醒脑静对重症脑外伤昏迷患者促苏醒作用的观察

目的:探讨醒脑开窍疗法对重症颅脑损伤患者的促苏醒作用以及对预后的影响。方法:将100例颅脑损伤患者(GCS≤8)分成两组,治疗组50例(在常规治疗基础上加用醒脑静),对照组50例(常规治疗),两组于伤后1个月按GCS预后评分评定预后,两组在促醒后1个月内对意识好转率作比较。结果:治疗组预后恢复良好70%,显著高于对照组的38%(P<0.01);两组病死率差异无显著性(P>0.05)。治疗组1个月内清醒40例,对照组25例(P<0.01)。结论:醒脑静在治疗重症脑外伤昏迷患者时,能加速促醒和提高生存质量。     

醒脑静注射液治疗重度颅脑损伤疗效观察

目的:观察醒脑静注射液治疗重度颅脑损伤临床疗效。方法:将46例患者分成2组。治疗组33例,对照组13例,2组有可比性。2组均予常规西医治疗,包括手术、脱水降颅压、营养脑细胞、脑保护等,治疗组在此基础上予醒脑静注射液10～30ml加入5%葡萄糖注射液100～250ml中静滴;每日1次。2组均治疗14d为1个疗程并观察疗效。结果:2组临床疗效无显著性差异,2组格拉斯哥昏迷评分比较有显著性差异(P0.05)。结论:醒脑静注射液能够改善重度颅脑损伤患者意识障碍。     

中药辅助治疗重度颅脑损伤临床体会

目的 观察和探讨多种中药治疗重度颅脑外伤的临床疗效.方法 重度颅脑外伤患者86例在西医常规治疗基础上静脉滴注醒脑静注射液、服用云南白药、安宫牛黄丸、大蒜素胶囊,观察清醒时间、应激性溃疡发生率、高热发生率及持续时间.结果 患者病情平稳,并发症的发生率明显减少,昏迷时间缩短.结论 中药辅助治疗重度颅脑外伤疗效优于单纯西医治疗,可减轻重度颅脑损伤继发性损害,促进意识和神经功能的恢复.     

醒脑开窍针法在颅脑损伤昏迷患者促苏醒治疗中的应用

目的:观察醒脑开窍针法在颅脑损伤昏迷患者促苏醒治疗中的临床疗效。方法:将100例颅脑损伤患者(GCS≤8)随机分成2组,治疗组50例(在常规治疗基础上加用醒脑开窍针疗法),对照组50例。两组在伤后治疗30天,按GCS预后评分评定预后,并将两组清醒率和清醒时间作一比较。结果:治疗组预后恢复良好为80%,明显高于对照组60%(P<0.001);两组死亡率差异无显著性意义(P>0.05)。治疗组30天内清醒40例,对照组30例(P<0.01)。结论:在常规治疗基础上配合醒脑开窍针法治疗颅脑损伤昏迷患者时,具有加速促醒和降低致残率的疗效。     

依达拉奉联合醒脑静注射液防治重型颅脑损伤急性期脑血管痉挛的临床研究

目的:探讨依达拉奉联合醒脑静注射液防治重型颅脑损伤急性期脑血管痉挛的效果。方法:将格拉斯哥昏迷(GCS)评分6-8分的颅脑损伤患者61例随机分为对照组(n=29)和治疗组(n=32),分别以常规方法和在常规治疗基础上加依达拉奉和醒脑静注射液治疗,以经颅多普勒超声(TCD)为主要评定脑血管痉挛的手段,比较两组患者入院第1、4、7、14 d脑血管痉挛发生率、颅内血管血流速度、外伤性脑梗塞的发生率、脑脊液内皮素-1(ET-1)浓度及GCS变化。结果:入院第1 d两组患者各项指标差异无统计学意义(P0.05),治疗组第4、7、14 d的各项指标均明显优于对照组(P0.05)。结论:在常规治疗的基础上加用依达拉奉和醒脑静注射液能较好地防治重型颅脑损伤急性期的脑血管痉挛。     

醒脑静注射液在治疗重症颅脑损伤中抗高热和促醒作用的？…

目的;探讨醒脑静注射液在治疗重症颅脑损伤患者中抗高热和促醒作用的疗效以及对颅后的影响,方法：按随机分组法将１４１例颅脑损伤患者分为２组,Ａ组７０例,伤后勤一术后在常规治疗基础上加用醒脑静注射液,Ｂ组７１例只用常规治疗,比较用药７２小时内２组间高热发生率的差异,将Ｂ组治疗７２小时后出现高热患者又随机分为Ｂ１组和Ｂ２２组。Ｂ１组加用醒脑静注射液降温,Ｂ２组用冬眠药物降温,观察Ｂ１,Ｂ２２组间的降温效果     

醒脑静对重度颅脑损伤患者血浆D-二聚体的影响

目的 观察醒脑静注射液对重度颅脑损伤患者血浆D-二聚体的影响.方法 按随机分组法将55例格拉斯哥昏迷评分(GCS)≤8分的颅脑损伤患者分为醒脑静注射液治疗组及对照组,观察两组血浆D-二聚体变化、治疗前后GCS变化.结果治疗组治疗后血浆D-二聚体下降幅度、治疗后7天GCS与对照组相比差异有统计学意义(P＜0.05).结论 醒脑静注射液能有效降低颅脑损伤患者血浆D-二聚体水平,缩短患者昏迷时间,降低伤残率,促进患者神经功能恢复,其机制应该与改善颅脑损伤患者的纤溶状态,抑制脑循环中微血栓形成,阻止继发性损伤有关.     

醒脑静注射液对急性有机磷农药中毒的促醒作用

目的:观察醒脑静注射液佐治急性有机磷农药中毒的临床疗效。方法:将急性有机磷农药中毒患者40例随机分为治疗组与对照组,治疗组20例在常规治疗基础上加用醒脑静注射液治疗,对照组20例采用常规综合治疗。结果:治疗组患者清醒时间、治愈时间,与对照组比较明显缩短(P<0.01)。结论:醒脑静注射液对有机磷农药中毒伴意识障碍患者有促醒作用,且明显缩短治愈时间。     

醒脑静防治重度颅脑损伤急性期脑血管痉挛效果观察

目的 研究醒脑静治疗重度颅脑损伤时患者急性期脑血管痉挛的发生率,从而降低迟发性神经功能缺损的发生率.方法 选择重度颅脑损伤患者分为对照组和治疗组,治疗组在西医治疗的基础上配合应用醒脑静针剂治疗,经颅多普勒超声检查两组患者入院第2、4、7、14、21天脑血管痉挛的发生率,统计分析中西医结合治疗的优势.结果 入院第2、4、7、14、21天两组患者脑血流速度及脑血管痉挛发生率差异存在统计学意义(P＜0.05),其中第4天差异最为显著.结论 在西医治疗的基础上加用醒脑静可以降低重度颅脑损伤后颅内血流速度,防治脑血管痉挛.     

醒脑静注射液治疗内科重症74例临床疗效观察

对我院内科2013年1¹2月收治的74例重症患者随机分为对照组和观察组各37例,其中对照组患者应用常规西医治疗;并基于此基础,给予观察组服用醒脑静注射液治疗,对两组患者的临床治疗情况进行分析与比较。观察组共有35例获得治愈,总有效率为94.6%,明显要优于对照组的29例(78.4%),比较差异有统计学意义(P<0.05)。给予内科重症患者应用醒脑静注射液治疗,能够有效提高临床整体治疗效果,帮助患者尽早实现康复出院,值得推广。     

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.     

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.     

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.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.