甲型H1N1流感流行期发热门诊发热患者焦虑水平分析及护理干预

目的 分析研究甲型H1N1流感流行期发热门诊发热患者的焦虑水平,探讨护理干预方法.方法 对80例发热门诊发热患者采用Zung焦虑自评量表进行测评.结果 甲型H1N1流感流行期发热门诊发热患者与内科住院发热患者的焦虑分值比较有显著性差异(P＜0.01);男性与女性患者比较有显著性差异(P＜0.05);21～40岁组焦虑水平明显高于其它3组,有显著性差异(P均＜0.01);高中组与大专以上组比较无显著性差异;初中以下组与高中组、大专以上组比较有显著性差异(P均＜0.01).结论 发热门诊发热患者的焦虑水平高于内科住院发热患者;其中女性患者、21～40岁患者、高中组及大专组患者焦虑程度较高,在接诊过程中应给予针对性的护理干预.     

78例严重急性呼吸综合征病人焦虑状况及护理

目的 :探讨SARS病人与慢性乙型病毒性肝炎病人的焦虑水平差异 ,以及SARS病人焦虑水平的性别特点、年龄特点以及与文化程度的关系。方法 :采用SAS自评焦虑量表进行测试。结果 :与慢性乙型病毒性肝炎病人相比 ,SARS病人具有很高的焦虑水平 ;女性病人比男性病人焦虑水平高 ;2 0岁～ 40岁年龄阶段病人焦虑水平最高 ;病人的焦虑水平随着文化程度的增高而上升。结论 :SARS病人有较高的焦虑水平 ,护理上主要应加强健康教育和进行心理疏导 ,缓解病人的焦虑。     

白细胞介素-6、12在乙型病毒性肝炎发病中的临床意义

目的探讨白细胞介素-6(interleukin-6,IL-6)、白细胞介素-12(interleukin-12,IL-12)在乙型病毒性肝炎发病机理中的临床意义。方法选择乙型病毒性肝炎患者138例,其中48例为急性乙型病毒性肝炎患者,男34例、女14例,年龄19￣58岁;52例为慢性乙型病毒性肝炎患者,男41例、女11例,年龄23￣69岁;38例为重型乙型病毒性肝炎患者,男31例、女7例,年龄21￣70岁。正常对照组60例,均为健康献血员。采用酶联免疫吸附试验(enzyme-linkedimmunosorbentassay,ELISA)双抗体夹心法检测各组乙型肝炎患者及正常对照组血清中IL-6、IL-12水平。结果三组IL-6、IL-12水平与正常对照组比较均有显著性差异(P<0.05);重型乙型肝炎组与急性及慢性乙型肝炎组比较,IL-6有显著性差异(P<0.01);急性乙型肝炎组与慢性及重型乙型肝炎组比较,IL-12有显著性差异(P<0.01);其余各组之间的比较无统计学意义。结论IL-6的变化与乙型肝炎肝细胞损害程度密切相关,而IL-12则在机体的抗病毒免疫应答中起重要作用,其值升高可能预示肝病向良好转归。     

健康教育对慢性乙型病毒性肝炎患者生活质量的影响

目的：探讨慢性乙型病毒性肝炎患者康复教育的实施方法及效果。方法：对72例慢性乙型病毒性肝炎患者进行随机分为对照组和实验组。对实验组实施常规治疗加健康教育，对照组仅实施常规治疗，比较两组1年内、2年内复发率及生活质量。结果：实验组的36例患者在1年内和2年内的复发率分别是33％和53％，明显低于对照组(58％和92％)，差异有显著性意义(X^2=4.53，13.60，P&;lt;0.01～0.05)。实验组患者对生活质量的满意度也明显高于对照组(P&;lt;0.001)，健康教育明显有利于慢性乙型病毒性肝炎患者的康复。结论：健康教育能减少慢性乙型病毒性肝炎患者的复发率及提高生活质量。     

健康教育对慢性乙型病毒性肝炎患者生活质量的影响

目的:探讨慢性乙型病毒性肝炎患者康复教育的实施方法及效果。方法:对72例慢性乙型病毒性肝炎患者进行随机分为对照组和实验组。对实验组实施常规治疗加健康教育,对照组仅实施常规治疗,比较两组1年内、2年内复发率及生活质量。结果:实验组的36例患者在1年内和2年内的复发率分别是33%和53%,明显低于对照组(58%和92%),差异有显著性意义(χ2=4.53,13.60,P<0.01～0.05)。实验组患者对生活质量的满意度也明显高于对照组(P<0.001),健康教育明显有利于慢性乙型病毒性肝炎患者的康复。结论:健康教育能减少慢性乙型病毒性肝炎患者的复发率及提高生活质量。     

