重症甲型H1N1流感患者2例的护理

甲型H1N1流感是甲型流感病毒引起的急性、人畜共患的呼吸道传染性疾病^[1]。病毒主要通过空气和接触传播,儿童、老年人、孕妇、肥胖者以及慢性疾病患者是甲型H1N1流感的高危人群,极易演变为病情凶险、病死率高的甲型H1N1流感重症患者。本院近期收治2例重症甲型H1N1流感患者,现将抢救及护理体会报告如下。     

1例重症甲型H1N1流感合并多种并发症的护理

甲型H1N1流感是由一种新型流感病毒引起的急性呼吸道传染病,其病原为新甲型H1N1流感病毒株,主要表现为流感样症状,轻症病人可实施居家隔离治疗,重症病人必须接受住院治疗。2009年7月始,我院积极收治甲型H1N1流感病人,控制疫情,病死率为0。2009年11月20日至29日成功救治1例重症甲型H1N1流感并脑炎、心肌炎、肺部感染的病人。现将护理报告如下。     

1例甲型HIN1流感重症患者镇静治疗期的护理体会

甲型H1N1流感是由变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病.通过飞沫、气溶胶、直接接触或间接接触传播,临床主要表现为流感样症状,少数病例病情重,进展迅速,可出现病毒性肺炎,合并呼吸衰竭、多脏器功能损伤,严重者可以导致死亡.我院于2009年9月收治1例甲型H1N1流感重症患者,治疗期间给予机械辅助通气以减轻缺氧状况.由于机械辅助通气患者常见的应激反应为焦虑、惧怕和躁动等,患者应激反应的程度及能否控制直接关系其预后,因此有效的镇静对于机械通气患者非常重要.有效的镇静措施可避免人机对抗,增强患者对持续机械通气的耐受性,避免机械通气带来的相关损伤[1].本文将针对患者镇静期间的护理措施进行总结,现报道如下.     

重症甲型H1N1流感患儿的护理管理

甲型H1N1流感又称A（H1N1）型流感,是由新型流感病毒引起的呼吸道感染[1],主要通过飞沫经呼吸道传播,早期症状与普通流感相似,主要有发热、咳嗽、喉痛、流涕、肌痛和头痛等[2].重症病例病情发展迅速,可导致严重肺炎,急性呼吸衰竭及多脏器功能损伤甚至死亡.我院为综合性儿童医院,2009年4-11月中旬共收治重症和危重症甲型H1N1流感患儿32例,现将相关护理经验介绍如下.     

重症甲型H_1N_1流感患者的呼吸道管理

甲型H1N1流感是由一个新型H1N1病毒亚型引起的,人群没有天然免疫力的急性呼吸道传染病[1], 也是变异最为频繁的流感病毒类型,容易引起世界性的大流行[2], 具有较强的传染性,可通过近距离飞沫和接触传播.据世界卫生组织报道,至2010年1月15日全球已有208个国家或地区出现甲型H1N1流感,共导致13 554例患者死亡.作为南通地区甲型H1N1流感的哨点医院,本院共收治甲型H1N1流感确诊病例76例,其中重症63例,危重症13例,均痊愈出院.本文对收治的重症病例进行回顾分析,并就呼吸道管理在疾病转归中的作用进行总结.     

一例血浆置换联合磷酸奥司他韦治疗危重症甲型H1N1流感患者的护理

<正>甲型H1N1流感是一种由新的甲型H1N1病毒引起的急性呼吸道传染病,具有较强的传染性,可通过近距离飞沫和接触传播。危重症甲型H1N1流感病情凶险,常导致肝肾功能、凝血功能损害以及免疫系统失衡、内环境紊乱,表现为多器官功能的损     

重症甲型H1N1流感肺部的影像学表现

目的：探讨重症甲型H1N1流感患者的胸部X线和CT表现特征,以期提高对甲型H1N1流感的认识。方法：搜集我院2009年6月～2010年3月住院确诊重症甲型H1N1流感的患者11例,对其临床及影像学资料进行回顾性总结分析。结果：重症甲型H1N1流感临床的主要特征是持续高热、咳嗽,部分出现呼吸衰竭和神志改变。肺部影像学特点是：①早期最常见影像学表现为斑片状磨玻璃影;②发病后1～3天达到高峰,重症患者肺部病变变化较快且易反复;③治疗后患者肺部大部分病变可完全吸收,部分可见肺间质的改变。④肺部影像学表现与临床表现基本一致。结论：重症甲型H1N1流感患者的影像学表现可以反映病情变化,对指导临床治疗及判断预后具有重要的参考价值。     

