行为干预对慢性阻塞性肺疾病缓解期患者生活质量的影响

目的:探讨行为干预对慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)缓解期患者生活质量的影响。方法:将54例COPD患者按随机抽签法分为行为干预组与对照组。两组临床治疗相同,行为干预组在此基础上增加行为干预:心理情绪干预、躯体功能干预、生活行为干预。参考方宗君等人的COPD患者生活质量问卷及评分方法分别在治疗前、出院前、出院后3个月、1年评估两组患者生活质量。结果:随访1年,行为干预组日常生活能力F1,社会活动状况F2,抑郁心理症状F3,焦虑心理症状F4评分(2.03±0.32,2.29±0.77,2.36±0.34,2.07±0.25)较对照组(2.29±0.30,2.39±0.41,2.41±0.28,2.16±0.51)降低明显,差异具有显著性意义(t=2.801,2.914,P<0.01,t=2.250,2.340,P<0.05)。结论:行为干预可有效改善COPD缓解期患者生活质量。     

综合疼痛管理在腰椎间盘突出症保守治疗中的应用效果

目的：探讨综合疼痛管理在腰椎间盘突出症(LDH)保守治疗中的应用效果。 方法：2018年1月~12月选取宜宾市第一人民医院中医骨伤科门诊LDH患者100例，随机分为对照组和管理组，在常规非手术治疗基础上，对照组不予特殊疼痛管理，管理组给予疼痛教育、疼痛评估和多模式镇痛等综合疼痛管理措施，干预3个月后比较其疼痛评分、对疼痛控制方法和疼痛教育的满意度及疗效。 结果：干预前两组患者疼痛视觉模拟(VAS)评分和简化McGill疼痛量表(SF-MPQ)评分差异无统计学意义(P>0.05)，干预后管理组显著低于对照组(P<0.05)。干预后患者对疼痛控制方法和疼痛教育的满意度管理组优于对照组[疼痛控制方法满意度：(37.3±7.7)vs(31.2±7.2)，对疼痛教育的满意度：(31.8±5.9)vs(22.9±6.1)，P<0.05]。管理组总有效率和疗效等级高于对照组(92.0%vs74.0%，P<0.05)。 结论：综合疼痛管理有利于缓解患者疼痛，维持患者身心健康和改善生活质量。     

住院病人陪护人员对陪探视需求的调查

[目的]了解住院病人陪护人员对陪探视的需求,旨在探讨有效的陪护管理对策。[方法]采用自行设计问卷对498名陪护人员进行调查。[结果]大多数调查者认为病人在住院期间需要陪护,对陪护人员的需求主要为直系亲属占84.6%;69.9%陪护人员认为应该限制探视时间,54.0%的陪护人员认为在任何时间均可探视。[结论]在现有条件下最大限度地支持家人陪护,满足病人的陪护需求,适当限制探视时间,才能保障病人的身心需求。     

吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响

目的 观察吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响。 方法 采用随机数字表法将56例喉癌术后放疗后患者分为实验组和对照组,每组28例。2组患者均接受常规健康咨询和吞咽训练,实验组在此基础上给予营养干预。在干预前、干预后3个月,采用安德森吞咽困难量表(MDADI)、患者主观整体营养状况评分量表（PG-SGA)、生活质量调查表30(QLQ-C30)评价2组患者的吞咽功能、营养状态、生活质量。 结果 干预前,2组患者MDADI评分、PG-SGA评分、QLQ-C30评分比较,差异无统计学意义（P>0.05）。实验组干预后3个月MDADI评分［（63.96±11.37）分］、PG-SGA评分［（3.07±1.75）分］、QLQ-C30评分［（55.93±7.07）分］较组内治疗前显著改善（P<0.05）,对照组干预后3个月仅MDADI评分［（58.72±10.57）分］较组内治疗前改善（P<0.05）。与对照组干预后3个月比较,实验组MDADI评分、PG-SGA评分、QLQ-C30评分显著改善（P<0.05）。实验组与对照组干预前、后3个月MDADI评分、PG-SGA评分、QLQ-C30评分差值［（13.43±10.23）分、（1.81±1.63）分、（7.47±6.32）分］比较,差异有统计学意义（P<0.05）。 结论 吞咽训练结合营养干预可以更有效改善喉癌患者术后放疗后的吞咽功能和营养状态,提高患者的生活质量。     

快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用

目的 探讨快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用效果.方法 选取该院2014年10月~2015年10月入院的行腹腔镜胆囊切除术患者88例,随机分为两组,对照组患者采用常规护理,实验组患者则加施快速康复护理联合中药治疗,比较两组患者总体治疗效果评价、并发症、干预前后健康知识评分与术后疼痛、相关临床指标与护理满意度.结果 两组患者治疗总有效率比较差异无统计学意义(P>0.05);实验组患者并发症发生率(9.09%)显著低于对照组(36.36%)(P<0.05);干预后健康知识评分(92.50±4.22)分显著高于对照组(75.49±17.38)分(P<0.05),术后VAS评分(0.57±0.29)分显著性低于对照组(1.26±0.82)分(P<0.05);肛门排气时间(27.14±8.07)h、首次排便时间(34.71±9.34)h与住院时间(3.24±1.33)h显著低于对照组(38.22±8.94,45.96±9.62,4.49±1.50)(P<0.05);总体护理满意度显著优于对照组(P<0.05).结论 快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用效果显著,可提高满意度,具有借鉴性.     

