集束化护理在小儿ICU重症肺炎中的应用分析

目的探讨集束化护理在小儿ICU重症肺炎患儿护理中的应用效果。方法选取88例小儿ICU重症肺炎患儿随机分为2组,对照组采用常规护理,实验组则加施集束化护理,比较2组患儿干预前后血气学分析结果、护理辅助治疗效果、护理干预后相关临床指标、VAP与死亡情况以及家属护理满意调查情况。结果实验组患儿干预后p(O2)、Sa O2与p H水平均显著性高于对照组(P0.01),p(CO2)水平、通气时间、ICU时间、住院时间与VAP发生率均显著性低于对照组(P0.01);实验组患儿辅助治疗总有效率高于对照组,病死率低于对照组,家属护理满意度调查结果优于对照组,差异均有统计学意义(P0.05)。结论集束化护理应用在小儿ICU重症肺炎患儿中效果显著,可提高家属护理满意度,具有借鉴性。     

循证护理在控制机械通气患者呼吸机相关性肺炎中的应用

目的探讨循证护理在控制机械通气患者呼吸机相关性肺炎(VAP)中的应用效果。方法收集160例机械通气患者按是否愿意接受循证护理干预分为2组,对照组给予常规护理,实验组加施循证护理,比较2组患者每日接受相关护理措施情况、相关临床指标与所受护理工作量、VAP与护理不良事件发生情况、满意度调查结果等。结果实验组患者每日接受插管固定评估、插管深度评估、气囊压力评估、口腔清洁处理、镇静镇痛处理与吸痰拍背处理率显著高于对照组(P0.01);实验组患者有创通气时间、总机械通气时间、住院时间显著短于对照组,NAS评分显著高于对照组(P0.01);实验组患者非计划拔管、VAP与投诉的发生率显著低于对照组(P0.05);实验组患者护理满意情况显著优于对照组(P0.01)。结论循证护理在控制机械通气患者呼吸机相关性肺炎中的应用效果显著,可提高满意度,具有借鉴性。     

创新型护理流程模式对ICU机械通气患者的临床效果分析

目的探讨创新型护理流程模式在重症监护病房(ICU)机械通气患者中对护理质量、临床指标及并发症的影响。方法选取2013年10月至2015年10月收治的ICU机械通气患者108例,分为两组(各54例)。对照组行ICU常规护理,观察组行创新型护理流程模式,对比两组护理质量评分、各项临床指标及并发症发生率。结果观察组基础护理、病房管理、特级护理、文书管理、急救药品管理、重点环节管理和总护理质量评分均高于对照组,差异有统计学意义(P0.05);观察组ICU时间、机械通气时间、住院时间均短于对照组,护理满意度评分优于对照组,差异有统计学意义(P0.05);观察组并发症发生率均低于对照组,差异有统计学意义(P0.05)。结论创新型护理流程模式在ICU机械通气患者中可明显提高护理质量,缩短机械通气时间和住院时间,降低并发症发生率,提高护理满意度,值得推广。     

经尿道前列腺等离子切除术治疗前列腺增生的精细化护理

目的探讨精细化护理干对经尿道前列腺等离子切除术治疗前列腺增生的临床效果。方法收集本院收治的50例经尿道前列腺等离子切除术治疗的前列腺增生患者分为2组,每组25例。对照组患者给予常规护理,实验组患者在常规护理基础上加施精细化护理,比较2组患者的术后相关临床指标、并发症发生与满意度。结果实验组患者术后IPSS评分与QOL评分明显低于对照组(P0.05);实验组患者下床时间、住院天数与医疗费用显著性低于对照组(P0.01);实验组患者出血、尿路感染、尿失禁、膀胱痉挛与尿道堵塞发生率差异无统计学意义(P0.05);实验组总并发症发生率显著性低于对照组(P0.01);实验组患者总体满意度显著性高于对照组(P0.01)。结论精细化护理干对经尿道前列腺等离子切除术治疗的前列腺增生患者临床效果显著,具有深远的意义。     

创新型护理流程模式对ICU机械通气患者并发症及护理质量的影响

目的探讨创新型护理流程模式对重症监护病房(ICU)机械通气患者并发症及护理质量的影响。方法选取2010年6月-2014年6月我院ICU收治的84例机械通气患者为研究对象,根据患者入院时间分为对照组(2010年6月-2012年5月)40例及观察组(2012年6月-2014年6月)44例,对比分析两组患者并发症发生率、护理质量及预后情况。结果观察组患者呼吸机相关性肺炎(VAP)、气道糜烂、声带受损、声门水肿、气管坏死、溃疡等发生率显著低于对照组,差异有统计学意义(P0.05)。观察组总护理质量及患者满意度评分高于对照组(P0.05),差异有统计学意义。观察组机械通气时间、入住ICU时间、平均住院时间少于对照组(P0.05),差异有统计学意义。结论创新型护理流程模式能有效提高ICU机械通气患者护理质量,降低患者并发症发生率,缩短患者机械通气时间,提高患者满意度。     

