双止血带法在慢性阻塞性肺病患者静脉留置针穿刺中的应用

目的探讨双止血带法对慢性阻塞性肺病患者浅静脉静脉留置针穿刺成功率的影响。方法将280例慢性阻塞性肺病患者随机分为实验组和对照组,实验组采用双止血带法进行浅静脉静脉留置针穿刺,对照组采用传统的单止血带法进行浅静脉静脉留置针穿刺。结果实验组一次穿刺成功率为95．0％,对照组为74．3％,实验组一次穿刺成功率显著高于对照组（χ2=24．14,P〈0．01）。结论采用双止血带法可提高慢性阻塞性肺病患者浅静脉静脉留置针穿刺成功率。     

手术患儿在颈外静脉留置套管针的探讨

目的：为减轻患儿反复静脉穿刺的痛苦，提高患儿术前静脉穿刺一次性成功率，缩短术前准备时间。方法：将100例手术患儿随机分为对照组和实验组，各50例。对照组采用四肢静脉留置套管针输液，实验组采用颈外静脉留置套管针输液。结果：实验组穿刺时间最短（P〈0．001），一次性穿刺成功率高（P〈0．005），有显著性差异，实验组方法明显优于对照组。结论：颈外静脉留置套管针具有减轻患儿痛苦，提高一次穿刺成功率，缩短术前准备时间，术后方便患儿起床活动等优点，只要颈部条件允许的患儿均可适用。     

穿刺技巧与血管充盈度对留置针穿刺成功率的影响

目的 探讨穿刺技巧与血管充盈度对留置针穿刺成功率的影响.方法 将140例手术患者随机分为实验组(70例)和对照组(70例),其中血管充盈者分别为41例和39例.实验组采用单纯外套管推入法,对照组采用外套管针芯并入法.比较2组首次穿刺成功率及不同血管充盈度下的首次穿刺成功率.结果 实验组和对照组首次穿刺成功率比较,差异有统计学意义(P<0.01).实验组中血管充盈度对首次穿刺成功率的影响无统计学意义(P＞0.05),对照组中血管充盈良好者的首次穿刺成功率高于充盈不良者,差异有统计学意义(P<0.01).结论 根据血管充盈情况和患者病情,采用不同的穿刺方法.在浅静脉充盈良好的情况下,2种方法均可采用;对于血管充盈不良者应选用单纯外套管推入法.     

颈外静脉留置针应用于大量输液的体会

目的　比较经颈外静脉输液与四肢浅静脉输液在大量输液中的应用及优越性。方法　 60例经颈外静脉穿刺并留置针为实验组 ,60例经四肢静脉穿刺并留置针为对照组 ,记录置管成功率、操作时间、留置时间、液体流速及并发症。结果　实验组一次置管成功率为 93 .3 % ,对照组为 88.3 % ,P<0 .0 1 ;实验组平均操作时间 2 .6min,对照组为 3 .1 min,P<0 .0 1 ;实验组平均留管时间为 1 2 0 h,对照组 61 h,P<0 .0 1 ;实验组并发症为 6.7% ,对照组为 2 8.3 % ,P<0 .0 1 4,留置套管针最大流速可达 97ml/min[1 ] ,能满足重危病人快速补液的要求。结论　实验组较对照组一次置管成功率高 ,节省时间和人力 ,留置针时间长 ,并发症低 ,病人痛苦少 ,在临床上值得推广应用     

正压穿刺置管在静脉留置针患儿中的应用及效果

目的:探讨正压穿刺置管在静脉留置针患儿中的应用方法及临床效果.方法:将100例拟行静脉留置针穿刺的患儿随机分成实验组和对照组各50例.对照组采用常规穿刺方法,实验组采用正压穿刺置管,观察两组一次穿刺成功率.结果:实验组一次穿刺成功率高于对照组(P<0.05).结论:对静脉留置针患儿应用正压穿刺法,可避免反复静脉穿刺,减轻患儿痛苦,提高穿刺置管成功率.     

