整体护理干预在初产妇分娩过程中的应用及效果观察

目的:探讨整体护理干预在初产妇分娩过程中的应用效果。方法:将360例初产妇随机分为干预组和对照组各180例,对照组实施常规护理,干预组实施整体护理。比较两组不同产程所用时间、分娩方式,两组胎儿窘迫、新生儿窒息、产后出血发生率及护理满意度情况。结果:干预组第一产程、第二产程和总产程时间均少于对照组(P<0.05);干预组自然分娩比率高于对照组、手术助产及行剖宫产比率低于对照组(P<0.01);干预组产妇产后出血率、胎儿宫内窘迫及新生儿窒息发生率低于对照组(P<0.01);干预组产妇及家属护理满意度明显高于对照组(P<0.01)。结论:将整体护理应用于初产妇分娩过程中的护理效果确切,可缩短产程时间,降低新生儿窒息的发生率,提高患者及家属的护理满意度。     

护理支持对自然分娩的促进和适度产程干预的对比研究

目的：探讨护理支持对促进孕妇自然分娩的有效途径。方法选取2011年6月至2013年6月来我院进行阴道分娩的产妇430例为研究对象,按照非等量数字表随机的方式,随机将符合研究的受试者分为护理支持组220例和适度产程干预组210例,分别对护理支持组采取护理支持,对适度产程干预组采取产程干预;比较两组孕妇在观察两组总产程时间、胎儿宫内窘迫发生率、新生儿窒息发生率、产时出血量及产后出血发生率的情况,差异有统计学意义（ P＜0．05）。结果在产妇的总产程时间方面差异无统计学意义（ P＝1．00＞0．05）;在胎儿宫内窘迫发生率、新生儿窒息发生率、产时出血量及产后出血发生率方面差异有统计学意义（ P＜0．05）。结论护理支持对自然分娩具有积极意义,值得临床推广。     

全人护理并左侧倾斜卧位对分娩效果的影响

目的:探讨全人护理并左侧倾斜卧位对促进自然分娩、降低剖宫产率的作用.方法:选择2009年5月～2010年10月245 例孕妇作为观察组,产程中实施全人护理并左侧倾斜卧位;选择2008年仰卧位190例孕妇作为对照组.观察两组产妇、分娩各产程时间、分娩方式、新生儿窒息发生率、产后出血量、产妇及其家属满意度.结果:观察组与对照组在第一产程时间、总产程时间、分娩方式、产后出血、新生儿窒息发生率、产妇及家属满意度方面比较差异均有统计学意义(P＜0.01,P<0.05).结论:产程中实施全人护理并左侧倾斜卧位有利于提高阴道自然分娩率,降低剖宫产率、新生儿窒息率及产后出血率,产妇及家属的满意度上升,利于母婴健康.     

集束化护理配合腰硬联合无痛分娩在高龄初产妇自然分娩中的临床研究

目的 观察阴道分娩的高龄初产妇实施集束化护理配合腰硬联合无痛分娩的临床价值。方法 我院收治 200 例行阴道分娩 的高龄初产妇,根据孕妇参与过程将其分为观察组和对照组,每组各 100 例。对照组腰硬联合无痛分娩时用常规护理,观察组 孕妇采用集束化护理配合腰硬联合无痛分娩。比较两组产妇产程所用时长（第一产程、第二产程及总产程时间）、剖宫产率与 阴道助产率及自然分娩率、视觉疼痛模拟（VAS）评分、胎儿窘迫发生率、产后 2h 出血量、新生儿窒息率、患者满意度。结果 观察组的产程所用时长（第一产程、第二产程及总产程时间）、剖宫产率与阴道助产率及自然分娩率、视觉疼痛模拟（VAS）评 分、胎儿窘迫发生率、产后 2h 出血量、新生儿窒息率、患者满意度优于对照组（P<0.05）。结论 高龄初产妇经腰硬联合麻醉 无痛分娩+集束化护理,能够有效减轻分娩疼痛,缩短产程,降低剖宫产率,减少产后 2 小时出血量,改善分娩结局。     

导乐分娩对产妇产程及妊娠结局的影响

目的 探讨导乐分娩对产妇产程及妊娠结局的影响.方法 选取初产妇120例,随机分为观察组和对照组,每组60例.对照组初产妇采用常规护理,观察组初产妇在常规护理的基础上采用导乐分娩.观察两组产妇的产程及妊娠结局.观察两组产妇的产程及妊娠结局,产程包括第一、第二、第三产程的时间,妊娠结局主要观察产妇的顺产率、产后出血量、胎儿窘迫率和新生儿窒息率.结果 观察组第一、第二产程和总产程时间显著短于对照组(P＜0.05),观察组的顺产率显著高于对照组(P＜0.05),产后出血量、胎儿窘迫率显著低于对照组(P＜0.05).两组新生儿窒息率无显著性差异.结论 导乐分娩可提高产妇的顺产率,缩短产程,改善了产妇的妊娠结局.     

