超声引导下PICC置管与传统置管技术成本效果分析研究

目的分析超声引导下改良Seldinger穿刺与传统盲穿进行PICC置管的成本与效果情况,为国家医疗保险政策制订和患者合理就医提供依据。方法选取某医科大学附属肿瘤医院行PICC置管的患者289例为研究对象,其中行超声引导下改良Seldinger穿刺法置管患者126例为实验组,同期行传统穿刺置管患者163例为对照组。经过6个月治疗后,比较两组患者置管效果、效果指标、成本效果比、增量成本效果比等。结果实验组患者置管结果和出血量与对照组比较优势明显,差异有统计学意义(P0.01);两组患者成本效果分析显示,实验组患者的一次穿刺成功率、舒适度良好率显著高于对照组,并发症发生率低于对照组(P0.01);实验组效果指标值为87.66%,对照组效果指标值为63.59%,表明实验组效果好于对照组;实验组患者成本效果比为2 391,对照组患者成本效果比为2 649;增量成本效果比为1 708,表明实验组的成本效果好于对照组。结论从长远经济利益考虑,超声引导下改良Seldinger穿刺法置管更准确、安全、经济、实用,值得临床推广应用。     

改良Seldinger技术在晚期肿瘤患者化疗中的应用

目的探讨改良Seldinger技术在晚期肿瘤患者经外周中心静脉置管（PICC）中的应用效果。方法将80例患者随机分为实验组和对照组各40例,分别行超声引导下改良Seldinger技术PICC置管术及传统PICC,比较两组患者的置管成功率及术后并发症发生率。结果超声引导下改良Seldinger技术置管成功率为97．5％、传统PICC置管成功率为80．0％,两者比较差异有统计学意义（x2=6．135,P〈0．05）;两组患者术后并发症比较差异有统计学意义（x2分别为12．468、16．970、2．051,P〈0．05）。结论超声引导下改良Seldinger技术提高患者的舒适度及护士的工作效率,值得在临床中广泛开展。     

超声引导结合改良 Seldinger 技术与传统 PICC 置管术在肿瘤患者中的对比研究及护理经验总结

目的：探讨改良Seldinger技术联合超声引导与传统盲穿经外周静脉穿刺置入中心静脉导管置管术（ PICC）在肿瘤患者中应用效果的差异,并总结护理经验。方法选择2013年3月至2014年3月80例需实施置管治疗的肿瘤患者,按数学随机方法分为对照组与观察组,各40例,对照组实施传统盲穿PICC置管术,观察组实施改良Seldinger技术联合超声引导置管,对比两组患者舒适度评分、穿刺出血量、单次穿刺成功率、穿刺时间、并发症。结果观察组置管舒适度评分、穿刺出血量、单次穿刺成功率、穿刺时间均优于对照组,对比差异有统计学意义（ P＜0.05）;两组患者穿刺点渗血、相关血行感染发生率相近,对比差异无统计学意义（ P＞0.05）;观察组静脉炎、血栓发生率为2.50％、0.00％,均优于对照组,对比差异有统计学意义（χ2＝14.329,P＝0.009;χ2＝10.322,P＝0.014）。结论肿瘤患者实施改良Seldinger技术联合超声引导置管穿刺成功率高且安全性好,结合护理干预有利于改善生活质量,值得临床推广应用。     

超声实时引导结合改良Seldinger技术与传统PICC置管术在肿瘤患者中的应用比较

目的:比较超声实时引导结合改良Seldinger技术与传统经外周静脉穿刺置入中心静脉导管(PICC)置管术在肿瘤患者中的应用价值.方法:将132例拟实施PICC置管化疗的肿瘤患者随机分为超声组(67例)和传统组(65例),超声组采用超声实时引导结合改良Seldinger技术穿刺置管,传统组采用传统方法置管.结果:超声组和传统组的一次性穿刺成功率、穿刺时出血量、穿刺时间、机械性静脉炎和血栓形成、置管后舒适度比较差异均有统计学意义(P＜0.05),但在穿刺点渗血方面差异无统计学意义(P＞0.05).结论:超声实时引导结合改良Seldinger技术行PICC置管成功率高、并发症少,可增加患者的舒适度,在肿瘤患者化疗中有应用和推广价值.     

超声导引下结合改良Seldinger技术置入PICC误入动脉的原因分析及对策

超声引导下结合改良Seldinger技术（modified seldinger technique,MST）进行经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）因能提高置管成功率,减少机械性静脉炎、穿刺点感染、血栓等相关并发症,提高舒适度,近年来已逐步在临床应用.但与传统的PICC置管相比,超声引导下结合改良Seldinger技术在穿刺方法上有很大区别,操作者需有熟练的PICC置管技术的基础,再经过血管超声知识培训,临床不断练习与实践,才能逐步提高置管成功率.我院2012年10月开展此项技术,主要应用于外周静脉条件差的肿瘤病人及院内疑难输液会诊,目前共置管198例.置管时有4例误穿动脉,现分析超声引导下结合改良Seldinger技术置入PICC时误穿动脉的原因,并总结对策.     

