脊髓栓系综合征术后患者膀胱功能的监测与康复护理

目的探讨脊髓栓系综合症(TCS)术后患者膀胱功能的监测方法和提高自主排尿的功能。方法对18例TCS病人术后进行膀胱充盈度的测试、尿流动力学检查、残余尿量测定,以测定膀胱功能的恢复程度。采用间歇性导尿和手法训练膀胱功能,促进膀胱功能的恢复。结果本组除2例术前已有肾积水的病人外,其余16例病人均于术后15～54d拔除尿管,基本恢复自主排尿功能。结论密切的膀胱功能监测结合适当的膀胱功能训练,可有效掌握TCS术后患者膀胱功能的恢复情况和促进病人建立自主排尿功能。     

康复训练介入时间对脑卒中后排尿功能障碍康复的影响

目的:探讨早期和晚期康复训练对脑卒中后排尿功能障碍康复的影响.方法:126例脑卒中并发排尿功能障碍患者,早期和晚期康复组各63例,早期康复组在神经病学体征稳定后1～4 d开始介入,晚期康复组在5～10 d介入.两组采用相同的康复方法,包括水出入量控制训练,尿道括约肌控制力训练,排尿反射训练,代偿性排尿方法训练,留置尿管期的膀胱充盈训练和心理康复.排尿功能的评估:记录每天排尿的尿量和次数;每次排尿的尿量与时间;是否有尿意;压迫腹部刺激会阴是否能引起排尿;排尿有关的末梢神经功能是否正常.结果:经3～15d治疗,两组排尿功能均显著改善,排尿功能康复,但早期康复组改善时间明显优于晚期康复组(P＜0.05).结论:早晚期康复训练均能显著改善排尿功能,但早期康复训练使恢复进程加快.     

脊髓损伤致截瘫患者膀胱功能训练的护理进展

综述了脊髓损伤所致排尿功能障碍患者膀胱功能训练的方法及效果.包括帮助患者建立脊髓性膀胱自主排尿功能,实行膀胱充盈训练、间歇性导尿、中医穴位按压诱导、手法挤压等刺激患者的排尿反射的方法,同时观察患者的排尿情况.认为膀胱功能训练有利于改善脊髓损伤致截瘫患者的排尿功能,提高其生活质量.     

截瘫病人建立自主排尿的效果观察及护理

[目的]探讨截瘫病人建立自主排尿的效果。[方法]将46例截瘫排尿障碍病人随机分为观察组和对照组各23例,对照组病人采取常规护理,观察组病人在常规护理的基础上训练病人的自主排尿功能,8周后对两组病人排尿功能和排尿效果进行评估。[结果]观察组、对照组自主排尿成功率分别为86.96%、78.26%,经比较差异有统计学意义(P<0.05);观察组留置尿管时间及自主排尿时间短于对照组、拔管1次成功率高于对照组(P<0.05)。[结论]对截瘫病人行自主排尿训练并加强护理可使病人恢复自主排尿时间缩短、提高恢复自主排尿效果。     

间歇性导尿配合音频电疗、微波治疗脊髓损伤后痉挛性膀胱的效果研究

目的 探讨脊髓损伤(SCI)后痉挛性膀胱患者恢复膀胱功能和自主排尿的方法.方法 对实验组30例患者间歇导尿6次/d,音频电疗、微波治疗各2次/d;对照组30例患者采用传统的留置尿管方法,观察2组患者膀胱功能恢复的情况.结果 实验组患者恢复自行排尿成功率显著高于对照组,差异有统计学意义(P＜0.01).实验组膀胱容量增加、残余尿量减少优于对照组(P＜0.05).结论 间歇性导尿结合音频电疗、微波进行膀胱功能训练能有效地促进SCI后痉挛性膀胱患者膀胱功能的恢复.     

神经外科昏迷病人拔除尿管方法对尿潴留的影响

目的 为神经外科昏迷病人留置尿管恢复正常排尿功能选择一种最佳的拔尿管方法,以减少病人的重复插管.方法 选择神经外科男性昏迷并留置尿管病人100例,随机分为观察组和对照组,各50例.两组均遵医嘱拔除尿管.观察组采用拔管前膀胱灌注温热液体至膀胱充盈时,结合膀胱区按摩拔除尿管.对照组不论膀胱是否充盈随即拔除尿管.比较两组拔管后排尿的成功率.结果 观察组拔管后第1次排尿成功率为90%,排尿时间9.3±3.6min;对照组拔管后第1次排尿成功率为64%,排尿时间60.7±19.3min.两组比较有显著性差异(P<0.01).结论 在膀胱充盈时,结合膀胱区按摩拔除尿管,排尿效果显著.     

