与1例失语病人的交流

语言在人类进化过程中已成为重要的交往工具和联络手段[1] 。脑梗死病人 ,由于大脑皮质语言功能区病损 ,发音肌肉瘫痪 ,使其说话、阅读和书写能力残缺 ,不能表达其思想 ,影响了人际间交往 ,给治疗、护理工作带来了很大困难。我院于 2 0 0 2年10月 9日收治 1例多发性脑梗死病人     

Bullous Eruption Associated With Dihydropyridines With Cross Reactivity

The spectrum of cutaneous eruptions associated with dihydropyridines is extensive, varying from exanthemas to severe adverse events. We report a case of bullous eruption, one month after starting nicardipine and lercanidipine. The same symptoms recurred few days after taking nitrendipine.     

Factors Associated With Self-Concept in Children With Asthma

PURPOSE: To investigate the relationship of demographic asthma, family, and child factors with self-concept in children with asthma. METHODS: Data were collected twice approximately 4 years apart from both the affected children and their mothers (N = 134) via interviews and self-report questionnaire. FINDINGS: Children who demonstrated more negative attitudes toward their illness, had less satisfaction with family relationships, and used more negative coping behaviors had the poorest self-concepts. Over time, the greatest improvement in self-concept occurred in children whose attitudes and satisfaction with family relationships improved and whose use of negative coping behaviors decreased. CONCLUSIONS: Results suggest that some children with asthma, especially girls with severe asthma, appear to be at risk for poor self-concept.     

Factors Associated With Home Discharge Among Veterans With Stroke

Objective

To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs.

Design

Retrospective observational study.

Setting

Veterans Affairs facilities nationwide.

Participants

Veterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N=12,565).

Intervention

Not applicable.

Main Outcome Measure

Discharge location after hospitalization.

Results

There were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.11–1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=.04; 95% CI=.03–.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR=.61; 95% CI=.50–.74) or other central nervous system hemorrhage (OR=.78; 95% CI=.63–.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR=1.36; 95% CI=1.07–1.73) were more likely to return home. Evidence of congestive heart failure (OR=.85; 95% CI=.76–.95), fluid and electrolyte disorders (OR=.86; 95% CI=.77–.96), internal organ procedures and diagnostics (OR=.87; 95% CI=.78–.97), and serious nutritional compromise (OR=.49; 95% CI=.40–.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge.

Conclusions

We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.     

Experience With Fibrinogenopenia

Simple pulmonary function tests such as vital capacity, maximum breathing capacity, and tidal volume can be used in any general hospital to aid in diagnosis and treatment of both medical and surgical conditions. Application of the tests in three different situations is described: differentiation of restrictive and obstructive types of pulmonary disease, preoperative evaluation, and n special bronchoscopic study.     

Faulty Assumptions Associated With the Use of Restraints With Children

TOPIC: The use of restraints in nursing and other professions has a long and troubling history, particularly in psychiatric settings. No research evidence has demonstrated restraints to be therapeutically effective. A number of faulty assumptions appear to support the continued practice of this unproven and potentially dangerous intervention. PURPOSE: To present and refute several faulty assumptions using the empirical literature and theory, and to discuss alternatives based on the developmental-ecological theoretical framework for responding to crises in children. SOURCES: Extant empirical literature. CONCLUSION: Alternatives to restraints must be investigated and developed to replace the current reactive, crisis-management orientation of practice.     

Glycation Gap Is Associated With Macroproteinuria but Not With Other Complications in Patients With Type 2 Diabetes

OBJECTIVE

We investigated whether glycation gap (G-Gap), an index of intracellular glycation of proteins, was associated with diabetes complications.

RESEARCH DESIGN AND METHODS

We measured concomitantly HbA_1c and fructosamine in 925 patients with type 2 diabetes to calculate the G-Gap, defined as the difference between measured HbA_1c, and fructosamine-based predicted HbA_1c. Patients were explored for retinopathy, nephropathy, peripheral neuropathy, cardiac autonomic neuropathy (n = 512), and silent myocardial ischemia (n = 506).

