两用型肩关节支具在肩关节损伤患者中的设计与应用

肩关节外展支具在肩关节疾病患者术后的功能康复中起着不可代替的作用。肩关节损伤患者卧位时护士通常在患侧肘与胸之间垫软枕,立位时佩带枕形肩部外展支具来保持患肢功能位。患者在卧位时软枕能不同程度的抬高患肢但不能有效固定肩关节和保持肩关节的外展、前屈、内旋、肘关节屈曲、腕关节功能位。在实施的过程中因患者床上或下床活动等体位改变而需要反复佩带肩关节支具,操作繁琐,患者对相应护理措施、保持功能位的依从性与配合度低,易发生肩关节肿胀、疼痛、关节粘连等并发症。     

背阔肌移位阔筋膜移植关节镜下重建上关节囊治疗肩袖损伤患者的术后护理

目的探讨背阔肌移位阔筋膜移植重建上关节囊治疗肩袖损伤患者的护理方法及疗效。方法对12例需背阔肌移位阔筋膜移植重建上关节囊治疗肩袖损伤患者,术后采用特制的肩关节外展支具。术前简单介绍术后患肢的姿势及特制肩关节外展支具的佩戴方法,术后进行详细的体位、外展支具松紧度、注意事项及伤口情况的观察。结果 12例患者伤口均一期愈合,外展支具对皮肤及重要组织未造成压疮及损伤。经过6~12个月随访,患者的功能恢复达到预期效果。结论掌握背阔肌移位阔筋膜移植重建上关节囊治疗肩袖损伤患者的护理要点,对提高手术效果至关重要。     

肩关节外展支具在关节镜下肩袖修补术后患者中的应用及康复护理

目的:探讨肩关节外展支具在关节镜下肩袖修补术后患者中的应用及康复护理。方法:选择2012年6月~2015年5月于我院行关节镜下肩袖修补术的患者86例作为研究对象并随机等分为对照组和研究组,术后两组均应用肩关节外展支具及常规护理,研究组在此基础上给予康复护理指导,随访1年,比较两组患者肩关节功能恢复情况。结果:术后4周至术后1年,研究组患者肩关节功能ASES评分均高于对照组,差异比较有统计学意义(P0.05)。结论:关节镜下肩袖修补术后正确应用肩关节外展支具,再辅以康复护理,可有效提高肩关节功能恢复效果,促进患者预后。     

脊柱术后患者支具佩戴依从性与认知的相关性分析

目的：了解脊柱术后患者支具佩戴的依从性现状及其对支具佩戴的认知情况,为提高患者术后佩戴支具的依从性、减少术后并发症的发生风险提供依据。方法采取电话采访的方式对100例脊柱术后需要佩戴支具的患者进行问卷调查,了解患者支具佩戴依从性及对于支具佩戴的认知状况。结果脊柱术后患者中支具佩戴依从性高者占41％,依从性中等者占47％;100例患者中,80％以上对“不能够接受自己所患疾病”、“认为没有必要佩戴脊柱支具”、“不愿意遵从医嘱佩戴支具”表示明确否定态度。不同依从性的患者对认为没有必要佩戴脊柱支具、对于脊柱手术后下床活动心存恐惧、佩戴支具不舒适的认知存在差异（χ^2分别为25．475,16．288,20．017;P＜0．05）。结论脊柱术后患者支具佩戴依从性不高,与患者的各种不良认知有关,临床护理人员应根据患者存在的各种不良认知开展有针对性的护理工作,以增加脊柱术后患者支具佩戴的依从性。     

