慢性阻塞性肺病患者社区康复模式的探讨

目的探讨适合慢性阻塞性肺病患者的社区康复护理模式。方法将100例社区慢性阻塞性肺病患者随机分为干预组和对照组各50例。对照组仅实施常规康复指导,而对干预组执行一套为期8周的家庭访视关键流程,并进行跟踪随访。1年后,应用肺功能和生活质量评估量表对2组患者进行评价。结果干预组与对照组比较,反映肺功能的FVC(L)、FEV(1L)、FVC/预计值(%)、FEV1/预计值(%)指标差异均有统计学意义。在反映生活质量的日常生活、社会活动、抑郁、焦虑4个因子的对比中,2组差异也有统计学意义(P<0.05)。结论以“合理营养、劝导戒烟、心理支持、活动指导”为干预重点,并将健康教育贯穿其中的社区康复模式,能有效延缓COPD的病情发展,减低COPD转归为肺心病及呼吸衰竭的发病率,提高患者的生存质量。     

健康教育对慢性阻塞性肺疾病患者的影响

目的延缓疾病发展；保持最适当的肺功能；改善活动能力，提高生活质量。方法将80例慢性阻塞性肺病患者随机分为干预组和对照组各40例。对照组仅实施常规的康复指导，而对干预组制定一套详细的健康教育计划，并进行跟踪随访。1年后，应用生活质量评估表和肺功能对两组患者进行评价。结果两组比较，反应肺功能的FVC（L）、FEV1（L）、FVC／预计值（％）、FEV1／预计值（％）指标差异均有统计学意义。在反映生活质量的日常生活、社会活动、抑郁、焦虑4个因子的对比中，两组差异也有统计学意义（P〈0．05）。结论以“合理营养、劝导戒烟、心理支持、活动指导”为干预重点，并制订执行详细的健康教育计划，能有效延缓COPD的病情发展，减低COPD转归为肺心病及呼吸衰竭的发病率，提高患者的生存质量。     

社区医疗干预对44例COPD缓解期临床疗效观察

将本社区住院治疗后出院的88例缓解期慢性阻塞性肺病患者随机分为观察组和对照组各44例,观察组予以社区医疗干预,对照组不实施主动性医疗干预。结果干预前,两组患者的各项肺功能指标(PEF、FEV1、VCmacx、FEV1/FVC)比较,差异均不具有统计学意义(P>0.05);干预后,观察组的各项肺功能指标均显著高于对照组(P<0.05)。对于COPD缓解期患者,实施系统的社区医疗干预,可有效延缓病情发展,改善肺功能,提高患者的生活质量。     

社区慢性阻塞性肺疾病患者的康复护理

目的探讨适合慢性阻塞性肺疾病患者社区康复护理。方法将60例社区慢性阻塞性肺疾病患者随机分为干预组和对照组，各30例。对照组仅实施常规康复指导，而对干预组执行一套为期8周的家庭访视关键流程，并进行跟踪随访。5个月后，应用肺功能和生活质量表对2组患者进行评价。结果2组比较，用力肺活量（p〈0．05）、第1秒用力呼气容积（p〈0．01）、FVC／预计值（p〈0．01）、FEV1／预计值（p〈0．01）。结论将健康教育贯穿其中的社区康复护理，能有效延缓慢性阻塞性肺疾病的病情发展，减低慢性阻塞性肺疾病转归为肺心病及呼吸衰竭的发病率，提高患者的生存质量。     

坐式八段锦联合呼吸功能锻炼对慢性阻塞性肺疾病患者肺功能的影响

目的：探究坐式八段锦联合呼吸功能锻炼对慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法：选取60例COPD患者，根据随机数字表法分为对照组（n=30）、干预组（n=30），均接受常规治疗。对照组给予坐式八段锦干预，观察组在此基础上联合呼吸功能锻炼，干预1个月。干预前后比较两组肺功能[第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大通气量（MVV）]、生活质量[健康调查简表（SF-36）]。结果：干预后，两组FEV1、FVC、MVV值及SF-36评分均升高，且干预组高于对照组，差异有统计学意义（P<0.05）。结论：坐式八段锦联合呼吸功能锻炼能够提高COPD患者肺功能，改善患者生活质量。     

一对一护理模式联合呼吸康复操演练在慢性阻塞性肺病患者中应用价值

目的 探讨一对一护理模式联合呼吸康复操演练在慢性阻塞性肺病患者中的应用价值.方法 选择2018年1月—2019年1月我院收治的80例慢性阻塞性肺病患者作为研究对象,随机分为对照组和观察组,每组40例.对照组实施常规护理模式,观察组实施一对一护理模式联合呼吸康复操演练.比较两组患者的肺功能、生活质量.结果 干预前,两组患者的肺功能指标、生活质量评分相比较,差异均无统计学意义(P>0.05);干预后,观察组患者的FEV1、PEF、FEV1/FVC等肺功能指标水平均高于对照组,观察组患者的生活质量评分高于对照组,上述差异均有统计学意义(P<0.05).结论 一对一护理模式联合呼吸康复操演练能改善患者的肺功能指标,提高患者生活质量,值得在临床推广.     

