早期心理干预对哮喘患者首次住院时间和住院次数及焦虑情绪的影响

【目的】观察早期心理干预对哮喘患者首次住院时间、每年住院次数及焦虑情绪的影响。【方法】60例哮喘患者按照住院时间段分为两组各30例,对照组予以常规治疗,观察组在对照组的基础上开展早期心理干预,记录两组患者首次住院时间,随访1～3年观察两组患者每年住院次数,治疗前后采用汉密尔顿焦虑量表评分（H AMA）评定。【结果】两组患者入院时焦虑量表评分无明显差异（P＞0．05）;首次住院出院时观察组焦虑量表评分减分值[（6．65±2．29）vs （3．80±1．45）]、首次住院时间[（18．03±4．05）d vs （13．80±4．49）d]、随访观察1～3年平均每年哮喘发作住院次数[（5．50±1．50）vs （9．60±2．55）]均显著优于对照组（P＜0．05）。【结论】开展早期心理干预能够减少患者住院次数,减轻患者焦虑情绪。     

药学干预对妊娠中晚期贫血患者的临床效果及药物服用依从性分析

目的观察妊娠中晚期贫血患者应用药学干预的效果及药物服用依从性。方法采集我院2016年7月～2018年7月妇产科接诊的80例妊娠中晚期贫血患者资料,按不同干预方案分为对照组和观察组各40例,对照组进行常规干预,观察组进行药学干预,比较两组疗效、用药依从性及妊娠结局。结果观察组干预后总有效率95.00%,高于对照组的75.00%(P0.05);观察组干预后用药依从性评分(6.76±1.24)分,高于对照组的(3.45±2.02)分(P0.05);观察组出现不良妊娠事件7.50%,低于对照组的30.00%(P0.05)。结论妊娠中晚期贫血患者通过药学干预后,疗效提升,且用药依从性提高,并能改善妊娠结局,效果良好。     

心理干预对乳房切除患者心理状态的影响

【目的】探讨心理干预对乳房切除患者心理状态的影响。【方法】选择128例行乳房切除＋乳腺癌改良根治术的乳腺癌患者,随机分为2组,每组各64例;对照组给予常规护理,观察组在对照组的基础上给予系统化的心理干预,比较两组出院前1 d 及出院后3个月的治疗依从性、心理状态。【结果】出院后3个月,观察组治疗依从性评分为（19．88±3．31）分,与出院前1 d 无显著差异（ P ＞0．05）;对照组评分为（15．57±3．64）分,较出院前1 d 显著下降（ P ＜0．05）;观察组评分显著高于对照组（ P ＜0．05）。出院后3个月,两组焦虑自评量表（SAS）及抑郁自评量表（SDS）评分均显著下降（ P ＜0．05）,观察组评分显著低于对照组（ P ＜0．05）。【结论】加强心理干预可以提高乳房切除患者战胜疾病的信心,对增强治疗效果,提高患者生活质量有重要意义。     

家庭干预对学龄期哮喘患儿治疗依从性及疗效的影响

目的：探讨家庭干预对学龄期哮喘患儿治疗依从性以及疗效的作用。方法选取确诊并在家庭进行治疗的学龄期哮喘患儿130例,随机分为干预组和对照组,每组65例。对照组患儿进行常规护理及健康教育,干预组采取家庭干预,时间为1年。比较两组患儿治疗依从率、发作次数、住院次数、住院天数、失学天数。结果干预组患儿治疗依从率明显高于对照组（P＜0.05）,发作次数、住院次数、住院天数、失学天数均少于对照组（P＜0.05）。结论家庭干预能明显提高学龄期哮喘患儿治疗依从性,并增强疗效。     

