不同时间间隔电话联合短信干预用于社区老年高血压患者中的临床价值

目的探讨不同时间间隔电话联合短信干预用于社区老年高血压患者中的临床应用价值。方法选取自2013年5月至2015年4月某社区老年高血压患者168例,以抽签的方法将其平均分为4组,每组42例。4组干预时间分别为:A组每天1次、B组2d1次、C组3d1次、D组5d1次,4组均连续电话和短信干预6个月。对比4组患者干预前后服药依从性得分及血压变化情况。结果干预后,4组服药依从性得分均明显增加,且B、C组得分明显优于A、D两组,差异有统计学意义(P0.05)。干预后,4组收缩压均有明显改善,且B、C两组明显低于A、D两组,差异有统计学意义(P0.05);4组舒张压有所降低,但比较后差异无统计学意义(P0.05)。结论对社区老年高血压患者进行2d或3d一次的电话联合短信干预模式,可有效改善患者的血压情况,提高其服药依从性,应用价值高。     

应用跨理论模型对老年高血压患者健康教育的效果观察

目的 运用跨理论模型对社区老年高血压患者实施分阶段干预,评估干预效果,为实施高血压社区干预提供依据.方法 随机抽取广州市番禺区某社区符合条件的老年高血压患者120例,随机分为干预组和对照组,干预组实施跨理论模型的分阶段干预,对照组实施常规的健康教育.干预前、干预后3个月、干预后6个月评估两组患者服药依从性、行为依从性、生活质量、血压.结果 两组干预前基线资料比较差异无统计学意义(P＞0.05),干预后两组的血压、服药依从性、行为依从性、生活质量明显改善(P＜0.05),但干预组改善程度比对照组更明显(P＜0.05),且干预组的血压、服药依从性、行为依从性、生活质量有随时间延长而改善的趋势(P＜0.05).结论 跨理论模型的分阶段干预能有效促进高血压患者的行为改变,提高患者的行为依从性,从而达到降压和提高生活质量的目的.     

基于希望理论的电话及短信干预随访在乳腺癌病人出院后的应用效果

[目的]探讨基于希望理论的电话及短信干预随访在乳腺癌病人出院后的应用效果。[方法]将87例乳腺癌术后病人随机分为观察组43例和对照组44例,对照组给予电话随访和短信干预,观察组给予基于希望理论的电话随访和短信干预,对比分析两组病人干预前、干预后3个月、6个月后的希望水平、服药依从性、生活质量、护理服务满意度等。[结果]干预3个月、6个月后,观察组希望水平、病人服药依从性、生活质量均明显高于对照组(P0.05);观察组护理满意度为97.7%,明显高于对照组的81.8%(P0.05)。[结论]基于希望理论的电话及短信干预随访可提高乳腺癌病人希望水平、服药依从性、生活质量和护理满意度。     

社区高血压患者的护理模式的探讨

目的 探讨居家护理对高血压患者血压控制及依从性的影响.方法 以性别、年龄、高血压等级为配对条件,筛选80例(40对)满足配对的高血压患者随机分为居家组和常规组,每组40例.居家组给予程序式居家护理、常规组常规性社区护理,共干预6个月.结果 两组患者干预3、6个月后降压效果及依从性差异均存在显著性意义(P＜0.05).结论 程序式居家护理可提高高血压患者的依从性,促进血压的降低,有利于患者生存质量提高,同时具有可操作性与实用性,值得在社区护理中推广应用.     

延续性护理干预对高血压患者服药依从性的影响

目的:探讨延续性护理干预对原发性高血压患者服药依从性的影响。方法:将住院治疗的高血压患者96例随机分为观察组和对照组各48例,对照组给予常规的出院指导和门诊随访,观察组在此基础上进行出院后持续护理干预及电话随访,6个月后比较两组血压变化及服药依从性。结果:观察组患者血压情况和服药依从性均优于对照组(P0.05)。结论:延续性护理干预能提高高血压患者的服药依从性,更好的控制血压水平。     

