青年乳腺癌患者负性情绪与自我接纳、生存质量的相关性分析

目的调查青年乳腺癌患者的负性情绪,分析负性情绪与自我接纳、生活质量的相关性。方法选取衡阳市4所三甲医院肿瘤科的青年乳腺癌患者219例,采用一般资料调查问卷、焦虑自评量表(SAS)、抑郁自评量表(SDS)、自我接纳问卷(SAQ)、乳腺癌患者生活质量测定量表(FACT-B)进行调查。结果青年乳腺癌患者的SAS、SDS评分均高于标准分;青年乳腺癌患者负性情绪与自我接纳、生存质量均呈负相关(P<0.01)。结论青年乳腺癌患者存在负性情绪,自我接纳水平与生存质量较低,护士应关注青年乳腺癌患者的心理变化,帮助患者树立健康积极的信念,缓解负性情绪,提高其自我接纳水平和生活质量。     

医护一体化护理对绝经后激素受体阳性乳腺癌术后患者的影响

目的:探讨医护一体化护理对接受内分泌治疗的绝经后激素受体阳性乳腺癌术后患者的影响。方法:将300例接受内分泌治疗的绝经后激素受体阳性乳腺癌术后患者按住院期间的护理方式分为医护一体化组154例和对照组146例,医护一体化组采用医护一体化护理模式干预,对照组采用常规护理干预;出院后随访12个月,比较两组负性情绪[采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评分]、依从性[包括用药依从性和用药信念]、生活质量[采用癌症治疗功能评价系统-乳腺癌(FACT-B)评分]及不良反应发生率。结果:出院后12个月,两组SAS、SDS评分均低于干预前(P0.01),且医护一体化组低于对照组(P0.01);医护一体化组用药依从性和用药信念评分均高于对照组(P0.01);两组FACT-B评分均高于干预前(P0.01),且医护一体化组高于对照组(P0.01);医护一体化组不良事件发生率低于对照组(P0.01)。结论:对接受内分泌治疗的绝经后激素受体阳性乳腺癌术后患者采用医护一体化护理,可有效改善患者抑郁、焦虑情绪,提高患者用药依从性和生活质量,降低不良反应发生率。     

舒适护理在乳腺癌围术期患者中的应用

目的:探讨舒适护理在乳腺癌围术期患者中的应用效果。方法:将2015年11月~2017年3月收治的138例乳腺癌患者随机分为观察组和对照组各69例,对照组实施常规护理干预,观察组在对照组基础上实施舒适护理干预。比较两组焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、生命质量测定量表(FACT-B)评分、病情认知率及满意度。结果:观察组SAS、SDS评分均低于对照组(P0.05),FACT-B评分、疾病认知率、护理满意度均高于对照组(P0.05)。结论:舒适护理可改善乳腺癌围术期患者心理状态与生命质量,提高其疾病认知度与护理满意度。     

乳腺癌术后患者婚姻质量与负性情绪、社会支持的相关性

目的调查乳腺癌术后患者婚姻质量,并探讨负性情绪、社会支持与乳腺癌术后患者婚姻质量的相关性。方法选取西安交通大学第二附属医院肿瘤外科的乳腺癌术后患者110例,采用一般情况调查问卷、中国人婚姻质量问卷(CMQI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)进行调查。结果患者的婚姻质量总分低于常模,SAS和SDS评分均高于常模(P<0.05)。患者的婚姻质量评分与SAS评分、SDS评分呈负相关,与社会支持评分呈正相关(P<0.05)。结论乳腺癌术后患者婚姻质量会降低且容易产生负性情绪,医护人员应该加强对其心理健康的关注,提高对患者的社会支持。     

心理护理在颅脑损伤术后昏迷期与清醒期的应用效果

探讨颅脑损伤患者术后昏迷期与清醒期实施心理护理的效果。收治的颅脑损伤手术患者100例,随机分为对照组和观察组,对照组给予常规护理,观察组在对照组基础上加强昏迷期和清醒期心理护理,比较患者清醒时间、护理后抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分及出院3个月后患者生活质量量表(QOLIBRI)评分。观察组患者清醒时间明显短于对照组,SDS、SAS评分明显低于对照组,出院3个月后生活质量明显优于对照组,差异均具有统计学意义(P均0.05)。颅脑损伤患者术后昏迷期与清醒期加强心理护理,可有效缩短患者清醒时间,改善患者焦虑抑郁情绪及生活质量,值得临床推广应用。     