超声引导血管穿刺技术对肿瘤患者PICC置管相关静脉血栓形成的影响

目的探讨超声引导血管穿刺技术对肿瘤患者经外周静脉置入中心静脉导管(PICC)后静脉血栓形成的影响。方法选取需行PICC置管的恶性肿瘤患者240例作为研究对象,按随机数字表法分为对照组和实验组。对照组在肘部静脉采用盲穿方法置入PICC导管;实验组选择贵要静脉或肱静脉作为穿刺点,在超声引导下置入PICC导管。比较2组PICC置管术后静脉血栓形成情况。结果 PICC置管28d,实验组静脉血栓发生率及血栓的程度明显低于对照组(χ2=8.949,P0.01;Z=-3.105,P0.01)。结论超声引导血管穿刺技术可以有效降低肿瘤患者PICC置管后相关静脉血栓的形成。     

超声引导结合改良Seldinger技术PICC置人法在肠外营养患者中的应用

目的：分析超声引导结合改良Seldinger技术PICC置入法在肠外营养患者中的应用效果。方法：选取40例需肠外营养治疗的患者实施PICC留置管,随机分为观察组和对照组各20例,观察组采用超声引导下结合改良Seldinger技术P1CC置入法,对照组采用PICC盲穿置入法。结果：两组患者置管后静脉炎、感染、导管堵塞、置管天数、日均耗材费用差异无统计学意义（P〉0．05）,但24h后穿刺点渗血发生情况、置管期间维护次数两组差异有统计学意义（P〈0．05）。结论：超声引导下结合改良Seldinger技术PICC置人法能改善穿刺点渗血,从而减少维护次数,不增加患者经济负担。     

超声引导下PICC置管时触摸非穿刺侧桡动脉的临床效果观察

[目的]探讨超声引导下经外周静脉置入中心静脉导管(PICC)置管时触摸非穿刺侧桡动脉对穿刺效果的影响。[方法]将212例拟行超声引导下PICC置管病人随机分为两组,每组106例,操作前均给予血氧饱和度探头监测脉率、操作中进行疼痛评分,对照组按常规超声引导下置管操作规程进行置管,实验组在穿刺时由助手触摸病人非穿刺侧桡动脉给予干预,置管后比较两组病人穿刺前、穿刺时脉率及疼痛评分、靶静脉在屏幕上显示情况、操作总时间、一次穿刺成功率。[结果]实验组一次穿刺成功率比对照组高,差异有统计学意义(P0.05)。[结论]超声引导下PICC置管时采用助手触摸病人非穿刺侧桡动脉,可提高一次穿刺成功率,减轻疼痛,降低穿刺时病人的脉率,增强靶静脉的显示清晰度,缩短置管时间。     

视锐5^TM超声引导下改良塞丁格穿刺法用于老年高龄患者PICC置管的效果

目的探讨视锐5TM超声引导下改良塞丁格穿刺法应用于老年高龄患者PICC置管的效果。方法将66例需行PICC穿刺的老年高龄患者随机分为观察组和对照组,每组各33例,观察组采用视锐5TM超声引导下改良塞丁格穿刺法,对照组采用常规PICC置管法或盲穿法。结果两组患者的舒适度、一针穿刺率、一次置管成功率、穿刺点出血发生率比较,差异有统计学意义（P〈0.05,P〈0.01）。结论视锐5TM超声引导下改良塞丁格穿刺法可显著提高老年高龄患者PICC穿刺置管成功率,减少穿刺点出血发生率,保证置管效果,值得临床推广应用。     

B超引导下改良Seldinger法在肿瘤患者PICC穿刺中的应用

目的探讨3M弹力绷带加B超引导下改良Seldinger法在穿刺PICC置管中的效果。方法将104例拟行PICC置管操作的患者分为对照组49例和观察组55例,均采用改良Seldinger法置管,其中观察组于B超引导下PICC穿刺置管,而对照组采用传统的盲穿技术。观察2组穿刺成功率、并发症的发生率和患者的满意度。结果观察组穿刺成功率达100%,对照组45例一次性成功穿刺,4例反复穿刺3次失败后改行B超引导下穿刺成功。观察组机械性静脉炎、血栓发生率和导管移位发生率等显著低于对照组(P0.05),而患者满意度观察组明显高于对照组(P0.05)。结论 B超引导下改良Seldinger法PICC置管,成功率高,并发症少,安全可靠,值得临床推广使用。     

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.