个性化护理在剖宫产产妇母乳分泌及新生儿喂养中的应用

目的:探讨个性化护理在剖宫产产妇母乳喂养及新生儿喂养中的临床应用效果。方法:将120例剖宫产产妇按照就诊顺序随机分为观察组和对照组各60例,观察组行个性化护理,对照组行常规护理,比较两组术后疼痛发生率、母乳喂养率、并发症发生率及产妇对护理的满意度,出院时采用抑郁自评量表(SDS)与焦虑自评量表(SAS)对产妇进行心理抑郁和焦虑评价,在产妇出院6个月后回访并详细记录母乳喂养情况。结果:观察组术后疼痛发生率及并发症发生率显著低于对照组(P0.05);观察组出院后母乳喂养率显著高于对照组(P0.05),对照组出院后母乳喂养率明显低于出院前(P0.05);观察组出院时满意度显著高于对照组(P0.05),SDS、SAS评分显著低于对照组(P0.05)。结论:个性化护理可降低产妇术后疼痛程度,提高母乳喂养率,并且有助于产妇心理健康及生理健康的恢复。     

探讨微信群在产后访视工作中的应用

目的 探讨产后访视中建立微信群对提高母乳喂养率及促进母婴健康的影响。方法 选取南京市鼓楼区凤凰社区卫生服务中心管辖区2016年180例产妇为研究对象,按接诊顺序分为对照组和观察组,每组各90例。对照组产后访视采取定期入户访视方式,观察组产后访视中增加建立微信群方式。对比两种访视方式对提高母乳喂养率、母乳喂养知识知晓率,降低新生儿红臀发生率及乳头皲裂发生率中的作用差异。结果 观察组产妇产后母乳喂养知晓率达86%、纯母乳喂养率67%,均高于对照组;观察组乳头皲裂发生率10%及新生儿红臀发生率4%均低于对照组。结论 在传统产后访视再建立微信群方式显著提高母乳喂养率和母乳喂养知识认知度,能有效降低乳头皲裂和新生儿红臀发生率,有效促进母婴健康。     

互联网+护理服务促进纯母乳喂养的护理实践

目的：运用互联网+护理服务提高纯母乳喂养率,关注人类全生命周期之生命起始1000天的营养供给,促进纯母乳喂养。方法：随机原则选取在我院产科住院分娩的200 例产妇为研究对象,按住院顺序分为对照组100 例,观察组100 例。向对照组实施母乳喂养常规宣教,对观察组应用互联网+护理服务,我院HIMMS6信息系统, “317护”、“ 云随访”健康教育软件,实施面对面、一对一的哺乳知识与技能指导,出院后随访。开设围产期护理门诊、微信群远程指导延伸护理服务。比较两组产妇在产后42天、6个月时的纯母乳喂养率。结果：产后42天、6 个月观察组纯母乳喂养率高于对照组(P <0.05)。结论：关注人类全生命周期生命起始1000天的营养供给,应用互联网+护理服务,围产期护理门诊、微信群延伸护理服务能够提高产妇的纯母乳喂养率,促进纯母乳喂养成功。     

路径化健康教育对提高乳头凹陷产妇母乳喂养率的效果观察

[目的]探讨路径化健康教育模式对提高乳头凹陷产妇母乳喂养率的效果。[方法]选择86例乳头凹陷产妇按入院顺位奇偶数分为常规组和路径组各43例。常规组采用传统的健康教育方法,路径组采用路径化健康教育,比较两组产妇母乳喂养相关知识掌握程度及两组出院前和出院后1个月、4个月、6个月的母乳喂养情况。[结果]出院时路径组产妇母乳喂养知识掌握程度高于对照组,出院前和出院后1个月、4个月、6个月母乳喂养率(95.35%,72.09%,65.12%,53.49%)均明显高于对照组(74.42%,51.16%,39.53%,25.58%),两组比较差异均有统计学意义(P0.05)。[结论]实施路径化健康教育可提高乳头凹陷产妇的母乳喂养知识掌握程度和母乳喂养率。     

家庭访视对提高母乳喂养率的效果观察

[目的]探讨家庭访视对提高母乳喂养率的效果.[方法]将160例产妇随机分为观察组和对照组,观察组和对照组在住院期间均按常规进行母乳喂养知识宣教和指导,出院后由护理人员对观察组产妇进行家庭访视,对照组产妇仅进行电话访视1次.比较两组产妇母乳喂养率及观察组在家庭访视前后的母乳喂养率.[结果]观察组母乳喂养率高于对照组母乳喂养率,且家庭访视后母乳喂养率高于访视前母乳喂养.[结论]出院后对产妇进行家庭访视能提高母乳喂养率.     