疗养期间森林浴对军队慢性阻塞性肺疾病患者肺功能和运动耐力的影响

目的探讨疗养期间森林浴对军队慢性阻塞性肺病(COPD)患者肺功能和运动耐力的影响。方法选取某院军队休养员中患有COPD患者120例作为研究对象,按照随机数字表法将研究对象分为干预组和对照组,在患者原有用药治疗的基础上,对照组实施常规呼吸康复训练,干预组在此基础上加入森林浴干预。比较两组干预前后患者运动耐力和肺功能的变化情况。结果干预前后比较两组COPD患者的肺功能和运动耐力,入院时测两组FEV1%预计值、FEV1/FVC比值和6 min步行距离、呼吸困难Borg评分差异无统计学意义(P0.05),干预结束后两组FEV1%预计值、FEV1/FVC比值和6 min步行距离、呼吸困难Borg评分均上升,干预组上升幅度大于对照组,差异具有统计学意义(P0.05)。结论森林浴可有效改善军队COPD患者肺功能,同时增加患者运动耐力,提高体力状况。     

慢阻肺康复护理自我管理对患者肺功能及生活质量的影响观察

目的 探讨在慢性阻塞性肺疾病（COPD）患者治疗期间实施康复护理自我管理干预的临床效果。方法 2022 年 1 月到 2023 年 1 月我院收治的 125 例 COPD 患者，以随机数字表法分成对照组和研究组。对照组（n=62）实施常规护理，研究组（n=63） 实施康复护理自我管理干预。对比两组的治疗依从性、肺功能、自护能力、生活质量。结果 研究组的治疗依从性，FEV1、PEF、 FVC，ESCA 评分和生活质量评分高于对照组（P<0.05）结论 COPD 患者实施慢阻肺康复护理自我管理，可提高治疗依从性、 自护能力和生活质量，改善肺功能。     

慢性阻塞性肺疾病应用三位一体化护理模式对肺康复的效果研究

目的探讨应用三位一体化护理模式(即医院-社区-家庭护理模式)用于慢性阻塞性肺疾病(COPD)患者出院后肺康复的效果。方法将80例COPD患者按住院号随机分为干预组和对照组,两组患者出院后均给予常规护理,干预组依据医院-社区-家庭护理模式制定康复计划并实施,两组患者在干预前、干预后1年进行肺功能测定和生活质量评分。结果患者干预后1年的肺功能监测指标比较,干预组与对照组比较有明显改善,差异有统计学意义(P0.05)。干预组患者干预后1年生活质量得分与对照组比较,差异有统计学意义(P0.05)。结论以三位一体化护理模式对COPD患者进行肺康复管理,有利于改善患者的肺功能,提高生活质量。     

综合干预对稳定期慢性阻塞性肺疾病患者生存质量的影响

目的：探讨综合干预管理对慢性阻塞性肺疾病（COPD）患者肺功能、生活质量的影响。方法选择120例稳定期中重度（Ⅲ、Ⅳ期）COPD 患者为研究对象,随机分为对照组、综合干预组,对照组给予常规治疗,综合干预组在常规治疗的基础上为每例患者建立个人健康档案,对患者进行COPD防治知识讲座、戒烟宣传教育、呼吸功能锻炼、用药指导、心理疏导,时间为12个月,比较2组患者综合干预前后肺功能、SGRQ 评分变化、COPD 急性发作次数、住院天数,每周使用急救药物次数。结果综合干预组 SGRQ 总评分均较管理前下降（P＜0.05）,FEV1、FVC、FEV1/Pred%均较入选时无明显变化（P＞0.05）,COPD 急性发作次数较对照组减少,差异有统计学意义（P＜0.05）;对照组 FEV1、FEV1/Pred%均较入选时下降、每周使用急救药物次数较干预前增加,差异有统计学意义（均P＜0.05）,SGRQ评分较干预前稍下降,差异无统计学意义（P＞0.05）。结论对COPD患者综合干预可以改善患者肺功能,提高患者生存质量,减少COPD急性发作次数。     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.