基于“5E”康复模式的延续性护理对糖尿病患者的影响

目的:探讨基于"5E"康复模式的延续性护理对糖尿病患者遵医行为、血糖控制效果及生活质量的影响。方法:将2013年7月~2015年6月收治的110例糖尿病患者作为对照组,接受传统延续性护理;将2015年7月~2017年7月收治的110例糖尿病患者作为研究组,接受基于"5E"康复模式的延续性护理。比较两组护理前后血糖水平、遵医行为情况及生活质量。结果:护理后两组患者血糖均显著下降,研究组空腹血糖及糖化血红蛋白水平显著低于对照组(P0.01);研究组遵医行为及生活质量评分均高于对照组(P0.01)。结论:应用以"5E"康复模式为基础的延续性护理对糖尿病患者进行干预,能够显著提高其遵医行为,取得理想的血糖控制效果,显著改善其生活质量。     

延续性护理在老年糖尿病出院患者中的应用

目的:探讨延续性护理在老年糖尿病出院患者中的应用效果。方法:将200例老年糖尿病患者随机分为观察组和对照组各100例,对照组接受常规的护理方案,观察组在对照组基础上给予延续护理,比较两组干预前后血糖水平、遵医行为、血糖达标率、并发症发生率和健康调查简表(SF-36)评分情况。结果:干预后观察组血糖水平低于对照组(P0.01),观察组血糖达标率、遵医行为及SF-36评分均高于对照组(P0.05)。结论:在老年糖尿病出院患者中实施延续性护理,可明显改善患者血糖水平,提高患者遵医行为及血糖达标率,从而提高患者生活质量。     

家庭延续性护理对2型糖尿病患者远期血糖控制情况及遵医行为的影响研究

目的探究家庭延续性护理对2型糖尿病(T2DM)患者远期血糖控制情况及遵医行为的影响。方法将2015年1~12月入院的110例T2DM患者采用随机数表法分为观察组和对照组,每组55例。对照组采取常规住院护理进行干预,观察组采取住院护理+家庭延续性护理进行干预。观察2组近远期血糖控制状况[空腹血糖(FPG)、糖化血红蛋白(Hb Alc)],评估2组延续性护理干预3月后遵医行为[糖尿病自我管理行为量表(SDSCA)]和生活质量[2型糖尿病生活质量量表(DMQLS)],并随访1年记录患者再入院情况及并发症发生率。结果 (1)干预3月、1年后,观察组FPG、Hb Alc水平均较对照组低(P0.05),且观察组干预1年后水平低于干预3月后(P0.05),对照组干预3月后与干预1年后FPG、Hb Alc水平对比,差异均无统计学意义(P0.05);(2)干预3月后,观察组SDSCA评分及遵医性优率均高于对照组(P0.05),遵医性差率低于对照组(P0.05),2组遵医性一般率对比差异无统计学意义(P0.05);(3)干预3月后,观察组DMQLS评分低于对照组(P0.05);(4)随访1年,观察组再入院率和并发症发生率均较对照组低(P0.05)。结论家庭延续性护理能显著改善患者近远期血糖控制水平,并对提升患者生活质量和遵医性产生积极影响。     

社区护理干预对2型糖尿病患者遵医行为及血糖控制的效果观察

目的 观察社区护理干预对2型糖尿病患者遵医行为及血糖控制的效果.方法 将出院的110例糖尿病患者随机分成干预组和对照组各55例,干预组进行社区护理干预,对照组未施加干预,比较2组遵医率及血糖控制情况.结果 干预组患者在遵医率及血糖控制方面明显优于对照组,差异均有显著性(p<0.05或0.01).结论 社区护理干预可明显提高糖尿病患者的遵医行为,并较好控制血糖.     

