老年髋部骨折患者围术期新发心脏不良事件危险因素的研究进展

心脏不良事件是老年髋部骨折患者围术期常见且严重的并发症,其发生会延长住院天数,加重经济负担,影响治疗效果和预后生活质量,甚至增加患者死亡风险。现从年龄、术前合并症、美国麻醉医师协会分级(ASA分级)、贫血与输血等方面对老年髋部骨折患者围术期新发心脏不良事件的危险因素进行综述,以期为临床护理人员预防老年髋部骨折围术期新发心脏不良事件的发生提供参考。     

老年患者跌倒原因分析及预防对策

随着社会人口的老龄化，老年住院患者日益增多。预防住院老年患者跌倒是护理人员探索的新课题。本文对24例老年住院患者跌倒事件的危险因素进行分析，并提出相应的预防措施，减少老年患者意外跌倒事件的发生，为老年患者提供温馨、舒适的住院环境，确保住院期间的安全。     

入院评估标示系统在降低老年住院患者护理不良事件发生率中的作用

目的：探讨入院评估标示系统在降低老年住院患者相关不良事件发生率中的作用.方法2012年7月解放军总医院南楼临床部开始在原有的入院评估中新增跌倒(坠床)危险因素评估、压疮危险因素评估、静脉液体外渗危险因素评估,对入院前或入院后留置管道者增加导管滑脱风险评估,并采取相应措施,在患者床头悬挂警示牌,形成入院评估标示系统,比较采用此系统前后老年住院患者相关不良事件的发生率.结果采用入院评估标示系统后,除压疮发生率外,患者跌倒(坠床)、静脉液体外渗、导管滑脱发生率均较实施前减少,差异有统计学意义(均P＜0．05).结论入院评估标示系统在老年住院患者中的应用,能有效降低相关不良事件的发生率,提高老年住院患者护理安全.     

老年内科护理不良事件的相关危险因素分析

目的探究老年内科患者发生护理不良事件的相关危险因素,为临床预防护理不良事件的发生提供依据。方法选取2014例住院患者为研究对象。将发生护理不良事件的22例设为研究组,未发生不良事件的1992例作为对照组,通过单因素与多因素分析护理不良事件发生的危险因素。结果护士工龄10年、护理评估较差、巡视频率12次/d、护士宣教不足等是发生护理不良事件的危险因素(OR值均1,95%CI:1.062~22.840,P0.05)。结论加强低年资护士培训,提高护士评估能力,增加巡视频率,强化健康宣教的效果,能有效减少老年内科护理不良事件的发生。     

老年重症颅脑损伤患者术后肺部感染的危险因素分析

目的:分析老年重症颅脑损伤患者术后肺部感染的相关危险因素,为其防治提供临床依据。方法:回顾性研究350例老年重症颅脑损伤术后患者的临床资料,分析患者肺部感染的相关危险因素及预防措施。结果:350例老年重症颅脑损伤术后患者中,102例(29.1%)发生肺部感染,作为感染组;248例未发生肺部感染,作为非感染组。单因素分析发现2组住院时间、基础疾病、格拉斯哥昏迷指数(GCS)评分、白蛋白水平、术前使用抗生素、意识障碍、气管切开等方面,差异均有统计学意义(P0.05);多因素Logistic回归分析显示,白蛋白35 g/L、住院时间≥3周、存在意识障碍及气管切开为老年重症颅脑损伤患者术后肺部感染的独立危险因素。结论:老年重症颅脑损伤患者术后肺部感染的发生与白蛋白水平低下、住院时间延长、出现意识障碍及气管切开密切相关,临床上应根据这些危险因素,采取综合防治措施,有效降低患者术后肺部感染的发病率及死亡率。     

老年冠心病患者非心脏手术围术期心血管事件危险因素筛选与分析

目的:筛选并分析老年冠心病患者非心脏手术围术期心血管事件的危险因素.方法:行择期手术的老年冠心病非心脏手术患者223例,记录术中、术后心血管事件(恶性心律失常、心肌缺血、不稳定性心绞痛、心肌梗死、高血压),根据有无发生心血管事件分为不良事件组和无不良事件组,并进行单因素分析及多因素非条件Logistic回归分析.结果:不良事件组中术前有ST段压低≥0.05 mV、不稳定型心绞痛、高血压、年龄>70岁、吸烟、糖尿病、射血分数≤50%、心功能Ⅲ级、心肌梗死、心律失常、血红蛋白<120 g/L、纤维蛋白原增高的患者心血管事件发生率均高于无不良事件组,以上危险因素均与不良事件发生呈正相关性(P<0.05).结论:术前心律失常、糖尿病、心肌梗死、不稳定型心绞痛、纤维蛋白原增高、射血分数≤50%、血红蛋白<120 g/L及ST段压低≥0.05 mV是老年冠心病患者非心脏手术围术期心血管事件的主要危险因素.     

