减痛分娩法对初产妇产程疼痛及产程进展的影响

目的：探讨减痛分娩法在初产妇分娩护理中的应用效果。方法将200例初产妇随机分为观察组和对照组,每组100例,对照组采用传统助产技术,观察组采用减痛分娩法,比较两组的产程进展、疼痛、分娩结局以及护理满意度。结果观察组的第一产程、第二产程、总产程时间均少于对照组,产程疼痛VAS、VRS、PPI评分少于对照组,差异有统计学意义（ P＜0．05）。观察组的阴道分娩率高于对照组,产后出血率、新生儿窒息率低于对照组,住院时间、住院费用少于对照组,护理满意度高于对照组,差异有统计学意义（ P＜0．05）。结论减痛分娩法有利于加快初产妇的产程进展,减少分娩时的疼痛,提高阴道分娩率和护理满意度。     

责任制助产对初产妇分娩质量及护理满意度的影响

[目的]探讨责任制助产对初产妇分娩质量及护理满意度的影响。[方法]抽取100例初产妇随机分为两组,对照组采用常规护理模式,观察组采用责任制助产,比较两组的围产期护理质量。[结果]观察组第一产程、第二产程、总产程时间缩短,有统计学意义(P0.05)。观察组与对照组相比,阴道分娩率、护理满意度提高,剖宫产率下降,新生儿结局较好,差异有统计学意义(P0.05)。[结论]责任制助产能够有效提高产科护理水平,改善产妇的分娩质量和护理满意度。     

责任制助产方案联合分娩球对孕妇分娩结局的影响

目的：探讨责任制助产方案联合分娩球对孕妇分娩结局的影响。方法选取在我院分娩的产妇80例,随机分为实验组和对照组,每组40例。对照组给予常规轮班制护理及传统的待产接产方式,实验组给予责任制助产方案联合分娩球的护理措施。比较两组产妇的各个产程进展情况、产后出血量、分娩方式、新生儿窒息情况以及Apgar评分和患者满意度。结果实验组产妇第一产程、第二产程平均时间均明显少于对照组（均P＜0.05）,第三产程平均时间两组无明显差异。产妇产后出血量显著少于对照组（ P＜0.000）,剖宫产率低于对照组（ P＜0.05）,新生儿Apgar评分高于对照组（ P＜0.000）,新生儿窒息率低于对照组（ P＜0.05）。患者满意度高于对照组（ P＜0.000）。结论责任制助产方案联合分娩球护理方式对产妇分娩结局有着积极促进的作用,能够在一定程度上减轻产妇痛苦,保障母婴健康和提高了产妇满意度。     

助产士连续性护理在围产期的应用研究

目的：探讨助产士连续性护理在围产期中的应用效果。方法240例初产妇随机分为观察组和对照组各120例,对照组采用常规护理,观察组采用助产士连续性护理,比较两组产妇的围产期情况。结果观察组第一产程、第二产程和总产程显著短于对照组,差异有统计学意义（ P＜0.05）。观察组阴道分娩率显著高于对照组,产后出血量显著少于对照组,护理满意度显著高于对照组,差异有统计学意义（ P＜0.05）。结论助产士连续性护理能为初产妇围产期提供更为专业的照护,有效缩短产程,提高阴道分娩率。     

产妇模拟分娩教育对产房质量控制的作用

目的：探讨产妇模拟分娩教育对产房质量控制的作用。方法选取在我院接受产前检查的孕龄38～40w的孕妇112名,随机分为观察组和对照组,每组56例。对照组的孕妇采取常规的住院分娩,观察组的孕妇在分娩前接受产妇模拟分娩教育。比较两组产妇的自然分娩率、剖宫产率及阴道助产率。结果观察组孕产妇自然分娩率明显高于对照组（ P＜0．05）,阴道助产率明显低于对照组（P＜0．05）,产妇第一产程、第二产程及总产程时间均明显短于对照组（均P＜0．05）,母子正常的概率远远高于对照组（P＜0．05）,新生儿窒息率、分娩并发症发生率均低于对照组（均P＜0．05）。结论对产妇产前进行模拟分娩教育可明显减轻产妇的不良情绪,提高自然分娩率,增加患者满意度,提高产房质量。     

