延续性护理干预对提高癌痛患者镇痛效果的临床研究

目的 探讨在癌痛示范病区延续性护理干预对提高癌痛患者镇痛效果的临床研究.方法 选取笔者所在工作单位的三甲医院肿瘤内科86例晚期住院癌痛患者作为研究对象,采用单纯随机抽样法将其分为对照组与实验组,每组43人.前者予以癌痛示范病区实施癌痛规范化管理,后者在癌痛规范化管理的基础上借助微信平台对出院患者实施延续性用药指导及人文关怀,出院后2～3周随访两组患者对疼痛知识的知晓率、疼痛评估准确率、爆发痛的发生率、治疗依从性及生活质量评分.结果 结合研究数据分析实验组癌痛患者对疼痛知识的知晓率、疼痛评估正确率、治疗依从性及生活质量评分均优于对照组,爆发痛的发生率显著低于对照组,均有统计学意义(P<0.05).结论 在癌痛示范病区实施延续性护理干预对提高癌痛患者的镇痛效果显著,对改善晚期癌痛患者的生活质量有研究意义和临床应用价值,愿广大医护同仁鉴定,采纳.     

基于微信平台提供的延续性护理对癌痛患者疼痛及生活质量的影响

目的 分析基于微信平台提供的延续性护理对癌痛患者疼痛及生活质量的影响。方法 按照随机抽签法将 2021 年 5 月至 2022 年 5 月在我院就诊的 86 例癌痛患者分为对照组和观察组，每组各 43 例。对照组开展常规护理及出院指导，观察组在对照 组基础上开展基于微信平台的延续护理。比较两组疼痛程度、疼痛控制率、自我管理效能感及生活质量。结果 观察组视觉疼 痛模拟（VAS）评分低于对照组（P<0.05）。观察组疼痛控制有效率（90.70%）高于对照组（67.44%）（P<0.05）。观察组自我 管理效能感、生活质量评分高于对照组（P<0.05）。结论 癌痛患者开展基于微信平台的延续性护理服务，能够提高自我管理效 能感，减轻疼痛程度，提高生活质量。     

微信在下肢骨折患者出院延续性康复护理中的应用

目的 探讨运用微信实施下肢骨折患者出院后延续性康复护理的效果。方法 选取复旦大学附属金山医院2020年4月～2020年12月下肢骨折患者120例，随机分为对照组和实验组，分别予以常规出院康复宣教及常规出院康复宣教+利用微信实施延续性康复护理，干预后分别使用服药依从性量表、Barthel指数、肌力分级评定出院时及出院后1、3个月患者服药依从性及功能恢复情况。观察利用微信实施延续性康复护理的效果。结果 使用微信对下肢骨折出院患者实施延续性康复护理后，实验组患者出院后1、3个月Barthel指数、肌力、Morisky服药依从性量表评分均高于对照组（P＜0.05）。结论 使用微信对下肢骨折患者出院后实施延续性康复护理可以明显促进出院后患者康复情况、提高日常生活能力及服药依从性。     

基于APP平台的健康教育在居家癌性疼痛患者延续护理中的应用研究

目的探讨以APP平台为基础的健康教育在居家癌痛患者中的应用及效果评价。方法选取140例首次使用阿片类镇痛药物的居家癌痛患者为对照组,140例为干预组。对照组沿用常规方法进行健康教育,干预组在此基础对患者或家属采用APP进行延续性健康教育护理,连续干预3个月。研究结束后,比较两组患者出院时、出院3个月后生活质量、焦虑、抑郁程度。结果出院3个月后,干预组居家癌痛患者生活质量高于对照组,焦虑和抑郁评分低于对照组,差异均有统计学意义。结论基于APP平台的延续性健康教育有效改善了患者的症状,提高了生活质量,改善了焦虑、抑郁状况,对居家癌痛患者进行延续护理应用效果较好,值得临床推广和借鉴。     

微信平台路径式管理在垂体瘤术后患者延续性护理中的应用

目的:探讨微信平台路径式管理模式在垂体瘤手术患者出院后延续性护理中的应用效果。方法:将112例经鼻蝶手术治疗的垂体瘤患者随机分为对照组和观察组各56例。对照组出院时给予出院指导,观察组在对照组基础上采用微信平台路径式管理模式实施延续性护理。观察两组用药依从性、疾病知识掌握程度、定期复诊率及护理满意度。结果:观察组用药依从性评分、疾病知识掌握程度、定期复诊率及护理满意度均高于对照组(P0.05)。结论:微信平台路径式管理模式能有效提高垂体瘤术后患者延续性护理的健康教育效果及护理满意度。     