肩关节运动八式配合穴位贴敷在乳腺癌术后肩关节活动障碍患者中的应用

目的：探讨肩关节运动八式配合穴位贴敷在乳腺癌术后肩关节活动障碍患者中的应用效果。方法：回顾性分析2018年5月1日～2021年1月31日乳腺科148例乳腺癌术后肩关节活动障碍患者的临床资料，所有患者均给予肩关节运动八式配合穴位贴敷护理。比较护理前、护理12周后患者肩关节恢复状况、治疗优良率、肩关节活动度与功能锻炼依从性。结果：护理12周后，患者治疗优良率为92.57%;患者美国加州大学(UCLA)肩关节评分、功能锻炼依从性评分均高于护理前(P<0.01),肩关节活动度优于护理前(P<0.01)。结论：肩关节运动八式配合穴位贴敷有助于促进乳腺癌术后肩关节活动障碍患者肩关节功能恢复，提高患者锻炼依从性。     

自制功能康复装置在乳腺癌术后患肢功能锻炼的应用

目的探讨使用自制功能康复装置对乳腺癌术后患肢功能锻炼的促进作用。方法选择80例乳腺癌改良根治术后患者,按照随机数字表法分为试验组和对照组,对照组采用常规乳腺癌术后渐进式功能康复操锻炼方法,试验组患者使用自制功能康复装置进行锻炼,观察患者肩关节活动度、锻炼依从性及患者满意度。结果试验组患者通过使用自制功能康复装置进行患肢功能锻炼,肩关节活动度、锻炼依从性及患者满意度均优于对照组(P0.05)。结论自制功能康复装置设计科学合理,使用方便,易于操作,患者锻炼依从性高,能有效促进患肢功能康复,提高患者生存质量。     

肩关节外展包于巨大肩袖损伤患者中的设计与应用

正目前,临床上巨大肩袖修补术后并未常规使用外展包,部分采用肩关节悬吊带[1-2],部分则在患者卧位时患侧肘与胸之间垫软枕,立位时佩带肩部外展支具。患者往往由于疼痛、床上翻身移动或下床活动等原因,对相应护理措施或保持功能位的依从性与配合     

提高肩关节镜术后患者康复功能锻炼达标率的实践

运用持续质量改进,提高肩关节镜术后患者康复功能锻炼达标率,促进患者关节功能康复。对影响达标率的原因进行调查分析,制订计划和改进措施,实施并评价效果。运用PDCA从支具佩戴、用具创新、康复器材、锻炼场所、训练图谱、健教形式、评估反馈等方面进行持续质量改进,使肩关节镜术后康复功能锻炼达标率由49.66%提高至70.83%。科学的质量持续改进减轻了患者疼痛,提高了关节功能,减轻了护士工作量,激发了护士工作热情,有效提高了肩关节镜术后患者康复功能锻炼达标率。     

肩关节镜下肩袖损伤修补术患者的护理

目的 探讨肩关节镜下肩袖损伤修补术患者的护理经验.方法 对14例患者术前做好心理护理及肩部支具佩戴方法的指导,术后功能体位护理、肩部支具护理、疼痛护理、并发症的观察与护理和功能锻炼的指导.结果 14例患者中1例患者于术后6周复查时发现右肩关节缝合锚拔出,给予肩关节镜下锚钉取出,切开肩袖修补术,术后康复出院.结论 肩关节镜下肩袖损伤修补术对组织损伤小,术后疼痛轻,并发症少,恢复快,可以早期进行功能锻炼.     

肩关节镜下肩袖损伤修补术患者的护理

目的 探讨肩关节镜下肩袖损伤修补术患者的护理经验.方法 对14例患者术前做好心理护理及肩部支具佩戴方法的指导,术后功能体位护理、肩部支具护理、疼痛护理、并发症的观察与护理和功能锻炼的指导.结果 14例患者中1例患者于术后6周复查时发现右肩关节缝合锚拔出,给予肩关节镜下锚钉取出,切开肩袖修补术,术后康复出院.结论 肩关节镜下肩袖损伤修补术对组织损伤小,术后疼痛轻,并发症少,恢复快,可以早期进行功能锻炼.     

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.     

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.     

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.     

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.     

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.