不同膀胱功能训练法对宫颈癌术后尿潴留的影响

宫颈癌根治术是治疗早期宫颈癌的首选方法,术后最常见的并发症是尿潴留[1],其发生率为28%.20%左右的病人需要再次导尿,既增加病人的痛苦又增加尿路感染的机会[1].目前,国内外对宫颈癌术后恢复自主排尿方面有许多研究,如留置尿管方式及时间的改变,术后盆底肌肉的锻炼,预防泌尿道感染,个体化放尿、排尿,物理疗法及心理护理等措施[2].但对于这方面的文献报道各说己见.本研究旨在探索有效预防措施,进行有意识的会阴部、盆底肌肉及腹壁肌肉的收缩锻炼、使支配膀胱的神经得到一定的恢复, 阻止膀胱肌肉的萎缩,加强尿道括约肌的作用, 促进自主排尿功能的恢复.为此,我科于2009年1月起对宫颈癌根治术术后采用常规护理加腹肌盆底肌膀胱肌锻炼的主动膀胱功能训练法,对拔除尿管后排尿时间和排尿成功情况进行临床观察,效果明显.现报道如下.     

系统性排尿训练对腹腔镜直肠癌根治术后病人排尿功能的影响研究

[目的]探讨系统性排尿功能训练对腹腔镜直肠癌根治术后病人排尿功能的影响效果。[方法]将130例腹腔镜直肠癌根治手术病人随机分为试验组和对照组各65例。对照组采取常规护理方法,试验组除了实施常规护理外,手术前后实施系统性排尿功能训练,直到病人术后拔除尿管,恢复自主排尿。对比观察两组病人术后尿意恢复时间、拔除尿管时间、自主排尿时间、尿潴留发生率、重复置管率、泌尿系统并发症的发生率等情况。[结果]试验组病人术后尿意恢复时间、拔除尿管时间、自主排尿时间与对照组相比,时间明显缩短,具有统计学意义(P0.05);试验组尿潴留发生率、重复置管率、膀胱刺激征、尿路感染等泌尿系统并发症的发生率与对照组相比,都有不同程度的下降,差异有统计学意义(P0.05)。[结论]对腹腔镜直肠癌病人手术前后运用系统性排尿功能训练能有效促进病人术后排尿功能恢复,减少病人膀胱刺激症状和留置尿管时间,预防和减少术后尿潴留的发生,降低重复置管率和泌尿系统并发症发生率,促进病人术后的快速康复。     

早期个性化开放尿管对宫颈癌患者术后排尿功能的影响

目的探讨早期个性化开放尿管对宫颈癌患者术后留置尿管拔除后排尿功能的影响。方法选择40例宫颈癌手术患者为观察组,前期收治的宫颈癌患者40例为对照组,观察组采用早期个性化开放尿管,对照组给予常规尿管护理。比较2组患者术后尿管拔除后首次排尿情况、膀胱功能恢复情况及拔尿管后3 d排尿情况。结果与对照组比较,观察组尿管拔除后首次排尿情况优于对照组(P0.05);膀胱功能恢复情况好于对照组(P0.05);拔尿管后3 d内排尿情况好于对照组(P0.05)。结论早期个性化开放尿管能有效提高宫颈癌患者术后的自主排尿功能,减少排尿障碍的发生。     

脊髓损伤患者的膀胱功能训练

目的探讨脊髓损伤(SCI)患者的膀胱功能训练方法及其临床效果.方法20例SCI患者通过留置导尿期的训练,手法排尿期的训练以及反射性排尿的训练等相结合,进行膀胱功能训练,观察疗效.结果5例在3周内拔除了尿管,15例25～53 d拔除了尿管.16例建立了反射性膀胱,可自主控制排尿,3例须用手法排尿,1例伴有尿失禁,需配合假性导尿.结论利用留置尿管按膀胱容量进行排尿的方式,使膀胱规律性充盈与排空,达到接近生理状态,促进脊髓低位中枢与大脑间的联系,可以取得较好的临床疗效.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.