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.     

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。     

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。     

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.     

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.