“3S2E”护理管理模式在脑卒中吞咽障碍患者中的应用

目的探讨"3S2E"护理管理模式在脑卒中吞咽功能障碍患者中的应用效果。方法选择2017年1—12月江苏省徐州市中心医院康复科收治的脑卒中伴吞咽功能障碍患者93例,将2017年1—6月的患者设为对照组(n=42),2017年7—12月的患者设为观察组(n=51),对照组患者住院期间、出院时给予常规护理措施及出院指导;观察组患者在对照组基础上实施"3S2E"护理管理模式,主要包括提高护理人员的业务技能、强化护理人员的服务意识、保障护理安全、对患者进行吞咽功能评估及健康教育。结果治疗4周后,观察组患者的吞咽功能障碍风险程度、吞咽功能障碍评分低于于对照组(P均0.05),观察组患者的误吸人次数和吸入性肺炎人次数均少于对照组(P均0.05),观察组患者血红蛋白、血清白蛋白水平高于对照组(P均0.05),且两组患者在护理满意度等级分布上存在统计学差异(P0.05)。结论 "3S2E"护理管理模式的实施,不仅改善了脑卒中吞咽障碍患者的吞咽功能,降低了患者不良事件的发生率,也提升了患者的护理满意度,保障了护理安全。     

“一病一品”护理对改善脑卒中患者吞咽功能的效果

目的评价"一病一品"护理项目对脑卒中患者吞咽功能和日常生活活动能力的影响。方法选取2017年1—6月湖北省黄冈市中心医院的脑卒中患者240例,按病区分为观察组(n=120)、对照组(n=120),收治在神经内科1及神经外科1病区的患者设为观察组,收治在神经内科2及神经外科2病区的患者为对照组。对照组采用脑卒中常规护理,观察组患者采用"一病一品"护理项目进行标准化流程护理。3周后采用洼田饮水试验评估两组患者吞咽功能,并采用Barthel生活指数评估患者护理前、护理3周后及3个月后随访时的日常生活活动能力。结果 "一病一品"护理项目实施3周后,观察组脑卒中患者吞咽功能正常所占比例为63.33%,而对照组患者吞咽功能正常所占比例为35.00%,两组患者相比差异具有统计学意义(P0.05);观察组脑卒中患者中重度吞咽功能障碍人数少于对照组(P0.05);观察组患者护理3周后、随访3个月后的生活指数评分均高于护理前及同期对照组(P均0.05)。结论 "一病一品"护理项目能够改善脑卒中患者的吞咽功能,并能提高患者的近、远期日常生活活动能力,值得临床推广。     

延续性居家护理对脑卒中吞咽功能障碍患者生活质量的影响

目的:探讨延续性居家护理对脑卒中吞咽功能障碍患者生活质量的影响。方法:选取我院于2014年11月~2016年4月收治的70例脑卒中吞咽功能障碍的患者为研究对象,随机等分为观察组和对照组,对照组出院后不进行干预,观察组实施延续性居家护理,比较两组患者院外吞咽功能恢复情况、并发症发生情况、饮食依从性及生活质量。结果:观察组随访时的吞咽功能优于对照组(P0.05),饮食依从性高于对照组(P0.05),并发症发生情况低于对照组(P0.05)。观察组随访时躯体功能、心理功能、社会功能、物质生活方面评分均高于对照组(P0.05)。结论:延续性居家护理能够促进脑卒中吞咽功能障碍患者的吞咽功能恢复,有利于营养摄入,改善患者的生活质量。     

精细化护理干预对老年脑卒中吞咽障碍患者的影响

目的:探讨精细化护理干预对老年脑卒中吞咽障碍患者吞咽功能、健康教育掌握程度及满意度的影响。方法:将2016年1月1日～2017年6月30日就诊的120例老年脑卒中合并吞咽功能障碍患者随机分为观察组和对照组各60例,对照组给予常规护理,观察组在对照组基础上给予精细化护理;比较两组护理3个月后吞咽功能[采用洼田饮水试验评分(WTDWT)和吞咽功能分级(SFA)]、健康教育知识掌握情况及满意度。结果:两组护理后WTDWT、SFA评分均高于护理前(P0.05),且观察组高于对照组(P0.05);观察组健康教育知识掌握程度评分及满意度均高于对照组(P0.05)。结论:精细化护理对老年脑卒中吞咽障碍患者的护理效果较好,可促进患者吞咽功能恢复,在提高患者对疾病认识的同时提高患者及家属满意度。     

