艾灸足三里联合神灯照射治疗痔疮术后尿潴留的效果观察

目的 探讨艾灸足三里联合神灯照射治疗痔疮术后尿潴留的效果.方法 将150例痔疮术后尿潴留的患者随机分成实验组和对照组各75例.实验组采用艾灸足三里联合神灯照射患者小腹部的方法解除尿潴留;对照组采用传统诱导法如改变体位、流水声诱导及局部热敷解除尿潴留.比较2组患者尿潴留的改善状况.结果 实验组显效44例,有效26例,总有效率94%;对照组显效17例,有效23例,总有效率53%.2组比较差异有统计学意义,χ2=31.7,P＜0.01.结论 艾灸足三里联合神灯照射小腹部是解除痔疮术后尿潴留的安全有效的护理措施.     

神灯照射联合开塞露纳肛治疗产后尿潴留的临床观察及护理

目的探讨神灯照射联合开塞露纳肛治疗产后尿潴留的效果。方法将104例产后尿潴留的患者分成实验组和对照组，每组各52例，实验组采用神灯照射膀胱区联合开塞露纳肛的方法；对照组采用新斯的明0.5mg双侧足三里穴位封闭。结果实验组总有效（显效加有效）率达96、2％，显效率80.8％；对照组总有效率71．1％，显效率26．9％。两组总有效率、显效率均差异有显著性（P〈0.01）。结论神灯照射联合开塞露纳肛是解除产妇产后尿潴留安全有效的方法，值得临床推广应用。     

维生素B1穴位注射配合按摩导引治疗痔疮术后尿潴留的效果观察

目的探讨穴位注射维生素B1配合按摩导引治疗痔疮术后尿潴留的临床疗效。方法将150例痔疮术后尿潴留的患者随机分成实验组和对照组各75例。实验组采用2ml一次性无菌注射器抽吸维生素B1100mg，注入两侧三阴交穴，在下腹部膀胱底部按摩与导引；对照组采用传统诱导排导方法，如改变体位，流水声诱导及热水袋热敷解除尿潴留。比较2组患者尿潴留的改善情况。结果实验组显效44例，有效26例，总有效率93％；对照组显效17例，有效23例，总有效率53％。2组比较差异有统计学意义，χ^2=31．7，P＜0．01。2组患者在术后排尿时间上比较，实验组显著优于对照组，P＜0．01。结论维生素B，穴位注射配合按摩导引是解除痔疮术后尿潴留的安全有效的护理措施。     

维生素B1穴位注射配合按摩导引治疗痔疮术后尿潴留的效果观察

目的 探讨穴位注射维生素B1配合按摩导引治疗痔疮术后尿潴留的临床疗效.方法 将150例痔疮术后尿潴留的患者随机分成实验组和对照组各75例.实验组采用2 ml一次性无菌注射器抽吸维生素B1 100 mg,注入两侧三阴交穴,在下腹部膀胱底部按摩与导引;对照组采用传统诱导排导方法 ,如改变体位,流水声诱导及热水袋热敷解除尿潴留.比较2组患者尿潴留的改善情况.结果 实验组显效44例,有效26例,总有效率93%;对照组显效17例,有效23例,总有效率53%.2组比较差异有统计学意义,X3=31.7,P＜0.01.2组患者在术后排尿时间上比较,实验组显著优于对照组,P＜0.01.结论 维生素B1穴位注射配合按摩导引是解除痔疮术后尿潴留的安全有效的护理措施.     

