急诊一体化救治护理急危重症患者中临床路径的应用

目的探讨危急重症患者实施护理过程中通过对患者进行急诊一体化救治护理方法的临床疗效。方法选取我院2014年10月~2015年10月收治的危急重症患者800例,将患者分为观察组以及对照组,对比两组患者护理效果、死亡率及满意度。结果观察组临床护理效果高于对照组,患者的死亡率以及患者的临床满意程度有差异,P0.05,差异具有统计学意义。结论实施急诊一体化救治护理,能够提升临床护理效果,是一种安全有效的救治方法 .     

Congress On Spinal Cord Medicine and Rehabilitation September 23-26, 2009 Sheraton Dallas Hotel Dallas,Texas Platform Abstracts

Abstract

Objective

To examine the psychometric properties of the Community Integration Questionnaire (CIQ) in large samples of individuals with spinal cord injury (SCI).

Design

Longitudinal 12-month survey study.

Setting

Nation-wide, community dwelling.

Participants

Adults with SCI: 627 at Time 1, 494 at Time 2.

Interventions

Not applicable.

Outcome measures

The CIQ is a 15-item measure developed to measure three domains of community integration in individuals with traumatic brain injury: home integration, social integration, and productive activity. SCI consumer input suggested the need for two additional items assessing socializing at home and internet/email activity.

Results

Exploratory factor analyses at Time 1 indicated three factors. Time 2 confirmatory factor analysis did not show a good fit of the 3-factor model. CIQ scores were normally distributed and only the Productive subscale demonstrated problems with high (25%) ceiling effects. Internal reliability was acceptable for the Total and Home scales, but low for the Social and Productive activity scales. Validity of the CIQ is suggested by significant differences by sex, age, and wheelchair use.

Conclusions

The factor structure of the CIQ was not stable over time. The CIQ may be most useful for assessing home integration, as this is the subscale with the most scale stability and internal reliability. The CIQ may be improved for use in SCI by including items that reflect higher levels of productive functioning, integration across the life span, and home- and internet-based social functioning.     

Using Winnicott or Finding Winnicott?

The author suggests, in the title, a difference between using Winnicott's ideas, as in applying them, and finding Winnicott in clinical work. It is in finding examples that resonate to his ideas that we can see most directly what Winnicott had been writing about. And it is at those times of finding Winnicott that his ideas most vividly come alive.     

In vivo cellular reactions to different biomaterials—Physiological and pathological aspects and their consequences

Biomaterials are widely used in guided bone regeneration (GBR) and guided tissue regeneration (GTR). After application, there is an interaction between the host immune system and the implanted biomaterial, leading to a biomaterial-specific cellular reaction. The present review focuses on cellular reactions to numerous biomaterials in vivo with consideration of different implantation models and microenvironments in different species, such as subcutaneous implantation in mice and rats, a muscle model in goats and a femur model in rabbits. Additionally, cellular reactions to different biomaterials in various clinical indications within the oro-maxillofacial surgical field were considered. Two types of cellular reactions were observed. There was a physiological reaction with the induction of only mononuclear cells and a pathological reaction with the induction of multinucleated giant cells (MNGCs). Attention was directed to the frequently observed MNGCs and consequences of their appearance within the implantation region. MNGCs have different subtypes. Therefore, the present review addresses the different morphological phenotypes observed within the biomaterial implantation bed and discusses the critical role of MNGCs, their subtypes and their precursors as well as comparing the characteristics and differences between biomaterial-related MNGCs and osteoclasts. Polymeric biomaterials that only induced mononuclear cells underwent integration and maintained their integrity, while polymeric biomaterials that induced MNGCs underwent disintegration with material breakdown and loss of integrity. Hence, there is a question regarding whether our attention should be directed to alternative biological concepts, in combination with biomaterials that induce a physiological mononuclear cellular reaction to optimize biomaterial-based tissue regeneration.     