家属参与型护理在脑卒中吞咽功能障碍患者中的应用

目的:探讨家属参与型护理在脑卒中吞咽障碍患者功能训练中的应用效果。方法:将80例急性脑卒中吞咽功能障碍患者随机分为观察组和对照组各40例,观察组家属参与吞咽康复训练全过程,对照组由康复护士进行常规康复训练,对两组实施效果、并发症发生情况、患者满意度等进行比较。结果:两组实施效果比较差异无统计学意义(P0.05),但观察组呛咳及误吸发生减少(P0.05),家属对患者吞咽障碍训练及并发症预防知识了解度明显高于对照组(P0.05),患者对护理工作满意度提高(P0.05)。结论:家属参与康复训练能减少急性脑卒中吞咽功能障碍患者并发症,促进吞咽功能恢复,提高护理满意度。     

“3S2E”护理管理模式在脑卒中吞咽障碍患者中的应用

目的：探讨“3S2E”护理管理模式在脑卒中吞咽障碍患者中的应用效果。方法：选取2020年8月1日～2022年8月31日收治的80例脑卒中吞咽障碍患者为研究对象,根据入院顺序分为对照组和观察组各40例,对照组行常规护理,观察组行“3S2E”护理管理模式,由8名责任护士实施对应护理措施。比较观察组干预前,干预14 d时责任护士临床护理质量;两组营养指标[包括血清总蛋白(TP)、白蛋白(ALB)及血红蛋白(Hb)],吞咽功能等级。结果：干预14 d时,观察组责任护士临床护理质量评分高于干预前(P<0.05,P<0.01);干预14 d时,两组TP、ALB及Hb均高于干预前(P<0.01),且观察组高于对照组(P<0.05);观察组吞咽功能等级优于对照组(P<0.01)。结论：“3S2E”护理管理模式可提升临床护理质量,改善脑卒中吞咽障碍患者的吞咽功能水平,保证体内营养均衡。     

集束化护理对脑卒中吞咽功能障碍患者康复效果与生存质量的影响

目的探讨集束化护理在脑卒中吞咽功能障碍患者中的应用效果及对生存质量的影响。方法将2015年6月至2017年5月在本院接受治疗的100例脑卒中吞咽功能障碍患者,随机等分为对照组和观察组。对照组采用常规护理干预,观察组采用集束化护理。比较两组吞咽功能、生存质量及其他并发症发生情况。结果观察组患者护理后吞咽功能优良率、社会适应性得分、生理得分、QOL总分高于对照组(P0.05),胃肠功能紊乱发生率、吸入性肺炎发生率低于对照组(P0.05)。结论集束化护理能够逐渐恢复脑卒中吞咽功能障碍患者的吞咽功能,提高生存质量。     

前瞻性护理质量管理模式在提高急诊科护理质量及降低不良事件发生率中的作用

目的评价前瞻性护理质量管理模式在提高急诊护理质量及降低不良事件发生率中的作用。方法选取2016年1月～2018年1月于我院急诊科抢救的100例患者为研究对象,其中2016年1月～2017年1月收治的50例患者设为常规组,2017年1月～2018年1月收治的50例患者设为观察组,分别采用常规护理质量管理模式以及前瞻性护理质量管理模式。对比两组患者应急反应时间、不良事件发生率以及患者护理满意度。结果观察组患者应急反应时间低于对照组患者,差异有统计学意义(P0.05);观察组应急反应时间小于30min患者比例显著高于对照组,应急反应时间大于60分钟患者比例显著低于对照组,差异有统计学意义(P0.05);观察组不良事件发生率(14%)显著低于对照组(5%),差异有统计学意义(P0.05);观察组护理满意度(92%)显著高于对照组(72%),差异有统计学意义(P0.05)。结论急诊科采用前瞻性护理管理模式能够显著缩短应急反应时间,降低不良事件发生率,提升护理满意度,值得临床推广应用。     

基于调整食物形态行摄食训练结合"3S2E"护理模式对脑卒中后吞咽功能障碍患者疾病自我感受负担及吞咽活动的影响

目的 探讨基于调整食物形态行摄食训练结合"3S2E"护理模式在脑卒中后吞咽功能障碍中的干预效果.方法 将我院收治的80例脑卒中后吞咽功能障碍患者以单双号抽签法分为对照组和观察组,各40例.对照组采取常规护理干预,观察组在常规护理基础上采取基于调整食物形态行摄食训练结合"3S2E"护理模式干预.比较两组的干预效果.结果 ...     

卒中单元护理模式对脑卒中后吞咽功能障碍患者康复的效果观察

目的探究卒中单元护理模式对脑卒中后吞咽功能障碍患者康复的临床效果。方法选择80例急性脑卒中患者分为2组,观察组采用卒中单元护理模式,对照组采用常规优质护理,对比2组患者出院前的治疗效果和护理满意度情况。结果对照组患者治疗有效率为50.0%,观察组为90.0%,差异有统计学意义(P0.05);对照组患者护理满意度为70.0%,观察组为92.5%,差异有统计学意义(P0.05)。结论对于脑卒中后吞咽功能障碍者,以常规治疗为基础,采用卒中单元护理模式,可在一定程度上提升治疗效果,促进疾病转归,值得在临床推广使用。     

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.