综合护理在乳腺癌护理中的临床应用分析

目的探讨综合护理干预在乳腺癌护理中的临床应用效果。方法选择本院2016年1月~2017年9月收治的80例乳腺癌患者作为研究对象,按照随机数字表法将研究对象分为两组,每组各40例。对照组采取常规护理方法,观察组采取综合护理干预模式,采用中文版FACT-B量表对其生活质量进行评分,采取焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者焦虑和抑郁进行评分。观察两组患者的生活质量、术后焦虑和抑郁评分、护理满意度。结果观察组生理状况、情感状况、附加关注显著低于对照组,社会状况和功能状况则显著高于对照组(P0.05);SAS、SDS评分显著低于对照组(P0.05);护理满意度(92.50%)显著高于对照组(70.00%)(P0.05)。结论对乳腺癌患者采取综合护理,显著缓解了患者焦虑、抑郁情绪,提高了患者生活质量和护理满意度。     

八段锦对乳腺癌根治术后化疗期患者生活质量的影响

目的 探讨八段锦锻炼对乳腺癌根治术后化疗患者生活质量的影响.方法 选取2015年1~12月共80例入住本科的乳腺癌术后预期行化疗的患者为研究对象,随机分为观察组和对照组,各40例.对照组患者进行常规康复功能锻炼,观察组患者除采用常规康复功能锻炼外,增加八段锦的锻炼,2次/d,30 min/次.干预前后,对2组患者的抑郁自评量表(SDS)及生活质量测定量表FACT-B中文版(V4.0)进行评价.结果 干预前,2组患者的抑郁自评量表(SDS)及生活质量FACT-B中文版(V4.0)测量表评分差异无统计学意义(P>0.05);干预后,观察组评分显著高于对照组升高显著(P<0.001) .结论 八段锦锻炼能够有效促进乳腺癌根治术后患者的患肢功能恢复,提高乳腺癌患者术后化疗期间的舒适度,改善患者的抑郁状态,从而提高患者的总体生活质量.     

思维导图式的健康教育模式对乳腺癌术后病人生命质量及焦虑抑郁心理的影响

目的:探讨思维导图式的健康教育模式对乳腺癌术后病人生命质量及焦虑抑郁心理的影响.方法:将80例乳腺癌改良根治术病人随机分为观察组和对照组,每组40例.对照组采用常规护理,观察组在常规护理的基础上采取思维导图式健康教育,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组病人干预前后心理状态进行评价,采用生命质量测定量表(FACT-B)评价两组病人干预后生命质量.结果:干预后观察组病人SAS、SDS评分低于对照组(P<0.05);生命质量各维度评分高于对照组(P<0.05).结论:在乳腺癌术后病人护理过程中开展思维导图式的健康教育,能缓解病人焦虑、抑郁情绪,提高其生命质量.     

基于奥马哈系统的个案管理模式对乳腺癌术后化疗患者生活质量的影响

目的探讨基于奥马哈系统的个案管理模式对乳腺癌术后化疗患者生活质量的影响。方法选取解放军第970医院乳腺癌术后患者136例为研究对象,随机分为干预组和对照组,每组68例,两组患者均接受术后辅助化疗治疗。对照组实施常规护理干预,干预组在常规护理干预的基础上给予基于奥马哈系统的个案管理模式护理。干预前后采用乳腺癌患者生活质量评定量表(FACT-B),焦虑自评量表(SAS),抑郁自评量表(SDS)评价患者的生活质量及焦虑抑郁状况并比较两组患者护理满意水平差异。结果干预后,干预组FACT-B各维度评分明显优于对照组,差异有统计学意义(P<0.05);SAS、SDS评分低于对照组,差异有统计学意义(P<0.05);护理总体满意水平高于对照组,差异有统计学意义(P<0.05)。结论对乳腺癌术后化疗患者实施基于奥马哈系统的个案护理模式,不仅在一定程度上改善生活质量,减轻不良情绪,同时还可以满足患者对个案管理的实际需求,提升护理服务满意度。     

“阳光护理服务”对乳腺癌术后化疗期间负性情绪及生活质量的影响

目的探讨"阳光护理服务"对乳腺癌术后化疗期间负性情绪及生活质量的影响。方法选取2015年1月~12月我科收治的行乳腺癌根治手术患者120例,根据分层抽样法分为观察组和对照组,各60例。对照组围手术期间行常规护理。观察组围手术期间实施"阳光护理服务"。比较两组化疗期间负性情绪及生活质量的差异。结果观察组引流时间、总引流量、平均住院时间少于对照组(P0.05),满意度评分高于对照组(P0.05)。观察组干预后抑郁自评量表(SDS)、焦虑自评量表(SAS)评分低于对照组,生活质量评分高于对照组(P0.05)。结论 "阳光护理服务"可提高乳腺癌患者术后护理质量,减轻患者围手术期焦虑、抑郁情绪,提高其术后生活质量。     

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.