基于Brown高级护理实践的癌痛专科护士岗位构建

通过文献回顾总结当前国内疼痛专科护士发展及癌痛管理中的不足,在此基础上以Brown高级护理实践理论框架为理论指导,侧重于资格要求、癌痛评估以及出院后的随访对癌痛专科护士岗位构建进行设计,旨在更好地促进癌痛专科护理的开展,提升癌痛护理水平。     

Comparison of Shoulder-Arm Complex Pain,Function, and Scapular Dyskinesia in Women With and Without Unilateral Lymphedema After Breast Cancer Surgery

IntroductionLymphedema is the most important complication seen after breast cancer surgery. The study aimed to evaluate pain, shoulder-arm complex function, and scapular function in women who developed lymphedema after breast cancer surgery and to compare these with women without lymphedema.Materials and MethodsFifty women with lymphedema (age, 54.34 ± 9.08 years; body mass index, 30.10 ± 4.03 kg/cm²) and 57 women without lymphedema (age, 53.68 ± 9.41 years; body mass index, 29.0 ± 5.44 kg/cm²) after unilateral surgery for breast cancer were included. Clinical and demographic information was noted. The severity of lymphedema with perimeter measurements (Frustum model), level of heaviness discomfort sensation with a visual analog scale, pain threshold with a digital algometer, shoulder-arm complex functionality with the Disabilities of the Arm, Shoulder, Hand Problems Survey (DASH), and scapular function with observational scapular dyskinesia and lateral scapular sliding tests were assessed. The t test, χ² test, and Mann-Whitney U test were used for analyses.ResultsThe follow-up duration after the surgery was 4.24 ± 2.97 years and 3.19 ± 1.76 years, and the upper extremity volume was 2106.65 ± 510.82 cm³ and 1725.92 ± 342.49 cm³ in the lymphedema group and in the no-lymphedema group, respectively. In the lymphedema group, arm-heaviness discomfort, pain threshold levels in the trapezius and deltoid muscles, and DASH scores were worse (P < .05). The rate of scapular dyskinesia (70.0%) and type 2 scapula (32%) in the surgical side was higher in patients with lymphedema.ConclusionThe pain pressure threshold in the trapezius and deltoid muscles, heaviness sensation level, and inadequate upper extremity function are significantly higher in patients with lymphedema, and the scapular dyskinesia rate was higher.     

Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol

ObjectiveTo evaluate differences in postoperative pain control and opioids requirement in thoracic surgical patients following implementation of an Enhanced Recovery after Thoracic Surgery protocol with a comprehensive postoperative pain management strategy.Material and MethodsA retrospective analysis of a prospectively maintained database of patients undergoing pulmonary resections by robotic thoracoscopy or thoracotomy from January 1, 2017, to January 31, 2019, was conducted. Multimodal pain management strategy (opioid-sparing analgesics, infiltration of liposomal bupivacaine to intercostal spaces and surgical sites, and elimination of thoracic epidural analgesia use in thoracotomy patients) was implemented as part of Enhanced Recovery after Thoracic Surgery on February 1, 2018. Outcome metrics including patient-reported pain levels, in-hospital and postdischarge opioids use, postoperative complications, and length of stay were compared before and after protocol implementation.ResultsIn total, 310 robotic thoracoscopy and 62 thoracotomy patients met the inclusion criteria. This pain management strategy was associated with significant reduction of postoperative pain in both groups with an overall reduction of postoperative opioids requirement. Median in-hospital opioids use (morphine milligram equivalent per day) was reduced from 30 to 18.36 (P = .009) for the robotic thoracoscopy group and slightly increased from 15.48 to 21.0 (P = .27) in the thoracotomy group. More importantly, median postdischarge opioids prescribed (total morphine milligram equivalent) was significantly reduced from 480.0 to 150.0 (P < .001) and 887.5 to 150.0 (P < .001) for the thoracoscopy and thoracotomy groups, respectively. Similar short-term perioperative outcomes were observed in both groups before and following protocol implementation.ConclusionsImplementation of Enhanced Recovery after Thoracic Surgery allows safe elimination of epidural use, better pain control, and less postoperative opioids use, especially a drastic reduction of postdischarge opioid need, without adversely affecting outcomes.     

There is a difference in functional ankle stability between different types of footwear in male athletes: A cross-sectional study

ContextLateral ankle sprains (LAS) are among the most common injuries in sports, with a poor long – term prognosis due to high chronicity and recurrence rates. Chronic ankle instability (CAI) results up to 40% of people that endured a first – time LAS.ObjectiveThe aim of this study was to compare ankle stability between groups characterised by the use of different types of footwear during their sport activities.DesignCross-sectional study.SettingFirm training surface, local sport clubs.ParticipantsFifty - one male subjects were recruited, distributed in four groups based on the type of footwear they use during their sport activities.Main outcome measuresAll subjects performed four clinical ankle stability tests, and completed the Dutch version of the Cumberland Ankle Instability Tool (CAIT) and Profile of Mood States (POMS). All clinical ankle stability tests were performed barefoot.ResultsSubjects performing their sport activities barefoot scored better than subjects performing their sport with shoes at the multiple hop test (p = .002 to .047) and executed the figure–of–8 hop test significantly faster than subjects with submalleolar ankle support (AS) (p = .019). Subjects with submalleolar AS and studs showed significantly better results than subjects with supramalleolar AS on the CAIT– score (p = .024, p = .030) and the side– hop test (p = .050, p = .045). They also scored significantly better than subjects with submalleolar AS for the side – hop test (p = .032), foot – lift test (p = .019) and figure–of 8 hop test (p = .011).ConclusionBarefoot sports performing subjects appear to have better ankle stability compared to subjects performing their sports with shoe support. Subjects performing sports with high AS appear to have worst ankle stability.Level of evidence: Level III, Cross–sectional study.     

