PICC携管化疗间歇期90例院外家庭维护效果观察

目的:探讨经外周静脉置入中心静脉导管(PICC)患者化疗间歇期院外家庭维护的效果.方法:将180例PICC携管化疗患者随机分为对照组和研究组各90例,对照组化疗间歇期由护理小组人员进行常规换药处理,研究组化疗间歇期按导管维护指导流程进行家庭维护.比较两组化疗间歇期结束返院时的导管固定情况、穿刺部位皮肤情况、细菌感染及机械性静脉炎的发生率.结果:两组化疗间歇期结束返院时的导管固定情况、穿刺部位皮肤情况比较差异无统计学意义(P>0.05);两组拔管后均未出现细菌感染及机械性静脉炎.结论:PICC携管化疗间歇期院外家庭维护效果较好,值得临床推广.     

健康教育模式在老年宫颈癌PICC置管化疗间歇期患者中的应用

目的:探讨健康教育模式在老年宫颈癌PICC置管化疗间歇期患者中的应用方法及效果。方法:将84例老年宫颈癌PICC置管化疗间歇期患者随机分为观察组和对照组各42例;对照组给予常规护理干预,观察组在此基础上实施健康教育模式;比较两组护理效果。结果:两组患者自我管理能力、宫颈癌认知率、治疗依从性、导管维护良好率、预后良好率比较差异均有统计学意义(P0.01,P0.05)。结论:健康教育模式可提高老年宫颈癌PICC置管化疗间歇期患者的治疗依从性,提升患者自我管理能力,改善导管维持效果和预后。     

化疗间歇期留置PICC导管维护在预防医源性皮肤损伤中的应用

目的:探讨化疗间歇期患者留置PICC导管维护在预防医源性皮肤损伤中的应用效果。方法:将2019年1月1日～6月30日在静脉治疗护理专科门诊行PICC导管维护的1029例患者分为对照组,采取常规PICC导管维护流程维护;将2019年7月1日～12月31日的994例患者分为观察组,在常规PICC导管维护流程维护的同时注意细节微调进行固定;比较两组化疗间歇期留置PICC导管形成医源性皮肤损伤的情况。结果:观察组发生医源性皮肤损伤64例(6.44%),对照组发生130例(12.63%),两组比较差异有统计学意义(χ~2=9.26,P=0.01)。结论:对化疗间歇期留置PICC导管患者采取常规PICC导管维护流程的同时注意细节微调固定,有效预防医源性皮肤损伤。     

个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用

目的:探讨个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用效果。方法:将2016年10月1日～2018年8月31日收治的104例肺癌PICC置管化疗患者按照入院顺序分为观察组和对照组各52例,对照组实施常规护理,观察组在常规护理基础上给予个案管理的延伸护理服务;比较两组自护能力评分、导管相关性血流感染发生率、护理满意度、干预前后自我效能评分[采用中文版癌症自我管理效能量表(SUPPH)]。结果:观察组自护信心、自护依从性、导管维护能力、异常情况处置评分高于对照组(P0.01);观察组导管相关性血流感染发生率低于对照组(P0.05),护理满意度高于对照组(P0.05);干预后,两组自我决策、自我减压、正性态度评分高于干预前(P0.05),且观察组高于对照组(P0.05)。结论:在延伸护理服务中采取个案按理方案有利于提高肺癌PICC置管患者化疗间歇期自护能力,降低导管相关性血流感染发生率,提高患者自我效能,且护理满意度高。     

护理干预对减少化疗患者 PICC 置管并发症的作用

目的：探讨护理干预对减少化疗患者经外周静脉穿刺中心静脉（ PICC）置管并发症的作用。方法选取我院2011年10月至2013年12月行PICC置管的化疗患者162例,采用随机数字表法分为对照组和观察组,每组81例。对照组患者实施常规护理,给予患者PICC置管的常规维护及换药,进行常规的健康指导;观察组患者实施护理干预。比较两组患者PICC置管的并发症情况。结果观察组患者导管相关感染、机械性静脉炎、导管堵塞、穿刺点渗血、静脉血栓、导管漂移、导管脱出、导管破裂的发生率均明显低于对照组（均P＜0.05）。结论有效地护理干预可显著减少化疗患者PICC置管并发症的发生。     

