改良3R护理对老年性痴呆骨折患者围手术期的护理干预研究

目的探讨改良的3R护理（reminisceneet往事回忆、realityorientations实物定位、Remotivation记忆再激发）对老年性痴呆骨折患者围手术期生活质量及术后康复的影响。方法将54例轻中度痴呆老年髋部骨折患者随机分成实验组与对照组各27例,实验组施行改良的3R护理法护理患者（在施行3R护理同时,加强病房环境管理、心理疏导,并结合图片、实物、多媒体演示等方法指导患者行功能强化训练,帮助患者恢复及强化记忆,促进机体康复）,对照组采用骨科手术患者常规护理。对两组患者实施护理前、护理训练计划完成后分别测定与记忆、智能有关的4种量表：IADL—FAQ、FIM（14-18）、WAIS—RC（简式）、RBMT—R。结果实验组与对照组测定的4种量表相比,在护理前差异无统计学意义（P〉0．05）,实施护理计划后差异有统计学意义（P〈0．01）。实验组患者实施护理计划干预后遵护嘱行为与对照组相比明显改善。结论改良3R护理能有效改善老年痴呆骨折患者的生活质量,促进康复。     

护理干预在老年血管性痴呆患者中的疗效

目的：探讨护理干预措施对改善老年血管性痴呆（ VD）患者的疗效。方法将60例老年VD患者随机分成治疗组（30例）和对照组（30例）,治疗组在服用药物尼莫地平片的基础上给予护理干预,而对照组仅接受尼莫地平片治疗,疗程为3个月。2组患者在治疗3个月前后分别采用简易精神状态检查量表（ MMSE）和日常生活能力量表（ ADL）进行评分,然后进行统计分析。结果3个月后,治疗组患者在MMSE和ADL评分上,都高于对照组,经统计学分析,两组差异有统计学意义（ P＜0．05）。结论护理干预措施能有效改善老年VD患者的认知功能,并提高其日常生活能力。     

3R强化护理对阿尔茨海默病患者生活质量的影响

目的探讨3R强化护理对提高阿尔茨海默病患者认知功能和生活质量的效果。方法选择轻、中度阿尔茨海默病患者66例,随机分为实验组（n=33）和对照组（n=33）。对照组接受内科常规护理外,实验组患者在此基础上实施往事记忆提取（Reminiscence）、记忆空间定位（Reality）和记忆再激发（Remotivation）的3R强化训练。采用工具性日常生活活动（ADL）、功能独立性评定（VIM）、成人韦克斯勒智力量表（WAIS-RC）和简易智力状态检查量表（MMSE）比较2组生活质量改善情况。结果在6个月的观察期间,对照组MMSE和WAIS逐渐下降（P〈n05）,实验组MMSE和WAIS无明显变化;对照组ADL和FIM无明显变化,实验组ADL和FIM评分比入组时有进步（P〈0.05）。结论3R强化训练可改善AD患者认知功能,一定程度上促进了患者日常生活能力的恢复,为预防痴呆发展和提高患者生活质量的有效措施。     

同理心护理联合康复训练对住院老年血管性痴呆患者的影响

目的:探讨同理心(EMP)护理联合康复训练对住院老年血管性痴呆(VD)患者的影响。方法:将86例住院老年VD患者随机分为对照组和观察组各43例,对照组给予常规基础护理,观察组在常规基础护理的基础上给予同理心护理联合康复训练为;观察两组护理效果。结果:干预后两组简易智能状态检查表(MMSE)评分及老年痴呆患者生活质量量表(QOL-AD)评分显著高于干预前(P0.05),神经精神科问卷(NPI-Q)评分及日常生活能力量表(ADL)评分显著低于干预前(P0.05),且观察组显著优于对照组(P0.05);观察组临床医生面谈印象变化量表(CIBIC plus)评估病情改善率优于对照组(P0.05);观察组对病房环境、基础护理、服务态度、康复指导及总体满意度显著高于对照组(P0.05)。结论:EMP护理联合康复训练应用于住院老年VD患者中,可显著改善患者病情、认知水平及精神行为症状,提高患者生活自理能力及生活质量,提高对护理工作、环境等满意度。     

中医护理干预对糖尿病患者生活质量影响的研究

目的探讨中医护理干预对糖尿病患者生活质量的影响。方法将60例2型糖尿病患者按人院顺序分为观察组和对照组各30例,对照组实施常规护理干预。观察组在常规护理干预的基础上实施中医护理干预。对两组患者干预前后用生存质量测定量表测评生活质量。结果观察组生活质量评分干预后较干预前明显提高,差异有统计学意义（P＜0．01）;干预后观察组生活质量评分高于对照组,差异有统计学意义（P＜0．01）。结论中医护理干预可改善糖尿病患者的生理、心理、社会功能,提高患者的生活质量。     

