经导管肝动脉化疗栓塞术后穿刺肢体制动及卧床时间的探讨

目的探讨经导管肝动脉化疗栓塞术（TACE）术后适当的穿刺肢体制动和卧床时间。方法2003年2月-2005年3月，将住院行TACE的236例患者分为对照组100例和实验组136例。对照组术后穿刺肢体制动和卧床时间分别为8h和24h。实验组术后穿刺肢体制动和卧床时间分别为5h和12h。比较2组患者48h内与穿刺置管有关的出血、血肿、动脉血栓形成情况和腰酸背痛、下肢麻木、失眠、烦躁和尿潴留情况发生的差异。结果2组患者出血、血肿、动脉血栓形成3种并发症的发生情况比较差异无显著性，P〉0．05。尿潴留、腰酸背痛、失眠、下肢麻木和烦躁情况进行比较P均〈0．01。结论TACE术后穿刺肢体制动5h，卧床时间12h是安全的，而且可以减少并发症，提高患者的舒适度。     

减少冠状动脉介入术后患者不良反应的护理

目的：通过一系列护理活动，减少冠状动脉介入术后患者的不良反应。方法：通过查找原因，然后采取护理干预50例和50例一般护理对照。对照组按常规护理冠状动脉造影术后卧床24h，PCI术后卧床48h，观察组术前、术后认真宣教及心理护理，改进卧位及缩短卧床时间，冠状动脉造影及PCI术后卧床时间分别为12h、24h协助完成各项生活自理，按摩腰背部。结果：护理干预组不良反应发生明显低于常规护理。结论：根据患者的需要及病情适当调节卧位及必要心理护理，可减少患者不良反应。     

经导管肝动脉化疗栓塞术后穿刺肢体制动及卧床时间的探讨

目的探讨经导管肝动脉化疗栓塞术(TACE)术后适当的穿刺肢体制动和卧床时间。方法2003年2月-2005年3月,将住院行TACE的236例患者分为对照组100例和实验组136例。对照组术后穿刺肢体制动和卧床时间分别为8h和24h。实验组术后穿刺肢体制动和卧床时间分别为5h和12h。比较2组患者48h内与穿刺置管有关的出血、血肿、动脉血栓形成情况和腰酸背痛、下肢麻木、失眠、烦躁和尿潴留情况发生的差异。结果2组患者出血、血肿、动脉血栓形成3种并发症的发生情况比较差异无显著性,P>0.05。尿潴留、腰酸背痛、失眠、下肢麻木和烦躁情况进行比较P均<0.01。结论TACE术后穿刺肢体制动5h,卧床时间12h是安全的,而且可以减少并发症,提高患者的舒适度。     

肝癌介入术后不同卧床体位及卧床时间的研究

[目的] 探讨肝癌介入治疗术后患者早期床上活动及卧床时间对患者舒适度、并发症及不良反应的影响。[方法]将150例患者随机分为2组,实验组和对照组各75例。实验组术后予床头抬高15-30度;术后患侧肢体制动6h后即开始床上活动(床上翻身、屈膝、屈髋等动作) ;静卧12h之后可行床旁活动。对照组术后取平卧位,常规绷带压迫局部6h,患肢制动12 h,静卧24 h后开始活动。比较2组患者术后穿刺点出血及血肿发生率、腰背酸痛情况、焦虑程度和排尿情况。[结果] 实验组患者中有2例穿刺部位出现血肿,而对照组患者则有1例出现血肿,两组比较差异无统计学意义（P>0.05）。两组患者的舒适度比较,实验组患者在排尿困难、焦虑程度和腰背痛 3 项指标均优于对照组患者,差异有统计学意义（P<0.05）。[结论] 肝癌介入治疗术后缩短卧床时间和改变卧床体位后,可提高患者舒适度,减少术后不适,提高护理质量。     

肾穿刺术后病人卧位及卧床时间探讨

[目的]探讨肾穿刺术后卧位及卧床时间对病人舒适度和并发症的影响。[方法]将肾穿刺术后病人分为对照组和实验组，对照组术后按常规进行护理，穿刺点包扎腹带，且用0．35kg～0．50kg砂袋压迫，平卧硬板床8h，卧床24h；实验组术后穿刺点包扎腹带且用0．35kg～0．50kg砂袋压迫，平卧硬板床6h，卧床24h。[结果]两组病人术后并发症发生率无统计学羞异，实验组舒适度高于对照组。[结论]实验组缩短了病人平卧硬板床时间，提高了病人舒适度。     