基于微信的延续性护理对妇科恶性肿瘤患者生活质量的影响

目的分析、探讨基于微信的延续性护理模式对妇科恶性肿瘤患者生活质量的影响。方法采用便利抽样法,选取2013年6月~2015年6月在本院实施手术及化疗的62例妇科恶性肿瘤患者作为研究对象,按随机数字表法将将62例恶性肿瘤患者分为对照组与实验组各31例,实验组出院后给予基于微信的延续性护理,对照组给予常规随访指导。出院半年后,采用癌症患者生活质量核心问卷,进行生活质量测评,观察基于微信的延续性护理模式对妇科恶性肿瘤患者生活质量的影响效果。结果实验组的角色功能、躯体功能、认知功能、情绪功能、社会功能、整体生活质量六个维度评分及治疗依从性均高于对照组,两组比较差异有统计学意义(P0.05)。结论基于微信的延续性护理模式可提高妇科恶性肿瘤患者生活质量,方法经济有效,简便易行,值得在临床普遍推广应用。     

延伸护理对癌痛患者出院期间用药依从性的影响

目的探讨延伸护理对癌痛患者出院期间用药依从性的影响。方法将128例出院的癌痛患者随机分为对照组和实验组,两组均实行出院时常规指导,并对实验组实施延伸护理。比较两组出院3个月后疼痛控制效果及控制满意度。结果实验组疼痛控制效果好于对照组(P0.05);疼痛控制满意度高于对照组(P0.05),说明实验组用药依从性好于对照组。结论开展延伸护理有效提高了癌痛患者出院后用药的依从性,提高了镇痛效果,提升了患者的满意程度。     

基于微信平台的延续性护理在肠造口患者院外自我护理中的应用

目的:探讨基于微信平台的延续性护理在肠造口患者院外自我护理中的应用效果。方法:将2013年1月~2015年11月我院160例肠造口患者分为实验组和对照组各80例。实验组以基于微信平台的延续性护理进行造口指导,对照组按常规方法进行指导。结果:实验组造口并发症发生率明显低于对照组(P0.05);生活质量评分中,食欲、疲乏、疼痛、治疗副作用、面部表情、家庭理解配合、同事理解配合、对癌症的认识、对治疗的态度等项目得分明显高于对照组(P0.05);对护理指导满意度明显高于对照组(P0.05)。结论:基于微信平台的延续性护理运用于肠造口患者自我护理中,可以有效降低肠造口并发症发生率,提升生活质量,提高患者对护理指导的满意度。     

微信对心血管病患者进行延续性护理的效果评价

目的:探讨运用微信对心血管病患者进行延续性护理的效果,为医院发展慢性病原理提供参考.方法:采用随机数字表法将我院心内科住院的68例心血管病患者分为试验组和对照组,每组为34例.对照组实行常规的出院健康教育;试验组除了常规出院健康教育外,由微信延续性护理小组成员运用微信对其出院的延续性护理.比较两组患者在出院后3月的焦虑抑郁程度指标.结果:出院后3月,试验组患者焦虑抑郁测评结果优于对照组,差异有统计学意义(P＜0.05).结论:运用微信对心血管病患者进行延续性护理的效果较好.     

微信在痛风性关节炎患者延续护理中的应用

目的探讨微信在痛风性关节炎出院患者延续性护理中的应用效果。方法选择2016年1月~2017年3月在本科住院的90例痛风性关节炎患者,随机分为2组,每组45例。对照组进行常规的出院健康宣教,观察组除进行常规出院健康宣教外,还由微信延续护理小组成员利用微信平台对出院患者进行延续护理。比较2组患者出院3个月复查时的焦虑抑郁程度、血尿酸指标、服药依从性以及痛风相关知识掌握情况。结果 2组患者出院后3个月复查时,观察组综合性医院焦虑、抑郁亚量表测评结果、血尿酸指标、服药依从性以及痛风相关知识掌握情况均明显优于对照组(P0.05)。结论运用微信对痛风性关节炎出院患者进行延续性护理的效果较好,值得在临床上推广。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.