Mortality prediction in chronic obstructive pulmonary disease and obstructive sleep apnea

BackgroundWe aimed to assess mortality in chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and overlap syndrome, and evaluate which polysomnographic indices—apnea-hypopnea index (AHI) or hypoxemic load measurements—better predict mortality within 10 years.MethodsAdults with symptoms suggestive of sleep apnea and airway disease who underwent both polysomnography and spirometry plus bronchodilator response tests between 2000 and 2018 were included and divided into four groups according to presence of COPD and moderate-to-severe OSA (AHI ≥15/h). We estimated mortality using a Cox model adjusted for demographic/anthropometric covariates and comorbidities; this was called clinical model. To evaluate prognostic performance, we compared the concordance index (C-index) between clinical model and extended models, which incorporated one of polysomnographic indices—AHI, sleep time spent with SpO₂ < 90% (TS90), and mean and lowest SpO₂.ResultsAmong 355 participants, patients with COPD alone (57/355, 16.1%) and COPD–OSA overlap syndrome (37/355, 10.4%) had increased all-cause mortality than those who had neither disease (152/355, 42.8%) (adjusted HR, 2.98 and 3.19, respectively). The C-indices of extended models with TS90 (%) and mean SpO₂ were significantly higher than that of clinical model (0.765 vs. 0.737 and 0.756 vs. 0.737, respectively; all P < 0.05); however, the C-index of extended model with AHI was not (0.739 vs. 0.737; P = 0.15).ConclusionsIn this cohort with symptoms of sleep apnea and airway disease, patients with overlap syndrome had increased mortality, but not higher than in those with COPD alone. The measurement of hypoxemic load, not AHI, better predicted mortality.     

医用退热贴冷敷治疗产后生理性乳房胀痛的效果观察

目的 比较医用退热贴冷敷及卷心菜叶外敷2种方法对缓解产后生理性乳房胀痛的疗效。方法 选取2018年3-12月在产科住院的产后生理性乳房胀痛的患者100例为研究对象,将其随机分为对照组和观察组,各50例。对照组采用卷心菜叶外敷,观察组采用医用退热贴冷敷。结果 观察组产后生理性胀痛乳房评分低于对照组(Z=-2.568,P=0.010),乳房硬度优于对照组(Z=-4.361,P<0.001),使用维持时间长于对照组(t=19.804,P＜0.001)。结论 医用退热贴冷敷用于产后生理性乳房胀痛效果理想,操作方法简单易行,实施方便,易被产妇接受,值得临床推广应用。     

Effects of throat packs during orthognathic surgery: a double-blind randomized controlled clinical trial

Throat packs are commonly used in maxillofacial surgeries. However, the evidence to support the benefits of their use is controversial. The aim of this study was to evaluate the effectiveness of throat packs in preventing postoperative nausea and vomiting, and their influence on the incidence of sore throat and dysphagia in patients undergoing orthognathic surgery. This was a prospective double-blind randomized study with 54 patients, who were randomized to two groups: with throat pack (n = 27) and without throat pack (n = 27). Fifty patients (25 in each group) were included in the analysis; 66% female and 34% male, mean age 29.44 ± 8.53 years. Postoperative nausea and vomiting (Kortilla scale), sore throat (visual analogue scale), and dysphagia were evaluated. Statistically significant differences in favour of the without-pack group were found for the variables throat pain at 24 hours (P = 0.002) and dysphagia at 2 hours (P = 0.007) and 24 hours (P < 0.001). There was no difference between the groups regarding postoperative nausea and vomiting (P = 1.00). The results of this study indicate that throat packs as utilized here do not prevent postoperative nausea and vomiting and are associated with worse sore throats and postoperative dysphagia.     

CGF联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的比较

目的探讨血小板浓缩生长因子(CGF)联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的临床疗效。方法选择80例慢性窦道型根尖周炎患者为研究对象,分成CGF组和对照组。对照组采取根尖刮治术治疗,CGF组在对照组基础上给予CGF覆盖根尖区创面治疗。结果 CGF组治疗后总有效率95.00%显著高于对照组77.50%。CGF组治疗后PD、BOP和PLI显著低于治疗前及对照组治疗后。CGF组治疗后EGF、VEGF和IGF显著高于治疗前及对照组治疗后。CGF组颜色匹配、边缘着色和表面光滑度评分显著低于对照组。两组并发症总发生率对比无显著差异。结论 CGF联合根尖刮治术治疗慢性窦道型根尖周炎患者,可提高治疗效果,安全性较高。