围术期综合护理在膝关节周围骨肉瘤人工假体置换术患者中的应用

目的:探讨围术期综合护理在膝关节周围骨肉瘤行人工假体置换术患者中的应用效果。方法:将50例膝关节周围骨肉瘤行人工假体置换术患者随机分为对照组和观察组各25例,对照组实施基础护理,观察组实施围术期综合护理,比较两组护理效果。结果:两组Enneking骨骼肌肉肿瘤下肢评分量表(MSTS)评分、术后并发症发生率及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数量表(PSQI)评分比较差异均有统计学意义(P0.05)。结论:对膝关节周围骨肉瘤行人工假体置换术患者实施围术期综合护理,有利于患者肢体功能康复,降低并发症发生率,改善其心理状态,提高睡眠质量。     

全髋关节置换术后股骨假体周围骨折患者的围术期护理干预

目的探讨护理干预在全髋关节置换术后股骨假体周围骨折患者围术期的应用效果。方法选取人工全髋关节置换术后股骨假体周围骨折患者38例,随机分为观察组20例与对照组18例。对照组采用围术期常规护理,观察组采用围术期综合护理干预,比较2组患者护理后Harris髋关节功能评分、疼痛(VAS)评分及并发症发生率。结果护理后,观察组患者Harris评分和VAS评分均优于对照组,并发症发生率低于对照组,差异有统计学意义(P0.05)。结论对人工髋关节置换术后股骨假体周围骨折患者实施围术期综合护理干预,可有效减轻患者疼痛,改善髋关节功能,降低术后并发症发生率,护理效果良好。     

案例需求的导向护理模式预防髋关节置换术老年患者假体脱位的临床效果

目的探讨案例需求的导向护理模式对预防髋关节置换术老年患者假体脱位的效果。方法选取2019年9月至2020年9月医院接受髋关节置换术治疗的老年患者120例,按照组间基本特征相匹配的原则分为观察组65例与对照组55例。对照组患者接受常规护理干预,观察组患者接受基于案例需求的导向护理干预,比较两组患者的假体脱位率、深静脉血栓发生率和Barthel评分、Harris评分。结果观察组患者干预后假体脱位率、深静脉血栓发生率明显低于对照组(P <0.05);观察组患者Barthel评分、Harris评分明显优于对照组(P <0.05)。结论给予髋关节置换术老年患者案例需求的导向护理干预,可有效降低患者术后出现假体脱位的几率,提高患者的肢体功能恢复效果。     

护理干预对髋关节置换术患者心理状态及术后并发症的影响

目的探讨护理干预对髋关节置换术患者心理状态及术后并发症的影响。方法选取78例髋关节置换术患者,根据随机数字法分为对照组(常规护理)和观察组(护理干预),各39例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估2组患者护理前后心理状态,并比较2组髋关节功能、术后并发症以及生活质量、满意度。结果观察组护理后SAS及SDS评分均显著低于对照组(P0.05);观察组术后Harris髋关节功能评分、生活质量评分均显著高于对照组(P0.05);观察组并发症发生率显著低于对照组,且护理服务满意度显著高于对照组(P0.05)。结论护理干预能够明显改善髋关节置换术患者的负面情绪,降低术后并发症发生率,提升患者术后生活质量。     

目标策略的针对性护理在骨肉瘤护理中的效果

目的探讨目标策略的针对性护理在骨肉瘤护理中的效果。方法选取2020年4月至2022年4月于海军军医大学第二附属医院接受治疗的骨肉瘤患者70例, 根据随机数字法分为对照组和观察组, 各35例。对照组实施常规护理干预, 观察组实施目标策略的针对性护理。对比两组患者的并发症发生率, 并使用保肢评分量表(Musculo Skeletal Tumor Society, MSTS)和数字评价量表(Numerical Rating Scale, NRS), 分别测评两组患者肢体功能及疼痛情况。结果入院当日, 两组各项临床指标比较差异无统计学意义(P>0.05);出院前1 d, 观察组并发症发生率及NRS量表评分均低于对照组, 且对照组MSTS量表评分低于观察组, 差异均有统计学意义(P<0.05)。结论实施目标策略的针对性护理能够降低骨肉瘤患者并发症的发生, 改善其肢体能力。     

