心理干预在青年女性颔骨骨折护理中的应用效果

目的探讨心理干预在青年女性颌骨骨折护理中的应用效果。方法将84例青年女性颌骨骨折患者随机分为观察组和对照组各42例,对照组采用常规护理方法,观察组除常规护理外给予相应的心理干预。采用焦虑自评量表（SAS）与抑郁自评量表（SDS）对患者干预前后的焦虑、抑郁心理状态进行评估。结果观察组干预后SAS评分与SDS评分较干预前均显著降低（P〈0．05）,2组干预后SAS评分与SDS评分比较差异均有统计学意义（P〈0．05）。结论心理干预可以减轻青年女性颌骨骨折患者的焦虑、抑郁情绪。有利于其术后恢复。     

心理认知护理在2型糖尿病伴抑郁障碍患者治疗中的作用

目的 探讨心理认知护理在2型糖尿病伴抑郁障碍患者治疗中的作用.方法 将118例2型糖尿病伴抑郁障碍患者随机分为观察组59例对照组59例,对照组采用常规护理,观察组在此基础上同时进行心理认知护理.比较两组患者抑郁、焦虑状况、应对方式状况及代谢指标控制状况.结果 干预4周后2组比较,观察组的抑郁、焦虑得分明显低于对照组,差别有统计学意义(p<0.01).观察组的应对方式评分与对照组比较,积极应对多于消极应对,差异有统计学意义(p<0.05).代谢指标中空腹血糖测定、餐后2h血糖、糖化血红蛋白测定2组比较,差异有统计学意义(p<0.01).结论 实施心理认知护理对糖尿病伴抑郁障碍患者有较好的效果.     

心理护理干预对突发意外损伤患者的影响

目的 探讨心理护理干预对突发意外损伤患者的影响.方法 将164例突发意外损伤患者随机分为观察组和对照组各82例,对照组接受常规治疗和护理,观察组在此基础上实施为期1个月包括支持性心理护理、认知行为治疗、放松疗法和家属辅助心理疏导在内的综合心理护理干预.比较2组患者干预前后抑郁焦虑评分、生活质量评分.结果 2组患者干预后的抑郁焦虑评分明显下降(p<0.01),且观察组的抑郁焦虑评分、生理领域、心理领域和社会关系因子评分的改善明显优于对照组(p<0.05),差异有统计学意义.结论 心理护理干预可改善突发意外损伤患者的负性情绪和躯体功能状态,并可提高其生活质量.     

认知行为干预对早期先兆流产病人焦虑、抑郁情绪影响的研究

[目的]探讨认知行为干预对早期先兆流产病人焦虑、抑郁情绪的影响。[方法]将82例早期先兆流产病人随机分成观察组和对照组各41例,对照组采取常规护理,观察组实施认知行为干预,比较两组干预前后焦虑得分和症状自评量表(SCL-90)评分情况。[结果]对照组干预前后焦虑评分、SCL-90各因子得分及总分比较差异无统计学意义(P>0.05),观察组干预前后焦虑评分、SCL-90各因子得分及总分比较差异具有统计学意义(P<0.05或P<0.01);干预后观察组SCL-90各因子(偏执除外)得分及总分明显低于对照组(P<0.05)。[结论]认知行为干预可减轻早期先兆流产病人焦虑、抑郁情绪。     

心理认知行为干预对尿毒症血液透析患者抑郁、焦虑的影响

目的 从心理和认知行为方面对尿毒症血液透析患者进行护理干预,探讨其对患者抑郁、焦虑负面情绪的影响.方法 选取本院84例行维持性血液透析的尿毒症患者,采用双盲法随机分为对照组和干预组,每组42例.对照组采用常规护理,干预组行心理认知行为干预.护理干预2个月后,采用Zung抑郁自评量表(SDS)、焦虑自评量表(SDS)及AViLLo情绪与情感形容词量表对两组患者的抑郁、焦虑及情绪情感进行评分比较.结果 两组患者干预前SAS、SDS评分统计学差异不显著(P>0.05),经过2个月的护理干预,组内比较SAS、SDS评分较干预前均有所改善,干预组显著优于对照组(P<0.001,P<0.001).干预前两组患者情绪情感评分无显著差异(P>0.05),护理后干预组评分显著提高(P<0.05),对照组提高不明显(P>0.05).结论 对尿毒症血透析患者实施心理认知行为干预能显著改善患者抑郁、焦虑情绪,提升情绪情感质量,改善患者生存质量,该护理模式值得临床推广与运用.     