综合护理干预对2型糖尿病患者遵医行为及血糖控制的影响

目的探讨综合护理干预对2型糖尿病患者遵医行为及血糖控制的影响。方法选取2型糖尿病患者238例,随机分为观察组和对照组各119例。对照组采用常规护理,观察组采用综合护理干预,比较2组干预前后遵医行为及血糖控制情况。结果干预后,2组用药规律、饮食控制、运动情况、自我管理评分均显著提高(P0.01),空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb Alc)水平均显著降低(P0.01),且观察组遵医行为各项评分均显著高于对照组(P0.01),FPG、2 h PG、Hb Alc水平显著低于对照组(P0.01)。结论综合护理干预能够提高2型糖尿病患者依从性,改善血糖控制情况。     

延续性护理干预对社区2型糖尿病患者治疗依从性的影响

目的:探讨延续性护理干预对2型糖尿病患者治疗依从性的影响。方法:选择2013年4月~2014年4月入选的92例社区2型糖尿病出院患者作为研究对象,并将其随机等分为对照组和研究组,对照组采用常规护理,研究组采用延续性护理。观察两组患者干预前及干预6个月后血糖及血红蛋白的情况,并比较两组患者的治疗依从性。结果:护理干预6个月后,研究组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白指标均低于对照组(P0.05)。研究组治疗依从性优于对照组(P0.05)。结论:延续性护理干预对2型糖尿病患者治疗依从性有着积极影响,可明显提高患者遵医行为,有利于控制患者的血糖。     

互联网随访护理对2型糖尿病患者遵医行为及血糖控制的影响

目的:探讨互联网随访护理对2型糖尿病患者遵医行为和血糖控制的影响。方法:将100例2型糖尿病患者随机分为观察组和对照组各50例,观察组出院后采用互联网进行定期随访,对照组仅给予出院指导,出院后不进行干预;比较两组遵医行为及血糖控制情况。结果:观察组干预3个月后在用药、运动、饮食、情绪管理等方面的遵医行为均高于对照组(P0.05),观察组干预3个月后血糖控制水平优于对照组(P0.05)。结论:互联网随访不受时间和空间的限制,可提高糖尿病患者出院后的遵医行为,改善血糖控制水平。     

护理干预对2型糖尿病患者治疗依从性的影响

目的:探讨护理干预对2型糖尿病患者遵医行为的影响。方法:选择2010年6月～2011年12月120例住院2型糖尿病患者为研究对象,随机等分为对照组和试验组。对照组实施常规护理,试验组在常规治疗的基础上实施护理干预,比较两组患者治疗依从性及血糖值变化。结果:两组患者干预1个月后遵医行为和干预1,3个月后血糖降低效果比较均有统计学差异(P0.05)。结论:护理干预可提高糖尿病患者的遵医行为,有利于血糖的控制。     

社区综合护理干预对2型糖尿病患者康复效果、遵医行为及生活质量的影响研究

目的：探讨社区综合护理干预对2型糖尿病患者康复效果、遵医行为及生活质量的影响。方法将我社区卫生服务中心收治的2型糖尿病患者162例,随机分为对照组和观察组,每组81例。对照组患者给予常规的综合治疗和护理,观察组患者在此基础上实施社区综合护理干预。比较两组患者空腹血糖（FBG）、餐后2h血糖（2h PG）、糖化血红蛋白（HbAlc）水平;遵医行为及生活质量改善情况。结果观察组干预后FBG、2 h PG和HbAlc水平均较治疗前和对照组干预后显著降低（均P＜0.05）,患者合理饮食、适量运动、遵嘱服药、自我监测及定期复查等遵医依从率均较对照组显著提高（均P＜0.05）,患者总生活质量评分显著高于干预前和对照组（均P＜0.05）。结论对2型糖尿病患者实施社区综合护理干预可有效控制血糖水平,改善患者遵医行为并提高其生活质量,具有较好的临床应用价值。     

护理随访对糖尿病病人生活质量和遵医情况的影响

[目的]探讨护理随访对2型糖尿病病人生活质量和遵医情况的影响。[方法]根据病人家庭实际情况将104例2型糖尿病病人分为观察组和对照组各52例。对照组仅接受在院护理干预,出院后由不进行任何干预,观察组出院后进行护理随访干预,比较两组随访前后血糖状况、生活质量评分,并在随访1个月后进行遵医情况评价。[结果]观察组经随访后,空腹血糖和餐后2h血糖均显著低于对照组(P0.05);观察组随访后生活质量评分显著高于对照组(P0.05);观察组随访后按时用药、控制饮食、规律生活、血糖监测和适当运动等遵医情况显著优于对照组(P0.05)。[结论]结合2型糖尿病病人家庭实际情况,针对性地开展护理随访,能够改善病人遵医状况,更有效控制血糖,提升生活质量。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.