产程中实施护理干预对分娩结果的影响

目的:探讨产程中实施护理干预对分娩结果的影响。方法:将238例初产妇随机分为对照组100例和观察组138例,对照组采用常规护理方法;观察组在此基础上,及时评估产妇存在的护理问题,针对性地实施护理干预,减少不必要的医疗干预。比较两组产妇总产程平均时间、产痛耐受性、分娩方式、产后出血及新生儿窒息发生情况。结果:观察组产妇总产程较对照组明显缩短,产痛耐受性较对照组明显提高,剖宫产率、产后出血率和新生儿窒息率较对照组明显降低(P<0.01,P<0.05)。结论:产程中实施护理干预能缩短产程,有效减轻产痛,提高阴道分娩质量,降低剖宫产率、产后出血率和新生儿窒息率。     

自由体位分娩对产程及分娩方式的影响分析

分析本院2014年10月~2015年10月入院进行分娩的初产妇150例临床资料,依据体位不同进行分组,对照组(常规体位组)50例和观察组(自由体位组)100例。观察两组产妇分娩过程中的产程时间情况、观察两组产妇分娩方式情况、产后出血量、胎儿窘迫、新生儿窒息发生率情况。观察组产妇分娩过程中第一产程时间、第二产程时间、总产程时间均低于对照组,t=11.61、10.16、7.83,观察组自然分娩比例均高于对照组,剖宫产、阴道助产均低于对照组,字2=10.01、5.98、3.70,观察组产后出血量、胎儿窘迫、新生儿窒息发生率均低于对照组,t=5.98、字2=7.78、6.19,P0.05,差异均有统计学意义。自由体位分娩可以明显的缩短产程时间,提高自然分娩比例,降低产后出血,提高新生儿质量,值得临床推广应用。     

导乐分娩对催产素引产结局的影响

目的 探讨导乐分娩对催产素引产结局的影响.方法 选择本院收治的催产素引产的初产妇108例,按入院顺序分为对照组54例和观察组54例.对照组产妇行催产素引产常规护理,观察组产妇在催产素常规护理基础上,由1位培训合格的助产士进行全程陪伴分娩.比较2组产妇各产程及总产程时间、产后出血量、分娩方式、新生儿窒息发生率的差异.结果 观察组各产程及总产程时间、产后出血量、剖宫产率、新生儿窒息发生率显著低于对照组(P＜0.05),2组比较差异有统计学意义.结论 导乐分娩用于催产素引产可明显缩短产程、减少产后出血量、降低剖宫产率及新生儿窒息发生率.     

预见性护理在高危产妇产时护理中的应用效果

目的探讨预见性护理在高危产妇产时护理中的应用效果。方法选择2016年11月至2017年12月于我院待产的高危产妇60例作为研究对象,将其随机等分为对照组和观察组,对照组实施常规护理,观察组实施预见性护理,比较两组产后出血量、产程用时及胎儿宫内窘迫和新生儿窒息发生率。结果观察组产后2,24 h出血量均少于对照组(P 0. 05),各产程时间短于对照组(P 0. 05),胎儿宫内窘迫及新生儿窒息发生率均低于对照组(P 0. 05)。结论预见性护理在高危产妇产时护理中的应用,可缩短产程时间,改善新生儿结局,促进分娩顺利进行。     

水针用于分娩镇痛33例的临床观察

目的：研究水针镇痛的效果及对产程、母婴的影响。方法：采用腰椎旁穴位注射无菌注射用水与利多卡因对33例产妇进行水针分娩镇痛作为观察组；对未采用水针镇痛进入产程28例产妇作为对照组，比较两组的产程时间、分娩方式、产后出血、胎儿窘迫、新生儿窒息情况。结果：两组总产程时间比较无显著性差异，两组正常率有显著性差异，胎吸助产率剖宫产率，产后出血量，胎儿窘迫，新生儿窒息发生率比较，无显著性差异。结论：水针分娩镇痛效果可靠，对母婴无不良影响，可提高正常产率，值得推广。     

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.     

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.     

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."