聚焦解决模式干预对美沙酮维持治疗患者海洛因渴求反应的影响

目的:探讨聚焦解决模式干预对美沙酮维持治疗患者海洛因渴求反应的影响。方法:将100例美沙酮维持治疗患者随机等分为对照组和干预组,对照组给予常规护理,干预组在对照组基础上实施聚焦解决模式干预,比较两组患者干预期间海洛因渴求问卷评分及尿吗啡检测结果。结果:入组时两组患者海洛因渴求问卷各因子分和总分差异无统计学意义(P0.05),干预组患者干预3,6个月时海洛因渴求问卷各因子分和总分均明显低于对照组(P0.05),干预组干预6个月期间尿吗啡检测阳性总次数低于对照组(P0.05)。结论:聚焦解决模式能有效降低美沙酮维持治疗患者对海洛因的渴求反应,减少患者复吸、偷吸行为。     

心理干预对美沙酮维持治疗者依从性和复吸的影响

目的探讨心理干预对美沙酮维持治疗者依从性和复吸的影响。方法选取美沙酮维持治疗的海洛因成瘾者60例,根据就诊序列将其随机分为对照组与观察组,每组30例。对照组给予常规护理干预,观察组在常规护理基础上加强心理干预,比较两组患者临床依从性和复吸情况。结果对照组治疗3、6、12个月脱失率分别为16.67%、30%、50%,观察组分别为6.67%、13.33%、20%;观察组12个月脱失率低于对照组;心理干预后,观察组心理健康测试评分低于对照组,生活质量高于对照组,差异有统计学意义(P0.05)。观察组随访抽检复吸阳性率(20%)低于对照组(53.33%),差异有统计学意义(P0.05)。结论给予美沙酮维持治疗患者在常规护理干预基础上加强心理干预,可提高患者治疗依从性,改善生活质量及心理健康水平,对于降低复吸率也具有重要临床价值。     

心理干预对男性美沙酮维持治疗者依从性和复吸的影响

目的探讨心理干预对用美沙酮维持治疗的男性海洛因依赖者依从性和复吸的影响。方法将200例男性美沙酮维持治疗者分为对照组和观察组。对照组进行常规的美沙酮维持治疗,观察组在美沙酮维持治疗的基础上,在首次服药时、治疗引入期、维持治疗期分别进行定期支持性心理干预,持续1年,然后对两组患者进行治疗脱失率及海洛因复吸率的比较研究。结果 1年后,美沙酮维持治疗脱失率和海洛因复吸率降低(P0.01)。结论心理干预有助于提高美沙酮维持治疗者的依从性,减少美沙酮维持治疗脱失率及复吸率。     

护理干预对海洛因依赖者治疗依从性的影响

目的探讨护理干预对海洛因依赖者在美沙酮维持治疗中治疗依从性的影响。方法将100例在本门诊进行美沙酮维持治疗的海洛因依赖者随机分为对照组和观察组，各50例。对照组采用美沙酮维持治疗，观察组在美沙酮维持治疗的基础上对患者及家属实施为期24周的护理干预，对两组患者维持治疗率和尿检阳性率进行比较。结果第24周对照组和观察组的维持治疗率分别为62％、78％，干预期间尿检阳性率分别为22．9％、12．7％，两组比较有显著性差异（P〈0．05或〈0．01）。结论通过护理干预，增加了患者及家属对美沙酮维持治疗的认识、理解，提高美沙酮维持治疗中患者的治疗依从性。     

美沙酮维持治疗患者滥用苯二氮卓类药物调查与护理

目的:调查美沙酮维持治疗者滥用苯二氮卓类药物的发生率及相关因素。方法:对参加美沙酮维持治疗的海洛因依赖者进行尿苯二氮卓及吗啡检测,将苯二氮卓尿检结果与患者性别、婚姻状态、文化程度、滥用海洛因方式、年龄、海洛因滥用时间、美沙酮维持治疗剂量、参加美沙酮维持治疗的时间及尿吗啡检测结果等共九个因素进行Logistic回归分析。结果:共调查160例,尿苯二氮卓阳性率是8.1%,尿吗啡阳性率是36.3%,苯二氮卓阳性与吗啡阳性及注射使用海洛因相关(OR=27.328,P<0.005),与性别、年龄、海洛因依赖时间、服用美沙酮剂量等其他因素无相关性。结论:美沙酮维持治疗者存在滥用苯二氮卓类药物的现象,尤其是注射使用海洛因,并且在治疗期间仍滥用海洛因的患者。     