连续护理模式对老年冠心病患者的负性情绪及依从性的影响

目的：探讨连续护理模式对老年冠心病患者的负性情绪及依从性的影响。方法选取我院收治的老年冠心病患者86例,随机分为观察组和对照组,每组43例。对照组患者给予常规护理干预,观察组患者在常规护理基础上实施连续护理模式。比较两组患者干预前后SAS和SDS评分情况,患者的依从性及护理满意度。结果干预后观察组患者的SAS、SDS评分均明显低于干预前和对照组（均P＜0．05）,患者的服药依从性、运动依从性及饮食依从性均明显高于对照组（均P＜0．05）,患者的护理满意度明显高于对照组（ P＜0．05）。结论对老年冠心病患者实施连续护理模式,可显著改善患者的负性情绪,提高患者的依从性和护理满意度,值得临床推广与应用。     

医护一体化模式在老年糖尿病肾病腹膜透析患者中的应用

目的探讨医护一体化模式在老年糖尿病肾病腹膜透析患者中的应用效果。方法选取2015年7月至2016年12月在本院进行腹膜透析的124例患者作为对照组,另选取2017年1月至2018年6月在本院进行腹膜透析的124例患者作为观察组,对照组给予常规护理,观察组实施医护一体化护理干预,比较两组患者生活质量评分及并发症、低血糖发生率。结果观察组并发症、低血糖发生率明显低于对照组(P 0. 05)。实施一体化模式前,两组患者生活质量评分比较差异无统计学意义(P 0. 05);实施后,两组生活质量评分均高于实施前,且观察组生活质量评分明显高于对照组(P 0. 05)。结论医护一体化模式的护理干预能有效改善老年糖尿病肾病腹膜透析生活质量,降低其并发症与低血糖的发生率,值得临床推广应用。     

综合护理干预对老年结直肠癌造口患者焦虑抑郁状态及生活质量的影响

目的：探讨综合护理干预对老年结直肠癌患者焦虑抑郁状态及生活质量的影响。方法选择2012年6月～2013年9月在本院进行手术治疗的156例老年结直肠癌患者为研究对象,并随机分为观察组与对照组各78例,对照组患者给予常规护理和健康宣教,观察组在对照组的基础上给予综合护理干预,包括饮食指导、心理疏导、健康教育、造瘘口的术后护理。利用SCL－90和SF－36健康调查简表对患者综合护理干预前后的生活质量和精神状态进行评价。结果干预后观察组和对照组SCL－90各因子评分比较,观察组均低于对照组,差异均具有统计学意义（均P＜0．05）;干预后观察组和对照组SF－36各因子评分比较,观察组均高于对照组,差异均具有统计学意义（均P＜0．05）。结论对老年结直肠癌患者实施综合护理干预可有效缓解患者的负性情绪,提高患者术后的生活质量。     

强化营养联合抗阻运动对老年肌少症患者躯体功能和日常生活能力的影响

目的 探讨强化营养联合抗阻运动对老年肌少症患者躯体功能和日常生活能力的影响。方法 选择 2020 年 8 月至 2022 年 12 月我院收治老年肌少症患者 63 例,按照数表随机法分为对照组和研究组。对照组（30 例）给予常规营养支持,研究组（33 例）给予强化营养联合抗阻运动训练。比较两组骨骼肌指数、握力、6 分钟步行距离、日常生活能力,生活质量和护理满意度。 结果 两组干预前老年患者的骨骼肌指数、握力与 6 分钟步行距离对比无统计差异意义（P>0.05）。研究组老年患者干预后骨 骼肌指数较对照组更高、握力较对照组更大、6 分钟步行距离较对照更远（P<0.05）。干预前两组老年患者日常生活能力与生 活质量评分对比无统计差异意义（P>0.05）。干预后研究组老年患者日常生活能力与生活质量评分较对照组更高（P<0.05）。 研究组患者满意度高于对照组（P<0.05）。结论 老年肌少症患者联合开展强化营养与抗阻运动训练,能够显著的改善肌力水平 与躯体活动功能,提高日常生活自理能力,生活质量和护理满意度。     

心理护理干预对老年患者全膝关节置换术围手术期的负性情绪及生活质量的影响

目的探讨心理护理干预对老年患者全膝关节置换术围手术期的负性情绪及生活质量的影响。方法选取我院收治的老年全膝关节置换术患者40例,随机分为对照组和观察组,每组20例。对照组给予常规护理干预,观察组在常规护理干预基础上给予心理护理干预。观察两组患者术后4、12、24、48h疼痛情况,比较SAS、SDS评分情况,并对患者的生活质量进行评定。结果观察组患者术后4、12、24、48h的VAS疼痛评分明显低于对照组（P〈0．05）;两组患者SDS、SAS评分均明显低于干预前（均P〈0．05）,观察组患者SDS、SAS评分明显低于对照组（均P〈0．05）;观察组患者角色功能评分、心理功能评分、躯体功能评分、社会功能评分及GQOL-74总评分均明显高于对照组（均P〈0．05）。结论实施有效的心理护理干预,能够有效地改善老年患者全膝关节置换术围手术期的疼痛症状,缓解患者的焦虑抑郁的心理状态,提高患者的生活质量。     

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.