、"虫子"学说,并沿着"免疫异常"理论进入"自身免疫病"理论.同时这是一个科学思维付诸实践不断探索的过程.大量证据表明再生障碍性贫血是一种自身免疫病,它应该符合自身免疫病的共性,这一认识开阔了人们的视野,使人们能在更高的层面上考察原来的事物.     

平均数差异显著性检验统计检验力和效果大小的估计原理与方法

该文以平均数差异显著性检验为例,对实验数据进行假设检验后,继续对其统计检验力和效果大小进行估计的基本原理和方法作一介绍。     

等效性检验——结构方程模型评价和测量不变性分析的新视角

常用的结构方程模型拟合指数存在一定局限, 如χ ²以传统零假设为目标假设, 无法验证模型, 而RMSEA和CFI等描述性的拟合指数不具备推断统计性质, 等效性检验有效弥补了这些问题。首先说明等效性检验如何评价单个模型的拟合, 并解释其与零假设检验的不同, 然后介绍等效性检验如何分析测量不变性, 接着用实证数据展示了等效性检验在单个模型评价和测量不变性检验中的效果, 并与传统模型评价方法比较。     

差数显著性t检验与元分析方法的模拟对比

利用计算机程序构造被试总体、模拟实验研究程序进行抽样研究 ,探讨差数显著性t检验方法与元分析方法在检验实验结果数据和进行实际应用方面的差异。模拟实验结果表明 ,差数显著性t检验与总体效果大小和样本容量有明显关系 ,但与随机抽样分布样本数目基本无关 ;抽样分布样本效果大小的平均值可以作为总体效果大小的估计值 ,它与样本容量和抽样样本数目有密切关系 ;本研究提供的实际应用数据结果可以作为研究者进行元分析方法实验研究的参考依据     

差数显著性t检验与元分析的对比研究

利用计算机构造被试总体、模拟实验研究程序进行抽样研究,探讨显著性ｔ检验方法与元分析方法在检验实验结果数据方面的差异。在模拟实验过程中,ｔ验受到显著性水平、样本容量和总体效果大小的影响,因此最终影响了统计推断的可靠性,建议：在进行显著性检验过程中,应对统计检验能力进行估计;元分析方法以样本为元素对总体进行推断,因此具有很高的准确性和可靠性,它将很有可能成为今后心理学研究的重要统计工具。     

人文关怀：ICU不容忽视的问题

ICU挽救了大量重症患者的生命,但也让很多患者留下了痛苦的回忆,ICU内人文关怀的缺失是发生这种现象的重要原因。疾病及医疗护理行为、ICU的环境、失眠、生命尊严与求生欲望之间的矛盾都使患者产生痛苦,由此提出要从制度层面完善学科设置,明确学科定位,加强专科人才培养,合理配置人力资源,完善管理政策,技术层面要对患者进行有效的镇静、镇痛治疗,重视患者诉求,减少有创操作,开展ICU床旁早期活动和康复治疗,从心理层面建立友好的ICU环境,注重医护患沟通,从多角度实施临终关怀,帮助患者减少痛苦。     

The Impact of Resource Loss and Critical Incidents on Psychological Functioning in Fire-Emergency Workers: A Pilot Study

The relationship between critical incident exposure and resource loss, as conceptualized by Conservation of Resources (COR) theory, in predicting later psychological outcome (e.g., depressive symptoms, anger expression, and state anger) was examined in a sample of 150 fire-emergency workers from a Fire Department in a mid-sized, midwestern city. Additionally, a measure of critical incidents (Critical Incidents Inventory) was developed, and preliminary data on its validity are presented. Results from multiple regression analyses indicated that fire-emergency workers' exposure to critical incidents was directly related to their report of depressive symptoms, outward expression of anger, and state anger. Additionally, results indicated that fire-emergency workers' resource loss was strongly related to their psychological outcome. Results also suggest that resource loss may mediate the impact of critical incident stress exposure on depressive symptoms and the outward expression of anger. These results offer support to applying COR theory to populations under extreme stress.     

