维生素B12并烟酸缺乏症1例并文献复习

目的 探讨烟酸缺乏症的病因、发病机制、临床表现、实验室检查、脑电图特点、治疗及预后.方法 本科收治合并亚急性脊髓联合变性的烟酸缺乏症1例,对其临床资料进行分析.结果 烟酸缺乏症又称糙皮病,该病病因多种多样,夏秋季节多发,主要临床表现为“4D综合征”,即皮炎,腹泻,痴呆及死亡.早期及时给予补充烟酸等综合处理后,预后较好,长期烟酸缺乏造成能量代谢障碍,引起维生素B12吸收及转运障碍,可继发周围及中枢神经损害.结论 长期缺乏烟酸可以发生多系统的损害,早期治疗可改善预后.     

Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control

Aims: Recent guidelines for the management of hypertension recommend an individualised stepped‐care treatment approach in mild‐to‐moderate hypertensive patients, to achieve blood pressure (BP) goals. This study evaluated the probability of patients achieving BP targets with an aliskiren‐based stepped‐care treatment regimen. Methods: This was a 24‐week, open‐label, non‐comparator study design that included six sequential 4‐week treatment periods in patients with mild‐to‐moderate hypertension. Over the potential 24 weeks of active treatment, incremental therapy included the following add‐on therapies at 4‐week intervals: aliskiren 150–300 mg once daily, hydrochlorothiazide (HCTZ) 12.5–25 mg once daily, and finally amlodipine 5–10 mg once daily, as needed to achieve target BP. Subjects achieving BP targets following any given 4 weeks of therapy were considered study completers, while subjects not achieving their clinical BP target entered into the next step of incremental therapy. The primary efficacy end‐point was the estimated cumulative probability of patients achieving BP target. Results: Of 256 patients treated, 232 (90.6%) completed the study. Baseline mean sitting BP was 155.7/91.7 mmHg. At study end‐point, the estimated cumulative probability of reaching BP target was 86.12%. The stepped‐care treatment regimen was well tolerated at the maximal recommended doses of all the individual complimentary therapies. Conclusion: An aliskiren‐based stepped‐care treatment regimen that subsequently included both HCTZ and amlodipine is effective in achieving BP goals in approximately 90% of patients with mild‐to‐moderate hypertension.     

Combination of telmisartan plus amlodipine in the treatment of hypertension: review of results

The rate of control of hypertension remains suboptimal despite widespread educational programs and an increasing number of novel medications. The combination of drugs with different mechanisms of action has become an alternative to improve blood pressure reduction and control, enhance adherence to the treatment and reduce adverse events. Telmisartan and amlodipine in monotherapy provide effective blood pressure lowering at all clinically relevant doses, but less than 50% of stage 1 and 2 achieve the target blood pressure. This article presents most of the relevant results of combinations of telmisartan plus amlodipine, at different doses, in hypertensive patients and a post hoc analysis of subgroups including the elderly, Type 2 diabetics, those with systolic hypertension and obese patients.     

Combination of telmisartan plus amlodipine in the treatment of hypertension: review of results

The rate of control of hypertension remains suboptimal despite widespread educational programs and an increasing number of novel medications. The combination of drugs with different mechanisms of action has become an alternative to improve blood pressure reduction and control, enhance adherence to the treatment and reduce adverse events. Telmisartan and amlodipine in monotherapy provide effective blood pressure lowering at all clinically relevant doses, but less than 50% of stage 1 and 2 achieve the target blood pressure. This article presents most of the relevant results of combinations of telmisartan plus amlodipine, at different doses, in hypertensive patients and a post hoc analysis of subgroups including the elderly, Type 2 diabetics, those with systolic hypertension and obese patients.     

