自制复方漱口液预防白血病化疗所致口腔黏膜炎的效果观察

目的 探讨自制复方漱口液预防白血病化疗所致口腔黏膜炎的效果.方法 将96例接受化疗的白血病患者,采取随机分组的方法,分为对照组和观察组.对照组采用生理盐水进行口腔护理,观察组采用复方漱口液进行口腔护理,观察2组患者口腔黏膜炎发生情况.结果 对照组口腔黏膜炎发生率为95%,观察组口腔黏膜炎发生率为29%,2组比较差异有统计学意义(p<0.01).结论 采用自制复方漱口液进行口腔护理可预防白血病化疗所致口腔黏膜炎,效果优于传统生理盐水法,值得在临床推广.     

优口净漱口液在脑卒中病人口腔护理中的应用观察

[目的]探讨优口净漱口液颗粒剂对脑卒中病人口腔护理的临床效果。[方法]将160例需要口腔护理的脑卒中病人随机分为观察组和对照组,观察组采用优口净漱口液颗粒剂进行口腔护理,对照组采用生理盐水溶液进行口腔护理,分别在护理后第3天、第7天、第10天,从口臭、口干、口腔舒适度、口腔感染和肺部感染发生率5个方面进行疗效评价。[结果]观察组病人口臭、口干症状的改善和口腔舒适度明显优于对照组(P<0.01),口腔感染发生率明显低于对照组(P<0.01)、肺部感染发生率亦低于对照组(P<0.05)。[结论]优口净漱口液颗粒剂用于脑卒中病人口腔护理,对增进病人口腔舒适度,防治口臭、口干,预防口腔感染及肺部感染的发生,效果明显优于生理盐水组。     

九尔口爽漱口液用于神经外科ICU昏迷患者口腔护理效果观察

目的:探讨九尔口爽漱口液(牙龈炎冲洗器)用于神经外科ICU昏迷患者口腔护理的效果。方法:将400例神经外科ICU昏迷患者随机分为观察组和对照组各200例。入住ICU开始至转出ICU进行观察,对照组采用生理盐水进行口腔护理,观察组采用九尔口爽漱口液进行口腔护理。结果:观察组牙龈出血、口腔溃疡、口臭、呼吸道感染发生率低于对照组(P0.01,P0.05)。结论:九尔口爽漱口液用于神经外科ICU昏迷患者口腔护理效果明显。     

自制溃疡散含漱液治疗放射性口腔炎的效果观察

目的 探讨自制溃疡散含漱液治疗头颈部肿瘤患者放射性口腔炎的效果.方法 随机将80例头颈部放射治疗的肿瘤患者分为两组各40例.观察组使用自制溃疡散含漱液于3餐饭前30min、3餐饭后和睡前7个时间点口腔含漱;对照组采用口泰漱口液、温盐水(0.9%氯化钠),于3餐饭前30 min、3餐饭后、睡前7个时间点交替含漱.两组患者治疗过程中不采用其他药物性漱口液,坚持使用漱口液至放疗结束.两组疼痛严重患者均予静脉补充能量、抗炎治疗.观察比较两组患者放疗第3周末、第7周末口腔黏膜炎损伤及疼痛程度.结果 放疗后第3周末、第7周末,两组口腔黏膜炎损伤及疼痛程度比较,差异均有统计学意义(P<0.01),观察组口腔黏膜炎损伤及疼痛程度明显轻于对照组.结论 使用自制溃疡散进行口腔含漱可以减轻放射性口腔黏膜炎的损伤及疼痛程度.     

复合漱口液用于化疗所致口腔黏膜炎的效果观察

[目的]观察复合漱口液防治血液科化疗病人所致口腔黏膜炎的效果.[方法]选取血液科住院病人80例,分为观察组和对照组,观察组采用复合漱口液漱口的方法,对照组采用氯己定漱口液漱口的方法.[结果]观察组病人口腔黏膜炎发生率较对照组低,并且治疗口腔黏膜炎的效果优于对照组（P〈0.05）.[结论]复方漱口液可有效防治化疗所致的口腔黏膜炎.     

