强化护理干预在脑卒中偏瘫患者早期康复锻炼中的应用效果

目的 探讨强化护理干预在脑卒中偏瘫患者早期康复锻炼中的应用效果。方法 将68例脑卒中偏瘫患者随机分为观察组和对照组各34例,对照组给予常规康复护理,观察组给予强化护理干预,对患者及家属加强健康教育和规范康复锻炼。两组患者在干预前,干预3个月均进行简化Fugl-Meyer运动功能量表、Barthel指数评定量表评分,比较两组患者的肢体运动功能和日常生活活动能力的康复效果。结果 两组患者干预前简化Fugl-Meyer运动功能量表、Barthel指数评定量表评分比较差异无统计学意义(P>0.05),干预3个月后,观察组与对照组,简化Fugl-Meyer运动功能量表评分、Barthel指数评定量表评分与干预前比较均有改善(P<0.001),但观察组的改善更为明显。结论 强化护理干预能够显著提高脑卒中偏瘫患者的肢体运动功能及日常生活活动能力,提高早期康复锻炼的效果。     

Contribution of metabolic risk factors and lifestyle behaviors to cardiovascular disease: A mendelian randomization study

Background and aimsEtiologic associations between some modifiable factors (metabolic risk factors and lifestyle behaviors) and cardiovascular disease (CVD) remain unclear. To identify targets for CVD prevention, we evaluated the causal associations of these factors with coronary artery disease (CAD) and ischemic stroke using a two-sample Mendelian randomization (MR) method.Methods and resultsPreviously published genome-wide association studies (GWASs) for blood pressure (BP), glucose, lipids, overweight, smoking, alcohol intake, sedentariness, and education were used to identify instruments for 15 modifiable factors. We extracted effects of the genetic variants used as instruments for the exposures on coronary artery disease (CAD) and ischemic stroke from large GWASs (N = 60 801 cases/123 504 controls for CAD and N = 40 585 cases/406 111 controls for ischemic stroke). Genetically predicted hypertension (CAD: OR, 5.19 [95% CI, 4.21–6.41]; ischemic stroke: OR, 4.92 [4.12–5.86]), systolic BP (CAD: OR, 1.03 [1.03–1.04]; ischemic stroke: OR, 1.03 [1.03–1.03]), diastolic BP (CAD: OR, 1.05 [1.05–1.06]; ischemic stroke: OR, 1.05 [1.04–1.05]), type 2 diabetes (CAD: OR, 1.11 [1.08–1.15]; ischemic stroke: OR, 1.07 [1.04-1.10]), smoking initiation (CAD: OR, 1.26 [1.18–1.35]; ischemic stroke: OR, 1.24 [1.16–1.33]), educational attainment (CAD: OR, 0.62 [0.58–0.66]; ischemic stroke: OR, 0.68 [0.63–0.72]), low-density lipoprotein cholesterol (CAD: OR, 1.55 [1.41–1.71]), high-density lipoprotein cholesterol (CAD: OR, 0.82 [0.74–0.91]), triglycerides (CAD: OR, 1.29 [1.14–1.45]), body mass index (CAD: OR, 1.25 [1.19–1.32]), and alcohol dependence (OR, 1.04 [1.03–1.06]) were causally related to CVD.ConclusionThis systematic MR study identified 11 modifiable factors as causal risk factors for CVD, indicating that these factors are important targets for preventing CVD.     

