偏远农村地区下肢慢性溃疡远程伤口专科治疗模式可行性调查

[目的]探讨构建以手机彩信为平台的下肢慢性溃疡远程医疗的可行性和适用性。[方法]采取整群抽样的方法收集湘西地区综合性医院就诊的32例偏远农村地区下肢慢性溃疡病人,并通过自制问卷调查表了解病人的伤口特点,治疗现状以及伤口愈合影响因素,并进行手机拍照和彩信收发技能培训。[结果]接受调查的病人年龄为(47.5±12.3)岁;伤口病程为(6.5±3.9)个月;引起溃疡的基础疾病是烧伤外伤引起的伤口慢性感染12例;第1次入院前主要治疗方式是传统草药外敷13例;伤口类型主要是感染伤口15例;病人对手机拍照和彩信收发技能培训后掌握率(84.4%)明显高于培训前(21.9%),差异有统计学意义(χ2=25.098,P<0.001)。[结论]湘西偏远农村地区下肢慢性溃疡病人未获得合适的伤口专科治疗的医疗覆盖,构建面向偏远山区下肢慢性溃疡病人的手机彩信平台远程医疗模式具有有一定的可行性和适用性。     

医护治一体化伤口管理模式在老年下肢慢性溃疡患者负压引流护理中的应用

目的:探讨医护治一体化伤口管理模式在老年下肢慢性溃疡患者负压引流护理中的应用效果。方法:将2015年1月~2017年12月84例下肢慢性溃疡患者根据随机数字表法分为观察组和对照组各42例,两组均行负压引流治疗,对照组治疗期间应用常规护理干预,观察组治疗期间应用医护治一体化伤口管理模式。比较两组溃疡愈合时间、新肉芽长出时间、每天换药次数、伤口渗液时间、平均住院时间、疼痛评分、生活质量评分及满意度评分。结果:观察组溃疡愈合时间、新肉芽长出时间、每天换药次数、伤口渗液时间、平均住院时间均少于对照组(P0.05),疼痛感、生活质量及满意度评分均优于对照组(P0.05)。结论:医护治一体化伤口管理模式能有效改善负压引流治疗老年下肢慢性溃疡患者预后。     

湿性愈合敷料治疗压疮的效果观察与成本效益分析

目的探讨湿性愈合敷料对压疮的疗效和成本效益。方法将149例压疮患者随机分为甲乙两组,甲组为湿性敷料治疗组,乙组为常规治疗组。比较两组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用。结果甲组各期创面治疗的治愈率明显高于乙组,平均愈合时间、换药次数、换药时间明显少于乙组(均P<0．05),而两组压疮各期的换药费用比较,P>0．05,说明两组换药方法费用相当,湿性愈合敷料并没有增加换药费用。结论湿性愈合敷料治疗压疮效果明显优于传统干性疗法,具有治愈率高、伤口愈合快、总体费用降低、护理总时数少及患者舒适等优点。     

康惠尔溃疡贴治疗下肢慢性溃疡的疗效观察

本文随机对160例因多种病因造成的下肢慢性溃疡病患者采用两种不同的方法换药.观察组使用康惠尔溃疡贴,对照组使用艾利克液(乙胺碘肤酮),分别就两者在换药时伤口的疼痛程度,用药后创面的分泌物情况及创面修复所需时间进行对比观察,并行综合比较.结果发现,观察组创面修复所需时间短,换药时伤口疼痛减轻.认为康惠尔溃疡贴是治疗下肢慢性溃疡较为理想的药物.     

