非药物性护理干预对缓解新生儿操作性疼痛的探讨

疼痛是继体温、脉搏、呼吸、血压之后的第5生命体征。在新生儿病房中的新生儿每天都要接受大量疼痛性操作,疼痛将会对新生儿产生一系列近期和远期的不良影响。因而对新生儿疼痛的管理是新生儿科医护人员面临的一个重要又迫切的问题。我科2007年6月～2007年12月对新生儿操作性疼痛进行了非药物性护理干预,探讨对缓解新生儿疼痛的效果。现报告如下。     

非药物性护理干预对缓解新生儿操作性疼痛的探讨

疼痛是继体温、脉搏、呼吸、血压之后的第5生命体征.在新生儿病房中的新生儿每天都要接受大量疼痛性操作,疼痛将会对新生儿产生一系列近期和远期的不良影响[1].因而对新生儿疼痛的管理是新生儿科医护人员面临的一个重要又迫切的问题.我科2007年6月-2007年12月对新生儿操作性疼痛进行了非药物性护理干预,探讨对缓解新生儿疼痛的效果.现报告如下.     

新生儿疼痛的护理干预

疼痛是尚未被新生儿科医护人员关注的第五生命体征。在新生儿重症监护病房（NICU）中的新生儿每天都要接受大量疼痛性操作，疼痛将会对新生儿产生一系列近期和远期的不良影响。因而对新生儿疼痛的管理是新生儿科医护人员面临的一个重要又迫切的问题。我科自2007—01开始，对新生儿的操作性疼痛进行了干预护理，采用新生儿面部编码系统（neonatal facial coding system，NFCS）。结合新生儿疼痛评估量表（neonatal inrant pain scale，Nips），进行疼痛评估，发现对缓解新生儿疼痛起到了明显的作用。     

疼痛护理在新生儿静脉留置针穿刺中的应用

随着疼痛研究及疼痛护理的进步,新生儿疼痛受到越来越多的关注。静脉留置针穿刺所致的疼痛是住院新生儿经常反复经历的不良刺激,对新生儿可造成一系列近期及远期的不良影响。因此在此项操作中,应对新生儿疼痛加以重视并给予疼痛护理干预,以达到减轻疼痛,减少并控制疼痛所致不良影响的目的。     

新生儿疼痛护理体会

大量研究证明，新生儿出生即具有感受疼痛的能力，疼痛对于新生儿可造成一系列的近期和远期影响。应引起临床工作者的高度重视，给予相应的护理干预措施，以减轻疼痛及其带来的不良后果。现就新生儿疼痛的来源、影响、评估及护理干预体会如下。     

新生儿疼痛的护理

新生儿侵入性护理操作所致的疼痛是新生儿经常、反复经历的疼痛刺激，对新生儿可造成一系列近期和远期的不良影响，已引起临床的广泛关注。2002年-2006年我院共接生新生儿7821名，其中患病新生儿323名，占出生总数4．13％。笔者将近5年来有关新生儿操作疼痛的护理介绍如下。     

护理干预对早产儿疼痛的临床作用

目的 探讨早产儿疼痛的临床表现,观察护理干预对早产儿疼痛的临床效果.方法 选取46例早产儿,随机分为干预组和对照组,每组23例.对照组不给予任何干预措施；干预组给予抚触、非营养性吸吮等减轻疼痛的护理干预措施.按早产儿疼痛量表( PIPP)进行评分,观察护理干预对早产儿疼痛的临床效果.结果 干预组PIPP评分小于对照组(P＜0.01).干预组的早产儿疼痛面容和啼哭的持续时间、心率和血氧饱和度均显著短于非干预的早产儿(P＜0.05).结论 早产儿疼痛可造成一系列近期和远期不良影响,进行相应的护理干预可减少早产儿的疼痛.     

非营养性吸吮对新生儿疼痛的护理干预

在临床疼痛治疗领域中,小儿镇痛未曾得到应有的重视,尤其是新生儿,认为其神经系统发育尚未成熟,对疼痛敏感性差,故一直未予以重视和正确的处理。大量的研究证实,反复疼痛可对新生儿造成一系列的近期和远期的不良影响。因此,指导有效安全的非药物干预疗法对新生儿疼痛控制显得尤为重要,非营养性吸     

新生儿疼痛的护理

新生儿侵入性护理操作所致的疼痛是新生儿经常、反复经历的疼痛刺激,对新生儿可造成一系列近期和远期的不良影响,已引起临床的广泛关注。2002年—2006年我院共接生新生儿7821名,其中患病新生儿323名,占出生总数4.13%。笔者将近5年来有关新生儿操作疼痛的护理介绍如下。1新生儿疼痛特点及来源新生儿疼痛的主要来源于正常新生儿接种卡介苗、注射乙型肝炎疫苗、注射维生素K1等,患病新生儿及早产儿如足底挤压采血,动静脉穿刺及插管,局部感染损伤组织周围痛觉过敏等,也可引起疼痛。早产儿和患病新生儿在治疗护理过程中,则要承受长时间反复的疼痛…     

新生儿行不同方式采血疼痛程度比较

近10年来的实验和临床研究结果显示，胎儿和新生儿虽然没有主诉痛感的能力，却具有痛反应的能力。新生儿疼痛和应激及其预防、治疗、护理问题不再仅仅是个学术争论问题，而是需要及时采取措施认真对待的临床问题。新生儿期经历长时间、反复的疼痛刺激可引起一系列近期及远期不良影响。     

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.     

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.     

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.     

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.