系统护理干预在社区糖尿病视网膜病变患者中的应用

目的 探讨系统护理干预在社区糖尿病性视网膜病变患者中的应用效果.方法 选择南海桂城社区5年及5年以上病程糖尿病患者共100例(共200眼),均进入糖尿病视网膜病变患者资料管理档案.将患者按随机数字表法分为对照组和试验组各50例(100眼),2组患者均给予降血糖药物治疗,对照组未给予系统的护理干预,试验组在此基础上接受系统的护理干预.随访1年半,观察并比较2组患者视网膜病变的发生和发展情况.结果 治疗12个月后,对照组患者DR分期提高1级10眼,提高2级4眼,恶化率为14％(14/100);试验组DR分期提高1级2眼,恶化率为2.0％ (2/100).2组恶化率比较差异有统计学意义(P＜0.05).结论 通过系统的护理干预措施提高患者对糖尿病性视网膜病变的认识,正确指导饮食、运动、用药和定期检查等,可有效控制患者糖尿病性视网膜病变的发生和发展程度.     

基于赋能理论的互联网型延续护理对宫颈癌术后带尿管出院患者排尿功能的影响

目的 探讨基于赋能理论的互联网型延续护理对宫颈癌术后带尿管出院患者排尿功能的影响.方法 将81例宫颈癌术后带尿管出院患者按照出院时间分为对照组40例和研究组41例.对照组采用常规出院延续护理模式,研究组在对照组基础上采用基于赋能理论的互联网型延续护理模式,2组患者均干预1个月.采用一般自我效能感量表(GSES)评估2组患者的自我效能状况,比较2组尿潴留发生率及尿管重置率.结果 干预后,2组患者GSES评分均高于干预前,且研究组GSES评分高于对照组,差异有统计学意义(P＜0.05).研究组尿潴留发生率为24.4％(10/41),低于对照组的47.5％(19/40),差异有统计学意义(P＜0.05).研究组患者尿管重置率低于对照组,差异有统计学意义(P＜0.05).结论 基于赋能理论的互联网型延续护理可促进宫颈癌术后带尿管出院的患者排尿功能的恢复,提高患者自我健康管理能力.     

美沙酮维持治疗海洛因成瘾者脱失原因分析

目的:通过分析连云港市第四人民医院美沙酮维持治疗门诊海洛因成瘾者脱失原因及其影响因素,为制定降低脱失率方案提供参考依据,降低HCV等血源性疾病的风险。方法:选取2014年1月~2016年12月有过脱失经历的海洛因成瘾患者139例为研究对象,采取搜集门诊病例资料、电话回访、同伴告知及公安机关协助等方式,对脱失者人口学特征、脱失相关情况及脱失原因进行分析总结。结果:139例脱失人员中以偷吸、买卖毒品被公安机关强戒或劳教64例(46.0%)和与毒品无关的违法犯罪被抓37例(26.6%)为脱失主要原因。其次为生病/死亡11例(7.9%)、超15 d未治疗/违反门诊规章制度9例(6.5%)、外地务工/出差/做生意5例(3.6%)、怀孕生育4例(2.9%)、自认为戒断4例(2.9%)、不明原因/联系不上3例(2.2%)、主动退出2例(1.4%)。结论:进一步加强美沙酮知识宣传,全国拓展美沙酮门诊点,建立健全的公安、卫生、社区康复等体系共同管理,采取个性化处理,综合干预措施,创造就业条件和环境,提高保持率等是降低脱失率的重要方法。     

早期充气压力泵治疗干预对预防脑梗死后下肢静脉血栓的护理

目的 探讨脑梗死患者行充气压力泵预防下肢静脉血栓的护理.方法 选择2012年1月至2012年7月收治的脑梗死患者100例,随机分为干预组和治疗组,每组50例,对照组采取常规护理,干预组在常规护理基础上采取充气压力泵治疗,观察疗效及静脉血栓发生率.结果 干预组发生DVT1例(发生率2％),对照组发生DVT3例(发生率6％).结论 在常规预防DVT的基础上采取间歇泵气压治疗,可明显降低DVT的发生.     

护理干预辅助治疗消化性溃疡临床分析

目的 探讨护理干预辅助治疗消化性溃疡.方法 将120例在内科治疗的消化性溃疡患者均分为干预组和对照组两组,每组各60例患者,干预组在内科治疗基础上采用相应的护理干预措施.结果 干预组治愈38例(63.3％),显效15例(25.0％),有效5例(8.3％),无效2例(3.3％),总有效率为96.7％；对照组治愈22例(36.7％),显效16例(26.7％),有效12例(20％),无效10例(16.7％),总有效率为83.3％.两组总有效率比较差异有显著意义(P＜0.05).结论 护理干预辅助治疗消化性溃疡,可取得良好疗效.     

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.     

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.     

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.     

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.