利用留置针结合注射疗法治疗颈椎病的疗效观察

[目的]探讨两种方法治疗颈椎病的效果.[方法]将120例颈椎病病人随机分观察组和对照组,对照组采用小针刀进行治疗,观察组在小针刀治疗基础上利用留置针结合注射疗法进行治疗.[结果]治疗后2周及治疗后6个月观察组显效率高于对照组(P＜0.01).[结论]利用留置针可使小针刀治疗和注射疗法有机地结合起来,操作简便,疗效更加确切.     

头体针疗法结合早期康复治疗中风后肢体瘫痪的疗效观察

[目的]观察头体针疗法结合早期康复治疗中风后肢体瘫痪的疗效。[方法]将60例中风后肢体瘫痪病人随机分为观察组和对照组,每组30例,对照组采用传统针刺法,观察组采用头体针疗法结合早期康复。观察并比较两组病人的治疗效果。[结果]观察组治疗效果优于对照组。[结论]头体针疗法结合早期康复治疗中风后肢体瘫痪可有效改善肢体运动功能,提高日常生活活动能力。     

新鲜马铃薯外敷预防静脉炎的研究

[目的]探讨预防静脉炎的有效措施，减少静脉炎的发生。[方法]将使用静脉留置针静脉输注甘露醇的100例病人随机分成实验组和对照组，实验组采用新鲜马铃薯外敷注射部位。对照组未采用新鲜马铃薯外敷。观察两组静脉炎发生率及留置针留置时间。[结果]实验组较对照组静脉炎发生率明显降低，静脉留置针留置时间明显延长。[结论]新鲜马铃薯外敷静脉留置针注射部位，可有效地预防静脉炎的发生，延长静脉留置针的使用时间。减轻病人痛苦。     

Mckenzie疗法治疗青年颈椎病的疗效观察

[目的]探讨Mckenzie疗法治疗青年颈椎病的疗效及其护理。[方法]将86例青年颈椎病病人随机分为治疗组和对照组，治疗组采用Mckenzie疗法加传统治疗（牵引、理疗）及护士的密切配合；对照组采用传统方法进行治疗，观察两组病人的疗效及出院后1年复发情况。[结果]治疗后治疗组疗效明显优于对照组（P〈0．05），1年后复发率明显低于对照组（P〈0．05。[结论]Mckenzie疗法对青年颈椎病有较好的疗效，且能预防复发，护士在治疗中起着重要的作用。     

小针刀疗法合半夏白术天麻汤治疗椎动脉型颈椎病观察

目的:分析小针刀疗法结合半夏白术天麻汤治疗椎动脉型颈椎病的临床效果。方法:选取2017年3月~2018年9月收治的椎动脉型颈椎病患者70例为研究对象,采用随机数字表法分为对照组和观察组,各35例。对照组采用小针刀疗法治疗,观察组采用小针刀疗法结合半夏白术天麻汤治疗。比较两组治疗前后血流动力学指标及临床疗效。结果:治疗前,两组左椎动脉、右椎动脉和基底动脉血流速度比较,差异无统计学意义(P>0.05);治疗后,两组左椎动脉、右椎动脉和基底动脉血流速度均较治疗前提高,且观察组较对照组提高明显(P<0.05);观察组治疗总有效率明显高于对照组(P<0.05)。结论:采用小针刀疗法结合半夏白术天麻汤治疗椎动脉型颈椎病患者临床效果显著,可促进患者血流动力学的改善。     

头体针疗法结合早期康复治疗中风后肢体瘫痪的疗效观察

[目的]观察头体针疗法结合早期康复治疗中风后肢体瘫痪的疗效.[方法]将60例中风后肢体瘫痪病人随机分为观察组和对照组,每组30例,对照组采用传统针刺法,观察组采用头体针疗法结合早期康复.观察并比较两组病人的治疗效果.[结果]观察组治疗效果优于对照组.[结论]头体针疗法结合早期康复治疗中风后肢体瘫痪可有效改善肢体运动功能,提高日常生活活动能力.     

两种小儿留置针固定方法比较

[目的]探讨小儿留置针固定的稳定性,延长留置针留置时间。[方法]将270例应用小儿留置针的患儿随机分为观察组和对照组,对照组穿刺成功后常规使用圣纳愈敷膜贴住针眼及针柄,再加以胶布固定;观察组穿刺成功后先用圣纳愈敷膜内附有的纸胶贴进行固定针眼及针柄,再用圣纳愈敷膜进行固定。[结果]观察组静脉留置针固定时间明显长于对照组(P<0.05)。[结论]改进后的留置针固定方法可延长留置时间,任何部位穿刺固定。     

Mckenzie疗法治疗青年颈椎病的疗效观察

[目的]探讨Mckenzie疗法治疗青年颈椎病的疗效及其护理。[方法]将86例青年颈椎病病人随机分为治疗组和对照组,治疗组采用Mckenzie疗法加传统治疗(牵引、理疗)及护士的密切配合;对照组采用传统方法进行治疗,观察两组病人的疗效及出院后1年复发情况。[结果]治疗后治疗组疗效明显优于对照组(P<0.05),1年后复发率明显低于对照组(P<0.05)。[结论]Mckenzie疗法对青年颈椎病有较好的疗效,且能预防复发,护士在治疗中起着重要的作用。     

新鲜马铃薯外敷预防静脉炎的研究

[目的]探讨预防静脉炎的有效措施,减少静脉炎的发生。[方法]将使用静脉留置针静脉输注甘露醇的100例病人随机分成实验组和对照组,实验组采用新鲜马铃薯外敷注射部位,对照组未采用新鲜马铃薯外敷。观察两组静脉炎发生率及留置针留置时间。[结果]实验组较对照组静脉炎发生率明显降低,静脉留置针留置时间明显延长。[结论]新鲜马铃薯外敷静脉留置针注射部位,可有效地预防静脉炎的发生,延长静脉留置针的使用时间,减轻病人痛苦。     

高举平台固定法在小儿静脉留置针中的应用

[目的]观察高举平台固定法在小儿静脉留置针中应用的可行性。[方法]将100例静脉留置针患儿随机分为观察组和对照组各50例,观察组采用高举平台固定法固定静脉留置针,对照组采用普通的固定方法,观察两组患儿3 d后更换留置针敷贴时局部皮肤情况。[结果]观察组皮肤损伤率明显低于对照组（P〈0.05）。[结论]留置针穿刺成功后在留置期间采用高举平台固定法可有效预防局部皮肤损伤。     

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.