舌头操在慢性心衰患者康复护理中的作用

[目的]探讨舌头操对慢性心衰(CHF)患者的临床效果及对患者生活质量的影响,并评估护理满意度,为临床护理提供依据.[目的]选择本院2013年1月至2014年12月收治的CHF患者120例,随机分为对照组和观察组,每组各60例.对照组患者采用常规护理干预,观察组在常规护理干预基础上,指导患者应用舌头操进行功能锻炼.比较两组干预后6 min步行试验、左室射血分数(LVEF)、心功能NYHA分级,急性缺血及心功能恶化等心血管事件发生情况、再次住院次数;并进行生活质量评估和护理满意度评价.[结果]两组干预后6 min步行距离、左室射血分数(LVEF)、心功能纽约心脏病协会(NYHA)分级和生活质量评分均优于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05);观察组住院天数、再次住院率和心血管事件发生率少于对照组,差异有统计学意义(P<0.05);观察组护理满意度为(94.78±3.61)分,高于对照组(90.23±2.96)分,差异有统计学意义(P<0.05).[结论]应用舌头操对CHF患者进行护理干预,能够显著改善患者心功能及生活质量,并提高护理满意度,减少患者再次住院率,对心衰患者的康复具有一定价值.     

肺康复干预治疗稳定期慢性阻塞性肺疾病患者的疗效观察

目的 观察肺康复干预治疗稳定期慢性阻塞性肺疾病（COPD）患者的疗效。 方法 采用随机数字表法将110例稳定期COPD患者分为观察组及对照组，每组55例。2组患者均给予常规治疗，观察组患者在此基础上辅以肺康复干预（包括肢体运动训练、呼吸肌训练及社会心理支持干预等）。于治疗前、治疗6个月后分别评价2组患者肺功能、病情严重程度、焦虑/抑郁情绪及生活质量改善情况。 结果 治疗后观察组第1秒钟用力呼气量占预计值百分比［(70.71±4.96)%］和第1秒钟用力呼气量占用力肺活量比值［(73.55±9.21)%］均较治疗前及对照组显著提高(P<0.05)；治疗后观察组患者BODE指数评分［(2.01±0.68)分］、焦虑量表(SAS)评分［(38.75±8.22)分］、抑郁量表(SDS)评分［(44.59±7.80)分］及圣·乔治COPD生活质量调查问卷(SGRQ)评分［(43.55±7.31)分］均较治疗前及对照组显著降低(P<0.05)。 结论 在常规治疗基础上辅以肺康复干预可明显改善稳定期COPD患者肺功能及心理状况，减轻病情程度，提高生活质量，该疗法值得在COPD患者人群中推广、应用。     

陪护人员职业态度现状调查分析及干预对策

目的:调查陪护人员职业态度现状,探索有针对性的干预措施,做好陪护的管理工作,为患者提供优质的身心护理。方法:自行设计陪护人员职业态度现状调查表(内容包括:陪护人员职业态度的3个组成方面,即认知成分、情感成分、行为成分)。对129名陪护人员进行调查。结果:在认知方面,60.8%陪护人员过去未接触过陪护工作,82.2%的人是因为生活来应聘,12%的人认为陪护工作意义不大;在情感方面,15%陪护人员工作心情不愉快,28.2%陪护人员觉得,做一名陪护人员不好意思告诉别人,低人一等;在行为方面,陪护人员对工作的热情程度占69.5%,对工作责任心自我评价强的占80%,一般强占20%。结论:加强陪护人员管理,促进护理质量的提高。     

强化管理在糖尿病足高危患者保肢治疗中的意义

目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。     

质量持续改进在非内分泌科护士糖尿病知识培训中的应用

摘要 目的：评价质量持续改进PDCA模式对非内分泌科护士糖尿病专科知识培训的效果 方法：遵循质量持续改进PDCA循环理念的全面质量管理方法。2016年1月至2016年12月对我院糖尿病联络员54名进行糖尿病理论和技能系统化的培训每月一次共6次,组织培训前评估及阶段性考核及质量督查,对存在问题再培训,再考核的质量管理模式。采用自身前后对照的方法,比较糖尿病理论知识、专科技能、健康教育患者满意度、糖尿病专科质量控制等指标。结果: 专科理论知识：干预前49.95±9.98干预后80.11±9.14,;专科技能：血糖检测干预前87.88±6.33干预后94.24±3.82、胰岛素注射干预前81.15±4.93干预后90.20±6.13;健康教育满意度干预前63.23±8.21干预后87.39±5.06;糖尿病专科质量督查：血糖仪质控干预前87.00±5.15干预后 94.61±4.26、血糖检测规范记录干预前90.40±9.57干预后96.32±6.21;胰岛素保存干预前75.26±4.23干预后98.96±2.17、降糖药发放正确率（发放时间服用方法）干预前79.12±6.21干预后97.76±3.22。以上比较干预前后均有显著性差异。结论: 通过对非内分泌科护士糖尿病专科知识的评估、培训、考核,再培训,再考核的质量持续改进的阶梯性上升的质量管理方法,非内分泌科护士的糖尿病专科知识、技能有显著的提高显著,患者健康教育满意度提升,非内分泌科糖尿病专科质量提高。     

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.     

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.     

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.     

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.