痔瘘洗剂熏洗联合藻酸盐敷料在肛周脓肿根治术后的应用观察

目的:痔瘘洗剂熏洗联合藻酸盐敷料对肛周脓肿患者根治后相关并发症及创面愈合的影响.方法:将符合标准的60例就诊于安徽省中医院肛肠诊疗中心并行肛周脓肿一期根治术的患者,随机分为观察组30例和对照组30例,观察组于术后每日便后,使用痔瘘洗剂熏洗创面,藻酸盐敷料填塞创面;对照组术后每日用高锰酸钾坐浴后凡士林纱条填塞创面.分别观察并记录两组患者结扎皮筋脱落及创面愈合时间,比较分析两组患者术后第3d、7d、14d疼痛评分、创面水肿评分及创面渗液评分.结果:观察组患者术后皮筋脱落时间及创口愈合时间较短(P＜0.05).同时,观察组患者术后第7d、14d,创面疼痛评分及创面水肿评分均小于对照组(P＜0.05),术后3d、7d、14d创面渗液评分小于对照组(_P＜0.05).结论:痔瘘洗剂熏洗结合藻酸盐敷料可有效减轻肛周脓肿根治术后患者疼痛、降低创面渗液量、加速创缘水肿的消退,同时还能显著降低切挂皮筋脱落的时间促进创面恢复.     

光子治疗仪在肛周脓肿术后切口中的应用

目的探讨光子治疗仪治疗肛周脓肿术后创面的疗效。方法将80例符合低位肛周脓肿的患者随机分为光子治疗组40例和对照组40例,光子治疗组于术后第2天采用Carnation33型光子治疗仪照射,10d1个疗程,照射后常规换药;对照组常规换药;于术后第1天、第5天、第10天评价切口疼痛程度、渗液量,比较两组切口愈合天数。结果光子治疗组切口疼痛程度、渗液量、平均愈合时间明显优于对照组,差异具有统计学意义（P〈0．05）。结论光子治疗仪能明显减轻切口疼痛,减少渗液量,缩短切口愈合时间。     

肛周脓肿术后配合中药薰洗的临床观察与护理简

目的：观察中药薰洗促进肛周脓肿术后创面愈合的临床疗效。方法将60例肛周脓肿术后患者随机分为对照组和治疗组,每组30例。对照组采用常规护理及高锰酸钾溶液薰洗。治疗组除常规护理外,配合中药薰洗治疗。并对两组肛周脓肿术后创面疼痛、创面渗出、组织水肿及肉芽生长、创面愈合时间及排便、排尿等情况进行比较。结果治疗组术后第7、14、21、28d的创面疼痛、创面渗出、组织水肿及肉芽生长情况评分较对照组显著降低,两组比较有显著性差异（P＜0．05,P＜0．01）。治疗组创面平均愈合时间较对照组明显缩短,两组比较有显著性差异（P＜0．05）;治疗组术后7d排便、排尿情况评分与对照组比较有显著性差异（P＜0．01）。结论肛周脓肿术后采用中药薰洗治疗,可有效的减轻疼痛,控制渗出,促进创面愈合,改善排便、排尿障碍等并发症,疗效确切,可应用于临床。     

改良药纱联合微波在肛周脓肿术后治疗中的作用

目的探讨改良药纱(康复新液+高渗葡萄糖)联合局部微波理疗在肛周脓肿术后创面修复治疗中的作用。方法随机将因肛周脓肿行手术治疗的患者80例分为两组。对照组40例术后行常规方法换药,改良组40例使用改良药纱换药联合局部微波理疗。比较两组术后切口疼痛、水肿、肛坠等症状消失时间,创面恢复情况和住院时间。结果改良组在术后切口疼痛、水肿、肛坠等症状消失时间短于对照组,创面渗液、肉芽组织、愈合时间和住院时间上均优于对照组(P0.05)。结论使用改良药纱(康复新液+高渗葡萄糖)换药联合局部微波理疗,能明显改善肛周脓肿患者术后不适症状,改善创面愈合,有效地缩短了创面愈合时间。     

长效抗菌膜用于肛周脓肿切开术后的临床效果观察

目的观察长效抗菌膜喷洒创面促进肛周脓肿术后创面愈合的临床疗效。方法将52例肛周脓肿术后患者随机分为试验组和对照组各26例,试验组术后换药消毒后采用长效抗菌膜喷洒,对照组则常规消毒换药。观察两组肛周脓肿术后创面疼痛程度,创面渗液量及创面愈合时间。结果试验组术后创面疼痛轻,渗液量少,愈合时间短,与对照组相比均具有统计学差异（P〈0.05）。结论长效抗菌膜能有效减轻肛周脓肿术后创面疼痛,减少渗液、缩短创面愈合时间。     

康复新液治疗肛周脓肿术后愈合的疗效观察

随机将80例肛周脓肿术后患者分为对照组和治疗组各40例。对照组术后给予常规方法换药;治疗组使用康复新液换药处理。比较两组术后切口疼痛、水肿、肛门坠胀等症状消失时间,平均愈合时间及肉芽生长周期。治疗组术后切口疼痛、水肿、肛门坠胀等症状消失时间明显短于对照组;平均愈合时间及肉芽生长周期亦优于对照组(P<0.05)。肛周脓肿术后运用康复新液换药,能明显改善患者术后症状,促进创面愈合,疗效满意,值得推广。     