围术期护理干预在人工髋关节置换术中的应用效果

目的探讨围术期护理在人工髋关节置换术中的应用效果。方法选取2013年2月-2016年2月在本院行人工髋关节置换术的234例患者,随机分为两组,观察组116例,对照组118例。对照组实施常规护理干预,观察组实施围术期护理干预,比较两组患者的治疗效果及并发症发生率。结果观察组患者并发症发生率明显低于对照组,差异有统计学意义(P0.05)。观察组患者经过治疗和护理后,优良率为100%,对照组优良率为88.6%,两组治疗结果比较差异有统计学意义(P0.05)。结论人工全髋关节置换术患者的围术期护理干预可以减少术后并发症,提高治疗效果,提高手术成功率。     

58例骨肉瘤行特制人工膝关节假体置换术患者的护理

目的 探讨促进骨肉瘤特制人工膝关节假体置换术患者患肢功能恢复和机体康复的有效护理措施.方法 总结58例骨肉瘤特制人工膝关节假体置换术后的护理经验,密切观察病情变化,加强饮食与疼痛的护理,根据特制人工膝关节置换术护理要点,择期开始功能锻炼,做好出院指导.结果 术后2周伤口拆线,切口均Ⅰ期愈合,4周观察膝关节伸屈活动度5 ～ 100°,其中4例屈膝达不到90°,无术后并发症发生.结论 精心护理骨肉瘤行特制人工膝关节假体置换术患者,有效减少了并发症的发生,促进了功能恢复和机体康复.     

家属协同康复护理对人工半髋关节置换术后患者康复效果的影响

目的探讨家属协同康复护理对人工半髋关节置换术后患者康复效果的影响。方法选择2017年8月—2019年8月于医院行人工半髋关节置换术的88例患者为研究对象,按照性别、年龄、疾病类型匹配的原则分为对照组和观察组,每组44例。对照组实施常规护理干预,观察组采取家属协同康复护理。干预前、干预6个月后比较两组患者Harris髋关节功能评分(HHS)和心理状态[焦虑自评量表(SAS)和抑郁自评量表(SDS)]及并发症发生情况。结果两组患者干预前HSS评分、SAS评分、SDS评分比较,差异无统计学意义(P>0.05);干预6个月后,观察组患者HHS评分高于对照组,SAS评分、SDS评分均低于对照组,差异具有统计学意义(P<0.05);观察组患者并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论人工半髋关节置换术后患者实施家属协同康复护理,可有效减轻其负面情绪、减少术后并发症发生,利于促进髋关节功能恢复。     

预见性护理干预对脑出血手术患者神经功能及肢体功能的影响分析

目的 探讨预见性护理对脑出血手术患者神经功能、肢体功能的影响。方法 选取2020年10月至2022年10月我院收治的90例脑出血手术患者，随机分为对照组和观察组，各45例。对照组进行常规护理，观察组45例进行预见性护理，比较两组干预前后神经功能、肢体功能、日常生活能力，选取两组术后并发症。结果 干预后，观察组美国国立卫生研究院卒中量表（NIHSS）评分显著低于对照组，上肢、下肢运动功能评定量表（FMA）评分及Barthel指数（BI）评分显著高于对照组，差异有统计学意义（P<0.05）。观察组并发症总发生率为4.44%，低于对照组的20.00%，差异有统计学意义（P<0.05）。结论 对脑出血手术患者进行预见性护理可显著改善其神经功能、肢体功能，提高日常生活能力，有助于减少术后并发症的发生。     

人工髋关节置换术后假体松动原因分析及围术期护理干预

目的:探讨人工髋关节置换术后假体松动的原因,总结围术期护理干预的方法。方法:选取2006年1月~2012年1月人工髋关节置换术后发生假体松动患者45例,针对发生的原因进行相关分析,采取心理护理、疼痛管理、肢体康复锻炼、生活指导及并发症防治等护理干预方法。结果:45例患者中44例按照指定的康复治疗和训练方法进行功能锻炼,髋关节术后功能恢复良好,无脱位、感染发生,仅1例患者出现下肢深静脉血栓。结论:针对人工髋关节置换术后假体松动原因,并根据手术的不同采取围术期护理干预,能有效恢复髋关节功能,防止术后并发症的发生,提高患者手术满意度。     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.