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。     

经桡动脉途径行外周血管介入的临床研究

目的评价经桡动脉途径(TRA)行外周血管介入的安全性和可行性。方法回顾性收集2017年9月至2019年3月于中国医学科学院肿瘤医院TRA行外周血管介入治疗的106例肿瘤患者的临床资料,分析患者的桡动脉穿刺率、穿刺完成后续操作的手术成功率以及术后30 d内相关并发症。结果106例患者中,TRA外周血管介入操作112例次,其中行经导管肝动脉化疗栓塞术83例次,支气管动脉灌注术4例次,盆腔肿瘤栓塞术11例次,其他手术14例次。所有介入操作穿刺成功率为97.3%(109/112),手术成功率为98.2%(107/109)。5例患者TRA失败,转为股动脉穿刺,并顺利完成操作。手术严重并发症为主动脉夹层2例次;轻微并发症中,桡动脉闭塞2例次,桡动脉痉挛1例次,手臂疼痛1例次,穿刺点血肿1例次。严重并发症和轻微并发症发生率分别为1.8%(2/112)和4.5%(5/112)。急诊操作16例次,均顺利完成操作,无并发症发生。结论TRA行外周血管介入治疗是安全、可行的。     

正念行为护理对肺癌合并肺结核患者的护理效果观察

目的探讨正念行为护理对肺癌合并肺结核患者的护理效果。方法选取2019年1月至2020年1月间陕西省结核病防治院收治的97例肺癌合并肺结核患者,采用随机数表法分为对照组和观察组。对照组49例患者采用亲情护理,观察组48例患者采用正念行为护理。比较两组患者的屈服、回避和面对评分、自我效能感量表(GSES)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分及生活质量。结果护理后,两组患者的屈服、回避、SDS和SAS评分均较护理前降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。护理后,两组患者的面对、GSES、情绪功能、社会功能、认知功能、躯体功能和角色功能评分均较护理前升高,且观察组均高于对照组,差异均有统计学意义(均P<0.05)。结论正念行为护理能促进肺癌合并肺结核患者养成积极的应对方式,提高自我效能,减轻不良情绪,提高生活质量,值得推广。     

Comparative Outcome Analysis of N-Butyl Cyanoacrylate Embolization of the False Lumen Versus Thoracic Endovascular Aortic Repair in Aortic Dissection

PurposeTo evaluate the feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) embolization for the treatment of aortic dissection.Materials and MethodsIn this single-center retrospective study conducted from February 2003 to June 2019, NBCA embolization of an aortic false lumen was attempted in 12 patients (median age, 59 y; range, 41–68 y) and thoracic endovascular aortic repair (TEVAR) was performed in 53 patients (median age, 59 y; range, 37–70 y) for aortic dissection with one or more indications of persisting pain, malperfusion, rupture or impending rupture, maximal aortic diameter ≥ 55 mm, and/or rapid aortic enlargement. The main exclusion criterion for embolization was the presence of fast blood flow in the aortic false lumen on aortography. The efficacy of NBCA embolization and TEVAR was compared by evaluating technical and clinical outcomes, repeat intervention–free survival (RFS), and overall survival (OS).ResultsTechnical success was achieved in 11 of the 12 patients treated with NBCA embolization (91.7%), and clinical success was achieved in 9 of these 11 (81.8%). No significant difference was found between embolization and TEVAR in clinical success rates (embolization, 81.8%; TEVAR, 84.9%; P = .409) or procedure-related complications (embolization, 1 patient [8.3%]; TEVAR, 4 patients [7.5%]; P = .701). In addition, embolization showed comparable 5-y RFS (embolization, 82.5% ± 9.3; TEVAR, 85.5% ± 4.8; P = .641) and 5-y OS (embolization, 100%; TEVAR, 95.4% ± 3.2; P = .744) rates to TEVAR.ConclusionsNBCA embolization of the false lumen in aortic dissection seems to be a safe and effective treatment modality for the closure of false lumen in selected patients.     

Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundContrast associated-acute kidney injury (CA-AKI) has been associated with adverse outcomes after ST-segment elevation myocardial infarction (STEMI). However, early markers of CA-AKI are still needed to improve risk stratification. We investigated the association between elevated serum uric acid (eSUA) and CA-AKI in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).Methods and resultsSerum creatinine (Scr) was measured at admission and 24, 48 and 72 h after pPCI. CA-AKI was defined as an increase of 25% (CA-AKI 25%) or 0.5 mg/dl (CA-AKI 0.5) of Scr level above the baseline after 48 h following contrast administration. Multivariable analyses to investigate CA-AKI predictors were performed by binary logistic regression and multivariable backward logistic regression model.In the 3023 patients considered, CA-AKI was more frequent among patients with eSUA as compared with patients with normal SUA levels, considering both CA-AKI definitions (CA-AKI25%: 20.8% vs 16.2%, p < 0.012; CA-AKI 0.5: 10.1% vs 5.8%, p < 0.001). The association between eSUA and CA-AKI was confirmed at multivariable analyses (CA-AKI 25%: odd ratio 1.32, 95% CI 1.03–1.69, p = 0.027; CA-AKI 0.5: odd ratio 1.76, 95% CI 1.11–2.79, p = 0.016).ConclusionElevated serum uric acid is associated with CA-AKI after reperfusion in patients with STEMI treated with pPCI.     

The effectiveness of specialized nursing interventions for patients with Parkinson disease: A randomized controlled study protocol

Background:The purpose of this experiment is to evaluate the impact of the care of Parkinson disease nurse specialist on improving motor symptoms and life quality for patients with Parkinson disease (PD).Method:This is a randomized controlled research, and it will be conducted from April 2021 to October 2021 at Sichuan Provincial People''s Hospital. The experiment was granted through the Research Ethics Committee of Sichuan Provincial People''s Hospital (004510293). All the patients suffer from PD, age 18 years or older, both female and male, regardless of the duration or severity of this disease are eligible. The exclusion criteria contains: lack sufficient knowledge to complete questionnaires, serious physical comorbidities or refuse to take part in the program. In our experiment, the major result measures are motor symptoms and life quality. For the measurement of life quality, we will utilize Parkinson disease Questionnaire-39, the most extensively utilized the scale of life quality in PD. The evaluation of motor symptoms severity is carried out with the revision of Unified Parkinson Disease Rating Scale sponsored by Movement Disorder Society.Results:Table 1 indicates clinical outcomes at different time points.Conclusion:The Parkinson''s disease nurse specialist care may promote the life quality in the PD patients.Trial registration number:researchregistry 6284.     

Conserving resources in the diagnosis of intraoral fibroepithelial polyps

Fibroepithelial polyps (FEPs) are common, benign intraoral lesions that tend to develop slowly at predictable sites, often in response to local irritation or trauma. Historical precedent often results in referral to oral and maxillofacial surgery (OMFS) departments for biopsy, often irrespective of symptoms, and histological assessment. OMFS and pathology services are struggling to cope with an increasing workload that will potentially lead to widespread delays to diagnosis and treatment. Over the past 20 years, clinical pathways and guidance have been developed to ensure that healthcare interventions, such as the removal of third molars, tonsils, skin tags, and benign moles, are evidence-based, have a net patient benefit, and ensure the best use of finite NHS resources. However, no such guidance exists for intraoral lesions and we regard this as an oversight. We analysed the removal of 682 FEPs over a seven-year period and report sensitivities of 92.4% for a “confirmed clinical suspicion of an FEP” and 99.7% for a “confirmed clinical suspicion of a benign diagnosis”. The incidence of non-benign disease was 0.3%. Primary care dentists should be able to diagnose and monitor FEPs and refer only if symptoms are serious or in high-risk patients or sites. Adopting this practice across the UK could free up to 1825 four-hour OMFS clinics, 405 hours of consultant histopathologists’ time, and recurring savings to the NHS estimated to be in the region of £620 000/annum. We believe that the removal of FEPs should be reclassified as an “intervention not normally funded”, and the time and resources put to better use treating patients with lesions of questionable pathology.     

妊娠期高血压疾病危险因素及护理干预新进展

妊娠期高血压疾病是女性妊娠期间极为常见的一种妊娠并发症，亦为妇产科临床中极为常见的一种病症，该病症可产生 极大的危害性。目前临床主要站在流行病学角度上研究妊娠期高血压疾病，针对该病症的发病诱因、机制等尚未有统一认识形 成。本文主要分析和总结妊娠期高血压疾病的相关危险因素和护理干预措施，以供今后临床作参考。