湿性愈合疗法治疗糖尿病足部慢性溃疡的临床疗效观察

目的探讨湿性愈合疗法治疗糖尿病足部慢性溃疡的临床效果。方法对31例糖尿病足部慢性溃疡共31处伤口,随机分为常规换药组16例和湿性换药组15例。湿性换药组采用湿性敷料和水胶体敷料进行换药治疗,常规换药组采用0.5%碘伏纱条进行换药,并观察两组临床效果。结果两组伤口愈合时间、换药次数比较有显著性差异(P<0.01)。结论湿性愈合疗法治疗糖尿病足部慢性溃疡明显优于常规换药方法。     

湿性愈合敷料用于腹部术后愈合不良伤口的效果观察

目的 探讨湿性愈合敷料对腹部术后愈合不良伤口的疗效.方法 将42例腹部术后伤口愈合不良患者随机分为观察组22例和对照组20例,观察组采用湿性敷料治疗,对照组采用传统换药方法.比较2组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用.结果 观察组的治愈率明显高于对照组(p<0.05),平均愈合时间、换药次数、换药时间明显少于对照组(p<0.05),而2组患者换药费用比较差异无统计学意义(p>0.05).结论 湿性愈合敷料治疗术后愈合不良伤口效果明显优于传统干性疗法,具有治愈率高、伤口愈合快、总体费用降低、换药次数少及患者舒适等优点.     

湿性愈合敷料治疗腹部术后愈合不良伤口的疗效观察

目的 探讨湿性愈合敷料对腹部术后愈合不良伤口的疗效.方法 将90例腹部术后伤口愈合不良患者随机分为实验组47例和对照组43例,实验组采用湿性敷料治疗,对照组采用常规治疗.比较2组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用.结果 实验组治疗的治愈率明显高于对照组,平均愈合时间、换药次数、换药时间明显少于对照组,而2组伤口各期的换药费用比较无显著差异.结论 湿性愈合敷料治疗术后愈合不良伤口效果明显优于传统干性疗法,具有治愈率高、伤几愈合快、总体费用降低、护理总时数少及患者舒适等优点.     

自制负压吸引装置在治疗感染切口中的应用研究

目的 观察自制负压吸引装置在治疗感染切口中的应用效果.方法 将36例切口感染患者随机分为对照组和观察组,每组18例.观察组伤口内放置吸痰管接负压袋吸引渗液,对照组使用传统方法敞开换药,比较两组在伤口愈合时间,换药次数,换药费用及患者舒适度方面的差异.结果 观察组在伤口愈合时间,换药次数,,换药费用及舒适度方面均优于对照组(P＜0.01,P＜0.05).结论 自制负压吸引装置应用于感染切口,可促进伤口愈合,减少医护工作量,降低医疗费用,提高患者舒适度及满意率.     

自制紫草油治疗下肢慢性溃疡效果观察及护理

将60例下肢慢性溃疡患者随机分为观察组31例和对照组29例,两组同法清洁、消毒疮面后,观察组采用本院自制紫草油纱布湿敷,对照组采用凡士林纱布湿敷.观察两组的治疗效果、换药次数及疮面愈合时间的差别.结果观察组治疗效果显著优于对照组、换药次数显著少于对照组,疮面愈合时间显著短于对照组(P<0.01).认为自制紫草油可有效治疗下肢慢性溃疡,且无任何毒副作用.     

一体化伤口管理模式配合负压引流在下肢慢性溃疡患者中的应用效果

目的探讨一体化伤口管理模式配合负压引流在下肢慢性溃疡患者中的治疗效果。方法选取2018年1月—2019年5月就诊于本院的90例下肢慢性溃疡患者,按随机数字表法分为对照组和试验组两组各45例。对照组行负压引流等一般常规护理,试验组在对照组基础上采用一体化伤口管理模式。采用视觉模拟评分表(VAS)、简易健康量表(SF-26)等来比较两组治疗相关指标、生活质量、疼痛程度。结果与对照组相比,试验组每天换药次数较少,住院时间、伤口渗液时间、新肉芽长出时间、溃疡愈合时间较短(P<0.05);试验组简易健康量表(SF-36)评分较高,而视觉模拟评分法(VAS)评分较低,与对照组相比有统计学差异(P<0.05)。结论一体化伤口管理模式配合负压引流能够减轻下肢慢性溃疡患者疼痛程度,减少每天换药次数,促进伤口愈合,缩短住院时间,提高生活质量。     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.