经结膜入路冷冻摘除眼眶肌圆锥内海绵状血管瘤手术的护理配合

【目的】探讨经结膜入路冷冻摘除眼眶肌圆锥内海绵状血管瘤的手术配合及护理措施。【方法】对36例经结膜人路冷冻摘除眼眶肌圆锥内海绵状血管瘤手术患者术前、术中、术后的医护配合及护理措施进行总结分析。【结果】36例患者通过手术和精心的护理均收到良好的治疗效果,无严重并发症发生。【结论】护理人员掌握术中配合步骤和特殊器械的应用,能确保手术安全顺利的完成,精心的实施专科护理,能有效地减少手术并发症。     

胰十二指肠切除术后出血的护理

【目的】总结胰十二指肠切除术后出血的护理体会,以提高护理质量。【方法】对350例行胰十二指肠切除术发生术后出血并发症的36例患者护理干预进行总结。【结果]36例术后发生大出血者中24例以上消化道出血为主,12例以腹腔内出血为主,36例均在出血早期发现并及时进行了处理。33例出血治愈出院,3例大出血未能有效止血并最终死亡。【结论】及时发现、严密观察和精心的护理在胰十二指肠切除术后出血并发症防治中至关重要。     

18例癫痫发作致烧伤患者的护理体会

【摘要】 目的 总结18例癫痫发作致烧伤住院患者的护理资料,探寻该类患者的适宜护理模式。方法 回顾近4年我科收治的18例癫痫发作致烧伤患者的临床资料,总结针对该类患者的安全护理、心理护理、药物护理及创面护理情况,评估临床收效。结果 患者入院后均行切削痂及自体取植皮治疗,通过系统的药物治疗及临床护理,创面均顺利愈合。 结论 注重预防,加强身心等全方位护理,对癫痫致烧伤患者治疗及预后具有重要意义。     

拔除T型管后致胆汁性腹膜炎的观察及护理

【目的】介绍拔除T管后致胆汁性腹膜炎的临床观察与临床护理经验。【方法】对拔除T管后致胆汁性腹膜炎46例患者的临床表现的观察、护理及预后进行回顾性分析。【结果】本组46例胆总管切开探查T管引流术患者在拔除T管后出现胆漏，由于观察病情仔细，均及时发现胆漏的存在，给予及时有效的护理，并与医师密切配合，对33例患者从原窦道口插入导尿管引流，其中治疗成功30例，另有3例在保守治疗6～8h后急诊行T管引流术。13例胆漏严重的患者急诊行T管引流术。46例均治愈出院。全组治愈率100％（46／46）。【结论】拔除T管后致胆汁性腹膜炎在临床上时有发生，但只要细心观察，及时发现，通过正确的处理，精心护理，可促进患者早日康复，避免严重后果的出现。     

内镜下射频治疗消化道息肉患者的观察及护理体会

【目的】总结消化道息肉患者射频治疗后的观察与护理经验。【方法】对92例内镜下射频治疗后的消化道疾病患者进行密切观察,加强护理。【结果】经射频治疗后并实施精心护理,82例息肉全部消失,个别患者留有浅表瘢痕。【结论】射频治疗后的观察及护理可避免并发症的出现,提高了治愈率,使治疗获得良好效果。     

羊水栓塞致DIC、急性呼吸窘迫综合征患者的抢救护理

【目的】总结羊水栓塞、D IC、急性呼吸窘迫综合征患者的抢救和护理经验。【方法】准确、快速执行医嘱,建立多条静脉留置通道,积极抢救护理,严密观察。【结果】经过抢救治疗和精心护理,患者痊愈出院。【结论】密切配合的护理对提高羊水栓塞致DIC、ARDS患者的抢救成功率有重要意义。     

眼外伤89例急诊治疗与护理

目的：探讨眼外伤的急诊手术的处理方法和护理要点。方法：对89例不同部位不同程度眼外伤患者进行伤后急诊手术处置和护理,观察患者的治疗效果和总结护理体会。结果：89例患者病情都得到有效地控制,经过精心的护理,患者得以康复出院。结论：眼是人体一个非常重要的器官,眼外伤的急诊处理要点要求：手术严格无菌操作,技术动作轻柔准确,精心缜密的护理,是眼外伤顺利康复的关键。     

79例板栗刺致眼外伤的临床治疗与护理

总结了79例板粟刺致眼外伤的临床处理与护理。治疗处理方法主要介绍了直接剔除、深层处理和并发角膜溃疡的处理方法；护理措施是：心理护理、避免交叉感染、观察患者全身情况和饮食指导等。认为正确的处理方法和精心的护理是保证治疗成功的关键。     

36例急性A型主动脉夹层患者围术期的护理体会

【目的】探讨如何提高急性A型主动脉夹层（TAAD）患者围术期护理质量。【方法】对2012年1月至2013年12月本院收治的36例急性TAAD患者实施围术期护理,对其资料进行回顾性分析总结。【结果】36例患者在全麻低温体外循环下实施手术治疗,33例患者均康复出院,术后死亡3例。【结论】良好围术期护理对提高急性TAAD患者术后质量,促进患者早日康复有重要意义。     

经黏膜下隧道内镜肿瘤切除术治疗食管固有肌层肿瘤的护理

【目的】探讨经黏膜下隧道内镜肿瘤切除术治疗食管固有肌层肿瘤的临床护理配合措施及技巧。【方法】收集2014年9月至2015年12月共64例行经黏膜下隧道内镜肿瘤切除术治疗的食管固有肌层肿瘤患者的临床资料,并对其术前、术中、术后护理方法及要点进行回顾性分析。【结果】64例患者均成功完成手术,平均操作时间为58min,整块切除率100％,仅2例病人出现皮下气肿,均在3d内自然吸收,经治疗和护理,所有患者痊愈出院。【结论】经黏膜下隧道内镜肿瘤切除术治疗食管固有肌层肿瘤的疗效肯定,充分的术前准备、术中医护良好配合及术后严密的病情观察和精心护理是手术成功的必备条件。     

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.