全程优质护理模式对食管癌伴负性情绪患者的影响

【目的】探讨全程优质护理模式对于食管癌伴负性情绪患者的影响。【方法】本院肿瘤内科住院治疗的食管癌患者80例,按入院时间分为观察组和对照组,对照组实施常规护理,观察组给予全程优质护理模式干预,采用焦虑自评量表（SAS）、抑郁自评量表（SDS）及生活质量量表（SF-36）评分,比较两组患者负性情绪状态、生活质量及依从性情况。【结果】入院2周后对照组患者的SAS评分（53．3±7．8）分、SDS评分（52．4±5．5）分均高于观察组的 SAS评分（48．9．±7．2）和 SDS评分（48．7±5．3）,差异有统计学意义（P＜0．05）;观察组生理职能、社会职能、情感职能等生活质量评分均优于对照组,差异有统计学意义（P＜0．05）;观察组依从性优于对照组,差异有统计学意义（P＜0．05）。【结论】全程优质护理模式能明显缓解食管癌患者的负性情绪,增强患者的依从性,改善患者的生活质量。     

老年支气管哮喘急性发作综合护理干预效果研究

目的 评价综合护理方案对老年支气管哮喘急性发作的应用价值。方法 以2016年6月至2018年8月于合肥市第二人民医院呼吸科就诊的老年急性支气管哮喘患者98例为研究对象,分为研究组（50例）与对照组（48例）。对照组接受常规护理方案,研究组接受综合护理方案,比较两组患者症状控制效果、治疗依从性、住院时间及满意度。结果 研究组患者入院后5 d总体控制率高于对照组（92.0% vs. 77.1%）（P＜0.05）;临床症状评分低于对照组[（2.8±1.1）分vs.（3.5±1.0）分]（P＜0.05）;治疗依从性及满意度均高于对照组（P＜0.05）;平均住院时间少于对照组[(8.6±2.3) d vs.(10.1±2.8) d]（P＜005）;出院后服药依从性高于对照组（P＜0.05）。结论综合护理方案可为老年支气管哮喘急性发作患者提供规范、高效的护理服务,对提升症状控制效果具有重要意义。     

集束干预策略对晚期癌症患者癌痛的影响

【目的】探讨集束干预策略对晚期癌症患者癌痛的影响。【方法】选择本院2012年3月至2013年9月住院的晚期癌症癌痛患者120例,随机分为观察组和对照组各60例,观察组实施集束干预策略,对照组实施常规疼痛护理。比较两组患者入院后的疼痛评分（NRS）,爆发痛次数,阿片类药物使用情况和阿片类药物不良反应发生率。【结果】观察组24小时后疼痛评分及爆发痛次数低于对照组（P＜0．05）,阿片类药物使用剂量较对照组显著增加,便秘、嗜睡及过度镇静不良反应较对照组明显减少（P＜0．05）。【结论】通过集束干预策略对癌痛患者进行规范化管理,完全可以控制癌痛,减轻肿瘤患者痛苦,提高生活质量。     

游戏式健康教育对学龄期慢性腹泻患儿健康行为依从性及治疗效果的影响

【目的】探讨游戏式健康教育对学龄期慢性腹泻患儿健康行为依从性及治疗效果的影响。【方法】选取2018年1?12月就诊于本院的慢性腹泻患儿92例为研究对象,根据住院时间分为观察组47例、对照组45例。对照组给予包括环境干预、饮食指导、并发症预防、随访管理等常规护理干预,观察组联合应用游戏式健康教育,比较两组患儿健康行为依从性、营养状况、护理满意度。【结果】干预组慢性腹泻患儿饭前便后洗手、不喝生水、口服补液率,不偏食等健康行为依从性明显高于对照组(95.74%vs 82.22%,93.62%vs77.78%,95.74%vs80.00%,95.74%vs75.56%)(χ^2=4.339,4.753,5.414,7.726,P<0.05);血清总蛋白(TP)、白蛋白(Alb)、血红蛋白(HB)明显高于对照组(60.60±1.24vs54.82±1.15,39.14±1.15vs32.43±1.54,115.12±6.78vs106.20±6.01)g/L(t=23.155,27.748,6.667,P<0.05,P<0.01);护理满意度明显高于对照组(95.74%vs 82.22%,χ^2=4.339,P<0.05)。【结论】游戏式健康教育有助于促进学龄期慢性腹泻患儿健康行为的养成,改善患儿营养状况,提高护理满意度。     