气道优化护理对重症机械通气患者VAP的影响

目的探讨气道优化护理对重症机械通气患者VAP的影响。方法选择90例机械通气的重症患者随机分为观察组和对照组各45例,对照组采用常规气道护理,观察组实施优化的气道护理方案,比较2组的排痰情况,机械通气时间、住ICU时间以及VAP发生率。结果观察组护理第2天、第4天、第6天时的排痰量均多于对照组,痰液粘稠程度好于对照组,痰痂形成率低于对照组,差异有统计学意义(P0.05);观察组的机械通气时间、住ICU时间短于对照组,VAP的发生率低于对照组,差异有统计学意义(P0.05)。结论气道优化护理能够促进重症机械通气患者顺利排痰,减少VAP的发生,缩短住ICU时间。     

针对性护理干预对肝癌介入治疗患者疼痛和胃肠道反应的影响

目的探讨针对性护理干预对肝癌介入治疗患者疼痛和胃肠道反应的影响效果。方法选取80例肝癌介入治疗患者随机分为2组,对照组采用常规护理,实验组则加施针对性护理干预,比较2组患者干预前后焦虑与疼痛程度、胃肠道相关临床指标与睡眠时间、治疗期间不良事件与止痛药使用情况、家属护理满意度等。结果干预后,实验组患者S-AI与VAS评分显著低于对照组,差异有统计学意义(P0.01);实验组患者肠鸣音恢复时间、首次排气时间、首次排便时间与下床时间显著短于对照组,睡眠时间显著长于对照组,差异有统计学意义(P0.01);实验组患者恶心呕吐、腹胀便秘、咽喉不适发生率低于对照组,差异有统计学意义(P0.05);实验组止痛药使用率显著低于对照组,差异有统计学意义(P0.01);实验组患者护理满意度显著优于对照组,差异有统计学意义(P0.01)。结论针对性护理干预对肝癌介入治疗患者疼痛和胃肠道反应的影响效果显著,可提高满意度,具有借鉴性。     

气道分级管理在ICU机械通气患者中的应用

目的:探讨气道分级管理在ICU机械通气患者中的应用效果。方法:将96例ICU机械通气患者随机分为实验组47例和对照组49例,实验组根据患者咳嗽反射、痰液的黏滞度、痰液的量将气道管理级别分为A、B、C、D四级,按气道分级制定护理措施,实施不同频次的综合胸部物理治疗;对照组按常规每2 h胸部物理治疗1次。结果:机械通气第7天,实验组潮气量、呼吸频率、氧合指数(动脉血气氧分压/氧气浓度PaO2/FiO2)、急性生理与慢性健康评分(APACHEⅡ评分)均优于对照组(P<0.01);实验组患者机械通气时间明显少于对照组(P<0.01)。结论:基于不同频次胸部物理治疗的气道分级管理对ICU机械通气患者有积极作用,提高患者生活质量。     

预见性护理干预模式在ICU患者中的应用

目的:探讨预见性护理干预模式在重症监护室(ICU)患者中的应用方法及效果。方法:将100例ICU患者按随机对照法分为研究组和对照组各50例,研究组采用预见性护理干预模式,对照组予以ICU常规护理,比较两组患者护理效果。结果:研究组入ICU第3日、第7日视觉模拟评分法(VAS)评分低于对照组(P0.01);研究组ICU停留时间、机械通气时间、住院时间均短于对照组(P0.01);研究组护理满意度为96.0%,对照组护理满意度为78.0%,两组比较差异有统计学意义(P0.01);研究组不良反应发生率低于对照组(P0.01)。结论:ICU护理单元中应用预见性护理干预,可降低患者不良反应发生率,促进患者康复,值得临床推广。     

心理护理干预对胸外科手术患者康复效果的影响

目的探讨心理护理干预对胸外科手术患者康复的影响效果。方法收集160例行胸外科手术的患者,按是否愿意接受心理干预分为2组,对照组行常规护理,实验组则加施心理护理干预,比较2组患者治疗前后心理症状、睡眠、疼痛、相关临床指标、并发症与护理满意度。结果实验组患者术后焦虑、抑郁、敌对、恐惧、偏执、强迫、人际关系、精神病性因素、PSQI与VAS评分显著低于对照组,差异有统计学意义(P0.01);实验组患者监护时间、拔管时间、下地时间与住院时间显著低于对照组,差异有统计学意义(P0.01);实验组并发症发生率低于对照组,差异有统计学意义(P0.05);实验组患者护理满意度显著优于对照组,差异有统计学意义(P0.01)。结论心理护理干预对胸外科手术患者的康复效果影响显著,可提高护理满意度。     

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.