家庭护理干预对1型糖尿病患者长期携泵治疗的影响

目的 探讨家庭护理干预对1型糖尿病患者长期携泵治疗的影响.方法 对2例1型糖尿病出院后长期携泵治疗的患者,建立家庭支持系统,给予心理护理、相关知识宣教与测试,并结合家庭病情一览表及患者的定期随访机制等一系列护理干预措施观察干预前后患者的血糖状况.结果 2例患者的家庭护理干预后血糖水平均较干预前有所下降,糖化血红蛋白亦有所下降,低血糖发生次数减少.结论 家庭护理干预延续院内了护理工作,提高了患者的治疗效果和生存质量,受到患者及家属的欢迎.     

循证护理对胰岛素泵强化治疗2型糖尿病的效果分析

目的探讨循证护理对胰岛素泵强化治疗2型糖尿病患者的干预效果。方法收集本院50例行胰岛素泵强化治疗的2型糖尿病患者按是否接受循证护理分为2组各25例,对照组患者携泵期间给予常规护理,实验组患者加施循证护理,比较2组患者携泵期间健康行为评分、糖尿病相关参数、意外事件发生与满意度等。结果实验组患者用药治疗、合理饮食、适量运动、自我监测与尊医携泵评分均显著性高于对照组,血糖达标时间与胰岛素用量显著性低于对照组,具有统计学意义(P0.05);低血糖、黎明现象、针头脱落、导管堵塞与感染发生率明显低于对照组,护理满意度明显高于对照组,具有统计学意义(P0.05)。结论循证护理对胰岛素泵强化治疗2型糖尿病患者的干预效果显著,具有借鉴性。     

胰岛素泵治疗2型糖尿病8例的护理体会

目的：叙述8名2型糖尿病患者在我科住院期间使用胰岛素泵控制血糖的实施及护理经过，阐明胰岛素泵能有效、平稳、快速控制血糖，从而防止或延缓各种糖尿病并发症的发生。方法：使用Roch公司制造的H—TRONPLus V100 Standard胰岛素泵，配制Novo Nordisk的诺和锐胰岛素，为8例2型糖尿病患者进行胰岛素泵治疗，特别注意心理护理及携泵护理，监测携泵前后血糖。结果：置泵后患者的血糖控制水平较置泵前明显好转，胰岛素用量显著减少。结论：胰岛素泵治疗糖尿病，可有效地模拟生理状态下胰岛素分泌，缩短控制高血糖的时间，减少低血糖的发生，减轻病人多次皮下注射胰岛素的痛苦。     

胰岛素泵治疗2型糖尿病的疗效观察及护理

目的:探讨胰岛素泵治疗2型糖尿病的疗效及护理。方法:对20例确诊为2型糖尿病患者住院后给予胰岛素泵强化治疗,严密监测血糖变化,同时进行心理护理、携泵健康教育。结果:本组血糖水平控制良好,3d内基本恢复正常。结论:应用胰岛素泵治疗2型糖尿病,结合全面、持续地观察及护理,可有效控制血糖,降低低血糖反应的发生率,达到最佳治疗效果。     

胰岛素泵治疗2型糖尿病40例疗效观察及护理

目的:探讨胰岛素泵治疗2型糖尿病的疗效及护理方法.方法:将80例2型糖尿病患者随机分为治疗组和对照组各40例,治疗组给予胰岛素泵皮下输入胰岛素,对照组给予诺和笔多次皮下注射胰岛素.结果:治疗后治疗组空腹血糖达标时间明显短于对照组(P<0.05),胰岛素用量和餐后2 h血糖明显低于对照组(P<0.01).结论:对患者实施全方位护理,使之在治疗期间掌握携泵相关知识,提高了糖尿病患者的护理质量及生活质量.     