前列地尔注射液对缺血性脑卒中患者神经功能恢复、血液流变学及血清炎症因子的影响

目的探讨前列地尔注射液对缺血性脑卒中患者神经功能恢复、血液流变学及血清炎症因子的影响。 方法选取2018年3月至2019年5月深圳市第二人民医院收治的缺血性脑卒中患者100例,按照数字随机表法将患者分为观察组（50例）及对照组（50例）。对照组行神经内科常规性治疗,观察组在对照组基础上联合前列地尔注射液进行治疗,对比分析2组患者治疗前后神经功能、血液流变学［纤维蛋白原（FIB）、血浆黏度（PV）、全血低切黏度（LBV）、红细胞刚性指数（ERI）］及血清炎症因子［人高前移率族蛋白B1（HMG-B1）、白介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）］水平的变化。 结果在治疗前,2组患者各项基线资料差异不显著（P＞0.05）。治疗后,观察组治疗总有效率（96%）显著高于对照组（78%）,差异有统计学意义（P＜0.05）。2组患者治疗后神经功能、血液流变学以及血清炎症因子各项指标与治疗前相比均得到显著改善（P＜0.05）。治疗后观察组与对照组NIHSS评分［（13.43±4.08）分 vs（19.67±4.06）分,P＜0.05］、MoCA评分［（28.75±2.76）分 vs（26.06±2.64）分,P＜0.05］、ADL评分［（90.26±5.27）分 vs（76.16±5.82）分,P＜0.05］比较,差异有统计学意义。治疗后,观察组FIB［（2.07±0.32）g/L］、PV［（2.04±0.65）mPa.s］、LBV［（15.06±3.42）mPa.s］、ERI（2.42±0.11）较对照组［FIB（3.35±0.41）g/L、PV（3.56±0.70）mPa.s、LBV（18.44±3.18）mPa.s、ERI（3.47±0.24）］显著降低（P＜0.05）。治疗后,观察组血清HMG-B1［（4.54±1.12）μg/ml］、IL-8［（64.62±11.54）pg/ml］、TNF-α［（36.17±4.67）mmol/L］较对照组［HMG-B1（8.65±1.67）μg/ml、IL-8（88.64±9.17）pg/ml、TNF-α（59.45±4.09）mmol/L］显著降低（P＜0.05）。 结论前列地尔注射液能有效改善缺血性脑卒中患者血液流变学,抑制血清炎症因子释放,减轻患者脑损伤程度,有助于患者神经功能恢复,改善患者预后。     

多元化健康宣教对支气管哮喘患儿家属认知程度及服药依从性的影响

目的:探讨多元化健康宣教对支气管哮喘患儿家属认知程度及服药依从性的影响。方法:选取2015年8月~2017年8月我院收治的支气管哮喘患儿60例为研究对象,随机分为研究组35例和对照组25例,对照组给予常规雾化吸入治疗,并对其家属进行常规健康教育,研究组在对照组基础上对患儿家属实施多元化健康宣教,比较两组患儿治疗效果及干预前后哮喘发作次数与肺功能,即第1 s用力呼气量占预计值百分比(FEV1%)、最大呼气峰流速占预计值百分比(PEF%),采用自拟"哮喘儿童家长知信行调查问卷"、Morisky用药依从性问卷(MMAS-8)评估家属认知水平及患儿服药依从性,并观察两组用药期间不良反应。结果:研究组治疗有效情况明显高于对照组(P0.05);研究组干预后哮喘发作次数明显少于对照组,而FEV1%、PEF%较对照组高(P0.05);干预后研究组家属认知总评分高于对照组(P0.05);干预后研究组服药依从性明显高于对照组,不良反应较对照组(P0.05)。结论:对支气管哮喘儿童家属开展创新健康教育,可提高其认知程度及患儿服药依从性,同时改善患儿肺功能、减少哮喘发作次数及药物相关不良反应,提高整体疗效,值得在临床推广实践。     

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.     

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.     

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.     

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.