细节护理对尿毒症血液透析患者的效果研究

目的针对尿毒症血液透析患者护理工作中应用护理细节对其生存质量和并发症的作用予以分析和研究。方法 2017年6月-2018年12月选择本院收治的90例尿毒症透析患者作为研究对象,按照硬币法将所有人随机分为两组,其中常规组45例,细节组45例。采用常规护理对常规组予以护理,在常规护理的基础上,采用细节护理干预措施对细节组予以护理。对两组患者的护理效果进行分析和比较。结果在SF-36评分方面,两组患者护理前比较差异无统计学意义(P>0.05),护理后,细节组明显优于常规组(P<0.05)。在并发症发生率方面,细节组明显低于常规组(P<0.05)。结论采用细节护理干预措施对尿毒症血液透析患者进行护理效果很好,患者的生存质量经过护理后具有很大改善,且并发症也明显减少。     

Éthique de la recherche : réglementations françaises et applications en oncologie radiothérapie

French regulations about research ethics are based on the so-called Jardé law, which defines researches involving human beings. Researches involving human beings require the submission of research protocols to a committee for protection of persons with a precise list of documents to submit for a favourable opinion. This law describes different categories of researches and determines the ethical procedures to apply before setting up a research protocol. This issue of categorisation is central and must be taken into account by researchers from the beginning of the research process. Researches considered as not involving human beings also require a set of ethical precautions focused on patients’ information and the collection of their non-opposition (due to the application of the General Data Protection Regulation adopted by the European Parliament). Thus, many regulations exist and they require a real work for researchers to meet these requirements in research ethics. This article aims to summarise French regulations. Selected examples are specifically taken into the field of radiation oncology research.     

复方鲜竹沥液联合噻托溴铵粉雾剂治疗慢性阻塞性肺疾病急性加重期的临床研究

目的研究复方鲜竹沥液联合噻托溴铵粉雾剂治疗慢性阻塞性肺疾病急性加重期的临床疗效。方法选取2018年9月—2019年9月在安阳市第六人民医院治疗的100例慢性阻塞性肺疾病急性加重期患者,将所有患者随机分为对照组和治疗组,每组各50例。对照组吸入噻托溴铵粉雾剂,1粒/次,1次/d。治疗组在对照组基础上口服复方鲜竹沥液,20 mL/次,3次/d。两组持续治疗3个月。观察两组的临床疗效,比较血气指标、肺功能指标、血清炎性因子水平。结果治疗后,治疗组总有效率94.00%显著高于对照组82.00%(P0.05)。治疗后,两组二氧化碳分压(pCO_2)显著降低,血氧分压(pO_2)显著升高(P0.05),且治疗组血气指标改善程度较大(P0.05)。治疗后,两组第一秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、每分钟最大通气量(MVV)显著升高,残气量/肺总量(RV/TLC)明显降低(P0.05);且治疗组肺功能指标改善较多(P0.05)。治疗后,两组白细胞介素-17(IL-17)、IL-8、肿瘤坏死因子-α(TNF-α)水平显著降低(P0.05);并且治疗组血清炎性因子水平降低较多(P0.05)。结论复方鲜竹沥液联合噻托溴铵粉雾剂治疗慢性阻塞性肺疾病急性加重期具有较好的临床疗效,可改善血气指标和肺功能指标,降低血清炎性因子水平,值得在临床上推广应用。     

自我护理理论在预防妇产科术后疼痛中的效果

目的探究自我护理理论在预防妇产科术后疼痛中的效果。方法选取我院2018年1月-2019年2月期间治疗的妇产科手术患者130例,其中65例采用常规护理,为对照组;另外65例在护理中应用自我护理理论,为观察组。比较分析两组患者的术后疼痛(VAS)、术后住院时间、护理满意度和并发症发生率。结果观察组术后VAS评分(2.13±0.65)分和术后并发症发生率(4.62%)低于对照组[(3.52±0.74)分,(15.38%)],其住院时间(6.48±1.82)d短于对照组(8.75±2.11)d,护理满意度评分(92.34±4.33)分高于对照组(84.26±6.17)分,差异有统计学意义(P<0.05)。结论对妇产科手术患者实施自我护理理论能够减轻患者术后疼痛,降低并发症发生率,缩短住院时间,提高护理满意度。     

Respiratory disease in pregnancy

Physiological changes to the respiratory system in pregnancy make breathlessness a common symptom. However, it is still important to investigate symptoms of breathlessness to exclude pathological causes. This review illustrates some unusual cases of women presenting with breathlessness in pregnancy. Prompt recognition, investigation and management of these women is essential as delays can impact the mother and the neonate. Investigations should be used appropriately and not withheld or delayed due to pregnancy. Effects of respiratory conditions on pregnancy and the neonate are also discussed.     

Understanding and helping children who have experienced maltreatment

Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. This has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the paper these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.     

从母胎界面着眼探究子痫前期的发病机制

        子痫前期（pre-eclampsia，PE）是指妊娠20周以后出现的新发高血压伴多系统受累和损害的综合征。在世界范围内，每年子痫前期可造成大于50万新生儿和胎儿以及大于7万孕产妇死亡，全球发病率约2%～8%［1］。而重度子痫前期可继发出现溶血、肝酶升高、血小板减少等，即HELLP综合征，导致全身多个系统器官损害。子痫前期是多种因素共同作用所致，因此应该从多角度、多机制探究子痫前期的分子病理学基础，方有可能实现PE的早期预测和预防。 浏览更多请关注本刊微信公众号及当期杂志。     

Trial of Labor After Cesarean in Adolescents – A Multicenter Study

Study ObjectiveData regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.DesignA multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.ResultsThe study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.ConclusionsTOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.