配制于3L聚氯乙烯袋中胰岛素活性的观察

目的为观察3L聚氯乙烯袋中胰岛素配制时、24h输注中其活性的变化，作者将相同单位的胰岛素配入3L聚氯乙烯袋内的不同混合液中。结果配制后即刻（0h），全肠外营养混合液中的胰岛素活性明显高于葡萄糖盐水混合液中的胰岛素活性（P＜0．01）；不同温度保存48h内，各液体中胰岛素活性无明显降低（P＞0．05）。结论（1）尽量降低胰岛素在配制时的丢失；（2）配制后24h内输注是安全可靠的。     

全营养混合液配制的护理管理

为了确保全营养混合液(TNA)在临床的正确实施和应用的安全性,通过对TNA液配制保证了TNA液的质量.在6年期间共配制TNA液20803袋,用于4522例病人,结果各例病人均未发生因输注TNA液引起的发热,寒战、呼吸困难、胸闷、胸痛、恶心、呕吐、皮疹等不良反应.认为①严格遵守TNA液配制的程序是确保TNA液质量的关键;②正确的贮存方法和严格限制贮存时间确保了TNA液的理化性质不变,从而达到安全输注的目的;③配制室的管理对TNA液的质量起保障作用.     

输注静脉营养液滴系数的影响因素分析

目的探讨输注静脉全营养混合液(total nutrient admixture,TNA)滴系数的主要影响因素,为临床计划输注TNA提供理论依据。方法模拟输液方法,测定2种不同配方的TNA在3种不同输注管道及2种不同滴注流量下5 mL的滴数各50次,计算出滴系数并比较其差异;测定2种不同配方TNA的表面张力、黏度及密度各20次,比较其差异。结果 2种不同配方TNA在同一滴注流量下同一输注管道中滴系数比较差异有统计学意义(P<0.01),不同滴注流量下同一种配方TNA在同一种输注管道滴系数的比较差异有统计学意义(P<0.01),不同输注管道中同一种配方TNA在同一滴注流量下滴系数的比较差异有统计学意义(P<0.05);2种不同配方TNA的表面张力、黏度及密度差异有统计学意义(P<0.01)。结论临床计划输注TNA时不能按管道包装上标注的滴系数来计算,在相同条件下输注与本研究相同配方的TNA滴系数可按本研究结果计算;输注不同配方TNA时,可利用本研究结果的规律来推测滴系数的值,精确的方法是在输前实测滴系数的值。     

雾化液配制后有效使用时间的研究

目的 探讨雾化液配制后的有效使用时间.方法 于雾化液配制后24,48,72,96 h分别取0.1 ml直接接种于普通琼脂培养基进行细菌培养,同时分别取8 ml加入无菌小瓶送药剂科进行药物稳定性分析.结果 雾化液配制后72 h内无细菌生长、药物稳定性良好.结论 雾化液配制后的有效使用时间为≤72 h.     

风扇形活塞注射器行非传统吸药法安全性实验研究

[目的]研究风扇形活塞注射器行非传统吸药法与使用后放置时间与细菌污染的相关性，探讨一种既省力、省时、省材又更适合于临床大量配制输液的非传统吸药法的安全性。[方法]用20mL风扇形注射器行非传统吸药法和传统吸药法连续配制相同液体A、B、C、D、E五组，分别对能量合剂、灯盏细芯、银杏达莫配制液进行细菌培养各90组，对连续配制五组液体后的注射器取即刻及放置1h、2h、3h各组的45个活塞进行细菌培养，并进行耗时对比。[结果]配制液细菌培养阳性率为0，连续抽吸20次内的注射器放置2h内其活塞细菌培养阳性率为0，非传统吸药法比传统吸药法省时。[结论]采取非传统吸药法配制液体后，风扇形活塞注射器在短时间内连续抽吸一定的次数是安全的。     

