老年骨科患者的临床护理体会

目的探讨老年骨科患者的临床护理方法。方法选取本院2014年1月~12月的老年骨科患者100例,对他们采取心理、饮食、并发症预防等全面的护理措施,并总结护理体会。结果对于压疮、呼吸道、泌尿道、心脑血管、骨的延迟愈合等并发症要采取针对性的护理措施。结论实施有效的护理措施,能提高老年骨科患者的治愈率。     

预防骨科患者发生Ⅱ期压疮的护理方法及体会

由于骨折的疼痛和治疗的需要，骨科患者多处于被动体位，因此压疮发生的危险也相对增加，压疮的预防成为骨科护理管理的重要组成部分。本科自2003年4月～2006年4月共收治骨折患者1231例，达到了“住院患者Ⅱ期压疮发生率为零”的要求，将护理方法及体位介绍如下。     

骨科患者发生压疮相关因素分析与护理对策

目的探究骨科患者发生压疮的危险因素与护理对策。方法选择2007年10月至2011年10月本院骨科压疮患者42例,对其危险因素进行调查与分析,并采取相应的护理对策。结果对于骨科压疮的护理重点在于及时掌握患者的危险因素,做好预防工作,通过护理方法改善患者受压处的皮肤情况。结论对于骨科卧床患者压疮危险因素进行评估,可以及时预测早期压疮的出现,以便采取相应的措施进行早期干预,延缓压疮的进展。     

Braden压疮风险评估表在骨科压疮高危患者中的应用

目的探讨Braden压疮风险评估量表应用于骨科压疮高危患者压疮预防的效果。方法将234例骨科住院患者随机分为实验组和对照组,每组各117例,对照组给予常规压疮预防护理,实验组在对照组基础上采用Braden评分量表进行评估,并对评分结果为13—14分的中度危险及得分小于该分的高度危险患者给予针对性预防措施。比较两组患者压疮发生情况。结果对照组117例患者中发生压疮10例,压疮发生率为8．7％,实验组发生压疮2例,压疮发生率为1．7％,组问比较差异有统计学意义（χ2=4．435,P〈0．05）。结论根据Braden评分量表对高危患者进行风险评估并采取针对性的护理措施能有效地降低压疮发生率,值得在临床推广应用。     

巧用小水枕预防压疮

我科从1998年以来将小水枕应用于神经外科危重患者和骨科患者,在防止压疮上取得满意的效果,现报告如下：     

品管圈活动对降低骨科患者压疮发生率的效果

目的：探讨品管圈活动在降低骨科患者压疮发生率中的应用效果。方法在开展品管圈活动前,选取2013年6—7月于骨科住院的96例患者为对照组;开展品管圈活动后,选取2013年9—10月于骨科住院的96例患者为观察组。骨科8名护士自愿组成“奔跑圈”,确定活动主题为“降低骨科患者压疮发生率”,分析压疮发生的原因,并对其进行改进。结果观察组压疮发生率明显低于对照组（8.3%比17.7%,P〈0.05）。品管圈每位成员的责任心、发现并解决问题的能力、专业知识、沟通能力、团队协作精神、展示自我这6个方面均得到显著提高。结论品管圈活动不仅大大降低了骨科患者压疮的发生率,同时也提高了每位圈员的质量管理能力和团队协作意识。     

3000ml3％氯化钠溶液在骨科压疮防治中的应用

骨科患者由于疾病的困扰卧床时间长，容易发生压疮，为了有效预防压疮的发生，本科将3000ml3％氯化钠溶液置于患者受压部位，取得了良好的效果。现将具体方法介绍如下。     

水垫在预防骨科患者局部压疮中的应用

压疮又称压力性溃疡,是骨科患者中最常见的护理问题之一,也是评价护理质量的一项重要内容。骨折患者由于肢体疼痛及活动受限,容易导致压疮的发生。压疮不仅给患者带来身体的痛苦,同时也增加其经济负担,严重时将延迟手术。如臀部、骶尾部的压疮将影响老年髋部骨折患者进行股骨头置换。我科护理人员在长期工作中发现应用水垫可预防骨折患者臀部     

品管圈活动在降低老年骨科手术患者中发生压疮的作用

目的：探讨品管圈活动在降低老年骨科手术患者中发生压疮的作用。方法采用随机抽样法选取2012年10月至2013年10月在我院实施骨科手术的患者100例,将2012年10月至2013年4月的50例患者设为对照组,将2013年5月至2013年10月的50例患者设为观察组。对照组患者给予常规的护理措施;观察组患者按照品管圈活动的要求进行系统的护理。记录并分析两组患者的满意度,并比较两组发生压疮的人数与次数以及圈内人员实施品管圈活动后的各项目平均值。结果品管圈活动后,观察组患者的各项满意度均高于对照组（均P＜0．05）,且观察组压疮人数和压疮次数与对照组相比,均有了明显的改善（均P＜0．05）。品管圈活动后,圈员的各项目的评分均明显高于活动实施前（均P＜0．01）。结论应用品管圈活动在降低骨科手术患者中发生压疮的因素多为外在因素,可通过护理人员加以预防。     

压疮预防快速参考指南应用于骨科围手术期效果评价

目的探讨《压疮预防快速参考指南》运用于骨科围手术期患者预防压疮的临床效果.方法观察2010年7月~2011年6月123例行骨科手术的患者,围手术期按照2009年《压疮预防快速参考指南》对患者实施护理,与往年未执行参考指南时期同类患者压疮发生率进行比较.结果观察组按照《压疮预防快速参考指南》流程实施护理,未出现1例新发压疮患者,远低于往年同类患者压疮发生率3.3%,预防效果显著.结论应用《压疮预防快速参考指南》可有效降低压疮的发生率,提高患者的生活质量.     

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.     

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.