苏银汤漱口液联合组合吸痰管和旋转式喷雾器在长期鼻饲高龄患者口腔护理中的应用

目的探讨苏银汤漱口液联合组合吸痰管和旋转式喷雾器在长期鼻饲高龄老年患者口腔护理中的应用效果。方法将80例长期留置胃管的高龄老年患者随机分为观察组与对照组,每组各40例。观察组给予苏银汤漱口液联合组合吸痰管和旋转式喷雾器行口腔护理,而对照组则采用传统的等渗盐水棉球擦洗法行口腔护理,每日8∶00和16∶00进行口腔护理2次,14 d后比较两组患者口腔护理的效果。结果观察组的口腔黏膜湿化总有效率为92.50%,明显高于对照组的62.50%;口腔黏膜完整性、口腔残留物、口腔溃疡、口腔炎、口臭指数、舌苔指数均显著优于对照组;院内肺部感染情况显著低于对照组;患者的舒适度、依从性、护理满意度明显高于对照组,差异均具有统计学意义(P0.05)。观察组护士的备物时间、操作时间明显低于对照组,差异有统计学意义(P0.05)。结论苏银汤漱口液联合组合吸痰管和旋转式喷雾器口腔护理法的临床疗效优于传统口腔护理法,更适合长期鼻饲的高龄老年患者。     

益口漱口液加康复新防治鼻咽癌放射性口腔炎的观察

目的观察益口漱口液和康复新联用对鼻咽癌放射性口腔炎的防治效果。方法将我科2008年3月-2009年3月住院首程放疗的鼻咽癌患者70例随机分为对照组和观察组,各35例。对照组采用常规口腔护理,观察组在常规口腔护理的基础上加用益口漱口液含漱并于出现咽干痛时含康复新10ml,每天3次,至放疗结束。结果两组发生Ⅲ、Ⅳ度放射性口腔炎比较有显著性差异（P〈0.01）。合并口腔霉菌感染分别为2.8%和22.9%,两组比较有显著性差异（P〈0.01）。结论采用益口漱口液漱口并含服康复新可降低放射性口腔炎的发生率,减少合并口腔霉菌感染发生率,促进放射性口腔炎的愈合。     

rhGM-CSF雾化吸入及漱口治疗急性白血病病人化疗所致口腔炎的疗效观察

[目的]探讨重组人粒细胞-巨噬细胞集落刺激因子(rhGM-CSF)雾化吸入及漱口治疗急性白血病化疗病人口腔炎的临床效果。[方法]将180例急性白血病化疗后发生口腔黏膜炎病人随机分为对照组、漱口组和雾化组各60例。对照组常规采用0.9%氯化钠注射液、利多卡因、维生素B12漱口液治疗,漱口组采用0.9%氯化钠注射液及rhGM-CSF注射液含漱,雾化组采用0.9%氯化钠注射液及rhGM-CSF注射液雾化吸入。治疗7d后进行效果评价,观察病人口腔黏膜炎治疗有效率、口腔黏膜炎愈合时间。[结果]对照组经治疗后部分病人口腔炎有所缓解,漱口组与雾化组治疗有效率明显高于对照组(P0.05),漱口组与雾化组口腔炎治疗有效率比较差异无统计学意义(P0.05)。对照组口腔炎愈合时间为(10.10±3.48)d,漱口组口腔炎愈合时间为(5.70±2.83)d,雾化组口腔炎愈合时间为(5.35±2.63)d,漱口组及雾化组愈合时间较对照组明显缩短(P0.05)。3组治疗过程中均未发现明显不良反应。[结论]应用rhGM-CSF漱口及雾化吸入均可提高急性白血病化疗所致口腔黏膜炎的治疗效果,能够加速病人口腔黏膜炎的愈合,缩短治疗时间。     

康复新联合漱口液治疗放疗后口腔黏膜炎的疗效观察

目的：观察康复新联合漱口液治疗放疗后口腔黏膜炎的疗效。方法：放疗后口腔黏膜炎患者68例,随机分为治疗组（36例）和对照组（32例）。对照组采用益口漱口液常规护理,治疗组在对照组的基础上使用康复新漱口液。观察两组疗效。结果：治疗组的总有效率（94.4%）明显高于对照组（62.5%）,差异有统计学意义（P〈0.01）。结论：康复新联合漱口液治疗放疗后口腔黏膜炎治疗效果较好。     

自制漱口液联合吹氧治疗化疗后口腔黏膜炎

摘要：目的 探讨自制漱口液联合吹氧治疗血液病患者化疗后口腔黏膜炎的效果。方法 将１０６例化疗后口腔黏膜炎患者分成两组，观察组５６例应用自制漱口液漱口联合吹氧疗法进行口腔护理，对照组５０例应用我院常规漱口液即甲硝唑加锡类散进行口腔护理。结果 观察组总有效率显著优于对照组，且患者更易接受（均Ｐ＜０．０５）。结论 自制漱口液和吹氧疗法联合应用于化疗后口腔黏膜炎，可以达到消炎、抑菌、镇痛的作用，可以促进口腔黏膜炎的愈合。关键词：血液病；　口腔黏膜炎；　自制漱口液；　吹氧疗法；　护理中图分类号：Ｒ４７２；Ｒ４７３．７３　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）１３-００５６-０２     

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.     

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.     

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.     

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.