基于跨理论模型的社区家庭访视护理对老年高血压患者服药遵从行为的影响

目的 探讨基于跨理论模型的家庭访视护理对社区老年高血压患者服药遵从行为的影响。 方法 在宁夏银川市某医院下属的社区卫生服务站中,选取符合纳入排除标准的社区老年高血压患者 129 例,分组后实验组患者接受为期 6 个月基于跨理论模型的社区家庭访视护理干预,对照组患者则给予常规家庭访视护理干预。 干预前后比较两组患者血压、服药遵从行为改变阶段、服药依从性得分。 结果 实验组社区老年高血压患者服药遵从行为阶段改变优于对照组（ P＜0.05 ）;服药依从性得分高于对照组（ P＜0.05 ）,且收缩压和舒张压控制幅度优于对照组（ P＜0.05 ）。 结论 基于跨理论模型的社区家庭访视护理干预模式可较好地改变老年高血压患者的服药遵从行为改变阶段,提高其服药依从性,帮助患者有效控制血压。     

基于行为阶段理论的社区家庭访视对老年糖尿病患者服药依从性的影响

目的探讨基于行为阶段理论的家庭访视护理对社区老年糖尿病患者服药依从性的影响。方法选取64例老年糖尿病患者为对照组,64例为试验组。对照组给予常规家庭访视护理干预,试验组给予基于行为阶段理论的社区家庭访视护理干预。干预前、干预后3个月、6个月对两组老年糖尿病患者服药依从性、血糖进行比较;干预前后对两组老年糖尿病患者的服药遵从行为改变阶段进行比较。结果干预后3个月、6个月试验组患者服药依从性得分均高于对照组(P0.01或P0.05);干预后3个月、6个月试验组患者空腹血糖、餐后2 h血糖、糖化血红蛋白均低于对照组;干预后试验组服药遵从行为阶段改变优于对照组(P0.01或P0.05)。结论基于行为阶段理论的社区家庭访视护理可较好地改变老年糖尿病患者的服药遵从行为改变阶段,提高服药依从性,帮助控制血糖。     

家庭医生服务模式对社区老年高血压患者服药依从性和血压的影响

目的探讨家庭医生服务模式对社区老年高血压患者服药依从性和血压的影响。方法选取2016年3月至2018年2月于该院接受管理的高血压患者248例为研究对象,按照随机数字表法分为对照组和观察组,每组124例。对照组实施常规社区管理模式,选择合适的降压药,并且与非药物干预结合。观察组采用家庭医生服务模式。干预1年后,对比两组患者服药依从性和血压的变化。结果与干预前比较,观察组和对照组血压有明显下降,差异均有统计学意义(P0.05),且观察组血压下降更明显(P0.05)。干预后观察组服药依从性较好者占71.77%,远远高于对照组的53.23%,差异有统计学意义(P0.05)。结论家庭医生服务模式能够提高社区老年高血压患者的服药依从性,并且有效地控制了血压,值得临床进一步推广。     

城镇高血压患者程序式居家护理的研究

目的 探讨程序式居家护理对高血压患者血压控制及依从性的影响.方法 以性别、年龄、高血压等级为配对条件,筛选70例(35对)满足配对条件的高血压患者随机分为居家组和常规组,居家组35例给予程序式居家护理;常规组35例给予常规性社区护理,共干预6个月.结果 两组患者干预3个月、6个月后降压效果及依从性差异均存在显著性意义(P<0.05).结论 程序式居家护理可提高高血压患者的依从性,促进血压的降低,有利于患者生存质量提高,同时具有可操作性与实用性,值得在社区护理中推广应用.     

微信健康教育在高血压脑出血病人延续护理中的应用

[目的]探讨微信健康教育在高血压脑出血病人出院后延续护理中的应用效果。[方法]将神经外科100例高血压脑出血病人出院时根据随机数字表法分为对照组和观察组。出院后6个月内对照组常规予以每月1次电话随访干预,观察组由延续护理小组通过微信健康教育进行干预,比较两组病人的干预效果。[结果]干预后观察组病人各项健康自我管理行为评分较对照组明显升高(P0.05);观察组病人在干预3个月、6个月后服药依从性、血压控制情况优于对照组(P0.05);观察组病人满意度高于对照组(P0.05)。[结论]将微信健康教育应用于高血压脑出血病人延续护理管理中能提高出院病人自我管理能力,改善健康行为,提高服药依从性,保持血压稳定,提高病人满意度,有助于延续护理的持续化。     

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."