Advances in stroke care and research in 2010

1. There have been many advances in stroke research and care over the past year. The aim of the present review is to highlight the significant advances that are likely to have considerable impact on the direction of future investigations and models of clinical practice. 2. In terms of the acute treatment of stroke, there is now Level I evidence for the use of thrombolysis in the treatment of ischaemic stroke. The results of clinical trials suggest potential new treatments for stroke of inherited origin, whereas other potential treatments have been suggested following the identification of a novel mechanism of emboli clearance by extravasation. Clinical guidelines have also been updated, with tight blood pressure control advocated in cases of acute intracerebral haemorrhage. 3. In terms of stroke prevention, new information has been added to the long-standing debate regarding the value of carotid stenosis management: the predictive value of asymptomatic carotid emboli may enable the identification of individuals at high risk of stroke. Furthermore, the identification of novel risk factors for stroke opens up new avenues for stroke prevention. 4. Robot-assisted therapy has heralded a new era in stroke rehabilitation and the 'Get With The Guidelines' programme has set a milestone in the quality control of stroke care. 5. Undoubtedly these advances will have a marked impact on future research and clinical practice.     

铊中毒与急救的研究进展

稀有元素铊对人体的毒性因一系列中毒事件的出现而广受重视。近10年来,铊中毒的作用机制和救治措施成为研究热点。初步研究表明,铊经胃肠道、呼吸道和皮肤吸收后,在体内广泛分布,浓度最高的是肾脏,其次为唾液腺。以离子状态存在的铊可以取代体内的钾离子,影响钾离子参与的生理功能及神经信号传导,并影响一系列酶的活性,使之失去正常功能。此外,铊还能拮抗钙离子,从而影响心脏功能、与核黄素结合干扰生物氧化等途径。在临床上,铊中毒可见周围神经中毒症状、胃肠道症状、黏膜炎症、毛发脱落和视力受损等。24h尿液中铊浓度检测为评价铊中毒的最佳方法,尿铊〉5μg/L具有诊断意义。当前临床治疗措施主要是减少吸收、加速清除和对症治疗。最新研究表明,血液灌流能有效清除已吸收的铊。     

药学监护研究进展

21世纪药师的基本任务就是实施药学监护 ,它是满足社会需要、医生需要和患者需要的必然产物。药学监护要求药师对其所进行的药物治疗负直接责任 ,因此全面理解和提高药师提供药学监护的意识非常关键。本文重点论述了药学监护的内涵和临床应用 ,并对其发展前景做出展望。     

Pharmaceutical care research and education project: patient outcomes

OBJECTIVE: To compare patients' adherence to therapy, expectations, satisfaction with pharmacy services, and health-related quality of life (HRQOL) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care. DESIGN: Randomized controlled cluster design. SETTING: Sixteen community pharmacies in Alberta, Canada. PATIENTS AND OTHER PARTICIPANTS: Ambulatory elderly (> or = 65 years of age) patients covered under Alberta Health & Wellness's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles. INTERVENTION: Pharmacies were randomly assigned to either treatment (intervention) or control (traditional pharmacy care) groups. Patients at treatment pharmacies were recruited into the study, and pharmacists provided comprehensive pharmaceutical care services. Pharmacists at control pharmacies continued to provide traditional pharmacy care. MAIN OUTCOME MEASURES: Study participants' opinions, adherence to therapy, and scores on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: Compared with those of patients receiving traditional care, treatment patients' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period. Treatment patients' satisfaction with the constructs "trust," "evaluation and goal setting," and "communicates with doctor" were also positively affected. HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions. CONCLUSION: Successful implementation of a pharmaceutical care practice model has the potential to increase patients' satisfaction with their pharmacists' activities and may increase patients' expectations that pharmacists will work on their behalf to assist them with their health care needs. If pharmaceutical care affects patients' HRQOL, instruments more specific than the SF-36 may be needed to detect the differences.     

护理投诉与处理对策的综合研究

分析总结新形势下常见护理投诉的原因,探讨护理投诉处理对策。目的在于,通过采取积极的防护措施,改善护患关系,消除护患纠纷的隐患,减少护理投诉,维护护患双方的合法权益,保障医疗护理安全顺利地进行。     

舒缓疗护的研究进展和思考

舒缓疗护通过给予治愈性治疗无反应的晚期患者积极和全面的照顾,从而提高和改善患者和家属的生活质量,注重以人为本的原则。国、内外舒缓疗护事业相继发展,而我国舒缓疗护工作起步较晚,面临较多的困境与问题。笔者对此提出针对性的建议,强调中医、中药对于实现“以人为本”的舒缓疗护具有不可取代的地位。     

从胆囊结石研究现状谈基层医生的科研工作

本文分析胆石成因、胆囊结石的流行病学研究、胆囊结石与肿瘤的关系以及胆囊切除术后综合征等胆囊结石研究现状,以期为基层医生提供科研思路。