中西医结合序贯治疗支气管哮喘64例疗效观察

目的：观察中西医结合序贯治疗对支气管哮喘患者的临床疗效。方法将128例支气管哮喘患者随机分为观察组与对照组,均分发作期、缓解期、稳定期三期序贯治疗。对照组64例予西医常规治疗,观察组64例在对照组基础上配合中药,应用中西医结合疗法,每一期疗程结束评价疗效。结果观察组在发作期病情平均缓解时间,以及肺功能指标、症状体征积分、临床总有效率、1年内复发率等方面与对照组比较,差异有统计学意义（P ﹤0.05,P ﹤0.01）。结论中西医结合序贯疗法能有效改善哮喘患者肺功能,临床近期、远期疗效高,复发率低,提高患者生活质量,值得推广应用。     

Integrated health and social care in England – Progress and prospects

This paper reviews recent policy initiatives in England to achieve the closer integration of health and social care. This has been a policy goal of successive UK governments for over 40 years but overall progress has been patchy and limited. The coalition government has a new national framework for integrated care and variety of new policy initiatives including the ‘pioneer’ programme, the introduction of a new pooled budget – the ‘Better Care Fund’ – and a new programme of personal commissioning. Further change is likely as the NHS begins to develop new models of care delivery. There are significant tensions between these very different policy levers and styles of implementation. It is too early to assess their combined impact. Expectations that integration will achieve substantial financial savings are not supported by evidence. Local effort alone will be insufficient to overcome the fundamental differences in entitlement, funding and delivery between the NHS and the social care system.With a national election set to take place in May 2015, all political parties are committed to the integration of health and social care but clear evidence about the best means to achieve it is likely to remain as elusive as ever.     

Prediction of Falls in Subjects Suffering From Parkinson Disease,Multiple Sclerosis,and Stroke

Objective

To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.

基于本体和关联数据的馆藏资源融合模型

介绍了数字图书馆中关联数据的应用和馆藏资源融合中关联数据的应用意义,分析了馆藏资源融合的必要性,从系统构建、技术实现和发现算法上详细探讨了馆藏资源语义关联过程及馆藏资源在语义关联研究中存在的不足,并基于关联数据,通过融合框架、本体以及关联数据的设计实现了馆藏资源语义化融合。     

安徽省卫生服务体系整合结构和有效性研究——以马鞍山市、肥西县和肥东县为例

目的:通过对安徽省三县市卫生服务体系整合结构和有效性的研究,为促进卫生服务体系整合提供政策建议。方法:采用典型抽样,对安徽省马鞍山市、肥西县和肥东县卫生服务体系进行案例分析。数据主要来源于机构调查问卷、医生和患者调查问卷和机构关键知情人访谈。定量和定性数据分析相结合,采用社会网络分析方法分析体系整合结构和有效性。结果:马鞍山市卫生服务体系结构的整合度最高,其次是肥西县,肥东县最低。体系有效性与结构整合程度一致。三县市的卫生服务体系在整合方面均存在优势和不足。结论:卫生服务体系整合效果是各体系内外环境综合作用的产物。马鞍山市的市立医疗集团改革和肥西县的县乡医联体改革在整合卫生服务体系结构的同时对卫生服务体系的有效性产生了积极影响。     

Tissue Engineered Cartilage Integration to Live and Devitalized Cartilage: A Study by Reflectance Mode Confocal Microscopy and Standard Histology

This study investigated the in vivo formation of engineering cartilage within living or devitalized cartilage discs using reflectance mode confocal microscopy and conventional light microscopy. Pig articular chondrocytes were suspended in fibrin glue and placed between two cartilage discs. Four experimental groups were prepared: in groups 1 and 2, the cell-hydrogel composite was placed between two live or between two devitalized cartilage discs, respectively; in groups 3 and 4, acellular fibrin glue was placed between two live or between two devitalized cartilage discs, respectively. Samples were implanted in the back of nude mice and analyzed after 2, 5, and 8 weeks. Results showed that engineered cartilage seems to grow more homogenously when the cell-seeded gel was placed between devitalized cartilages than when it was placed between live cartilage matrices. Confocal microscopy provides valuable information on the integration of tissue-engineered cartilage with native tissue and could be useful for nondestructive imaging in vivo.