RESULTS

Macroproteinuria was the only complication that was associated with G-Gap (prevalence in the first, second, and third tertile of G-Gap: 2.9, 6.2, and 11.0%, respectively; P < 0.001). The G-Gap was higher in patients with macroproteinuria than in those without (1.06 ± 1.62 vs. 0.03 ± 1.30%; P < 0.0001). Because HbA_1c was associated with both G-Gap (HbA_1c 7.0 ± 1.4, 7.9 ± 1.4, and 10.1 ± 1.8% in the first, second, and third G-Gap tertile, respectively; P < 0.0001) and macroproteinuria (HbA_1c 8.8 ± 2.2% if macroproteinuria, 8.3 ± 2.0% if none; P < 0.05), and because it could have been a confounder, we matched 54 patients with macroproteinuria and 200 patients without for HbA_1c. Because macroproteinuria was associated with lower serum albumin and fructosamine levels, which might account for higher G-Gap, we calculated in this subpopulation albumin-indexed fructosamine and G-Gap; macroproteinuria was independently associated with male sex (odds ratio [OR] 3.2 [95% CI 1.5–6.7]; P < 0.01), hypertension (2.9 [1.1–7.5]; P < 0.05), and the third tertile of albumin-indexed G-Gap (2.3 [1.1–4.4]; P < 0.05) in multivariate analysis.

CONCLUSIONS

In type 2 diabetic patients, G-Gap was associated with macroproteinuria, independently of HbA_1c, albumin levels, and confounding factors, suggesting a specific role of intracellular glycation susceptibility on kidney glomerular changes.Protein glycation is involved in diabetes complications, and glycated hemoglobin (HbA_1c) level is associated with diabetes complications. Because glycation starts with glucose, it has been assumed that mean blood glucose is at the beginning of this association. However, even if there has been a close correlation between HbA_1c and mean blood glucose level over the previous 3 months, one-fifth (1) to one-third (2) of HbA_1c variance cannot be explained by mean blood glucose. Nonglycemic determinants of HbA_1c actually also could account for diabetes complications. One of the involved mechanisms might be an interindividual variation in the intracellular glycation of proteins, independently of glucose levels: the higher the protein glycation in target tissues (such as retina, kidney, neuronal tissues, and vessels), the more prevalent the tissue damages would be.Some indexes have been developed to estimate nonglycemic determinants of HbA_1c: hemoglobin glycation index is the difference between observed HbA_1c and the value calculated from its regression with mean plasma glucose (3), and glycation gap (G-Gap) (previously called glycosylation gap) is the difference between observed HbA_1c and the value calculated from its regression with fructosamine (4). There are several advantages to consider fructosamine rather than mean blood glucose to evaluate nonglycemic determinants of HbA_1c. First, fructosamine level is more stable than glucose itself. Second, fructosamine represents the 2-week blood glucose exposure, whereas frequent 7-point blood glucose profiles or continuous blood glucose monitoring is required to evaluate mean glucose. Moreover, fructosamine, unlike mean blood glucose, can be used to compare protein glycation in the extracellular space (fructosamine) and in the intracellular space (HbA_1c in red cells and, by assumption, in target tissues).G-Gap has been shown to be consistent over time in type 2 (5,6) and type 1 diabetic patients (4,6). In a study including 40 patients with type 1 diabetes for >15 years, a 1% increase in G-Gap was associated with a 2.9-fold greater frequency of progression in the nephropathy stage. The data demonstrated that nephropathy correlated better with G-Gap than with HbA_1c or fructosamine alone (4). Furthermore, it recently has been shown that G-Gap predicted the progression of nephropathy in type 2 diabetic patients independently of fructosamine, even after adjustment for HbA_1c (5). Nevertheless, in type 1 diabetes, controversial data have been published on G-Gap and retinopathy (7), whereas in type 2 diabetes there has been no report on the relations between G-Gap and complications outside of nephropathy.Thus, the aim of our study was to evaluate, in a large series of type 2 diabetic patients, the potential association between G-Gap and the presence of nephropathy, retinopathy, neuropathy, or silent myocardial ischemia independently of glycemic control.     

Coping With Enuresis

Enuresis is a common and vexing problem for physician, parent and child. It is a self-limiting phenomenon in most patients, so that any treatment is aimed at shortening the length of time the process goes on without doing any harm to the child. An outline of a program for the management of simple enuresis is presented in the light of personal experience.