综合性心理干预对学龄期白血病患儿负性情绪的影响

[目的]探讨综合性心理干预对学龄期白血痛患儿负性情绪的影响.[方法]将48例学龄期白血病患儿随机分为干预组和对照组,对照组给予常规护理,干预组在常规护理基础上进行综合性心理干预,比较干预前后两组患儿焦虑、抑郁症状.[结果]干预结束时两组患儿焦虑和抑郁评分均低于住院前,化疗后第14天干预组焦虑、抑郁评分明显低于对照组(P＜0.01).[结论]综合性心理干预能有效改善学龄期白血痛患儿焦虑、押郁症状.     

综合性心理干预对学龄期白血病患儿负性情绪的影响

[目的]探讨综合性心理干预对学龄期白血病患儿负性情绪的影响。[方法]将48例学龄期白血病惠儿随机分为干预组和对照组，对照组给予常规护理，干预组在常规护理基础上进行综合性心理干预，比较干预前后两组患儿焦虑、抑郁症状。[结果]干预结束时两组患儿焦虑和抑郁评分均低于住院前，化疗后第14天干预组焦虑、抑郁评分明显低于对照组（P〈0．01）。[结论]综合性心理干预能有效改善学龄期白血病患儿焦虑、抑郁症状。     

农村地区学龄期哮喘患儿教育管理3年随访观察

目的:研究基层医院临床医师对农村学龄期哮喘患儿实施家庭教育管理的模式和效果.方法:对185例农村学龄期哮喘患儿采取了连续3年的随访,建立规范化、个体化的治疗方案,并予以生理--心理--社会的综合干预.结果:患儿和家属对哮喘防治知识增加,自我处置能力提高,患儿的服药依从性增加,反复发作比例下降,家长的心理健康水平提高,家庭经济负担减轻.结论:本研究不仅验证了建立教育管理可提高农村学龄期儿童哮喘防治效果的观点,还为农村地区学龄期哮喘患儿的家庭康复提供了一套系统的教育管理计划、措施、评价依据.     

拉米夫定预防肿瘤患者化疗后HBV再激活的疗效及护理

目的 探讨拉米夫定预防合并乙型肝炎病毒(HBV)感染的恶性肿瘤患者化疗后HBV再激活的疗效及护理方法.方法 选取2011年1月至2012年12月收治的50例合并HBV感染的恶性肿瘤患者为观察组,以2009年1月至2010年12月收治的40例合并HBV感染的恶性肿瘤患者为对照组.观察组患者在化疗前1周开始口服拉米夫定预防治疗,并持续至化疗结束后6个月;对照组40例患者仅予化疗、未接受拉米夫定治疗.观察2组患者HBV-DNA、肝功能的变化及不良反应,并采取针对性护理.结果 观察组化疗结束后HBV再激活率、肝炎发生率、延迟或中断化疗率明显低于对照组(均P＜0.05).结论 预防性应用拉米夫定能明显减少合并HBV感染的恶性肿瘤患者化疗后的HBV再激活,进而减少化疗后肝炎发生率、延迟或中断化疗率.护理措施包括心理护理,饮食指导,用药指导,恶心、呕吐护理,肝功能损害护理及出院指导.     

学龄期恶性肿瘤患儿运动康复的最佳证据总结

目的 检索、评价及总结学龄期恶性肿瘤患儿运动康复的相关证据,为医护人员指导患儿及其家庭开展运动康复提供参考。方法 计算机系统检索国内外数据库、相关指南网站及专业学会网站中关于学龄期恶性肿瘤患儿运动康复的临床决策、推荐实践、指南、证据总结、专家共识及系统评价。检索时限为2017年2月—2022年2月。由2名研究者独立进行文献质量评价、证据提取及整合。结果 最终纳入13篇文献,其中指南3篇、证据总结3篇、推荐实践1篇、专家共识1篇、系统评价5篇。从运动目的 、运动对象、运动评估、运动方案和运动管理5个方面共总结21条最佳证据。结论 该研究总结了学龄期恶性肿瘤患儿运动康复的最佳证据,建议医护人员应用证据时充分考虑临床情境,结合患儿及其家庭的需求和偏好,制订更为详细的个性化运动康复方案。     