老年住院患者跌倒相关因素分析及预防对策的研究

目的通过对老年住院患者跌倒的相关因素进行分析,为制定出适宜有效的护理预防对策提供科学依据。方法对2013年5月至2016年9月在吉林大学第一医院老年病科住院的老年患者发生的跌倒不良事件进行回顾性分析,探讨老年住院患者跌倒的相关因素及预防对策。结果在19例老年住院患者跌倒不良事件中,发生跌倒的年龄主要为70-80岁,发生跌倒频次最高的地方为卫生间,时间主要发生在0:00-8:00,大部分没有造成伤害,63.16%的跌倒没有被目睹,47.37%的老年患者跌倒风险评估为中度风险,42.11%的老年住院患者有低钠血症。结论防范老年住院患者的跌倒,应在关键的年龄、时间、地点,对关键的人物给予有针对性的个体化的预防措施才能有效防范老年住院患者意外跌倒的发生。     

老年急性心肌梗死患者心血管不良事件发生危险因素调查分析

目的探讨老年急性心肌梗死患者心血管不良事件发生危险因素。方法选取2016年1月至2019年1月我院收治的老年急性心肌梗死患者200例为研究对象,回顾性调查和收集其相关资料,参照心血管不良事件判断标准,发生心血管不良事件26例,采用单因素和多因素logistic回归分析法确定老年心肌梗死患者心血管不良事件发生的影响因素。结果本组患者中发生心血管不良事件26例(13. 00%),其中血流动力异常10例(38. 46%),组织灌注不足9例(34. 62%),不良预后结局7例(26. 92%)。多因素分析显示,年龄、合并基础疾病、房颤史为老年急性心肌梗死患者心血管不良事件的独立危险因素(P 0. 05)。结论针对影响老年急性心肌梗死患者心血管不良事件发生的危险因素,护理人员应高度警惕,预防不良事件的发生。     

老年全膝关节置换患者术后感染的手术室危险因素分析

目的:探讨分析老年全膝关节置换(TKA)患者术后感染的危险因素并提出相应护理预防措施。方法:选取我院2015年1月~2017年6月期间收治的老年TKA患者192例为研究对象,根据术后是否感染分为感染组和未感染组,采用单因素和logistic多元回归分析老年TKA术后感染危险因素,并制定相应手术室护理预防措施。结果:经单因素分析,感染患者和非感染患者在血红蛋白水平、是否为接台手术、术中是否有参观、手术时间方面差异有统计学意义(P0.05);经多因素分析,血红蛋白水平低下、接台手术、术中有人员参观以及手术时间长是老年TKA术后感染的独立危险因素(P0.05)。结论:老年TKA术后感染独立危险因素有血红蛋白水平低下、接台手术、术中有人员参观、手术时间时间长,进行护理预防干预可降低术后感染率。     

PCI治疗冠心病心绞痛不良事件发生情况及危险因素分析

目的：分析经皮冠状动脉介入治疗冠心病心绞痛不良事件发生情况及危险因素。方法：回顾性分析2018年7月~2019年5月收治的行经皮冠状动脉介入治疗的120例冠心病心绞痛患者临床资料,对其出院后1年的预后情况进行随访调查,并分析影响其心绞痛不良事件发生的危险因素。结果：120例患者心绞痛复发率为29.17%,12个月总生存率为92.50%;多元Logistic回归分析结果显示高脂血症、心功能分级≥Ⅲ级、支架个数＞1个以及病变血管数目≥3支是影响冠心病患者心绞痛不良事件发生的独立危险因素（P＜0.05）。结论：影响冠心病患者心绞痛不良事件发生情况的危险因素较多,需积极采取预防措施,降低心绞痛等不良事件的发生率。     

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."