临床护理路径在脑卒中患者健康教育及遵医行为中的应用

目的:观察临床护理路径在脑卒中患者健康教育中的应用,探讨脑卒中健康教育的规范化模式.方法:将2011年8月～2012年8月收治的100例脑卒中患者随机分为观察组和对照组各50例.对照组采用常规的健康宣教和护理,观察组采用临床护理路径表对患者进行健康教育,比较两组患者的健康教育效果.结果:观察组患者的健康教育知晓率、遵医行为、满意度均高于对照组.结论:临床护理路径可提高脑卒中患者健康教育知晓率,提高患者满意度及遵医行为,提高患者自我管理水平.     

临床护理路径对首次住院精神分裂症患者健康教育的研究

目的 探讨临床护理路径对首次住院精神分裂症患者健康教育的效果.方法 随机将80例首次入院精神分裂症患者分为实验组和对照组各40例.对实验组患者采用临床护理路径进行健康教育,对照组患者采用传统健康教育方式进行健康教育.运用自设量表在患者出院前进行患者相关知识的掌握、遵医行为和对护理工作的满意度评估.结果 实验组患者对疾病相关知识的掌握优于对照组(P＜0.05);实验组患者的遵医行为优于对照组(P＜0.05);实验组患者对护理工作的满意度大于对照组(P＜0.05).结论 应用临床护理路径对首次住院精神分裂症患者实施健康教育可使健康教育规范化、系统化,改善患者的遵医行为,提高患者对护理工作的满意度.     

临床路径健康教育对首次住院肝豆状核变性患者疾病认知及遵医行为的影响

目的探讨临床路径健康教育对首次住院肝豆状核变性患者疾病认知及遵医行为的影响。方法选取本院2016年1~12月收治的66例首次住院治疗的肝豆状核变性患者作为研究对象,采用随机数字表法分为观察组和对照组,每组各33例,两组均给予健康教育,其中对照组患者采用常规教育方式,观察组患者采用临床路径健康教育方式。比较两组健康教育实施前后患者健康知识掌握情况、遵医行为执行情况以及两组患者健康教育满意度。结果两组健康教育干预后患者对肝豆状核变性疾病基础知识、用药知识、饮食及生活知识、并发症预防及复发预防等健康知识掌握率均明显高于干预前,且干预后观察组均明显优于对照组(P0.05);观察组患者健康教育干预后配合检查及护理、医嘱服药、医嘱饮食、适时锻炼、定期复查复诊等遵医行为率均明显高于对照组(P0.05);观察组患者健康教育总满意度(100.00%)明显高于对照组(81.82%)(P0.05)。结论对首次住院肝豆状核变性患者采用临床路径健康教育方式,可提高患者疾病健康知识掌握情况、遵医行为执行率以及患者满意度,值得在临床推广应用。     

功能锻炼路径手册在乳腺癌手术患者中的应用

目的:探讨功能锻炼路径手册在乳腺癌手术患者中的应用效果.方法:将160例乳腺癌手术患者随机分为实验组和对照组各80例,实验组应用功能锻炼路径手册,对照组采用传统健康教育方法.评价两组患者患肢肩关节活动度、康复知识掌握率、遵医行为、护理工作满意度.结果:实验组患肢肩关节活动度、康复知识掌握率、遵医行为、护理工作满意度与对照组比较差异均有统计学意义(P＜0.01).结论:功能锻炼路径手册可有效提高乳腺癌手术患者的健康教育质量.     

临床路径健康教育对血液透析患者遵医行为的影响

目的:研究临床路径健康教育对血液透析患者的遵医行为和生活满意度的影响,为血液透析患者个体化健康教育提供依据。方法:选择58例在本院进行血液透析的患者,将其随机分为观察组31例和对照组27例,观察组实施临床路径健康教育,对照组实施传统健康教育。6个月后对两组患者饮食、药物、运动等遵医行为和生活满意度进行比较分析。结果:观察组患者遵医行为、生活满意度及对护理工作满意度均显著优于对照组(P<0.05,P<0.01)。结论:临床路径健康教育能提高血液透析患者遵医行为、患者生活满意度和对护士工作满意度,是一种适合血液净化中心的健康教育模式。     