Promoting effective continence care for older people: a literature review

Recent United Kingdom guidelines have identified the need for integrated continence services within health regions. While there is evidence of improvements in community services there is little evidence that the quality of nursing care offered for older people with urinary incontinence in care settings has improved. This literature review identifies some of the underpinning issues that impact on continence promotion for older people. Despite evidence that older people suffer physical, social and psychological distress as a result of mismanaged urinary incontinence, costs of promoting continence are higher in financial terms than containing incontinence. The extent of the problem is difficult to identify in terms of how many older people are affected by different types of urinary incontinence. Nurses' attitudes are found to affect the quality of continence care delivered, and there continues to be a lack of evidence around sustainable strategies for continence promotion in care settings.     

Barriers to effective cancer pain management: a review of the literature

As many as 90% of patients with cancer-related pain can attain satisfactory relief through available pharmacological and medical means. However, as many as 45% of patients in the earlier stages of cancer and 75% of patients in the advanced stages experience at least some pain. Although published guidelines are available, the research literature suggests that health care providers continue to hold some negative misconceptions about cancer pain and its treatment. Patients also harbor similar misconceptions that contribute to ineffective management. Interventions have been discussed in the literature, and although some have proven successful, much still needs to be done to remedy this problem. This review outlines the published guidelines for cancer pain management and describes the literature related to provider and patient barriers, as well as some interventions designed to facilitate effective cancer pain management.     

护理文书质量控制的研究现状与分析

护理文书是护理人员在护理活动过程中形成的文字、符号、图案等资料的总称,是病历的重要组成部分.它不仅能客观反映患者的实际情况,还可以真实地反映护士的理论水平和专业能力[1].最新《医疗事故处理条例》《侵权责任法》的颁布实施,不仅为护理文书的书写赋予法律效力,也将医院与社会对护理文书的重视提高了一个层次.所以,护理文书的质量控制就显得尤为重要.现对我国护理文书质量控制的现状进行综述,期望能对护理文书的管理起到促进作用,提高护理文书的书写质量.     

Teaching anaesthetic nurses optimal force for effective cricoid pressure: a literature review

Aims and Objectives: This literature review explores the role of force and education in cricoid pressure, an essential aspect of practice for any nurse within a critical care environment. Background: Cricoid pressure is utilized in everyday practice during rapid sequence induction (RSI) of anaesthesia. The purpose of cricoid pressure is to occlude the oesophagus in order to reduce the risk of acid aspiration during emergency induction of anaesthesia. The importance of best practice cannot be overstated because of high rates of mortality following acid aspiration. Methods: Literature searches were conducted using the key words cricoid pressure, Sellick manoeuvre, rapid sequence induction and acid aspiration syndrome. Articles were obtained from online searches, with literature published in the last 10 years being used; some seminal literature and textbooks were incorporated for definition purposes. Results: The literature displayed a disparity in practice and differing opinions on the optimal force to occlude the oesophagus. The role of education in correct application of cricoid pressure was explored, with unanimous conclusions that education plays a role in ensuring best practice. Conclusions: Forces of 20–30 N are adequate to occlude the oesophagus and minimize the risk of acid aspiration. However, it is difficult for practitioners to accurately estimate this force in everyday practice. Various methods of assessing force were discussed, with the use of a 50‐mL syringe suggested as a cost‐effective and simple method to utilize in practice. Relevance to clinical practice: The literature review demonstrated that the subject of cricoid pressure is relevant in critical care practice in order to ensure patient safety during RSI. Thus, all critical care nurses have a duty to gain a working knowledge on the subject if patient safety is to be maintained. This paper provides a source of information on cricoid pressure and realistic methods of maintaining best practice.     

Static and dynamic components of the chiropractic subluxation complex: a literature review

Intervertebral dysfunction refers to a biomechanical fault which is abnormal in both its dynamic and static components. A subluxation may be considered as being fixated and also slightly malpositioned in one or more axes of rotation. Subluxation may be considered as one component of a complex or syndrome of intervertebral dyskinesia, dysarthrosis or dysfunction. The biochemical and histological components explain some of the pain mechanisms, tissue changes and residual effects of acute and chronic intervertebral fixation and the need for repeated spinal manipulations and prolonged care. Interexaminer reliability studies indicate that a standard method of motion palpation is quite feasible and accurate. X-ray evidence of dyskinesia shows promise as a means of documenting subluxation fixations.     

