集束化护理措施预防留置尿管患者发生相关性尿路感染研究

目的 探讨采用集束化护理措施对预防留置尿管患者发生相关性尿路感染的临床效果及应用价值.方法 将2011年10月至2013年10月间我院收治的150例留置尿管患者随机分为对照组和观察组各75例,对照组患者给予常规护理,观察组患者在对照组基础上给予集束化护理,观察对比两组患者的临床护理效果、不同时间的尿路感染率、尿管留置时间、膀胱刺激症状消失时间以及尿管外端菌落培养情况.结果 观察组患者护理后的临床有效率明显高于对照组（P＜0.05）;观察组患者不同时间的尿路感染率明显低于对照组（P＜0.01）;观察组患者的尿管留置时间以及膀胱刺激症状消失时间明显短于对照组（P＜0.01）;观察组患者的尿管外端菌落培养情况明显优于对照组（P＜0.01）.结论 采用集束化护理措施对于预防留置尿管患者发生相关性尿路感染具有较高的临床应用价值,疗效显著,能够有效减少尿路感染发生率,缓解患者病情,提高护理质量,值得临床大力推广.     

集束化护理在癌痛规范化治疗中的应用研究

目的：探讨集束化护理在癌痛规范化治疗中对癌痛患者疼痛强度和疼痛影响是否有明显的缓解。方法：将本科2013年6月-2014年3月收治的80例病理确诊为恶性肿瘤,存在癌性疼痛,并接受三级阶梯止痛药物镇痛治疗的患者随机分成对照组和试验组,每组40例。对照组按照规范的三级阶梯止痛原则进行护理,试验组采用集束化护理措施,包括：评估癌痛→实施镇痛→健康教育→观察与记录→定期随访。观察两组癌痛患者干预前后疼痛强度、疼痛影响及止痛药的不良反应。结果：护理干预后,两组在疼痛强度与疼痛影响方面评分均明显下降（P〈0.01）,试验组下降程度较对照组更明显（P〈0.01）;试验组癌痛缓解率明显高于对照组（P〈0.01）,且药物不良反应较低（P〈0.05）。结论：集束化护理措施能明显降低癌痛患者的疼痛程度和疼痛对生活质量的影响,值得推广应用。     

集束化护理防治ICU腹泻患者肛周皮炎的应用初探

目的：探讨集束化护理在预防和治疗ICU腹泻患者肛周皮炎的效果,为降低肛周皮炎的发生率、缩短治愈时间提供护理方面的参考。方法：将2011年1-8月ICU收治的52例腹泻患者作为对照组,2011年9月-2012年6月收治的43例作为观察组。对照组采用常规护理,观察组采用集束化护理,比较两组患者肛周皮炎的发生率、严重程度和愈合时间。结果：观察组肛周皮炎发生率为9.3%,低于对照组的32.7%,差异有统计学意义（P〈0.05）;且肛周皮炎愈合时间减少（P〈0.05）。结论：集束化护理防治ICU腹泻患者肛周皮炎效果明显,值得重视和发展。     

新生儿重症监护病房暖箱集束化管理效果探讨

目的 探讨新生儿重症监护病房暖箱集束化管理的效果。方法 对我院新生儿重症监护病房50台宁波戴维YP-920型暖箱进行集束化管理,以2011年的消毒管理方法作为对照组,2012年更新后的消毒管理方法作为实验组,两年的监测结果进行合格率的比较。结果 实验组552次培养中不合格次数为6次,不合格率1.1%,而对照组546次培养中不合格次数75次,不合格率13.7%,差别具有统计学意义。结论 采用集束化的管理措施可以有效控制暖箱内病原体的定植。从而控制病原体经暖箱进行的传播。     

Sepsis—Current Aspects of Pathophysiology and Implications for Diagnosis and Management

Abstract Sepsis is characterized by disrupted inflammatory homeostasis due to infection. While a localized and controlled inflammatory reaction helps to eliminate and control infection, a dysregulated host response triggers multiple organ failure determining course and prognosis. Consequent surgical source control paralleled by adequate and early antibiotic therapy remains the cornerstone of care. Nevertheless, mortality remains as high as 50–60% for severe sepsis and septic shock. As the molecular mechanisms are becoming increasingly better defined, interventions aiming to interfere with the host response to infection have been undertaken, largely with disappointing results. Thus, many evidence-based recommendations suggest waiving of resource-consuming interventions, such as supplementation of antithrombin or immunoglobulins. Nevertheless, several seminal studies have indicated that meticulous supportive care according to pathophysiological principles, most notably early goal-directed therapy, low-dose hydrocortisone and activated protein C, can disrupt dysfunctional cascades favorably influencing the course of the disease. In parallel, there is increasing evidence from national and international surveys that therapy of severe sepsis on ICUs worldwide is generally in poor compliance with current guidelines, while personal perception of the physicians in charge would suggest high rates of adherence to evidence-based recommendations. Thus, strategies of change management, such as implementation of ‘sepsis bundles’, are warranted to achieve better standards of care toward the aim of the “surviving sepsis campaign”, i.e. a reduction of mortality rates by 25% within the next years.     

