精神障碍患者跌倒事件108例分析及预防策略

目的分析精神障碍患者在住院期间跌倒风险因素, 以针对性改进预防对策, 提升护理质量。方法收集深圳市精神卫生中心(深圳市康宁医院)2021年1月至2022年12月院内发生的精神障碍患者跌倒事件108例为研究对象, 采用横断面描述性研究设计, 分析与跌倒事件相关的临床指标。结果 108例跌倒患者中, 男性39例, 女性69例;年龄范围12～88岁, 年龄(46.0±18.5)岁, < 60岁87例(80.6%), ≥ 60岁21例(19.4%);住院时间(32.2±50.4)d;精神分裂症37例, 抑郁发作13例, 双相障碍15例, 其他(癫痫、酒精所致精神障碍等)43例。在108例跌倒事件中, 在入院时被评估为跌倒高危人群40例(37.0%), 未被评估为高危人群68例(63.0%);跌倒地点:床旁38例(35.2%), 走廊43例(39.8%), 卫生间21例(19.4%), 其他场所6例(5.6%);发生跌倒时间:发生于床旁的跌倒时间20:00～08:00, 发生于走廊的跌倒的时间06:00～20:00;跌倒前24 h内服用药物:抗抑郁/抗精神病药57例(52.8%), 镇静/...     

呼吸内科住院患者跌倒原因分析及护理对策

目的探讨呼吸内科住院患者意外跌倒发生的原因及对策。方法对2011年11月至2012年11月住院跌倒的4 650例患者进行回顾性分析,了解患者跌倒的情况及跌倒发生的原因。结果在4 650例住院患者中,9例发生跌倒,占住院患者的0.19%,主要集中在高龄患者(>65岁者占55.56%);跌倒主要发生在高危时段(中班占33.33%,夜班占44.44%),以肺癌患者和呼吸衰竭患者为主,且责任护士均为护龄小于3年的低年资护士。结论呼吸内科患者发生跌倒的高危因素较多,跌倒风险大,应从改善环境、加强护士风险评估和预测及患者、家属、陪护的健康教育等方面降低呼吸内科住院患者跌倒的发生。     

肾内科住院患者跌倒的原因分析及护理对策

目的对肾内科住院患者跌倒的原因进行调查与分析,且提出有效的护理对策,以降低跌倒率。方法 1799例肾内科住院患者作为研究对象,其中55例患者均存在跌倒史(住院期间8例、居家期间47例),对其临床资料进行回顾性分析,以了解其跌倒的原因。结果 55例跌倒患者有18例为年龄因素(32.7%),12例为药物因素(21.8%),10例为环境因素(18.2%),9例为心理因素(16.4%),6例为护士因素(10.9%)。结论年龄、药物、环境、心理以及护士等,是导致肾内科住院患者发生跌倒事件的原因;临床上应予以切实有效的措施,如跌倒评估、打造安全的环境、加强宣教等,以降低跌倒事件的发生。     

CATCH模型在神经内科住院患者跌倒预防管理中的应用

目的 探讨CATCH模型在神经内科住院患者跌倒预防管理中的应用效果。方法 选取自贡市第一人民医院神经内科2015-2017年17 220例住院患者为对照组，实施常规跌倒预防措施；2018-2020年19 264例住院患者为试验组，在常规措施基础上应用CATCH模型开展跌倒管理工作；比较两组患者跌倒发生率及伤害率，分析跌倒发生的规律。结果 干预后跌倒发生率由0.370‰降至0.274‰,差异有统计学意义(P<0.05);试验组跌倒伤害占比为66.04%,低于对照组(75.00%),但差异无统计学意义(P>0.05);中重度跌倒伤害占比由43.06%降至18.87%,差异有统计学意义(P<0.05)。结论 CATCH模型能有效降低神经内科住院患者跌倒发生率及中重度跌倒伤害占比。     

心内科患者跌倒风险评估量表应用效果分析

目的 观察使用心内科住院患者跌倒风险评估量表并采取安全护理对策后住院患者跌倒发生情况的变化.方法 2009～2010年应用设计的心内科住院患者跌倒风险评估量表,对该科住院患者跌倒风险进行评估,实施安全护理,预防跌倒的发生(观察组);同时调查2007～2008年心内科住院患者跌倒发生情况(对照组),对两组结果进行比较.结果使用心内科住院患者跌倒风险评估量表后,患者预防跌倒意识加强,跌倒发生率显著下降.结论 对心内科住院患者是否存在跌倒风险危险因素进行评估,并对目标人群采取安全护理对策,可使跌倒发生率显著下降.     