社区2型糖尿病个体化家庭护理干预方法探讨

目的探讨社区2型糖尿病个体化家庭护理干预的方法及其对血糖控制的效果。方法选取民治社区105例糖尿病患者,以社区全科医护团队、患者及其家庭三位一体的服务模式,针对患者个体实施饮食、运动、心理治疗等综合护理干预,观察干预前与干预后10个月空腹血糖及餐后2h血糖变化情况。结果干预后患者空腹血糖及餐后2h血糖控制情况与干预前相比,差异均有统计学意义(P<0.05)。结论以社区全科医护团队、患者及其家庭三位一体的服务模式,针对社区2型糖尿患者提供个体化护理干预,对患者血糖控制、巩固疗效起着重要的作用,是社区糖尿病治疗的重要组成部分。     

山药参芪丸治疗老年2型糖尿病的综合护理干预

[目的]探讨护理干预对中药组方山药参芪丸治疗老年人2型糖尿病的血糖水平的影响.[方法]将156例使用山药参芪丸治疗的老年2型糖尿病患者随机分为干预组和对照组各78例,干预组实施综合护理干预,对照组实施常规护理.治疗3个月后比较两组患者的血糖水平.[结果]两组治疗干预后空腹血糖、餐后2小时血糖及糖化血红蛋白均明显下降（P〈0.01,P〈0.05）,干预组下降更为显著（P〈均0.05）.[结论]综合护理干预措施可以提高老年2型糖尿病患者自我管理、自我保健意识和治疗的依从性,有效控制血糖水平     

家庭护理干预对提高糖尿病患者治疗依从性的影响

目的：观察家庭护理干预对提高糖尿病患者治疗依从性的影响。方法：糖尿病患者100例,随机抽样分为干预组和对照组各50例,血糖控制后均出院,按常规回家服用控制血糖的药。干预组则给予家庭护理干预,包括糖尿病基础知识教育、按医嘱服药、饮食、运动及相关技能操作指导。2组均定期进行追踪随访。结果：经过3个月的家庭护理干预后,与干预前比较,2组血糖各项指标均有下降（P〈0.05,0.01）,但干预组治疗依从性明显优于对照组,且餐前、餐后2h及糖化血红蛋白的指数均较对照组更稳定（P〈0.05）。结论：家庭护理干预能有效提高糖尿病患者的自控能力,保持血糖的稳定。     

影响老年2型糖尿病患者饮食治疗的因素及护理对策

目的探讨影响老年2型糖尿病患者饮食治疗的因素及护理对策。方法针对56例老年2型糖尿病患者存在的影响饮食治疗的因素进行护理干预，观察患者在护理干预后血糖值、糖化血红蛋白值的变化，并进行统计学处理。结果护理干预后，空腹血糖（FBG）、餐后2小时血糖（PBG）、糖化血红蛋白（GHbAlC）均有明显下降，有显著性意义（P〈0．05）。结论：对老年2型糖尿病患者存在的影响饮食治疗的因素进行相应的护理干预是必要的。     

社区家庭护理干预对2型糖尿病患者血糖控制的效果分析

目的探讨社区家庭护理干预对2型糖尿病患者血糖控制的效果。方法选取本市天河区某6个社区出院后的2型糖尿病患者92例,将患者分为对照组与试验组,每组分别抽取3个社区,每组各46例,同时分别选择患者家属各46名。对照组患者及其家属采用常规护理,试验组患者及其家属在此基础上进行社区家庭护理干预。比较两组患者干预前及干预后1年空腹血糖、餐后2 h血糖、糖化血红蛋白的情况。结果两组患者干预前空腹血糖、餐后2 h血糖、糖化血红蛋白各项指标比较,均P0.05,差异无统计学意义;两组患者干预后空腹血糖、餐后2 h血糖、糖化血红蛋白各项指标比较,均P0.05,差异具有统计学意义,试验组患者血糖各项指标明显优于对照组。结论社区家庭护理干预对降低糖尿病患者的血糖,提高患者的治疗依从性和自我管理能力具有重要的意义。     

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.