全程陪伴助产配合体位指导对分娩结局的影响

目的:探讨全程陪伴助产配合体位指导对分娩结局的影响。方法:将2016年6月~2017年6月180例住院产妇采用计算机分组模式分为观察组和对照组各90例,观察组进行全程陪伴助产配合体位指导,对照组进行常规指导方式。比较两组分娩方式、总产程、对助产士满意度、出血量、新生儿窒息率、生活质量评分。结果:观察组阴道助产率、剖宫产率低于对照组,自然分娩率高于对照组(P0.05),产程均短于对照组(P0.05),产妇对助产士满意度高于对照组(P0.05),出血量少于对照组(P0.05),新生儿窒息率低于对照组(P0.05),护理后生活质量评分均高于对照组(P0.05)。结论:对产妇实施全程陪伴助产配合体位指导效果显著,值得推广。     

信息支持护理对产妇健康知识及产后焦虑的影响

目的 探讨信息支持护理在产妇健康教育中的应用效果.方法 选取86例初产妇为研究对象,将其随机分为观察组和对照组,对照组采用常规健康教育,观察组在围产期加强综合信息支持,比较两组的产妇的健康知识知晓率、分娩结局及产后焦虑情况.结果 观察组的健康知识知晓率显著、分娩前主观选择阴道分娩的比例、实际阴道分娩率显著高于对照组(P＜0.05).观察组的产后出血量、新生儿窒息率及产后焦虑评分显著少于对照组(P＜0.05).结论 信息支持更能满足产妇对围产期健康知识的需求,增加产妇的分娩知识,改善分娩结局.     

责任制助产护理模式配合体位管理对初产妇产程及分娩结局影响

目的 探讨分析责任制助产护理模式配合体位管理对初产妇产程及分娩结局影响。方法 抽取 2018 年 1 月至 2021 年 1 月 间于本院产科住院待产的 150 例初产妇作为研究对象,按照随机分配原则,分为对照组和研究组。对照组（75 例）接受常规轮 班制及传统助产护理,研究组（75 例）接受责任制助产护理配合体位护理。评估比较两组产妇干预后自我效能、健康知识掌握 情况、产前心理状态,并记录产妇产程进展情况、分娩方式以及母婴结局。结果 经护理后研究组自我效能、健康知识掌握评 分均高于对照组,产前心理状态优于对照组,第一、二产程及总产程时间均短于对照组（P<0.05）。研究组自然分娩率远高于 对照组（P<0.05）。研究组宫缩乏力和产后出血发生率均低于对照组（P<0.05）。研究组新生儿窒息率（0.00%）明显低于对照 组（6.67%）（P<0.05）。结论 利用责任制助产护理模式配合体位管理对初产妇围产期进行助产护理可有效加速产妇产程进展, 整体提升产妇分娩质量及分娩效率。     

穴位按摩加音乐疗法对产妇分娩过程的影响

目的探讨穴位按摩加音乐疗法对产妇分娩的影响。方法将300例阴道分娩的正常产妇随机分为观察组与对照组各150例,观察组在一对一责任制助产常规护理的基础上,采用穴位按摩加音乐疗法,对照组采用一对一责任制助产常规护理。比较两组产妇分娩过程宫缩疼痛程度、总产程时间、宫缩乏力使用缩宫素情况、产后2h出血量及分娩方式。结果两组产妇宫缩疼痛、分娩方式、总产程时间、宫缩乏力使用缩宫素及产后2h出血量情况比较,均P0.05,差异具有统计学意义,观察组分娩过程疼痛程度轻于对照组,自然分娩方式多于对照组,总产程时间明显缩短,使用缩宫素及产后2h出血量明显减少。结论产妇在一对一责任制助产的基础上配合穴位按摩和音乐疗法,可减轻产妇产程疼痛程度,缩短产程时间,减少产后出血量,提高了产妇自然分娩率,值得临床推广应用。     

责任制助产护理对初产妇分娩方式及产程进展的影响

目的:探讨责任制助产护理对初产妇分娩方式及产程进展的影响。方法:将116例初产产妇随机分为观察组和对照组各58例,对照组采用常规生产护理,观察组实施责任制助产护理,比较两组产妇和新生儿情况。结果:观察组自然分娩率高于对照组(P0.05);观察组产妇第一产程时间短于对照组(P0.05);观察组初产妇产后出血量、产后母乳始动时间均低于对照组(P0.05);观察组新生儿窘迫率和窒息率低于对照组(P0.05)。结论:责任制助产护理可提高初产妇自然分娩率、缩短产程用时、改善母婴分娩结局。     

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."