健康教育对改善DSA术后患者舒适度的影响

目的：通过健康教育及护理干预提高DSA术后患者的舒适度。方法：将DSA术后患者随机分为对照组与健教组各50例。对照组按传统的方法于DSA造影术后平卧24 h,卧床期间协助生活护理,按摩背部。健教组术前、术后给予健康教育;改进卧位,即在加压器包扎的24 h内协助水平移动身体,术肢伸直制动,平卧与非术侧30°翻身侧卧;协助生活护理。结果：健教组不良反应发生率明显低于对照组（均P〈0.01）,患者舒适度明显高于对照组（P〈0.01）,两组患者术后血肿、出血发生率比较差异无统计学意义（均P〉0.05）。结论：根据患者的需要适度调整卧位,可较大程度提高患者舒适度。     

冠状动脉介入治疗术后卧床时间的循证研究

目的通过运用循证护理，找出冠状动脉介入术后最佳的卧床时间。方法将60例冠状动脉成形术＋支架植入术患者作为实验组，术后4～6h拔管并徒手按压30min，2kg沙袋压迫穿刺点、卧床并制动6h后进行床上活动，24h后床旁活动。另60例作为对照组，除卧床并制动24h外，余同实验组。结果两组患者术后24h均有1例发生穿刺点出血、血肿。但实验组无1例需导尿，腹胀、排尿困难、腰酸、失眠的发生率也明显少于对照组。结论应用循证护理找出冠状动脉治疗术后最佳的卧床时间，并通过临床实践，表明改进后的护理方法可以显著降低术后并发症的发生，充分体现以人为本的护理理念。     

肾穿刺活检术后患者卧位及卧床时间的循证研究

目的通过运用循证护理,找出肾穿刺活检术后患者最佳的卧位及卧床时间。方法将肾穿刺术后患者分为对照组55例和循证组58例,对照组术后按常规进行护理,穿刺点包扎腹带,用0．5kg沙袋压迫,平卧硬板床8h,卧床24h;循证组术后穿刺点包扎腹带且用0．5kg沙袋压迫,平卧海绵垫床并且穿刺部位制动4～6h后,卧床12h。观察并比较两组并发症的发生及舒适度情况。结果两组患者术后并发症比较差异无统计学意义（P〉0．05）,循证组舒适程度优于对照组,差异有统计学意义（P〈0．05）。结论应用循证护理找出肾穿刺活检术后患者最佳的卧位及卧床时间,改进后的护理方法并未增加并发症的发生,但明显改善了患者的舒适度,体现了以人为本的护理理念。     

单纯冠状动脉造影术后2 h活动方法及其对患者的影响

目的探讨单纯冠状动脉造影术后2h床上活动及床旁排尿的方法及其对患者的影响。方法50例冠脉造影术患者作为对照组，采用传统方法，即患者术侧肢体保持伸直并严格制动6h，去除沙袋后术侧下肢可平移，12h可半卧位，24h床旁活动。实验组50例，在对照组的基础上，术后2h开始，根据患者需要在按压穿刺点的同时协助患者侧卧10～15min；对要求床旁排尿患者可在按压穿刺点同时协助患者坐或立于床旁排尿，12h可半卧位，24h床旁活动。结果两组术后24h均无穿刺点出血、血肿发生，但实验组无1例发生排尿困难或导尿，舒适度差、焦虑、失眠发生率也明显少于对照组。结论在护理人员协助下，单纯冠脉造影术后2h床上适当活动及在床旁排尿是安全、可行的，能够明显改善患者术后排尿困难及舒适度差、焦虑、失眠等不适。     

经皮冠状动脉内介入治疗术后患者卧位及卧床时间的研究

目的:探讨经皮冠状动脉内介入治疗(PC I)术后患者的卧位及卧床时间对患者舒适度及并发症发生率的影响。方法:将140例PC I术后患者随机分为对照组和实验组,对照组60例,穿刺点弹性绷带包扎并用1kg沙袋压迫8h,术侧肢体制动24h后下床活动;实验组80例,术后床头抬高30°,穿刺点弹性绷带包扎,术侧肢体伸直可水平移动,患者侧卧位与平卧位交替,12h后下床活动。结果:两组术后并发症发生率无明显差异(P>0.05),但实验组患者舒适度明显优于对照组(P<0.05)。结论:经皮冠状动脉内介入术后采取抬高床头30°、侧卧位与平卧位交替、早期下床活动可提高患者的舒适度,且不增加术后并发症发生率。     

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.     

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.     

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.     

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."