认知行为干预对类风湿性关节炎患者焦虑抑郁症状的影响

目的观察认知行为干预对改善类风湿性关节炎(RA)住院患者焦虑抑郁症状的效果。方法将80例RA患者按入院顺序分为对照组和干预组各40例。对照组进行常规的临床治疗及护理,干预组在常规治疗及护理的基础上采用认知行为干预方法进行2周干预。比较干预前后两组的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果干预前两组SAS和SDS评分比较,差异无统计学意义(P0.05);对照组干预后SAS和SDS评分均较干预前评分有所降低,但差异无统计学意义(P0.05);干预组干预后SAS和SDS评分均较干预前评分显著降低,差异有统计学意义(P0.05)。结论认知行为干预可有效改善RA住院患者的焦虑抑郁症状,提高患者的治疗效果和满意度。     

认知心理干预对垂体瘤患者心理障碍影响的研究

目的 探讨认知心理干预对垂体瘤患者心理障碍的影响,为减轻垂体瘤患者的心理障碍提供参考.方法 将出现心理障碍的垂体瘤患者96例,按住院时间先后分为两组,其中干预组49例,给予认知心理干预和常规住院宣教;对照组47例只给予常规住院宣教,出院前比较两组的焦虑抑郁得分.结果 干预组出院前的焦虑抑郁得分低于干预前,差异有显著意义(P＜0.05),对照组出院前的焦虑抑郁得分稍低于干预前,但差异无显著意义(P＞0.05),出院前干预组的焦虑抑郁得分明显低于对照组(P＜0.05).结论 认知心理干预方法能减轻垂体瘤患者的心理障碍,护士可以通过学习护理心理学理论知识,将认知心理干预方法应用于临床护理.     

团体认知行为干预对血液透析患者心理状态和生活质量的影响

目的观察团体认知行为干预对血液透析患者心理状态和生活质量的影响。方法将87例终末期肾病行血液透析治疗患者按随机数字表分为观察组43例、对照组44例。对照组行常规健康教育,观察组行团体认知行为干预;采用抑郁自评量表、焦虑自评量表、简明健康调查问卷评价两组患者心理状态、生活质量。结果干预后两组的抑郁、焦虑评分均有所降低,但干预前后评分比较观察组有统计学意义、对照组无统计学意义,干预后两组的抑郁、焦虑评分比较有统计学意义;干预后观察组简明健康调查问卷评分高于对照组,除生理功能、躯体疼痛外,其余6维度评分比较有统计学意义。结论对血液透析患者实施团体认知行为干预,可有效改善患者的心理状态,提高生活质量。     

心理护理对脑卒中后焦虑与抑郁障碍患者的效果观察

目的:探讨心理护理对脑卒中后焦虑与抑郁障碍患者的效果.方法:将100例脑卒中伴焦虑与抑郁障碍患者随机分为观察组和对照组各50例.对照组采用常规护理及健康教育;观察组在对照组基础上给予综合性心理干预,包括行为干预、支持性心理治疗、放松训练及生物反馈治疗等.对每例患者在干预前和干预3周后分别采用汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评分并进行对比分析.结果:干预前两组HAMA和HAMD评分比较差异无统计学意义(P>0.05);干预3周后观察组HAMA和HAMD评分均低于对照组(P<0.01).结论:对脑卒中后焦虑与抑郁障碍患者实施心理护理干预,能有效缓解患者的焦虑、抑郁情绪.     

团体认知行为干预在2型糖尿病护理中的应用

目的 分析团体认知行为干预在2型糖尿病患者护理中的应用价值.方法 选取2015年6月~2016年6月该院2型糖尿病患者130例,随机分为观察组和对照组各65例.均实施常规护理,在此基础上,观察组实施团体认知行为干预.对比两组干预前后的心理状态及糖代谢变化情况.结果 干预前两组患者的SAS(焦虑自评量表)评分、SDS(抑郁自评量表)评分比较差异无统计学意义(P>0.05);干预后,观察组的SAS评分、SDS评分均低于对照组(均P<0.05);干预前两组FBG(空腹血糖)、HbA1c(糖化血红蛋白)比较,差异无统计学意义(P>0.05);干预后观察组FBG、HbA1 c指标均优于对照组(均P<0.05).且两组干预前后糖代谢情况比较差异有统计学意义(P<0.05).结论 团体认知行为干预在2型糖尿病患者护理中的应用价值显著,建议进一步推广.     

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.     

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.     

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.     

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.     

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.