肠造口患者个人掌控感对其自我照护行为执行意向的影响

目的探讨肠造口患者个人掌控感对自我照护行为执行意向的影响。方法 2021年3-6月,采用便利抽样法选取在青岛市某三级甲等医院造口门诊就诊的182例肠造口患者作为研究对象,采用一般资料调查表、个人掌控感量表、领悟社会支持量表、肠造口患者自我照护行为执行意向问卷对其进行调查。结果肠造口患者自我照护行为执行意向得分为(76.24±16.83)分、个人掌控感得分为(20.68±2.47)分;多因素分析显示,家庭人均月收入、造口术后时间、个人掌控感、领悟社会支持为肠造口患者自我照护行为执行意向的主要影响因素(均P0.05),共解释总变异量的43.5%。结论肠造口患者自我照护行为执行意向处于中等偏低水平,医护人员应多关注家庭人均月收入较低、造口术后时间短的肠造口患者,可通过提高其个人掌控感、社会支持水平,从而促进自我照护行为执行意向的形成。     

肠造口病人自我管理评估工具研究进展

目的:总结肠造口病人自我管理的评估工具,为临床医护人员认识和选择合适的评估工具提供参考.方法:系统检索、提取和总结CINAHL、PubMed、SinoMed和万方数据库建库至2020年6月30日有关肠造口病人自我管理评估工具的文献.结果:纳入9篇文献,总结出8种评估工具,分别是自我管理能力量表(Self Management Ability Scale,SMAS)、视觉模拟评分法(Visual Analogue Scale,VAS)、肠造口病人自我管理能力评估表(Development of Self-Care Competence of the Person with an Intestinal Stoma,CAO-EI:ESEP)、肠造口病人自我管理问卷、肠造口病人自我管理行为问卷、造口病人专门自我护理问卷(Specific Self-Care for Ostomized Patients Questionaire,CAESPO)、造口自理指数(Ostomy Self-Care Index,OSCI)和造口病人自我管理量表.结论:综合评估各工具的科学性、实用性和适用性,在我国可优先选择肠造口病人自我管理行为问卷对肠造口病人自我管理行为进行评估.     

基于LEARNS模式的肠造口病人健康教育路径的制订

目的:构建基于LEARNS模式的肠造口病人健康教育路径，为临床护理人员对肠造口病人实施系统、全面的健康教育提供参考。方法:在文献回顾、小组讨论基础上形成专家函询问卷，采用德尔菲法对20名专家进行函询，结合指标筛选标准和各专家的建议，最终形成肠造口病人健康教育路径。结果:共进行了2轮专家函询，专家积极系数分别为95.2%和100.0%，专家权威系数分别为0.885和0.890，专家意见的Kendall协调系数分别为0.155和0.162。最终构建的肠造口病人健康教育路径包括10个一级指标和60个二级指标。结论:基于LEARNS模式的肠造口病人健康教育路径具有科学性及可行性，可以指导临床护士对肠造口病人实施健康教育。     

肠造口俱乐部模式的健康教育效果评价

目的实施肠造口俱乐部模式的健康教育并对其效果进行综合评价。方法选择2007年3月至2010年3月全程参加健康教育俱乐部活动的患者143例,在肠造口俱乐部接受20次肠造口知识培训及7次学习实践活动的前后,采用肠造口相关知识问卷、自我管理能力评价量表、SCL-90症状自评量表、医学应对方式量表对健康教育效果进行评价。结果教育前患者的肠造口知识问卷及格率为47.6%,教育后及格率为92.3%,差异有统计学意义(P<0.01);教育后患者的自我管理能力明显提升,与教育前比较差异有统计学意义(P<0.01);SCL-90症状自评量表评分在教育前后差异无统计学意义(P>0.05),而医学应对方式量表中"解决问题"因子分显著提高(P<0.05)。结论肠造口俱乐部的健康教育模式有利于帮助患者获得解决问题的知识与技能,建立健康行为,提高疾病应对能力以及对治疗的依从性。     