完全植入式静脉输液港在胃肠道恶性肿瘤病人应用中的护理

目的:总结经完全植入式静脉输液港在胃肠道恶性肿瘤病人中的应用及护理体会.方法:回顾性分析67例胃肠道恶性肿瘤病人经完全植入式静脉输液港行围手术期液体治疗及术后化疗的临床资料.结果:67例完全植入式输液港病人中有4例在化疗结束后要求取出,1例出现感染后取出,3例导管堵塞后取出,其余病人一直留置,期间未出现严重导管相关并发症.结论:完全植入式静脉输液港为胃肠道恶性肿瘤病人的围手术期营养支持及术后化疗建立了良好的静脉通道,使用和维护方便,病人耐受良好,并发症少,减轻了护理工作量.     

学龄期1型糖尿病患儿家庭功能与自我管理行为的相关性研究

目的 :分析学龄期1型糖尿病患儿家庭功能与自我管理行为的相关性。方法 :采用家庭功能评估量表和糖尿病自我管理活动量表对2013年1月至2014年1月期间入住我院内分泌科的215名学龄期1型糖尿病患儿进行调查。结果 :学龄期1型糖尿病患儿自我管理行为总体情况较好,其中饮食得分及遵医嘱服药情况最好,血糖监测情况最差;学龄期1型糖尿病患儿家庭功能总体较好,62.3%的患儿家庭功能良好,32.1%的患儿家庭功能中度障碍,5.6%的患儿家庭功能出现重度障碍;学龄期1型糖尿病患儿家庭功能与自我管理行为呈正相关(r=0.168,P0.05)。结论 :学龄期1型糖尿病患儿家庭功能与自我管理行为密切相关,提高家庭功能有利于改善患儿的自我管理行为。     

学龄期哮喘患儿母亲压力源的质性研究

目的探讨学龄期哮喘患儿母亲在照顾过程中的压力源。方法采用目的抽样法,对某院儿科病房2020年6月-9月住院的10名学龄期哮喘患儿的母亲进行半结构式访谈,以Colaizzi 7步分析法分析资料。结果学龄期哮喘患儿的母亲的压力源可归纳为4个主题:透支的时间和体力、复杂的负性情绪、缺乏专业的照顾知识、担忧患儿的前程。结论学龄期哮喘患儿的母亲在照顾的过程中存在多种压力源和心理压力,应结合其自身特点,制订针对性的健康教育,并根据具体压力源采取不同的心理疏导,从而减轻学龄期哮喘患儿母亲的照顾压力。     

学龄期肝癌患儿的护理

目的探讨学龄期肝癌患儿行肝癌切除术的护理方法。方法回顾性分析2010年1月至2012年6月在第二军医大学东方肝胆外科医院治疗的14例学龄期肝癌患儿的临床资料,并总结护理方法。结果根据学龄期肝癌患儿的特点,进行全面准确的评估,给予针对性的护理干预。住院时间12～20d,均顺利出院。出院后1个月随访有3名患儿诉胃胀不适,2名患儿诉切口牵拉痛,分别给予相应的指导后症状缓解,经过精心护理未诉肝区不适。结论对行肝癌切除术的学龄期患儿术前进行心理、饮食、环境干预和完善的术前准备,术后进行严密观察与监护、及时处理不适症状、预防引流管滑脱等,是手术成功和促进患儿早日康复的重要保证。     

自理行为训练对学龄期癫痫患儿疗效及自我概念的影响

目的 探讨自理行为训练对学龄期癫痫患儿疗效及自我概念水平的影响.方法 将学龄期癫痫患儿112例随机分为研究组和对照组.对照组患儿给予健康教育,研究组实施自理行为训练,在患儿出院1年后进行效果评价.结果 研究组患儿训练后在行为、智力与学校情况、躯体外貌、焦虑、合群、幸福与满足6个分量表及总分方面,与对照组比较,差异均有显著性意义(均P＜0.01).研究组患儿的服药依从性、药物自我管理能力及对药物的满意程度均明显优于对照组(P＜0.01);出院1年后治疗效果研究组显著优于对照组(P＜0.01).结论 以自理行为训练作为干预手段,可提高学龄期癫痫患儿的治疗依从性,改善治疗效果,提高自我概念水平.     

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.