心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响

目的探讨心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响。方法选取62例慢性乙型病毒性肝炎患者按将数字表法分为对照组和观察组,各31例。对照组采用一般的基础护理方法,观察组在对照组基础上再实施心理干预,对比2组患者干预前后焦虑与抑郁的发生率、SAS与SDS评分情况以及干预后患者用药依从性情况。结果护理干预前,2组患者焦虑和抑郁的发生率差异无统计学意义(P0.05);护理干预后,观察组焦虑发生率12.90%、抑郁发生率16.13%,显著低于对照组焦虑发生率48.39%、抑郁发生率51.61%,差异有统计学意义(P0.05)。护理干预前,2组患者SAS和SDS评分差异无统计学意义(P0.05);护理干预后,观察组SAS和SDS显著低于对照组,差异有统计学意义(P0.05)。观察组护理干预后用药依从性显著高于对照组,差异有统计学意义(P0.05)。结论对慢性乙型病毒性肝炎患者实施心理干预的效果显著,可有效减轻患者焦虑及抑郁情绪,促进患者康复。     

替比夫定对肺结核合并慢性乙型病毒性肝炎患者的临床作用

目的探析替比夫定对肺结核合并慢性乙型病毒性肝炎患者的临床作用。方法选取2015年11月~2017年1月我院收治肺的结核合并慢性乙型病毒性肝炎患者54例,随机分为对照组和观察组各27例。对照组行拉米夫定口服治疗,观察组行替比夫定口服治疗。比较两组治疗前后肝功指标及HBV-DNA水平,同时比较两组患者治疗期间不良反应发生情况。结果治疗前,两组肝功指标及HBV-DNA水平比较,无显著差异(P0.05);治疗后,两组肝功指标及HBV-DNA水平较治疗前显著下降,且观察组下降幅度显著大于对照组,差异有统计学意义(P0.05)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论替比夫定在肺结核合并慢性乙型病毒性肝炎患者的临床治疗中,效果显著。     

不同类型慢性肝炎人群戊型病毒性肝炎感染率现状调查研究

目的 了解深圳地区不同类型慢性肝炎人群戊型病毒性(Hepatitis E/HE)肝炎(戊肝)感染现状,为戊肝的预防和治疗提供科学依据。方法随机收集2013年7月～2015年6月来深圳市龙华新区人民医院体检及就诊的无肝炎正常人群1 746例为对照组,慢性乙型病毒性肝炎(乙肝)人群1 320例为乙肝组,慢性丙型病毒性肝炎(丙肝)人群615例为丙肝组,分别应用酶联免疫吸附试验法(ELISA)检测血清中戊肝抗体-IgG(抗HEV-IgG),分析不同类型肝炎人群戊肝感染情况,并比较不同组间戊肝感染率是否存在差异性。结果 1 746例对照组血清中抗HEV-IgG阳性率为3.49%,其中男性4.22%,女性2.68%; 1 320例乙肝组为10.9%,其中男性12.29%,女性8.23%; 615例丙肝组为10.2%,其中男性12.35%,女性7.64%。乙肝组和丙肝组抗HEV-IgG阳性率与对照组比较差异有统计学意义(χ²=9.163～9.405,P<0.05),乙肝组与丙肝组抗HEV-IgG阳性率之间差异无统计学意义(χ²=0.614,P>0.05),戊肝男性感染率高于女性,差异有统计学意义(χ² =2.873～4.025,P<0.05)。结论 慢性乙型病毒性肝炎和丙型病毒性肝炎人群抗HEV-IgG阳性率高于无肝炎正常人群,戊肝感染率男性高于女性。因此,加强对慢性乙型病毒性肝炎和丙型病毒性肝炎人群的早发现、早诊断和早治疗,对降低戊肝感染率有重要的意义。     

阿德福韦酯联合扶正化瘀胶囊治疗慢性乙型病毒性肝炎肝纤维化临床观察

目的探讨阿德福韦酯联合扶正化瘀胶囊对慢性乙型病毒性肝炎肝纤维化指标的影响。方法 70例慢性乙型病毒性肝炎患者被随机分为联合治疗组(n=35,阿德福韦酯联合扶正化瘀胶囊)和对照组(n=35,单用阿德福韦酯),临床观察48周疗效。结果联合治疗组患者48周后肝纤维化指标下降幅度明显高于对照组(P<0.05);联合治疗组48周时脾脏厚度恢复正常,门静脉内径明显缩小,与治疗前比较,差异均有显著性意义(P<0.05);其中48周时联合治疗组与单药治疗组比较,差异有显著性意义(P<0.05)。结论 阿德福韦酯联合扶正化瘀胶囊治疗肝纤维化疗效优于单药阿德福韦酯治疗。     

护理干预对慢性乙型病毒性肝炎患者睡眠障碍的影响

目的:探讨慢性乙型病毒性肝炎患者睡眠障碍的影响因素并观察实施护理干预的效果。方法:将100例慢性乙型病毒性肝炎伴有睡眠障碍的患者随机分为对照组和干预组,各50例。对照组给予内科常规护理,干预组在常规护理的基础上采用以改善患者睡眠障碍为目的的护理干预措施。4周后采用匹兹堡睡眠质量指数量表对两组患者的睡眠质量进行评估和比较。结果:干预组患者在干预前后比较有显著性差异(P0.01),两组患者干预后比较有显著性差异(P0.01)。结论:护理干预对慢性乙型病毒性肝炎患者睡眠障碍有积极的影响,能明显提高患者的睡眠质量。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.