利奈唑胺治疗ICU革兰阳性球菌感染的疗效及安全性观察

为了评估利奈唑胺治疗ICU革兰阳性球菌感染的疗效与安全性,回顾性分析了我院中心ICU接受利奈唑胺治疗的28例革兰阳性球菌感染患者的临床资料。结果显示治疗的总有效率为75％（21／28）,耐甲氧西林金黄色葡萄球菌感染患者有效率73．33％（11／15）,表皮葡萄球菌感染患者有效率66．67％（4／6）,屎肠球菌感染患者有效率80％（4／5）,溶血葡萄球菌感染患者有效率100％（2／2）,人葡萄球菌感染患者有效率100％（2／2）。治疗过程中不良反应发生率为25％。不良反应经对症处理后好转,无需停药。故得出结论,利奈唑胺是治疗革兰阳性球菌感染有效、安全的药物,值得进一步临床验证。     

Memoirs of a Mentor: Using Creativity for Counselors in Coping With the Loss of a Mentor

This article was inspired by my (S.S.) own personal loss. My mentor passed away during spring break of my 2nd year postgraduate school after a short battle with systemic lupus. I remember the deep sadness that I felt when it became apparent that she was coming home from the hospital for the last time. No words can describe the emotions; she had helped me through the toughest times in my academic life. How would I ever get the type of mentorship she provided again? She was there when I almost quit as a young student, back when my anger still got the best of me. She talked me down from the edge so many times; I never expected to be on this journey without her.

I dedicate this article to her and mentors like her. Equally, I dedicate this article to mentees who have lost their mentors. I offer my story (in italicized font) in the hopes that it will help others who are dealing with a similar loss. In this article, we attempt to illuminate the true power of mentorship, honor the significance of the relationship between mentor and mentee, and provide a tool useful to anyone who has lost their guide. I share my story in gratitude for my own mentor; I am so thankful that she was a part of my journey and that I can pass on to others the patience she had with me.     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

Loss aversion in the eye and in the heart: The autonomic nervous system's responses to losses

The common view in psychology and neuroscience is that losses loom larger than gains, leading to a negativity bias in behavioral responses and Autonomic Nervous System (ANS) activation. However, evidence has accumulated that in decisions under risk and uncertainty individuals often impart similar weights to negative and positive outcomes. We examine the role of the ANS in decisions under uncertainty, and its consistency with the behavioral responses. In three studies, we show that losses lead to heightened autonomic responses, compared to equivalent gains (as indicated by pupil dilation and increased heart rate) even in situations where the average decision maker exhibits no loss aversion. Moreover, in the studied tasks autonomic responses were not associated with risk taking propensities. These results are interpreted by the hypothesis that losses signal the subjective importance of global outcome patterns. Copyright © 2010 John Wiley & Sons, Ltd.     

Reconstructing the Loss: Bereaved Parents in Personal Commemorative Films

The aim of this study was to find answers to the question of how Israeli parents who have lost their child in battle or in a terror attack reconstruct their life story, as revealed in personal commemorative films. Twenty personal documentary commemorative films were systematically and thematically analyzed. Through exposing the themes of last shared experience, death event, and notification of death, the research sheds light on the self-healing process that enables parents to build a bridge in their narrative. The commemorative films provide a framework for reconstruction work adding to the new body of research in the field of video and cinema therapy.     

对高血压诊治的现象与本质的关系反思——聚焦血压变化与心脑肾血液灌注量的关系

高血压和低血压都存在急性状态和慢性状态,在急性状态,高血压表现为血流高灌注,低血压表现为血流低灌注;而在慢性状态,高血压和低血压则表现出共同的特点——血流低灌注。血压数值只是个表面现象,重要的是透过血压数值的变化去探究血压变化背后的病理生理改变,尤其是血压变化与重要脏器血液灌注量多少的关系,治疗的最终目的是维持人体脏腑器官一定的血流量,而不是仅仅满足于发现并治疗患者所表现出来的血压数值。