老年脑卒中患者跌倒相关因素分析及护理对策

目的 探讨老年脑卒中患者跌倒的相关因素及护理对策.方法 选取本院2013年1月～2014年1月神经内科收治的75例脑卒中患者作为研究对象,随机为观察组(45例)和对照组(30例).对照组仅进行神经内科常规健康教育,观察组在对照组的基础上进行跌倒评估,并采取防跌倒知识宣教.比较两组的跌倒发生率.结果 年龄≥80岁者发生跌倒的危险性最高,21:00～8:00为跌倒事件高发时间段,跌倒的地点多发生在床边,患者体力不支等是发生跌倒的主要因素.观察组的跌倒发生率显著低于对照组,差异有统计学意义(P＜0.05).结论 通过全面动态评估脑卒中的危险因素,采取有效的护理干预策略,可减少脑卒中患者跌倒的发生,值得临床推广使用.     

2003-2008年住院精神障碍患者跌倒损伤原因分析

目的:探讨住院精神障碍患者跌倒损伤的原因.方法:回顾分析2003-2008年上海市精神卫生中心住院患者发生跌倒损伤的可能因素,分老年组与非老年组进行比较.结果:6年跌倒损伤患者55例,跌倒损伤率3.6‰,其中女性40例,平均年龄(66.33±13.85)岁,60岁以上患者34例.46例(83.6%)服用抗精神病药物,其中19例(34.5%)合并服用2种以上抗精神病药、32例(58.2%)合并服用苯二氮(艹卓)类药物.跌倒发生的场所以厕所旁比例最高(50.9%).与非老年组相比,跌伤老人存在视听功能障碍者多(35.5% vs 0)、服药种类多[(6.12±1.87)vs(3.81±1.94)种]、抗精神病药服用剂量较低[(194.88±211.56) vs(389.10±284.01)mg ]、骨折发生率较高(94.1% vs 61.9%),两组相比均存在显著差异(P＜0.01).结论:年龄大、女性、服用抗精神病药物与苯二氮(艹卓)类药、上厕所可能是精神障碍患者跌倒损伤者的危险因素.老年患者跌倒后损伤更重.     

精神病患者跌倒因素分析及护理干预措施

目的分析精神病患者跌倒的相关因素,探讨护理干预措施。方法选取湘潭市第五人民医院2007年收治的320例住院精神病患者的临床资料进行分析,针对跌倒原因制定护理干预措施,并与2008年350例住院精神病患者进行比较。结果 320例患者共发生跌倒47例(14.69%),与跌倒相关的因素主要有年龄、地点、时间、跌倒方式、药物等,通过制定相应的护理干预对策,2008年350例患者发生跌倒20例(5.71%),较2007年又明显的降低。结论精神病患者跌倒因素较多,通过多方面采取护理措施,能够明显降低跌倒的发生率。     

住院患者跌倒的原因分析及对策

目的通过对住院患者发生跌倒的原因调查与分析,以探索有效的干预措施。方法回顾性调查我院2014年1月~2016年1月上报的56例住院患者发生跌倒的资料,对跌倒的相关因素进行分析。结果发生跌倒的患者年龄65岁的占61.9%,原发病为后循环缺血、脑出血、冠心病及高血压的占48.1%,在病房跌倒的占55.4%,无陪护发生跌倒的占57.1%,患者跌倒的原因主要与家属及护工对识别可能发生跌倒的情况能力不足有关。结论应加强住院患者跌倒高危因素的评估,改善住院环境,加强护患双方防范跌倒的宣教,最大程度地降低住院患者跌倒的发生率。     

慢性阻塞性肺疾病患者跌倒原因分析及预防对策

目的：探讨慢性阻塞性肺疾病患者跌倒的原因及预防策略。方法将2010年1月至2012年4月在该科住院的754例慢性阻塞性肺疾病患者随机分为对照组（320例）和干预组（434例）,对照组患者给予常规护理,干预组患者在常规护理的同时采用跌倒风险评估表对慢性阻塞性肺疾病患者进行评估,对中高危险跌倒患者采取预防措施。观察两组患者跌倒事件的发生率,分析实施预防措施对跌倒事件发生的影响。结果入组患者共计发生跌倒事件10例,跌倒发生率为1.3%,其中以70～90岁患者、跌倒发生时间23：00～7：00、患者如厕前后、当班护士工作年限1～3年为跌倒发生率最高的因素,其跌倒发生率分别为0.9%（7/754）、1.1%（8/754）、1.1%（8/754）、1.1%（8/754）。干预组患者跌倒事件发生率[0.7%（3/434）]明显低于对照组[2.2%（7/320）],差异有统计学意义（P＜0.05）。结论跌倒事件的发生与年龄、基础设施、发生时间、医生、合并疾病和护理缺失等因素有关。采用跌倒风险评估表对慢性阻塞性肺疾病患者进行评估,对中高危跌倒患者采取预防措施,可减少慢性阻塞性肺疾病患者跌倒的发生。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.