医护一体化“云病房”在化疗间歇期乳腺癌患者PICC导管管理中的应用

目的 :分析医护一体化"云病房"管理在化疗间歇期乳腺癌患者PICC导管维护方面的应用效果。方法 :方便抽样选取在天津市肿瘤医院接受术后化疗的160名乳腺癌患者为研究对象,随机分为观察组(医护一体化"云病房"随访管理)和对照组(常规的电话随访),分别加强化疗间歇期的PICC导管维护。干预前、干预后6个月比较两组患者的PICC导管自我管理能力和维护质量。结果:6个月后,观察组患者导管并发症和不良事件的总发生率尤其是导管感染率明显低于对照组,差异有统计学意义(P0.05);患者的导管自我管理能力总分及导管维护依从性、导管管理信心、导管异常的处理、导管信息获取、带管日常生活得分比较,观察组均高于对照组,差异有统计学意义(P0.05)。结论:医护一体化"云病房"管理模式能够显著提高化疗间歇期乳腺癌患者PICC导管维护的质量和自我管理能力,值得进一步推广应用。     

共享决策延续性护理在肺癌化疗间歇期患者中的应用效果

目的探讨基于共享决策理念的延续性护理在肺癌化疗间歇期患者中的应用效果。方法选择2019年1月-2020年6月我科收治的肺癌PICC置管化疗间歇期患者87例为研究对象,采用分层随机法分为观察组44例和对照组43例。对照组给予常规延续性护理,观察组采用基于共享决策理念的延续性护理干预。随访6个月,比较两组干预前后自我管理效能、PICC自我管理能力、PICC置管并发症的差异。结果观察组干预后自我决策、正性态度、自我减压、自我管理效能总分高于对照组(P<0.05)。观察组干预后日常导管观察、维护依从性、导管管理信心、异常情况处理、信息获取、PICC自我管理能力总分高于对照组(P<0.05)。观察组PICC置管并发症发生率27.27%低于对照组的48.84%(P<0.05)。结论基于共享决策理论的延续性护理干预有助于增强肺癌化疗间歇期患者自我管理效能,提高PICC自我管理能力,减少PICC置管并发症的发生。     

患者及家属全程教育的护理模式在化疗患者行PICC置管术中的应用

目的观察患者及家属全程教育的护理模式在化疗患者行PICC置管术中的应用。方法将73例化疗患者按不同的护理模式分为2组：观察组37例和对照组36例。观察组采取护理人员维护导管,患者及家属全程教育的护理模式;对照组采取常规护理模式,即置管至拔管由护理人员维护导管。结果观察组患者局部感染、导管堵塞的发生率及PICC导管留置时间均明显低于对照组,差异均有统计学意义（均P〈0.05）。结论患者及家属全程教育的护理模式能减少PICC导管留置并发症的发生,延长PICC导管留置时间。     

精准化延续护理对肿瘤患者化疗间歇期院外PICC管的影响

目的探讨精准化延续护理对肿瘤患者化疗间歇期院外PICC管的影响。方法选取120例接受化疗PICC置管患者按照置管时间顺序分为观察组(n=60)和对照组(n=60),观察组在PICC管常规护理操作的基础上实施精准化延续护理,对照组实施PICC管常规护理操作。观察两组化疗间歇期院外PICC管并发症发生率、维护依从率、护理工作满意度。结果观察组PICC管并发症发生率低于对照组,差异有统计学意义(P0.05)。观察组维护依从率、护理工作满意度均高于对照组,差异均有统计学意义(P0.05)。结论肿瘤患者化疗间歇期采用精准化延续护理,及时发现解决PICC管护理问题,降低PICC管并发症发生率,能提高患者院外PICC管维护依从率及护理工作满意度。     

PICC携管出院患者基于QQ群健康教育的效果观察

目的 探讨QQ群在PICC携管出院患者健康教育的应用效果.方法 将126例PICC携管出院患者根据QQ群建立时间的前后分为观察组和对照组各63例.对照组患者给予常规导管护理指导及电话随访,观察组患者在对照组基础上基于QQ群健康教育.观察比较2组患者PICC维护知识认知情况、导管按时维护依从率、护理服务满意度及PICC并发症的发生率.结果 随访3个月末,观察组患者PICC维护知识回答正确率高于对照组(P<0.05),出院后PICC导管按时维护依从率、护理服务满意度高于对照组(P<0.05);观察组患者携管出院后PICC穿刺点感染、静脉炎、导管移位及堵管并发症的发生率低于对照组(P<0.01).结论 对PICC携管出院患者基于QQ群健康教育,可提高了PICC携管出院患者PICC维护知识认知水平,提高患者导管按时维护的依从率及护理服务满意度,降低了置管后并发症发生.     

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.     

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."     

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.