综合护理对维持性血液透析患者动静脉内瘘的影响

目的:探讨综合护理在维持性血液透析患者动静脉内瘘护理中的应用。方法:随机选择2015年7月~2017年1月收治的建立动静脉内瘘作为血管通路接受维持性血液透析治疗的患者96例,并随机等分为对照组和观察组,对照组给予常规护理措施;观察组在此基础上予以护理,对比两组的内瘘相关并发症发生率、护理满意度等。结果:随访5个月,观察组的动静脉内瘘相关并发症发生率低于对照组,两组比较差异具有统计学意义(P0.05);观察组对护理服务满意率高于对照组(P0.05)。结论:综合护理渗透于建立动静脉内瘘的维持性血液透析患者中安全可行,保障内瘘的安全有效使用,减轻患者痛苦。     

优质护理干预在维持性血液透析患者内瘘维护中的应用

目的:探讨优质护理在血液透析患者内瘘维护中的应用效果。方法:将2012年8月~2013年3月行维持性血液透析的182例患者作为对照组,2013年4~10月行维持性血液透析的患者186例作为观察组,对照组采用常规护理,观察组在常规护理的基础上应用优质护理;比较两组动静脉内瘘功能完好及并发症发生情况。结果:在半年后观察组动静脉内瘘功能完好率高于对照组(P0.05),并发症发生率低于对照组(P0.05)。结论:优质护理干预可以有效提高患者半年内动静脉内瘘功能完好率,降低患者内瘘并发症发生率,值得临床推广应用。     

早期护理干预对维持性血液透析患者动静脉内瘘并发症发生率的影响

目的:探讨护理干预对维持性血液透析患者动静脉内瘘并发症发生率的影响。方法:选择同期我院收治的228例维持性血液透析患者为对象,按照随机数字表法分为观察组和对照组各114例,对照组实施常规护理,观察组在此基础上实施早期护理干预。比较两组动静脉内瘘并发症发生情况、医护人员服务、护理效果满意度。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量量表(QOL-C30)评价两组不良情绪、生活质量。结果:观察组血栓、出血、血管狭窄及感染等动静脉内瘘并发症发生率低于对照组(P0.05),观察组SAS和SDS评分低于对照组(P0.05),观察组QOL-C30评分高于对照组(P0.05)。观察组医护人员服务、护理效果满意度高于对照组(P0.05)。结论:对维持性血液透析患者实施早期护理干预措施,可降低患者动静脉内瘘并发症发生率,改善患者不良情绪,提高其生活质量、医护人员服务、护理效果的满意度。     

早期护理干预对维持性血透患者动静脉内瘘并发症发生率的作用

目的：探讨早期护理干预对降低维持性血液透析患者动静脉内瘘并发症发生率的作用。方法将2010年9月至2011年8月进行维持性血透患者的患者86例设为对照组,将2011年9月至2012年8月进行维持性血透患者92例设为观察组,对观察组患者实施早期护理干预。比较两组患者动静脉内瘘并发症发生率。结果动静脉内瘘并发症发生率观察组明显低于对照组（ P＜0.05）。结论对维持性血透患者实施早期护理干预可明显减少动静脉内瘘并发症,延长内瘘的寿命,能够保证维持性血液透析效果。     

全方位护理对血液透析中动静脉内瘘的影响

选取我院2013年1月~2014年2月采用动静脉内瘘行维持性血液透析患者86例,随机分为观察组和对照组各43例。对照组给予常规护理,观察组在对照组的基础上给予全方位护理。比较两组患者动静脉内瘘并发症发生率及护理满意度。结果观察组并发症发生率明显低于对照组(P<0.05),护理满意度明显高于对照组(P<0.05)。全方位护理可有效降低行维持性血液透析患者动静脉内瘘的并发症发生率,提高患者护理满意度,值得临床推广应用。     

中西医结合集束化护理模式在血液透析患者自体动静脉内瘘管理中的应用效果

目的 探讨中西医结合集束化护理模式在血液透析患者自体动静脉内瘘管理中的应用。方法 选择2019年12月至2020年12月在南京市中医院行维持性血液透析且使用自体动静脉内瘘的患者80例为研究对象,采用随机数字表法分为对照组和观察组,各40例,对照组采取常规护理干预,观察组采用中西医结合集束化护理模式进行干预,比较两组内瘘并发症发生率、自体动静脉内瘘自我管理能力以及患者的护理满意度。结果 干预后,观察组动静脉内瘘并发症发生率低于对照组,并发症的识别、并发症的管理、并发症的预防得分均高于对照组,护理满意度高于对照组,差异均有统计学意义(均P<0.05)。结论 中西医结合集束化护理模式能降低自体动静脉内瘘并发症发生率、提高患者自我管理能力和护理满意度。     