应用临床路径对肠息肉患儿及家属实施健康教育

目的 探讨应用临床路径在肠息肉患儿及家属健康教育中的效果.方法 将2005年4月至2007年4月120例肠息肉患儿随机分成两组,对照组给予传统的健康教育,观察组采用临床路径进行健康教育,比较两组患儿家属的疾病认知、饮食知识、遵医行为和护理满意度情况.结果 观察组患儿家属的疾病认知、饮食知识、遵医行为和护理满意度的优良率分别为93.33%、100%、100%、100%;对照组分别为53.33%、60.00%、53.33%、60.00%,两组比较均有统计学意义(P＜0.05).结论 应用临床路径对肠息肉患儿及家属实施健康教育是一种科学合理的教育方式,健康教育路径使健康教育目标更加明确化,有助于提高健康教育的效果和护理满意度.     

健康教育路径在前列腺增生症电切术患者中的应用

目的探讨健康教育路径在经尿道前列腺电切术患者中的应用。方法将2015年1~8月共102例经尿道前列腺电切术中的患者分两组,1~4月的43例患者作为对照组,按常规模式进行护理;5~8月的59例患者作为观察组,运用健康教育路径进行护理,从患者的认知、遵医行为、并发症、不良反应发生率、健康教育知晓率及满意度调查结果等方面进行比较。结果观察组患者并发症及不良反应发生率低于对照组,观察组患者的认知、遵医行为、健康教育知晓率及满意度调查结果明显高于对照组,差异比较均具有统计学意义(P0.05)。结论将健康教育路径应用在前列腺电切术患者中能有效减少术后并发症及不良反应发生率,提高病床周转率及护理工作质量,从而提高患者遵医行为及对术后效果的满意度。     

临床护理路径在结肠癌患者围术期健康教育中的应用

目的:探讨临床护理路径在结肠癌患者围术期健康教育中的应用效果。方法:将68例结肠癌根治术患者随机分为实验组和对照组各34例,对照组采用口头宣教、展板告示宣教为主的传统健康教育方式,观察组在传统健康教育基础上采用程序化和标准化的临床护理路径进行健康教育。出院前发放调查问卷,比较两组患者护理知识掌握情况、健康教育效果、遵医率和护理满意度。结果:实验组患者护理知识掌握评分明显高于对照组(P0.05);实验组患者术后肛门排气时间、住院天数、下床时间明显短于对照组(P0.05);实验组患者遵医率和患者满意度明显高于对照组(P0.05)。结论:采用临床护理路径进行健康教育,能提高结肠癌患者的临床疗效,对促进护患沟通、提高护理质量也有重要作用。     

临床护理路径在痛风患者健康教育中的应用

目的:探讨临床护理路径在痛风患者健康教育中的应用效果.方法:将249例痛风患者随机分为实验组127例和对照组122例,对照组实施常规健康教育,实验组在常规健康教育的基础上应用临床护理路径.观察两组患者在遵医行为、平均住院日、平均住院费用及护理满意度等方面的差异.结果:实验组在遵医行为、平均住院日、平均住院费用及对护理满意度等方面均优于对照组,两组比较有显著性差异(P＜0.05).结论:应用临床护理路径对痛风患者进行健康教育,患者能较好地获得疾病相关知识并自觉采取健康行为,缩短疗程,减少医疗费用,明显提高护理满意度.     

临床护理路径对急性脑卒中患者康复的影响

目的 探讨临床护理路径在急性脑卒中患者康复中的应用效果.方法 将120例患者随机分为实验组及对照组,各60例.实验组使用临床路径实施康复护理,对照组使用传统的康复护理.比较2组患者的平均住院日、平均住院费用、康复效果(包括自理能力、康复知识知晓率、ADL评价合格率、遵医行为、对疾病治愈的信心和对护理的满意度).结果 实验组患者的康复效果明显优于对照组患者(p均<0.05),且平均住院费用少于对照组患者(P<0.05).结论 临床护理路径对急性脑卒中患者的康复有积极意义,值得推广.     

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.