静脉留置针在婴幼儿CT增强扫描中的应用

目的观察静脉留置针在婴幼儿CT增强扫描中的应用效果。方法行CT增强扫描的婴幼儿252例随机分成实验组和对照组,各126例。实验组采用静脉套管留置针穿刺,对照组采用一次性蝶翼穿刺针穿刺。结果实验组穿刺一次成功率为100.00%,高于对照组的88.89%,差异有统计学意义(P0.01);实验组无穿刺相关不良反应,对照组主要为造影剂渗漏16例(12.70%)和血肿10例(7.94%)。结论在婴幼儿CT增强扫描中静脉留置针穿刺,可降低静脉穿刺的渗漏率,提高一次穿刺成功率,避免血肿和静脉炎的发生。     

浅静脉留置针穿刺中双止血带双交叉结扎法的临床研究

目的探讨浅静脉穿刺双止血带双交叉结扎法对浅静脉留置针穿刺止血带结扎成功率、静脉血管充盈度及静脉穿刺成功率的影响。方法将300例静脉血管充盈度差、在消化内科住院接受静脉输液的患者浅静脉穿刺时采用止血带单、双交叉结扎法进行对比研究,共穿刺600例次,平均每例穿刺2次。采用自身对照法,分单、双日组,双日组为实验组,单日组为对照组,实验组采用双止血带双交叉结扎法,对照组采用止血带单交叉结扎法。结果观察组止血带的一次结扎成功率、不同时间的静脉血管充盈度及静脉穿刺成功率明显高于对照组(P<0.05)。结论浅静脉留置针穿刺双止血带双交叉结扎法,能提高止血带一次结扎的成功率,改善静脉血管的充盈度,从而提高浅静脉留置针穿刺的成功率及护理的工作效率,为病人的治疗与抢救赢得时间。     

静脉留置针置入法的改进

静脉留置针置入方便、快捷，但有时外套管不能进入血管腔，甚至使外套管撕裂，影响患者的抢救治疗。现简介一种改进置入法。1材料与方法1．1材料：静脉留置针1根，心内科介入诊断或治疗使用过的静脉或动脉介入器中导丝1根，消毒备用，5ml一次性注射器1副，一次性消毒手套1副。1．2方法：以颈内静脉为例介绍置入方法：患者头转向左侧，穿刺部位消毒。打开手套外包装纸，将所需型号导丝（见附表）和注射器放入手套外包装纸内，戴手套后将注射器与留置针联接，采用自己所熟悉的进路法，持续复压进针，见回血后将外套管稍进1～2mm，左手固定留置…     

改进静脉留置针穿刺方法应用于老年患者的效果观察

目的 探讨静脉留置针在老年患者静脉输液过程中的穿刺方法,提高一次穿刺成功率.方法 对600例需要进行留置针穿刺的老年患者,随机分成2组,每组300例,对照组采用外套管与针芯分别送入血管至留置针根部的方法穿刺,实验组采用外套管与针芯一起送入血管至留置针根部的方法穿刺,观察穿刺成功率.结果 2组穿刺成功率比较,实验组高于对照组,有统计学意义(P<0.05).结论 外套管与针芯一起送人血管至留置针根部的穿刺方法,操作简单、方便、易行,能提高一次穿刺成功率,减轻老年患者再次穿刺的痛苦,减少人力物力资源.     

低血容量性休克病人建立套管针静脉通路的方法研究

[目的]研究二次穿刺法在低血容量性休克病人快速建立套管针静脉通路中的作用与效果。[方法]将64例急诊就诊的低血容量性休克病人随机分为实验组和对照组。实验组采用二次穿刺法，对照组采用传统穿刺方法。观察两种方法套管针穿刺次数与成功率、建立有效套管针通路所需时间、病人血管的保护程度、病人的医疗费用。[结果]两种方法套管针穿刺1次成功率、建立有效套管针通路所需时间、病人血管的保护程度、病人的医疗费用方面差异有统计学意义（P〈0．05）。[结论]二次穿刺法在低血容量性休克病人建立套管针静脉通路中的速度快、病人痛苦小并且费用少，可明显提高套管针1次穿刺成功率，达到良好的抢救效果。     

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."