1例应用体外膜肺氧合救治人感染H7N9禽流感重症肺炎患者的护理

正H7N9型禽流感是禽流感的一种亚型。人感染H7N9禽流感是由H7N9亚型禽流感病毒引起的急性呼吸道传染病。经呼吸道传播,也可通过密切接触感染的禽类分泌物或排泄物等被感染,直接接触病毒也可被感染。人感染H7N9潜伏期一般为7 d左右,临床表现一般为流感样症状,如发热、咳嗽、咳痰、伴有头痛、肌肉酸痛等。重症患者发展迅速,表现为     

1例重症小儿甲型H1N1流感合并心肌炎的护理

甲型H1N1流感是由变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病.通过飞沫、气溶胶、直接接触或间接接触传播[1].临床主要表现为流感样症状,少数病例病情重,进展迅速,可出现病毒性肺炎、心肌炎,合并呼吸衰竭、多脏器功能损伤,严重者可以导致死亡.我院2009年12月6收治1例重症甲型H1N1流感合并心肌炎患儿,现将护理体会总结如下.     

1例重症甲型H_1N_1流感患者的发现和护理体会

甲型H1N1流感是一种新的甲型H1N1病毒引起的急性呼吸道传染病,具有较强的传染性,可通过近距离飞沫和接触传播.随着患甲型H1N1流感患者的增多,发热患者到非定点医院呼吸科就诊的人数也不断增加,本院收住1位发热患者,确诊为甲型H1N1流感(重症)患者,现将发现与护理过程报告如下.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

Objective To explore the relation between chronic and persistent cough of children and MP infection and clinical observation and treatment.Methods Retrospective Study of the 55 children chronic and persistent cough cases, with a clinical features as pneumonia MP infection, in my hospital from March 2005 to March 2008.Results ①Clinical Feature:major symptom of these 55 children chronic cough cases is chronic and persistent cough.58%(32/55)of the cases showed no symptoms in their lungs.②Peripheral Blood:85％(47/55)cases showed no obvious changes in peripheral blood, with their WBC ranging from(4～10)×109/Land their eosinophile granulocyte increased.③Special Test:47.27%(26/55)IgM (MP-IgM)antibody positive,83.64%(46/55)cased showed pneumonia MP DNA specificity after PcR Test.④X-Rate Report:Results varied.Conclusion Pneumonia MP Infection is one of the pathogeny causing chronic and persistent cough of children.Treating the infection is a very important solution in curing chronic and persistent cough of children.     

Complementary and integrative medicine: An observational study on pediatric clinicians’ knowledge,beliefs and practices

ObjectiveComplementary and Integrative Medicine (CIM) is a group of diverse health care therapies that often serve as adjuncts to conventional medical treatments. Our aim for this study was to evaluate the current knowledge, beliefs and practices of pediatric clinicians regarding CIM.MethodsClinicians from the pediatric unit of a large US based teaching hospital in Connecticut were surveyed, through self-administered questionnaires.ResultsWe sampled 70 participants with a response rate of 99 %. Of the 70, 32 were Registered Nurses, 9 were Attendings, 7 were Fellows, 15 were Residents and 4 were Nurse Practitioners. Regarding use, 24 % had referred a patient to a CIM practitioner, 43 % reported using CIM while 47 % had a family member who had used CIM in the past year. Respondents were most familiar with massage (70 %) and yoga (69 %) least familiar with Ayurvedic medicine (20 %) and Qi Gong (24 %). Regarding attitude, 67 % believed that some CIM therapies hold promise for the treatment of symptoms while 59 % believed that incorporation of CIM would increase patient satisfaction. Most of the respondents indicated that they did not have easy access to clinical information on many CIM treatment modalities. Nurses were more familiar (p = 0.024), had more positive attitudes and beliefs (p = 0.001) and thought CIM therapies had a higher impact (p = 0.002) on patient care compared to physicians, even when controlled for gender.ConclusionThis study highlights the need to bridge the gap in evidence based medicine and clinician’s knowledge with the rise in CIM use. It also stresses the need for standardized learning competencies in the field of PIM.     

Primary and community care workforce planning and development

AIM: This article reports a study that provided primary and community care managers with information, allowing them to: (a) evaluate the size and mix of their workforce; and (b) develop knowledgeable and skilled teams to meet the demands of growing and changing services. BACKGROUND: Primary and community care services are growing in the United Kingdom, but workforce planning and development, despite their wide-ranging cost and quality implications, have not received the same attention. Indeed, most primary and community care workforce planning and development issues are universal. Demand 1-1 side workforce planning is concerned not only with the number, but also with staff mix; but how these autonomous and isolated practitioners spend their time is unique. The other side of the equation, workforce supply, raises many recruitment and retention challenges for managers in many countries. Any country's main workforce planning methods apply equally well to primary care, but each is flawed. A second, main problem is that the methods lead to fragmented services, whereas modern workforce planning methods should be multidisciplinary. Consequently, it has never been more important for managers to have data and algorithms to develop appropriate care teams. METHOD: A large and versatile workforce database, profiling 304 English primary care trusts using demographic, socio-economic, mortality, morbidity, staffing and performance workforce-related variables, compiled in 2002 and updated yearly, is described. Data were supplemented with a systematic literature review leading to a 340-item annotated bibliography; and qualitative interviews with managers. RESULTS: Workforce size and mix are historical and irrational at best. Moreover, the number of variables that influence staffing is growing, thereby complicating workforce planning. CONCLUSION: Evaluating and adjusting the size and mix of teams using empirically determined community demand and performance variables based on the area's socio-economic characteristics is feasible.     

