分析外科护理中的潜在风险及应对策略

目的：分析外科护理中的潜在风险及应对策略。方法收集外科的200例患者作为护理组、200例患者作为对照组，总结出外科护理中的潜在风险，并提出相应的安全护理措施。结果实现安全护理措施后，护理组安全意外事件发生率为0.2％，明显低于对照组的0.8%，两组对比差异显著，具有统计意义（P＆lt;0.05）。结论研究外科护理中的潜在风险及应对策略，有利于提高患者及家属对护理的满意度，降低医疗纠纷的发生率。     

Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center

Cerebral palsy (CP) is a set of nonprogressive neuromuscular disorders caused by defects in the developing fetal brain. The aim of this study is to investigate the prevalence and distribution of various dental conditions including dental caries and periodontitis among individuals with CP who receive care at the Rancho Los Amigos National Rehabilitation Center dental clinic. Medical records of 478 patients between the ages of 3 and 78 years were reviewed. Patients were divided into four age groups: 3–20, 21–35, 36–55, and 56 and above year old. Data related to their dental conditions including caries, periodontitis, and other oral diseases were assessed. Statistical analyses were conducted to evaluate the correlations between these oral diseases and age, gender, ethnicity as well as their living conditions (home or group home). The 36–55‐year‐old age group displayed significantly more caries and periodontitis than any other age groups. Individuals aged 3–20 years showed a significantly lower rate of periodontitis and caries. There was no significant association between gender and race with these outcome variables but there was a correlation between these variables and living conditions. Differences in oral health exist among people with CP from different age groups and living conditions. These findings suggest that there is a dire need for more oral hygiene training and education for the care givers. Dental schools should better prepare their graduates to meet the treatment demands of individuals with special healthcare needs.     

关于“问题患者”的特征和成因的质性研究

目的了解"问题患者"的特征以及成因,探讨"问题患者"的应对方法。方法以质性研究方法对20名临床护士进行半结构式、面对面的深度访谈以收集资料。结果 "问题患者"的特征包括攻击性行为、行为和症状前后不一致、要求过多过高、不寻常的求医行为、依从性差、不信任医务人员、自认为是专家、坏消息的传播者以及多种复杂的社会问题,其成因包括患者因素、医护人员因素和其他因素。结论及时识别"问题患者"表现,分析"问题患者"的特征以及成因,针对"问题患者"成因采取不同的应对方法,有助于减少护患矛盾。     

门诊西药房退药原因分析与应对策略

目的 通过对本院门诊西药房退药情况进行调查分析,提出应对策略,减少和规范退药。方法 对门诊退药处方进行统计分析,探讨应对策略。结果 退药原因排在前三位的分别是处方错误、患者拒用、不良反应,共110人次,占全部退药的61.7%。结论 退药现象不可避免,应针对原因,完善制度,减少和规范退药。     

New medical treatment options and strategies to assess clinical outcome in soft-tissue sarcoma

Soft-tissue sarcomas (STSs) are a heterogeneous group of rare malignant tumors predominantly arising from the embryonic mesoderm. The mainstay of curative therapy is the complete surgical resection of all tumor manifestations with negative histological margins. However, up to 50% of patients will develop distant metastases during the course of their disease. The prognosis for those patients is grim with a 5-year overall survival of less than 10%. First-line systemic therapy with ifosfamide and doxorubicin results in overall response rates of only 20% by conventional response evaluation criteria in solid tumors (RECIST). However, stabilization of disease can be seen in a greater proportion. Therefore, the role of the RECIST criteria has been questioned and the implementation of new imaging studies (e.g., FDG-PET) has shown promising results in assessing early tumor response to therapy. Furthermore, a broader insight into the molecular pathways of sarcomagenesis has been gained in recent years, revealing intriguing targets for new therapeutic approaches (e.g., VEGF, VEGF receptor, IGF receptor, EGF receptor, mTOR and cyclin-dependent kinases). In addition, a growing body of evidence is linking specific genetic aberrations with clinical outcome (e.g., SYT–SXX translocation in synovial sarcoma). With further insight into the biology of STS and the combination of new treatment options with modern imaging techniques, we will most certainly be able to improve clinical outcome in patients with STS in the upcoming years.     

Do fibromyalgia patients benefit from cognitive restructuring and acceptance? An experimental study

Background and objectivesThe aim of this study was to clarify mechanisms of psychological fibromyalgia treatment by experimentally examining the effectiveness of its core elements. We assessed the effects of cognitive restructuring and acceptance on experimentally-induced heat and cold pain tolerance and pain intensity in fibromyalgia patients.MethodsCold and heat pain were induced in a sample of 60 fibromyalgia patients using a thermode. We conducted ANCOVAs to examine group differences in posttest scores, co-varying for pretest scores. The between-groups factor was the type of instruction provided (acceptance, cognitive restructuring, and a control condition). In addition, we controlled for pain sensitivity, age, and depression.ResultsWe found that acceptance and cognitive restructuring were superior to the control condition in increasing heat pain tolerance, but did not differ from one another. With respect to cold pain tolerance, cognitive restructuring was associated with increases in cold pain tolerance compared to the control condition, while acceptance did not differ either from the control condition or from cognitive restructuring.LimitationsFurther experimental research on chronic pain treatment mechanisms is needed, particularly research on individually tailoring treatment strategies according to patients characteristics. Conclusion: Results show that both, cognitive restructuring and acceptance instructions, enhance pain tolerance in fibromyalgia patients.     

呼吸机相关性肺炎28例临床分析

目的探讨机械通气导致呼吸机相关性肺炎的防治措施。方法对我院RICU自2008年1月～2010年10月发生呼吸机相关性肺炎28例的临床资料进行回顾性分析。结果 28例呼吸机相关性肺炎中,治愈17例,死亡11例。结论 RICU中呼吸机相关性肺炎发病率高、死亡率高,防治呼吸机相关性肺炎应采取综合防治措施,以预防为主,严格无菌操作,尽量缩短机械通气时间,加强机械通气患者的护理。     

Primary psychopathy and alcohol pathology in college students: The role of protective behavioral strategies

Overview: Though not an official diagnosis, psychopathy has become an important area of research due to the litany of deleterious outcomes associated with this aspect of temperament. Psychopathy is composed of primary and secondary traits. Research consistently links psychopathy to alcohol pathology, though often only via secondary traits which are comprised of intractable aspects of behavior (e.g., poor impulse control). In contrast, primary psychopathy is comprised of behaviors that can be learned and thus may be more malleable (i.e., low harm reduction behaviors). Objectives: The current study examines associations between primary psychopathic traits and alcohol involvement as a function of Protective Behavioral Strategies (PBS) utilization in a sample of college students. Method: Participants (n = 936 college student drinkers; 66.56% female) completed a series of questionnaires assessing primary psychopathy, alcohol involvement, and PBS use. Results: There was a significant positive association between primary psychopathy and alcohol consumption and pathology. This association was partially mediated via diminished PBS use. PBS use also moderated the relationship between alcohol consumption and pathology. The indirect effects from psychopathy to alcohol outcomes were attenuated at high (+1SD) PBS and potentiated at low (?1SD) PBS. Conclusion: The current findings suggest that some of the alcohol pathology associated with psychopathy is a function of lower harm reduction strategies among individuals with more psychopathic traits. These findings suggest that interventions targeting PBS use may be one way to reduce alcohol problems among those with higher levels of primary psychopathy.