Depression and poor glycemic control: a meta-analytic review of the literature

OBJECTIVE: Depression is common among patients with diabetes, but its relationship to glycemic control has not been systematically reviewed. Our objective was to determine whether depression is associated with poor glycemic control. RESEARCH DESIGN AND METHODS: Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, calculate effect sizes (ESs), and statistically analyze the collective data. RESULTS: A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13-0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than self-report questionnaires were used to assess depression (ES 0.28 vs. 0.15). CONCLUSIONS: Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the long-term course of diabetes.     

Carney complex: Two case reports and review of literature

Carney complex (CNC) is an extremely rare genetic syndrome of pigmented skin lesions, endocrine hyperfunction and myxoma. Given its diverse clinical manifestations, CNC is often misdiagnosed. Recognition of some special clinical manifestations and imaging features may help with the diagnosis. Early diagnosis of CNC would alert ongoing surveillance of tumors and complications; the prognosis of CNC may thus be improved by early treatment. Herein, we report two cases of CNC with bone lesions.     

Combination povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature.

Topical antiseptic formulations containing single active ingredients of alcohol and iodine are recognized by the Food and Drug Administration as "generally safe and effective" for "preparation of the skin prior to surgery" or "prior to an injection" including "catheter care, ostomy hygiene, and intravenous site preparation" (Federal Register, 1994). However, a synergistic effect results from the combination of ethyl or isopropyl alcohol and povidone-iodine. Because each active ingredient has different modes of action and performance characteristics, these combination formulations are faster acting with a broader spectrum of antimicrobial activity than formulations containing povidone-iodine alone, and more persistent than formulations containing ethyl or isopropyl alcohol alone.     

Living with a stoma: a review of the literature

Aims and objectives. This systematic review looks at the psychological and social impact of stoma surgery on peoples’ lives. Background. The formation of a stoma can have a negative effect on a person's quality of life and affect lifestyle in a number of ways. Methods. The review examines nursing literature from 1990 to date and focuses on how stoma patients’ lives are affected by the presence of a stoma. It informs nursing practice so nurses are better able to help individuals improve, maintain or recover their health following ostomy surgery. Results. The findings of the review indicate that stoma surgery can impact on individuals’ lives in many different ways. Relevance to clinical practice. Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.     

Fremanezumab plus plasmapheresis in a patient with chronic migraine and myasthenia gravis: Case report of an effective treatment

A patient with chronic migraine and generalized myasthenia gravis was concurrently treated with fremanezumab and with therapeutic plasmapheresis (PEX). Fremanezumab was dosed right after a PEX session, or in the midpoint between sessions, and the efficacy of both treatments was maintained. This case broadens the drug's clinical applications and it helps in choosing the appropriate medical regimen in patients requiring both treatments.     

前列腺癌并阴茎转移综合治疗一例报告并文献复习

目的探讨前列腺癌并阴茎转移的发病机制、临床特征及诊疗预后。 方法回顾性分析1例前列腺癌并阴茎转移患者的临床资料。 结果患者68岁，因排尿困难在我院行经尿道前列腺电切术，术后病理检查报告为前列腺腺癌。术后行外放射治疗及内分泌治疗，15个月后发生阴茎转移，予以个体化的治疗方案后前列腺癌特异性抗原下降，阴茎肿块缩小，不适症状缓解。 结论前列腺癌阴茎转移发生罕见且预后差，有多种转移机制参与；手术及放化疗虽为姑息性治疗，但个体化的治疗方案可延缓疾病进展，改善患者生活质量。