针刺加艾灸治疗痔瘘术后尿潴留疗效观察和护理

目的 观察针刺加艾灸治疗痔瘘术后尿潴留的疗效,为病人的治疗和护理提供一定的依据。方法 对146例痔瘘术后尿潴留的患者随机分成观察组和对照组,观察组用针刺加艾灸法解除尿潴留,对照组用肌注新斯的明法解除尿潴留进行疗效对比观察。结果 观察组78例,显效46例,有效27例,总有效率94％;对照组(肌注新斯的明组)68例,显效15例,有效21例,总有效率53％。经统计学处理γ~2=31.7,P<0.01,两组治疗结果有显著性差异。结论 用针刺加艾灸法治疗痔瘘术后尿潴留疗效优于常用药新斯的明肌泣法。     

艾灸联合神灯照射在肛肠科术后尿潴留患者的护理效果观察

目的:探讨艾灸疗法联合神灯照射的特殊性护理在肛肠科术后尿潴留患者中的应用价值。方法:选取我院行肛肠外科手术并出现术后尿潴留的120例患者分为两组,对照组仅提供术后常规护理;观察组在常规护理的基础上给予艾灸与神灯照射的联合护理。观察两组护理效果。结果:观察组术后尿潴留症状(自行排尿时间、剩余尿量)较对照组有明显改善;且观察组术后机体各指标恢复时间较对照组更快;观察组术后并发症发生率明显短于对照组、舒适度较优于对照组,组间差异显著,P<0.05。结论:为肛肠科术后出现尿潴留的患者提供艾灸联合神灯照射的特殊性护理措施,配合优质护理干预,可有效缓解其尿潴留症状,降低并发症发生率,促进患者早日康复,是值得推广应用的护理措施。     

针刺加艾灸治疗痔瘘术后尿潴留疗效观察和护理

目的观察针刺加艾灸治疗痔瘘术后尿潴留的疗效,为病人的治疗和护理提供一定的依据.方法对146例痔瘘术后尿潴留的患者随机分成观察组和对照组,观察组用针刺加艾灸法解除尿潴留,对照组用肌注新斯的明法解除尿潴留进行疗效对比观察.结果观察组78例,显效46例,有效27例,总有效率94%;对照组(肌注新斯的明组)68例,显效15例,有效21例,总有效率53%.经统计学处理x2=31.7,P＜0.01,两组治疗结果有显著性差异.结论用针刺加艾灸法治疗痔瘘术后尿潴留疗效优于常用药新斯的明肌注法.     

艾灸配合磁珠压耳穴对解除中老年疝气手术后尿潴留的护理观察

目的 探讨艾灸配合磁珠压耳穴对解除中老年疝气手术后尿潴留的临床疗效.方法 选取行无张力疝修补手术术后发生尿潴留的中老年男性患者66例,随机分为对照组和观察组,每组各33例,对照组采用基础治疗方法,观察组在此基础上加用艾灸配合磁珠压耳穴,比较两组的治疗效果.结果 观察组显效24例,占72.7％,对照组显效7例,占21.2％,两组比较差异具有统计学意义(P＜0.05)；观察组总有效率90.9％,对照组总有效率69.7％,两组比较差异具有统计学意义(P＜0.05).结论 艾灸配合磁珠压耳穴对解除中老年疝气手术后尿潴留疗效显著,可减少尿路感染及患者痛苦,且操作方法简便,患者易于接受,是一种行之有效的方法.     

纳可佳湿敷联合神灯照射促进会阴侧切口愈合的疗效观察

目的 观察纳可佳湿敷联合神灯照射促进会阴侧切口愈合的临床疗效.方法 选择会阴侧切口愈合不良者160例,随机分为实验组和对照组各80例.实验组用纳可佳湿敷联合神灯照射,对照组用庆大霉素湿敷联合神灯照射,观察两组治疗前后的侧切口愈合情况.结果 实验组总有效率100％,对照组总有效率77.5％,两组临床疗效差异有统计学意义(P＜0.01).结论 纳可佳湿敷联合神灯照射促进会阴侧切口愈合有显著疗效.     

尿道外口湿热敷解除腹部术后尿潴留30例护理体会

目的 探讨尽早解除腹部术后尿潴留的有效方法。方法 将实验组30例尿潴留病人进行尿道外口湿热敷的效果与传统的下腹部热敷法作临床比较。结果 实验组排尿高峰在前3min内，其有效率为90．3％。对照组排尿高峰在5～10min时间段，有效率为63.3％。结论 实验组排尿时间比对照组明显提前，导尿机率明显少于对照组。尽早解除病人的痛苦，减少并发症的发生。     

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.     

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.     

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.     

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.