强化护理干预对 ICU 患者并发症及生存状态的影响

目的：探讨强化护理干预对ICU患者并发症及生存状态的影响。方法选取我院2013年3月至2014年3月ICU收治的477例患者为研究对象,采用随机数字表法分为对照组237例和观察组240例,对照组给予常规护理,观察组在对照组基础上施行强化护理干预对策,比较两组生活质量SF－36量表以及中心静脉导管相关血行感染（ CRBSI）、压疮形成、呼吸机相关肺炎（ VAP）、昏迷者误吸、肺不张、气压伤等并发症的发生情况。结果护理干预后,观察组患者SF－36各维度得分均显著优于对照组,差异有统计学意义（P＜0.05）;观察组治疗期间并发症的发生率显著少于对照组,差异有统计学意义（P＜0.05）。结论强化护理干预对策能显著改善ICU患者生存质量,降低ICU相关严重并发症的发生率。     

中西医结合孕前孕后并治不明原因早期复发性流产疗效观察

目的:观察中西医结合孕前与孕后联合治疗不明原因早期复发性自然流产的临床疗效。方法:选择符合入选标准的不明原因早期复发性流产患者90例,随机分为研究组48例和对照组42例,研究组自计划妊娠的前3个月开始接受补肾健脾中药治疗至孕3个月止,对照组孕后开始接受同样的中药治疗至孕12周;两组自孕前3个月至孕12周期间都同时服用天然维生素E胶丸和叶酸片,孕后两组都接受黄体酮安胎治疗。随访至孕28周,比较妊娠结局。结果:研究组临床妊娠成功率显著高于对照组(P<0.05)。结论:中西医结合孕前孕后并治不明原因早期复发性流产疗效显著优于孕后开始接受治疗者。     

A systematic review to determine the optimal type and dosage of land-based exercises for treating knee osteoarthritis

Background: Exercise has been acknowledged as an effective non-pharmacological intervention for osteoarthritis. Consensus regarding the type of exercise i.e., aerobic or resistance, weight bearing or non-weight bearing, and dosage i.e., frequency, loading, duration, or intensity, is yet to be reached.

Objective: The purpose of this review was to address two questions: (1) is there a difference in clinical outcomes between different exercise programmes; and (2) what is the optimal dosage of exercises for people with knee osteoarthritis.

Methods: A systematic review was conducted. A study of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, and the Cochrane Library) and unpublished literature (WHO International Clinical Trials Registry Platform, current controlled trials and the United States National Institute of Health Trials Registry, and Open Grey) was undertaken in January 2013. Studies assessing the clinical outcomes of different types and dosages of exercise for people with osteoarthritis of the knee were included. Methodological quality was assessed using the critical appraisal skills programme (CASP) randomized controlled trial (RCT) appraisal tool.

Results: Ten studies assessing 958 knees from 916 participants were included. Exercise significantly improved pain and function for people with knee osteoarthritis. There was no significant difference in outcomes for different types of exercise i.e., aerobic versus resistance, weight bearing versus non-weight bearing. There was no significant difference in respect to the intensity of exercise i.e., high- versus lower-intensity resistance or aerobic exercises. The quality of the literature was moderate to high.

Conclusions: While exercise appears to improve symptoms and optimize function for people with knee osteoarthritis, the optimal form and dosage of exercise remains unknown.

Funding: None.

PROSPERO Registration Number: CRD42012002811.     

论医学人文教育模式的构建

当前的医学人文教育实践存在教育内容滞后,教育途径重认知、轻实践,教育目的智育化、工具化,制度支持缺失等问题。为此,我们认为医学人文教育应坚持“以生为本、医学教育与人文教育融合”的理念,以思想教育为主导,以心理相容为基础,以制度强化为保障。这一医学人文教育模式既是对当前医学教育疏离社会、疏离人的主体性的时代回应,又是对客体化人文教育模式的超越,充分反映了当代医学生的个性特点,同时也体现了医学生人文行为养成与发展的规律。     

