心理护理对乳腺癌患者术后生活质量的影响

目的观察心理护理对乳腺癌患者术后生活质量的影响.方法180例乳腺癌术后患者随机分为:对照组(术后进行化疗)和观察组(化疗同时进行心理护理),治疗后2组采用生活质量问卷(QLQ-C30)和卡氏功能量表(KPS)测查.结果观察组QLQ-C 30各指标和KPS得分均优于对照组.结论心理护理能减轻乳腺癌患者化疗的负反应及术后提高生活质量.     

乳腺癌保乳根治术40例围术期护理

目的:探讨乳腺癌保乳根治术围术期护理方法.方法:对40例乳腺癌保乳根治术患者加强术前准备、心理护理、保持引流管通畅、加强术后创面的观察及护理、指导患侧上肢功能锻炼、化疗和放疗的护理、健康教育及出院指导等一系列综合性护理措施.结果:40例患者均愈后良好.结论:加强围术期护理是患者术后康复的关键.     

乳腺癌根治术后患者心理护理的现状

由于我国乳腺癌的治疗以根治术或改良根治术为主,术后患者容易出现上肢功能障碍,化疗、放疗引起的不良反应,以及乳房缺失对患者的心理状态的负性影响,如不能及时对患者进行有效地护理及心理调节,患者易产生心理障碍,不利于患者的治疗及康复,本文综述了乳腺癌术后者的心理特点及护理要点,认为乳腺癌术后心理护理可促进患者康复,应在临床推广应用。     

乳腺癌术后80例护理干预

目的:探讨乳腺癌患者术后护理干预方法。方法:对80例乳腺癌手术患者实施术后常规护理、心理护理、并发症预防及护理、患侧肢体功能锻炼及康复指导。结果:经护理干预后,患者基本能配合治疗和护理,焦虑、烦躁情绪得到改善,能够正确地对待乳腺癌手术。结论:对乳腺癌术后患者进行日常护理、心理护理和全面的功能锻炼可以有效地帮助患者建立信心,端正治疗态度,减少复发率,提高治愈率。     

心理护理对乳腺癌患者术后生活质量的影响

目的观察心理护理对乳腺癌患者术后生活质量的影响。方法180例乳腺癌术后患者随机分为:对照组(术后进行化疗)和观察组(化疗同时进行心理护理),治疗后2组采用生活质量问卷(QLQ-C30)和卡氏功能量表(KPS)测查。结果观察组QLQ-C30各指标和KPS得分均优于对照组。结论心理护理能减轻乳腺癌患者化疗的负反应及术后提高生活质量。     

乳腺癌术后化疗期实施护理干预的效果

目的 评价护理干预对乳腺癌术后化疗期心理及不良反应的影响.方法 将86例乳腺癌术后患者分为两组,对照组42例实施常规护理,观察组44例用制定的临床护理干预措施及康复指导,观察两组心理、生活质量及药物不良反应.结果 两组在心理(焦虑和抑郁)、生活质量、药物不良反应方面差异均有统计学意义(P＜0.05).结论 乳腺癌术后化疗期应用护理干预可减轻患者抑郁、焦虑、恐惧等心理障碍,使不良反应降低,提高生活质量.     

乳腺癌术后化疗患者心理韧性的现状及影响因素分析

目的 了解乳腺癌术后化疗患者心理韧性的现状及影响因素.方法 采用一般资料调查表、心理韧性量表、家庭亲密度和适应性量表对197例乳腺癌术后化疗患者进行问卷调查.结果 乳腺癌术后化疗患者心理韧性得分为(56.37±11.46)分,处中等水平.多元回归分析结果显示:婚姻状况、化疗疗程、实际亲密度、实际适应性、适应性不满意程度是乳腺癌术后化疗患者心理韧性的主要影响因素(P<0.05).结论 乳腺癌术后化疗患者心理韧性有待提高,家庭亲密度和适应性状况不理想,重点关注离异或丧偶、化疗初期、家庭亲密度和适应性水平不理想的患者,采取针对性措施,提高患者心理韧性水平,促进疾病康复.     

影响青年乳腺癌患者康复的护理干预措施

目的提高青年乳腺癌患者的生存质量。方法采取随机抽样法，对我院30例青年乳腺癌患者进行心理、术后护理及术后化疗和患肢功能锻炼等方面的指导，并进行评价和总结。结果通过对30例青年乳腺癌患者的整体护理干预，使患者的基本状况得到明显改善，并能积极配合治疗，增加了疗效。结论重视青年乳腺癌患者存在的不良心身症状，采用积极有针对性的护理干预措施，对其躯体疾病的康复治疗进程及生存质量的提高有积极的促进作用。     

乳腺癌根治术后的早期康复护理和功能训练

目的观察乳腺癌根治术后早期康复护理及功能训练对患者的康复作用。方法 5 8例乳腺癌根治术后的患者随机分为康复护理组 (3 0例 )和对照组 (2 8例 ) ,对前者 ,术后第 3天即开始早期康复护理 ,并根据具体情况进行功能康复训练 ,辅以心理康复指导及自我检查训练 ;后者术后 2 0天才开始康复护理和训练。结果康复护理组通过早期康复护理和功能训练 ,患肢水肿及功能障碍的发生率低于对照组 (P <0 .0 5 )。结论乳腺癌根治术后进行早期康复护理和功能训练可改善患肢的功能 ,提高患者的生活质量     

手指屈肌腱损伤患者的分期综合性护理

目的:总结手指屈肌腱损伤修复术后的分期综合性护理效果。方法:对72例125指手指屈肌腱损伤术后患者,根据术后时间分期进行系统护理。结果:术后3月随访,手部功能优良率达90.4%。结论:对手指屈肌腱损伤术后患者分期采用心理护理、疼痛护理、中药熏洗治疗及早期正规、系统康复功能训练等综合性的护理,能提高患者手指屈肌腱损伤后的手功能。     

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.