循证疼痛护理对混合痔术后患者的影响

目的：探讨循证疼痛护理对混合痔术后患者疼痛及创面愈合情况的影响。方法：选取2021年1~8月收治的混合痔手术患者62例作为研究对象,采用随机数字表法分为对照组和观察组,各31例。对照组术后采用常规疼痛护理,观察组术后采用循证疼痛护理联合常规疼痛护理。两组均护理至出院,并随访4周。比较两组术后疼痛情况、首次排便时间、创面愈合时间,术后24 h、48 h水肿情况,术后1 d、出院时创面评分,护理前后纤维蛋白原（FIB）、D-二聚体（D-D）、血管性血友病因子（vWF）水平,出院时护理满意度。结果：观察组术后最高疼痛评分、首次换药疼痛评分均低于对照组,首次排便及创面愈合时间均短于对照组（P＜0.05）。两组术后48 h水肿评分较术后24 h降低,且观察组低于对照组（P＜0.05）。两组出院时创面评分较术后1 d降低,且观察组低于对照组（P＜0.05）。两组护理后血浆FIB、D-D、vWF水平均较护理前升高,且观察组高于对照组（P＜0.05）。出院时,观察组病房环境、操作水平、护患沟通、患者感受评分均高于对照组（P＜0.05）。结论：混合痔术后应用循证疼痛护理干预能够改善患者凝血障碍,缓解手术部位疼痛,减轻创面水肿,促进恢复,提高患者满意度。     

肛周脓肿术后配合中药薰洗的临床观察与护理

目的观察中药薰洗促进肛周脓肿术后创面愈合的临床疗效。方法将60例肛周脓肿术后患者随机分为对照组和治疗组,每组30例。对照组采用常规护理及高锰酸钾溶液薰洗。治疗组除常规护理外,配合中药薰洗治疗。并对两组肛周脓肿术后创面疼痛、创面渗出、组织水肿及肉芽生长、创面愈合时间及排便、排尿等情况进行比较。结果治疗组术后第7、14、21、28d的创面疼痛、创面渗出、组织水肿及肉芽生长情况评分较对照组显著降低,两组比较有显著性差异(P0.05,P0.01)。治疗组创面平均愈合时间较对照组明显缩短,两组比较有显著性差异(P0.05);治疗组术后7d排便、排尿情况评分与对照组比较有显著性差异(P0.01)。结论肛周脓肿术后采用中药薰洗治疗,可有效的减轻疼痛,控制渗出,促进创面愈合,改善排便、排尿障碍等并发症,疗效确切,可应用于临床。     

复方紫草生肌膏对肛瘘术后创口愈合的疗效观察

目的观察复方紫草生肌膏对肛瘘术后创口愈合的疗效。方法选择2014年1月至2016年9月符合试验标准的需手术治疗的肛瘘患者100例,采用数字表随机法分为两组。对照组50例术后常规使用凡士林纱条换药,2次/d;治疗组50例术后给予自制复方紫草生肌膏换药,2次/d。术后1周评价两组患者临床疗效;比较两组患者术后1周、2周、3周局部症状体征改善情况、创面愈合情况;记录两组患者疼痛消失时间、创面渗液干净时间、上皮组织生长时间及创面愈合时间。结果治疗组术后1周、2周、3周疼痛、水肿评分均低于对照组,治疗组术后1周、2周渗液评分低于对照组,差异均有统计学意义(P0.05)。治疗组术后1周、2周、3周、4周肉芽生长和创面情况评分均低于对照组,差异有统计学意义(P0.05)。治疗组平均创面愈合时间(26.38±3.14)d,对照组为(33.38±9.75)d,治疗组创面愈合时间明显短于对照组(P0.05)。治疗组疼痛消失时间、创面渗液干净时间、上皮组织生长时间均短于对照组,差异有统计学意义(P0.05)。治疗组28 d治疗总有效率为100%,对照组为84%,差异有统计学意义(P0.05)。结论复方紫草生肌膏具有清热燥湿,活血补气之功效,应用于肛瘘术后可减轻疼痛、水肿、渗液等早期不适症状体征,缩短创面愈合时间。     

红光治疗仪联合无痛护理对痔疮套扎术患者术后疼痛程度的影响观察

目的 观察红光治疗仪联合无痛护理对痔疮套扎术患者术后疼痛程度的影响。方法 选取收治的痔疮患者85例,根据交替分组法分为对照组42例和观察组43例。两组均实施痔疮套扎术治疗,对照组术后实施无痛护理,观察组在对照组基础上联合红光治疗仪治疗,连续干预1周。比较两组干预前及干预1、3、7 d创面疼痛程度及肿胀程度,并比较两组疼痛消失、肿胀消失及创面愈合时间。结果 干预1、3、7 d,观察组VAS评分、创面肿胀评分低于对照组（P<0.05）;水肿、疼痛消失时间及创面愈合时间短于对照组（P<0.05）。结论 红光治疗仪联合无痛护理可有效改善痔疮套扎术患者术后创面疼痛及肿胀程度,缩短创面愈合时间。     

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.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.