扶正为主辨治晚期非小细胞肺癌的疗效研究

目的：观察扶正为主辨证论治对晚期非小细胞肺癌（NSCLC）的疗效。方法：采用前瞻性、随机设计研究方法。选取晚期NSCLC一线治疗后疾病无进展的患者,随机分为治疗组和对照组各29例,治疗组以扶正为主辨证论治进行巩固治疗,对照组不进行中药抗肿瘤治疗。每月随访1次,治疗直至疾病进展或患者拒绝治疗为止。观察扶正为主辨证论治对晚期NSCLC一线化疗后疾病控制患者巩固治疗的临床疗效。观察指标包括疾病进展时间（Time to Progression,TTP）、中医症状改善情况、体重变化、生活质量（Quality of Life,QOL）。结果：（1）治疗组中位TTP为89d,对照组中位TTP为70d,差异有统计学意义（P〈0．05）;（2）治疗组患者中医症状积分明显改善,总有效率86．21％较对照组的17．24％,差异有统计学意义（P〈0．05）;（3）治疗组体重稳定率79．31％较对照组的44．83％,差异有统计学意义（P〈0．05）;（4）扶正为主辨证论治能明显改善晚期NSCLC患者的生活质量,EORTCQLQ—LC43中的躯体、角色、情绪、社会功能领域,总健康状况,疲倦、恶心呕吐、气促、失眠、食欲丧失、便秘、咳嗽、口腔渍疡、脱发的症状领域方面较对照组都有明显改善,差异均有统计学意义（P〈0．05）。结论：（1）中医巩固治疗对晚期非小细胞肺癌一线化疗疾病控制后患者能延长疾病进展时间;（2）中医巩固治疗能明显改善晚期非小细胞肺癌患者一线化疗后中医症状和稳定体重;（3）中医巩固治疗能提高晚期非小细胞肺癌患者一线化疗后生活质量。     

贾文魁教授治疗肺癌经验探析

在2013年10月召开的第22届亚太抗癌大会上,中国工程院院士郝希山说:"亚太地区癌症新增病例占到全球癌症新增病例的45%,死亡人数约占全球癌症死亡人数的一半,肺癌、胃癌和肝癌是亚洲国家最常见的3种癌症。目前,肺癌是亚洲国家面临的最主要癌症。"肺癌属于疑难病,挖掘有效的治疗方法已是医学界热门的研究课题。贾文魁教授对肺癌的中医治疗有着丰富的临床经验,从临床角度提出"温阳散结化癌瘤、肺癌重在虚和痰、一扶三保贯始终"等一系列治疗方法和思想,在肺癌的临床治疗中取得了满意的效果。     

成人免疫前后乙肝抗体水平研究

目的 观察乙肝疫苗接种成人后疫苗应答效果,为制定移动人群乙肝预防方案提供依据。方法 对随机观察的674名受试者采用酶联免疫吸附试验(ELISA)检测免疫前后血清中抗-HBs。对检测结果抗-HBs S/N≥2.1mIu/ml的阳性者均强化免疫接种乙肝疫苗1支(5μ/0.5ml);而乙肝HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc均阴性者,全程免疫接种乙肝疫苗3支。统计方法:χ~2检验、秩和检验、2xC表线性回归分析、用Poisson分布与正态分布法估总体率可信区间。结果①对219例阳性者,强化免疫后产生抗-HBs S/N≥2.1mIu/ml～9.9mIu/ml)平均阳性率由63.01％(56.62％～69.41％)下降至27.40％(21.89％～32.90％);而抗-HBs S/N(≥10mIu/ml)回升至72.6％(66.70％～78.51％)。免疫前后差异有统计学意义(χ~2=54.65,P<0.01)。②对472例阴性者全程免疫接种乙肝疫苗第一针后,产生抗-HBs S/N≥2.1mIu/ml,平均阳性率为10.81％(8.00％～13.61％),而第三针免疫后达到74.36％(70.43％～78.30％);第三针免疫后,抗-HBs S/N≥10mIu/ml,平均阳性率为29.45％(25.34％～33.56％);无应答率为25.64％(21.70％～29.57％)。抗-HBs S/N≥10mIu/ml的阳性率,随免疫注射次数呈上升趋势(2xC表线性回归分析,χ~2=186.93,P<0.005)。即随年龄增长免疫应答呈下降趋势。