基于微信平台的延续性护理对产妇产后恢复情况、睡眠质量及母乳喂养行为的影响

目的探讨基于微信平台的延续性护理对产妇产后恢复情况、睡眠质量及母乳喂养行为的影响。方法选取2017年2—6月我院出院产妇200例,采用随机数字表法将其等分为观察组和对照组,对照组产妇实施常规产后护理,观察组给予基于微信平台的延续性护理干预。观察两组产妇的产后恢复情况、睡眠质量改善情况、母乳喂养行为及焦虑情况。结果观察组产妇产后恢复情况明显优于对照组(P0.05);两组产妇干预前PSQI各项指标评分及PSQI总分经比较无统计学意义(P0.05),观察组干预后PSQI各项指标评分及PSQI总分均较干预前有所降低(P0.05),对照组干预后PSQI评分中睡眠质量及睡眠效率两项指标较干预前有所降低(P0.05),干预后观察组PSQI各项指标及PSQI总分均明显低于对照组(P0.05);两组产妇哺乳3个月内坚持母乳喂养例数比较无统计学意义(P0.05),两组产妇哺乳6,9个月时母乳喂养例数比较有统计学意义(P0.05);观察组产妇干预后SAS评分低于对照组(P0.05)。结论在产后护理中开展基于微信平台的延续性护理不仅能够促进产妇产后恢复,改善睡眠质量,同时对改善母乳喂养行为及负面情绪方面具有积极作用,是一种切实可行的院外干预手段。     

延续性护理对出院产妇提高母乳喂养率的效果观察

目的探讨延续性护理在产科出院患者提高母乳喂养率中的应用效果。方法将220例产妇随机分为对照组与观察组各110例,对照组产前及产后给予母乳喂养知识宣教和哺乳技能指导,观察组在对照组基础上,实施出院后延续性护理,有针对性地给予母乳喂养指导。观察两组的母乳喂养、乳房肿胀、乳腺炎、母乳喂养率。结果两组产妇产后1个月、2个月、3个月、4个月、5个月、6个月纯母乳喂养率比较,均差异具有统计学意义(P0.05),观察组母乳喂养率明显高于对照组。结论延续性护理提高了产科出院产妇的母乳喂养率,降低了乳房肿胀和乳腺炎的发生率。     

电话访视对出院产妇实施延续性健康教育的效果分析

目的探讨电话访视对出院产妇实施延续性健康教育的效果。方法 2007年10月-2008年3月将本院出院的706例产妇随机分为观察组与对照组各353例,对照组在出院时进行系统的出院指导,观察组在出院指导基础上,在出院后28d内实施电话访视3次,加强产妇母婴保健知识的健康教育。比较两组产妇产后42d母婴保健知识掌握率、纯母乳喂养率及产妇对出院后护理服务满意度。结果两组产妇产后第42d母婴保健知识掌握率、纯母乳喂养率及产妇对出院后护理服务满意率比较,均P〈0.01,差异具有统计学意义,观察组健康教育效果优于对照组。结论电话访视有利于健康教育工作的延续性开展,增强了产妇健康保健知识,从而改善了医患关系,对提高医院服务质量起到积极的作用。     

早期母婴皮肤接触对新生儿睡眠、母乳喂养及母亲子宫复旧的影响

目的探讨早期母婴皮肤接触对新生儿睡眠、母乳喂养及母亲子宫复旧的影响。方法选取2018年1-6月于本院正常分娩的单胎产妇共400例作为研究对象,采用随机数字表法分为观察组和对照组各200例。新生儿娩出后给予对照组常规护理干预,观察组在此基础上开展早期母婴皮肤接触,观察比较两组不同干预措施对母婴预后的影响。结果出生1 h内,两组新生儿啼哭次数和啼哭持续时间比较差异有统计学意义(P0.05),出生4～5 h期间,观察组新生儿啼哭次数和啼哭持续时间同样低于对照组(P0.05);两组新生儿30 min内启动母乳喂养率、90 min内完成母乳喂养率、出院前纯母乳喂养率、出院前母乳喂养率和3个月纯母乳喂养率比较均有明显差异,观察组均高于对照组(P0.05);两组产妇产后24 h宫底高度下降比较,观察组优于对照组(P0.05),术后48 h比较差异无统计学意义(P0.05),观察组产妇子宫复旧情况优于对照组。结论早期母婴皮肤接触能有效提升新生儿睡眠质量和母乳喂养率,促进母亲子宫复旧,值得临床推广应用。     

动机性访谈在促进乳头凹陷初产妇母乳喂养中的应用

[目的]探讨动机性访谈在促进乳头凹陷初产妇母乳喂养中的应用效果。[方法]将90例乳头凹陷初产妇随机分为对照组和观察组,每组45例。对照组按常规进行母乳喂养指导,观察组以动机性访谈形式进行母乳喂养指导,在干预前、出院时、产后6周回院复查时采用母乳喂养自我效能简式量表(BSES)评估两组产妇的母乳喂养自我效能,对两组产妇的母乳喂养自我效能水平和母乳喂养率进行比较。[结果]观察组产妇出院前、产后6周的母乳喂养自我效能得分和母乳喂养率均高于对照组(P0.05)。[结论]动机性访谈可以明显提高乳头凹陷初产妇的母乳喂养自我效能和母乳喂养率。     

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.     

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.     

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.     

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.     

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.