维持性血液透析患者动静脉内瘘中西医结合护理效果观察

目的探讨中西医结合护理干预在维持性血液透析患者动静脉内瘘护理中的应用效果。方法 87例维持性血液透析患者随机分别为观察组与对照组。对照组40例患者给予动静脉内瘘常规护理,观察组47例患者在对照组基础上增加中西医结合护理措施。观察并对比2组动静脉内瘘相关并发症发生情况。结果观察组出现2例内瘘闭塞现象,对照组为4例,差异无统计学意义(P0.05)。结论中西医结合护理对维持性血液透析患者动静脉内瘘具有较好的保护作用,对预防内瘘闭塞等并发症具有积极意义。     

血液透析患者动静脉内瘘失功风险的预测与应用

目的探讨基于循证下的血液透析(MHD)患者动静脉内瘘(AVF)失功风险预测干预方案及其应用效果分析。方法选取2019年1月至2020年10月在河南省人民医院行AVF术的MHD患者92例, 按照随机数字表法均分为对照组和观察组, 各46例。对照组实施常规动静脉内瘘护理措施, 观察组在对照组基础上实施基于循证下的动静脉内瘘失功风险预测干预方案, 比较两组患者动静脉内瘘震颤感与成熟度, 并发症发生情况以及患者生存质量及护理满意度。结果干预后观察组动静脉内瘘失功率、不成熟度均显著低于对照组(P<0.05);观察组动静脉内瘘感染、血栓、出血、循环障碍、窃血综合征等并发症发生率均显著高于对照组(P<0.05);观察组生存质量评分明显高于对照组(P<0.05), 观察组满意率高于对照组(P<0.05)。结论 MHD患者应用基于动静脉内瘘失功风险的预测循证下的干预方案可有效减轻内瘘失功风险, 降低并发症发生率并改善生存质量, 获取患者较高满意度。     

维持性血液透析动静脉内瘘40例围术期护理干预

目的:探讨维持性血液透析患者动静脉内瘘的护理干预方法.方法:将我院行维持性血液透析的80例患者随机分为干预组和对照组各40例,对照组患者发放健康资料,遵医嘱给予随机常规对症护理;干预组采用个性化内瘘功能指导,并按计划对患者进行动静脉内瘘围术期系统的护理干预.比较两组护理干预效果.结果:与对照组比较,干预组护理满意度和内瘘保持完好率高,使用寿命长,且术后并发症发生率低,两组各指标比较差异有统计学意义(P＜0.05).结论:对动静脉内瘘患者进行围术期个性化的护理干预能明显提高护理满意度,降低并发症发生率.     

细节护理干预模式在维持性血液透析患者人造血管内瘘护理中的应用

目的:探讨细节护理干预模式在维持性血液透析患者人造血管内瘘护理中的应用效果。方法:按照随机数字表法将2016年7月1日~2019年7月31日收治的82例维持性血液透析人造血管动静脉内瘘患者分为对照组和观察组各41例,对照组给予常规护理,观察组则在常规护理基础上给予细节护理干预;比较两组人造血管内瘘阻塞发生率、自护能力[采用自我护理能力量表(ESCA)]、护理前后生活质量[采用健康调查简表(SF-36)]、并发症发生情况。结果:观察组人造血管内瘘阻塞发生率低于对照组(P<0.05),ESCA中自我概念、自我护理技能、自我责任感、健康知识水平及自护能力总分均高于对照组(P<0.05);护理后,两组SF-36中生理功能、社会功能、生理职能、情感职能、躯体疼痛、精神健康、总体健康及活力评分均高于干预前(P<0.05),且观察组高于对照组(P<0.05);观察组血肿、出血、感染、血栓形成等并发症发生率均低于对照组(P<0.05)。结论:细节护理干预模式在维持性血液透析患者人造血管内瘘护理中的应用效果显著,可提高患者自我护理效能及生活质量水平,降低并发症发生率,值得临床推广。     

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.     

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."