义眼座植入术后疼痛原因分析及护理对策

目的通过对义眼座术后疼痛的原因分析，寻找护理对策，增加患者的舒适度。方法对172例义眼座植入术的患者进行疼痛程度的计量、引起术后疼痛的原因分析，通过有效的护理措施，减少患者术后疼痛，增加其舒适度。结果引起义眼座术后疼痛最主要的原因是眶压增高和眼-心反应，Ⅱ期植入术后的疼痛发生率明显要高于Ⅰ期植入术后（P〈0．01）。在给予相应的护理后，患者的疼痛得到了有效的缓解，疼痛发生率下降了24．42％。结论对引起义眼座植入术后疼痛原因分析和有效的护理措施能减轻疼痛，增进患者的舒适度。     

羟基磷灰石义眼座植入术后疼痛原因分析及护理对策上海长征医院眼科 葛青华

【】： 目的 ： 通过方对羟基磷灰石义眼座植入后患者疼痛的原因分析及护理对策,为临床护理提供依据。方法 ：对我科2012年1月—2014年1月收治60例羟基磷石灰义眼座植入式患者进行术后疼痛评估及疼痛的相关因素进行分析,提高护士准确及时止痛的技能并对患者进行止痛的宣教,减少术后疼痛,增强舒适感。 结果：引起羟基磷石灰义眼座植入术后疼痛最主要的原因是眶压增高及心理因素、手术创伤、术后并发症有关,给予患者及时有效的护理措施,提高止痛技能、创造舒适环境,使患者疼痛得到有效缓解。 结论：重视术后患者的止痛,合理、正确、有效、及时的护理可缓解患者疼痛,提高患者舒适度。     

老年性白内障术后疼痛原因分析及针对性护理干预

目的:分析老年性白内障患者的术后疼痛原因,探讨针对性护理干预措施。方法:将1 390例老年性白内障术后疼痛患者随机分为观察组和对照组各695例,分析术后疼痛原因,对照组患者术后给予常规护理,观察组在此基础上给予针对性护理干预措施,比较两组视力水平、疼痛程度、舒适度、满意度。结果:两组视力水平、疼痛程度、舒适度、满意度比较差异有统计学意义(P0.05)。结论:了解老年性白内障患者术后疼痛原因,实施针对性护理干预措施,可以改善患者视力水平,缓解术后疼痛,提高患者的舒适度和满意度。     

跟骨骨折患者术后疼痛的护理

目的:探讨跟骨骨折患者术后疼痛的护理方法。方法:通过对100例跟骨骨折患者术后疼痛护理的回顾,总结护理方法。结果:通过分析原因、常规护理、心理护理、药物应用、镇痛泵的应用等方法对患者进行护理,患者的疼痛均得到了不同程度的缓解和控制,促进了患者的康复。结论:疼痛的护理是跟骨骨折患者康复的一项重要护理措施。     

疼痛评估及护理干预对骨折大手术患者术后疼痛与舒适度的影响

目的探讨疼痛评估及护理干预对骨折大手术患者术后疼痛与舒适度的影响。方法将2015年7月~2016年12月我科收治的86例骨折大手术患者,采用随机数字表法分为对照组和观察组,各43例。对照组给予常规护理。观察组在对照组的基础上进行疼痛评估及护理干预。比较两组术后疼痛程度、舒适度、康复依从性及护理满意度。结果观察组术后6、24、48、72h疼痛评分低于对照组,差异有统计学意义(P<0.05)。观察组生理、心理舒适度、康复依从性、护理满意度高于对照组,差异有统计学意义(P<0.05)。结论疼痛评估及护理干预能显著减轻骨折大手术患者的术后疼痛,提高患者术后的舒适度和康复依从性,改善护理满意度。     

舒适护理对骨折患者术后疼痛及满意度的影响

目的 探讨舒适护理对骨折患者术后疼痛及满意度的影响,为临床治疗、健康教育和临床护理提供相应的依据,并制订有利于骨折患者控制疼痛的相应对策.方法 选择住院的骨折患者662例为研究对象,将其分为对照组和实验组各331例.对实验组患者在常规护理措施的基础上采用了舒适护理措施,对照组患者应用常规护理措施进行护理.比较2组术后疼痛的发生情况及患者对护理工作的满意度.结果 实施舒适护理措施后实验组患者术后24 h疼痛程度显著轻于对照组,对护理工作的满意度显著高于对照组.结论 舒适护理措施使骨折患者舒适地度过了术后疼痛期,减轻了疼痛程度,提高了患者的满意度.     

护理干预对骨折患者术后疼痛及护理满意度的影响

目的：探讨护理干预对骨折患者术后疼痛及护理满意度的影响。方法选取骨折患者316例,根据随机数字表法分为对照组和观察组各158例,分别给予常规护理和护理干预,观察和比较两组患者术后疼痛程度,对疾病知识认知度、住院时间及费用,护理满意度差异有统计学意义。结果与对照组相比,观察组术后疼痛程度明显减轻,对疾病认知度明显升高,住院时间及费用显著降低,护理满意度明显提高,差异有统计学意义（ P＜0.05）。结论对于骨折患者,围术期给予个性化、系统的护理干预能够明显降低术后疼痛,提高患者舒适度,加速患者的康复速度,提升患者及其家属对护理服务的满意度。     

老年患者股骨颈骨折术后便秘原因分析及护理对策

总结150例股骨颈骨折发生便秘的原因并进行分析,探讨老年股骨颈骨折术后便秘的原因及护理措施。认为老年股骨颈骨折术后患者出现便秘多与疾病因素、疼痛因素、心理因素、排便习惯改变、环境、饮食等因素有关。通过饮食指导、心理护理、腹部按摩等综合护理干预可有效改善和解除老年股骨颈骨折术后患者的便秘,促进患者身心康复,提高患者生活质量。     

改进护理措施对妇科腹腔镜术后患者非切口疼痛的影响

目的探讨改进护理措施对缓解妇科腹腔镜术后患者非切口疼痛的效果。方法随机将128例妇科腹腔镜术后患者分为观察组和对照组,每组64例。对照组实施常规护理,观察组实施改进后护理措施。比较两组患者非切口疼痛发生率、疼痛程度及疼痛持续时间。结果观察组术后非切口疼痛发生率、术后疼痛程度及疼痛持续时间均显著小于对照组,差异均有统计学意义(均P<0.05)。结论改进后护理措施有效降低妇科腹腔镜手术患者术后非切口疼痛发生率,缓解疼痛程度,缩短疼痛持续时间,提高患者术后舒适度。     

系统化健康教育在脊柱骨折护理中的应用

[目的]探讨系统化健康教育在脊柱骨折护理中的应用效果。[方法]将2016年6月—2017年7月就诊的120例脊柱骨折病人分为观察组和对照组各60例,对照组病人给予常规护理措施,观察组病人在常规护理基础上给予系统化健康教育护理。比较两组病人术后舒适度、切口疼痛、尿管舒适度、睡眠质量评分。[结果]观察组病人舒适度评分高于对照组,尿管舒适度、睡眠质量评分优于对照组,切口疼痛评分低于对照组。[结论]在脊柱骨折护理中应用系统化健康教育护理措施能够有效改善病人术后舒适度、尿管舒适度和睡眠质量,缓解疼痛程度,效果优于常规护理。     

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.     

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.     

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.     

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.