凯时治疗糖尿病合并周围神经病变引起局部不良反应的临床观察与护理

目的观察糖尿病合并周围神经病变患者使用凯时治疗时出现局部不晟反应的情况，分析出现的原因、处理措施厦效果，为临床使用凯时治疗提供指导。方法糖尿病合并周围神经病变患者使用凯时治疗30例，输注凯时治疗306例次。记录糖尿病合并周围神经病变使用凯时治疗患者的一般临床资料、静脉输注配制方法、输注滴速、配制后放置时间、静脉输注持续时间、输液局部的症状、处理方法，用百分率表示局部不良反应的发生情况。结果凯时输注306例次，发生静脉炎27例次占8．82％，静脉疼痛26例次占8．50％，皮肤瘙痒6例次占1．96％、液体外渗1例次占0．33％。结论输注时滴速过快可引起静脉炎、血管刺激性疼痛，适当减慢滴数能减少局部不良反应的发生；配制后的凯时宜在2h内使用，凯时配制后放置时问超过3h可引起严重的静脉炎，输注凯时要现用现配；250ml生理盐水中加凯时输注滴速每分钟30～60滴，100ml生理盐水中加凯时输注滴速每分钟20～40滴、凯时10μg滴斗入每分钟10～20滴的滴速可减少局部不晟反应；液体外渗后局部肿胀套在短时间内面积扩大，可用如意金黄散调醋外敷结合紫外线照射治疗；使用凯时前要给惠者进行药物指导，使患者在使用前了解有发生局部不良反应的可能。     

静脉营养液输注不同时段pH值的变化

[目的]探讨静脉营养液不同时段pH变化,为选择最佳的输注时间及药物临床应用提供理论依据。[方法]使用赛多利斯PB-10pH计,测定30例病人的静脉营养液配制后0h、6h、12h、18h、24h的pH值。[结果]配制后静脉营养液在0h～18h的使用过程中pH值为6.399～6.339,且高于5.0,低于6.6。[结论]静脉营养液输注0h～24hpH值基本稳定。     

全营养混合液的配制与输注护理

全营养混合液(TNA)主要用于胃肠外营养病人,它能提供较充足的热量、氮源、维生素、电解质及微量元素,达到营养和治疗目的。TNA的配制与输注过程是比较复杂的,现结合临床实践介绍如下。一、TNA的成份 (1)基础液:包括高渗葡萄糖、脂肪乳剂及复方氨基酸。 (2)添加剂:包括电解质,维生素及微量元素。 (一)配制前准备:仔细检查液体的包装及质量,尤其应注意有无霉菌团、包装是否严密、有无破损,并注意其消毒有效期限。将配液所需用物品放于净化台旁以供使用。开始配液前洗手,不再接触污染物品。 (二)配制方法:依次将每份液体放于净化台     

肝素钠静脉封管液启用后有效期的研究

目的了解肝素钠静脉封管液在不同使用频率和保存条件下的使用有效期。方法配制常温和冷藏保存条件下的肝素钠静脉封管液各20瓶，配制启用后分别于24，48，72，96h和1周时进行细菌培养，分析不同保存条件下和使用频次的肝素钠封管液的有效使用时间。结果肝素钠封管液启用后常温下经过96h或1周和恒温下96h检出菌落数以及封管液细菌检出率和与72h前比较差异均有统计学意义（P〈0．05和P〈0．01）；常温和恒温保存条件下，封管液菌落数比较，差异有统计学意义（U=2．51，P〈0．05）。在常温保存条件下，封管液在抽吸≥25次和〈25次比较，细菌培养阳性率差异有统计学意义（P〈0．05）。结论肝素钠静脉封管液在72h以内或抽吸次数〈25次使用是安全的。     

凯时治疗糖尿病合并周围神经病变引起局部不良反应的临床观察与护理

目的观察糖尿病合并周围神经病变患者使用凯时治疗时出现局部不良反应的情况,分析出现的原因、处理措施及效果,为临床使用凯时治疗提供指导.方法糖尿病合并周围神经病变患者使用凯时治疗30例,输注凯时治疗306例次.记录糖尿病合并周围神经病变使用凯时治疗患者的一般临床资料、静脉输注配制方法、输注滴速、配制后放置时间、静脉输注持续时间、输液局部的症状、处理方法,用百分率表示局部不良反应的发生情况.结果凯时输注306例次,发生静脉炎27例次占8.82%,静脉疼痛26例次占8.50%,皮肤瘙痒6例次占1.96%、液体外渗1例次占0.33%.结论输注时滴速过快可引起静脉炎、血管刺激性疼痛,适当减慢滴数能减少局部不良反应的发生;配制后的凯时宜在2 h内使用,凯时配制后放置时间超过3 h可引起严重的静脉炎,输注凯时要现用现配;250 ml生理盐水中加凯时输注滴速每分钟30～60滴,100 ml生理盐水中加凯时输注滴速每分钟20～40滴、凯时10 μg滴斗入每分钟10～20滴的滴速可减少局部不良反应;液体外渗后局部肿胀会在短时间内面积扩大,可用如意金黄散调醋外敷结合紫外线照射治疗;使用凯时前要给患者进行药物指导,使患者在使用前了解有发生局部不良反应的可能.     

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.     

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.     

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.     

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.     

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.