永久性肠造口病人自我感受负担及健康相关行为与生活质量的关系研究

目的:探讨永久性肠造口病人自我感受负担及健康相关行为与生活质量的关系。方法:2018年9月—2019年9月应用自我感受负担量表、健康行为量表(HPL)及造口生活质量问卷(COH-QOLOQ)对85例永久性肠造口病人进行调查,应用Pearson单因素分析永久性肠造口病人自我感受负担及健康相关行为与生活质量的关系,采用多元回归分析影响永久性肠造口病人自我感受负担的相关因素。结果:永久性肠造口病人自我感受负担总评分为(38.02±4.12)分,健康相关行为总评分为(102.11±5.98)分,生活质量总评分为(72.12±6.78)分。Pearson单因素分析显示,永久性肠造口病人自我感受负担总评分、情感负担与健康行为总评分、健康责任感、心理健康及压力调解呈负相关(P<0.05),自我感受负担总评分、情感负担、身体负担与生活质量总评分呈负相关(P<0.05),自我感受负担总评分、情感负担与身心状况及与家属及朋友的关系评分呈负相关(P<0.05)。多元回归分析显示,医疗付费方式、定期参加造口知识讲座、病人疾病认知水平低下、并发症是影响永久性肠造口病人自我感受负担的主要因素(P<0.05)。结论:永久性肠造口病人自我感受负担与健康相关行为及生活质量有密切的关系,减轻病人自我感受负担可促进病人形成健康相关行为,提高病人生活质量。     

徐州地区肠造口患者健康教育现状及需求的分析

目的：调查徐州地区肠造口患者健康教育现状,分析造口患者及家属对造口知识的需求情况。方法采用自行设计的调查问卷对徐州市三级医院的200名肠造口患者进行问卷调查,分析结果。结果在院期间90%以上肠造口患者得到医护人员的专业指导,80%以上患者对肠造口方面知识有一定的了解;出院后100%患者有强烈学习和掌握肠造口知识的意愿,50%患者依靠造口门诊造口治疗师学习造口知识,70%以上患者乐于接受新型网络健康教育模式。结论为改善徐州地区患者造口相关知识掌握现状,减少造口并发症的发生,提高生活质量,应积极开展多种形式的肠造口患者健康教育。     

直肠癌肠造口患者健康教育需求调查

目的了解直肠癌肠造口患者的健康教育需求,以便进行有针对性的健康教育。方法采用自行设计的调查问卷对人住普外科的50名患者进行健康知识和健康教育需求凋查,收集资料进行分析。结果肠造口患者对家人及医护人员的心理支持,肠造口的日常护理与并发症的预防、饮食调养知识等方面存在强烈需求,并且对获得健康知识方式的需求存在多样性。结论医护人员应重视直肠癌肠造口患者的健康教育需求,根据患者的需求有针对性地进行宣教和指导。     

徐州地区肠造口患者造口产品使用及并发症发生现状分析

目的:调查徐州地区肠造口患者造口产品的使用情况和造口并发症的发生情况。方法:采用自行设计的调查问卷对徐州市200例肠造口患者进行问卷调查,分析结果。结果:经济收入较低肠造口人群造口产品使用率较低;肠造口患者并发症的发生率相对较高,医保病患者37例(18.5%),农保患者70例(35%);各种并发症中又以造口周围皮炎为多,医保患者有20例,农保患者40例;其他的造口内陷、皮肤黏膜分离、造口旁疝偶有发生。结论:通过指导患者正确使用造口产品,加强健康教育,减少患者并发症的发生,提高生活质量。     

健康教育路径结合多媒体课件在肠造口患者中的应用

目的:探讨健康教育路径结合多媒体课件在肠造口患者中的应用方法及效果。方法:将86例肠造口患者按入院先后顺序分为实验组和对照组各43例,实验组应用健康教育路径结合多媒体课件对肠造口患者进行健康教育,对照组应用传统健康教育方法。出院时采用问卷调查的方法比较两组健康教育效果。结果:实验组相关护理知识知晓率均明显高于对照组(P0.05),实验组问卷总分明显高于对照组(P0.05)。结论:应用健康教育路径结合多媒体课件能提高患者围术期肠造口护理知识知晓率,提高患者健康教育效果。     

肠造口患者健康教育需求调查

目的:了解肠造口患者的健康教育需求,更好地为肠造口患者开展健康教育提供依据。方法:根据临床所遇到的问题,自制问卷调查表,对80例肠造口患者在健康教育的内容、方法及对象的需求进行调查。结果:肠造口患者对健康教育的需求内容是多种多样的,需求率为45%～100%,对教育方法的需求以个别指导(95.00%)和健康教育处方(87.50%)为主,其他多种方法为辅。对实施教育者的需求特点为36例(45.00%)患者选择医师,首选护士者为28例(35.00%)。结论:肠造口患者对造口护理相关知识的健康教育需求非常强烈,且内容广泛,对健康教育方法的需求具有多样性的特点,护理人员应制定个体化的健康教育计划,在合适的时间、合适的场合,以合适的方法,传授合适的内容,使其接受有效的健康教育,提高生活质量。     

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.     

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.