狼疮性肾炎患者门诊分级管理的效果评价

目的 探讨对狼疮性肾炎患者实施分级管理和护理干预的效果.方法 对86例狼疮性肾炎患者实施分级管理和护理干预,采用自制“狼疮性肾炎患者自我管理行为问卷”,包括保持良好的生活习惯、自我处置药物行为、自我监控症状行为、心理自我调整行为、出现新问题及时处理和定期随访6个项目,评价干预前后患者的自我管理能力.问卷的Cronbach＇s α系数为0.641.结果 分级管理和护理干预10个月后狼疮性肾炎患者自我管理行为总分为（8.13±0.96）分,干预前为（7.35 ±0.86）分,差异有统计学意义（t=5.786,P＜0.01）,问卷6个项目均分干预前后比较,差异均有统计学意义（P＜0.01）.结论 分级管理和护理干预可以提高狼疮性肾炎患者的自我管理能力.     

中西医结合治疗狼疮性肾炎的观察与护理

改良四联疗法治疗狼疮性肾炎６０例取得理想疗效，提示中西医结合之改良四联疗法是治疗狼疮性肾炎的安全有效的治疗方法。本文介绍了狼疮性肾炎的治疗用药及护理，充分估计药物的不良反应及可能发生的并发症，并制定出相应的护理措施，做好患者的心理护理，预防并发症及不良反应，恰到好处的饮食护理是确保疗效并提高狼疮性肾炎患者生存质量的关键。     

狼疮性肾炎患者Th1／Th2细胞因子的研究

目的探讨狼疮性肾炎患者的发病与Th1／Th2优势活化状态之间的关系。方法采用酶联免疫吸附法（FLISA）测定32名狼疮性肾炎患者和10名健康人PBMC培养上清白细胞介素-4（IL-4）,白细胞介素-10（IL—10）,干扰素-γ,（IFN-γ）和白细胞介素-2（IL-2）水平。结果活动期狼疮性肾炎患者IL-4、IL-10水平明显高于非活动期、正常对照组,差异有显著性（P〈0．05）。活动期狼疮性肾炎患者IL-2水平明显低于非活动期、正常对照组。差异有显著性（P〈0．05）。IFN-γ水平3组间无显著性（P〉0．05）。结论Th2细胞因子介导的免疫应答在活动期狼疮性肾炎的发病机制中占主导地位,活动期狼疮性肾炎患者Th1细胞因子的细胞活化降低。     

难治性狼疮性肾炎患者生命质量的质性研究

目的 探讨难治性狼疮性肾炎（LN）患者的生命质量及其影响因素.方法 采用质性研究中诠释现象学研究法,对7例难治性狼疮性肾炎患者进行半结构式深入访谈,并运用Colaizzi分析法对资料进行分析.结果 影响难治性LN患者生命质量的因素,共有5个层面8个主题被提炼,生理层面;精神、心理层面（各种消极的情绪影响生存质量）;经济层面;社会层面（无法履行社会职能;以男性患者为代表;角色缺如;家庭支持系统的重要作用）;患者需求层面（相关健康教育知识的普及;完善的医疗保健系统及社会支持）.结论 对难治性狼疮性肾炎患者应开展以患者为中心的护患交流,提供个性化护理措施,促进患者生理、心理、社会功能方面的适应,提高患者的生命质量.     

血液透析联合双冲击治疗重症狼疮性肾炎合并狼疮性脑病病人的护理

[目的]总结血液透析联合双冲击治疗重症狼疮性肾炎合并狼疮性脑病病人的护理。[方法]对5例重症狼疮性肾炎合并狼疮性脑病病人在血液透析治疗基础上配合大剂量的糖皮质激素、环磷酸酰胺双冲击治疗,同时加强心理护理、血管通路的建立及护理、血液透析及药物冲击治疗的护理。[结果]5例病人狼疮性脑病痊愈,狼疮性肾炎病情稳定出院。[结论]加强重症狼疮性肾炎合并狼疮性脑病病人行血液透析联合双冲击治疗的护理是治疗成功的保证。     

血液透析联合双冲击治疗重症狼疮性肾炎合并狼疮性脑病病人的护理

[目的]总结血液透析联合双冲击治疗重症狼疮性肾炎合并狼疮性脑病病人的护理.[方法]对5例重症狼疮性肾炎合并狼疮性脑病病人在血液透析治疗基础上配合大剂量的糖皮质激素、环磷酸酰胺双冲击治疗,同时加强心理护理、血管通路的建立及护理、血液透析及药物冲击治疗的护理.[结果] 5例病人狼疮性脑病痊愈,狼疮性肾炎病情稳定出院.[结论]加强重症狼疮性肾炎合并狼疮性脑病病人行血液透析联合双冲击治疗的护理是治疗成功的保证.     

狼疮性肾炎患者心理健康状况分析及护理

目的探讨狼疮性肾炎患者心理健康状况及相关因素,为临床护理提供依据。方法采用症状自评量表(SCL-90)对52例狼疮性肾炎患者进行心理健康状况和一般情况调查,调查时以问卷和直接交谈相结合的方法,指导或帮助患者填写有关内容。结果本组患者心理健康状况较差,症状因子总均分与全国常模间差异有统计学意义(P<0.001)。心理健康状况影响较大的因素为患病时间长短、家庭经济状况、医疗费支付方式、社会支持、婚姻和生育状况。结论狼疮性肾炎患者总体心理健康处于较差状态,有针对性地进行心理护理,提供良好的社会支持、健康教育、建立随访档案,对纠正患者的心理健康状况十分重要。     

小儿狼疮性肾炎的护理

回顾性总地了17例小儿狼疮性肾炎患儿的护理体会,主要包括药物不良反应的护理有骨髓抑制、出血性膀胱炎、恶心呕吐、腹痛腹泻、高血压、脱发;避免诱因;合理安排休息与活动;膳食护理、心理护理和出院指导等,认为加强护理能有效促进患者康复及减狼疮性肾炎复发。     

狼疮性肾炎患者心理健康状况分析及护理

目的 探讨狼疮性肾炎患者心理健康状况及相关因素,为临床护理提供依据.方法 采用症状自评量表(SCL-90)对52例狼疮性肾炎患者进行心理健康状况和一般情况调查,调查时以问卷和直接交谈相结合的方法,指导或帮助患者填写有关内容.结果 本组患者心理健康状况较差,症状因子总均分与全国常模间差异有统计学意义(P＜0.001).心理健康状况影响较大的因素为患病时间长短、家庭经济状况、医疗费支付方式、社会支持、婚姻和生育状况.结论 狼疮性肾炎患者总体心理健康处于较差状态,有针对性地进行心理护理,提供良好的社会支持、健康教育、建立随访档案,对纠正患者的心理健康状况十分重要.     

狼疮性肾炎患者血清抗中性粒细胞胞浆抗体的检测及意义

系统性红斑狼疮（SLE）是我国最常见的自身免疫性疾病之一,狼疮性肾炎为其较常见的组织损伤,患者血清中含有多种自身抗体,除既往研究较多的抗核抗体（ANA）外,近年来还开展了抗中性粒细胞胞浆抗体（ANCA）的研究。本文通过对30例狼疮性肾炎（LN）患者血清中ANCA检测,旨在探讨ANCA在狼疮性肾炎中的阳性率以及与狼疮性肾炎的关系。     

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.     

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.     

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.     

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.     

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.