重度一氧化碳中毒性肺水肿急诊集束治疗分析

目的 探讨重度一氧化碳中毒性肺水肿急诊处置方法。方法重度一氧化碳中毒性肺水肿患者12例,急诊处置采用集束治疗,要点：①保护性通气间断纯氧氧疗。②甲基强的松龙240mg／d,静脉点滴。③6％羟乙基淀粉钠500ml＋10％氯化钠60ml＋速尿100mg,200ml／h,恒速泵入。结果显效9例（75．0％）,有效3例（25．0％）。氧合指数（203．4±69．7）VS（434．6±973X）（P〈0．01）。X线胸片的变化显效8例（66．7％）,有效4例（33．3％）。本组12例患者经后续高压氧等综合治疗,均治愈出院,其中,发生迟发性脑病1例。结论集束治疗可能是重度一氧化碳中毒性肺水肿的有效方法。     

Norepinephrine innervation of the cochlear nuclei by locus coeruleus neurons in the rat

Summary The cochlear nuclei (CN) contain a moderate concentration of norepinephrine (445±20 ng/g tissue) with dopamine levels (46±14 ng/g) that are low and within the precursor range expected for a norepinephrine (NE) terminal system. Lesion and horseradish peroxidase (HRP) experiments indicate that this innervation is bilateral and arises from fusiform and multipolar neurons in the locus coeruleus.Autoradiographic and fluorescence histochemical experiments demonstrate that locus coeruleus fibers reach the ipsilateral ventral cochlear nuclei via a rostral pathway that projects from the rostral locus coeruleus laterally through the brain stem to the rostral tip of the ventral nuclei. This pathway is located dorsal to the motor and spinal trigeminal nuclei and ventral to the middle cerebellar peduncle. Descending coeruleo-cochlear fibers travel between the fourth ventricle and the vestibular nuclei to enter the acoustic striae. These fibers innervate both the dorsal and ventral nuclei. Contralateral locus fibers reach the CN by crossing in the pontine central gray at the rostral border of the fourth ventricle and by decussating with the fibers of the mesencephalic trigeminal nucleus ventral to the medial longitudinal fasciculus. The bilateral locus coeruleus innervation of the cochlear nuclei comprises a highly collateralized network of varicose axons which are not topographically organized. Unlike the cochlear nerve fibers in the CN which form specific projections, the locus coeruleus afferents to these sensory nuclei are diffuse and non-specific.     

Étude ultrastructurale de quatre cas de leuco-encéphalite sclérosante subaiguë

Résumé Les auteurs rapportent 4 observations caractéristiques de LESS: L'analyse ultra-structurale montre: 1⁰ — des inclusions tubulaires intra-nucléaires neuronales ou gliales et intra-axonales de morphologie superposable à celle des nucléocapsides des myxo-virus, de la rougeole en particulier. 2⁰ — des formations non spécifiques: corps nucléaires, faisceaux cristallins et fibrillaires traduisant un trouble métabolique nucléaire, particules osmiophiles liées à une hyperactivité cellulaire. Les inclusions tubulaires virales sont présentes quelque soit la durée de la maladie (3 mois à 5 ans) indiquant l'absence d'autostérilisation virale dans le S.N.C. La LESS apparaît liée au virus rougeoleux mais le mécanisme indirect immunitaire ou métabolique de cette action est inconnu.

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Ultrastructural studies of four cases of subacute sclerosing leucoencephalitis

Summary Four cases of S.S.L.E are reported. The electron microscopy findings show: 1. Tubulary inclusion bodies: They appear in three cases out of four, either in neuronal and glial nucleus or in axis cylinders. Their morphological features are similar to the nucleocapsides of myxoviruses and particularly measles-virus. 2. Other different types of nonspecific inclusions: nuclear bodies, cristalline-like rods and fibrillar bundles which may be considered as the result of a nuclear metabolic disorder, osmiophilic particles which may be seen as the result of a cellular intracytoplasmic hyperactivity. The tubules are found whatever the duration of the disease (3 months up to 5 years) may be. This might indicate that there is no autosterilization of the virus in the C.N.S. during the course of S.S.L.E. According to the most recent papers, such a disease might be interpreted as an infection indirectly induced by measles-virus with an unknown immunologic or metabolic mechanism.

Laboratoire d'Anatomie Pathologique de la Faculté de Médecine et Unité de Recherches Neurobiologiques de l'Inserm (Pr. Gastaut)     

The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty

ObjectiveTo evaluate the effect of the Comprehensive Care for Joint Replacement (CJR) policy on the 90-day trajectory of post-acute care after a total hip arthroplasty (THA).DesignMultivariable difference-in-difference models applied to Medicare beneficiaries undergoing a THA prior to (2014-2015) and post-CJR implementation (2017) in areas subjected to or exempt from the policy.SettingHospitals in standard metropolitan statistical areas.Participants357,844 elderly Medicare patients nationwide undergoing THA (N=357,844).InterventionsNone.Main Outcome MeasuresEscalation in care to institutionalization (ie, admission to an inpatient rehabilitation or skilled nursing facility during 90-days postdischarge for those initially discharged to the community and return to the community at the end of the episode of care among those initially discharged to an institutional setting).ResultsOf the 357,844 elderly Medicare patients nationwide undergoing THA during the study period, 47.6% were discharged directly to the community and 52.4% received post-acute care in an institution. Patients discharged to an institution post-policy in a CJR area were about 10% less likely to return to the community (odds ratio=0.91; 95% confidence interval, 0.84-0.98; P=.02) at the end of the 90-day episode of care than those treated in policy-exempt areas. Despite the large magnitude, estimates of escalation in care among patients treated in bundling areas post-CJR implementation were not statistically significant.ConclusionsOur findings support further exploration of unanticipated effects of mandatory bundled payment policies on outcomes, as well as further examination of outcomes among policy-relevant subgroups of patients undergoing hip replacement in the United States.