头体针治疗脑卒中临床观察

目的观察头体针结合治疗脑卒中的临床疗效。方法 183例脑卒中患者分头针、体针、头体针 3组进行治疗 ,疗程满2个月后比较疗效。结果头针组与体针组之间、体针组与头体针组之间无显著性差异 ,但头体针组与头针组之间有显著性差异 (P<0 .0 5 )。结论头体针结合较单纯的头针或体针治疗能获得更好的临床疗效     

加强对人类健康影响重大的内分泌代谢病防治

以联合国名义直接作出决议的疾病只有艾滋病和糖尿病,国际糖尿病联盟(IDF)发表的新的糖尿病防治指南,展现了在糖尿病预防与诊治方面的最新进展。甲状腺疾病流行病学、临床及实验室研究和长期随访,填补了我国在世界卫生保健数据库中的空白。     

Drugs and Medical Devices: Adverse Events and the Impact on Women’s Health

A large number of medications and medical devices removed from the market by the US Food and Drug Administration over the past 4 decades specifically posed greater health risks to women. This article reviews the historical background of sex and gender in clinical research policy and describes several approved drugs and devices targeted for use in women that have caused major morbidity and mortality. The intended population for the medications and devices, population affected, approval process, and the basic and legal actions taken against the medication/drug company are also discussed. It is recognized that women are still at risk for harm from unsafe medications and devices, and continued improvements in legislation that promotes inclusion of sex and gender into the design and analysis of research will improve safety for both men and women.     

介入放射技术在妇产科临床运用探讨

目的探讨介入放射技术在妇产科临床诊断与治疗的应用可行性与安全性．方法临床34例患者，16例为剖宫产术后反复大出血者，3例为顽固性功能性子宫出血者，10例为晚期官颈癌者，5例为子宫肌瘤者。34例经Scldinger介入放射技术诊断与治疗。结果经介入放射技术诊断与治疗，34倒不同的患者得到及时、准确、有效的诊断与治疗，未见并发症和后遗症。结论介入放射技术在妇产科临床运用安全、有效。     

Molecular and point-of-care diagnostics for Ebola and new threats: National POCT policy and guidelines will stop epidemics

Introduction: US hospitals that admitted Ebola virus disease (EVD) patients mitigated risk by using point-or-care testing (POCT) for critical support in isolation units. Success proved unequivocally the need for POCT. Additionally, molecular diagnostics have been used to help stop new outbreaks, and even handheld diagnostic solutions are emerging.

Areas covered: This update of ‘Molecular detection and point-of-care testing in Ebola virus disease and other threats’ [Expert Reviews 2015;15(10):1249–1255], assesses the impact of EVD epidemics, documents insights from recent reviews, summarizes evolving POC molecular technologies, presents General Accountability Office (GAO) recommendations, identifies the role of POC Coordinators, and casts a vision for national POCT policies and guidelines. Factual updating comprised summarizing EVD outbreaks including 2017–2018, analyzing reviews and evidence-based publications since the 2014–2016 epidemic, and tabulating published technical and molecular diagnostics. New graphics illustrate POC error mitigation/risk reduction, a framework for national POCT policy and guidelines, modular adaptations for country-specific solutions, and a logic diagram for future progress embedding artificial intelligence.

Expert commentary: The USA is still not prepared for highly infectious diseases. Key is lack of community rapid response and resilience, which must be enhanced not via mechanisms distant, but instead by molecular diagnostics directly at critical points of need.     

婴幼儿流动注射车的研制与临床应用

目的 为了提高婴幼儿头皮静脉穿刺成功率，减轻护士的体力消耗。方法 根据儿科临床实际的需要，经过二年来的设计及二次改进，研制出实用新型的“婴幼儿流动注射车”，并应用于儿科临床操作过程中。结果 经统计学处理，表明应用“婴幼儿流动注射车”对提高婴幼儿头皮静脉穿刺成功率具有显著意义，对缩短婴幼儿头皮静脉注射时间具有非常显著的意义。结论 在流动车上实施头皮静脉穿刺，能充分利用自然光线，提高头皮静脉穿刺成功率并减轻护士体力消耗。