网球肘的综合康复治疗

目的探讨网球肘的综合康复疗效。方法对50例网球肘患者行局部封闭、理疗、按摩、运动疗法及小针刀等综合康复治疗，观察患者症状和体征的改善情况。结果综合康复治疗痊愈率、显效率、好转率、总有效率分别为68．0％、16、0％、12．0％、96．0％。结论局部封闭、理疗、运动疗法及小针刀等综合治疗是治疗网球肘的有效方法。     

Anatomy of the extensor carpi radialis brevis muscle related to tennis elbow

The lateral elbow region was studied in embalmed specimens and living persons. The area is characterized by the origin of muscles extending wrist and fingers. Particular attention was paid to the extensor carpi radialis brevis muscle. It is shown that its anatomical features are different from the other muscles involved in movements like grasping and pinching. Consideration of the functional anatomy and biomechanics shows that repeated relatively large forces are exerted at the tendon of the extensor carpi radialis brevis muscle and at its origin at the lateral epicondyle of the humerus.     

Management and treatment of elbow and forearm injuries

Orthopedic injuries to the upper extremity are frequently seen in the emergency department (ED). The emergency medicine practitioner must be proficient in recognizing these injuries and their associated complications, and be able to provide appropriate orthopedic management. This article highlights the most frequent forearm and elbow injuries seen in the ED.     

Coronoid fractures of the elbow

Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize. They often occur in association with elbow dislocations and play an important role in elbow instability. Historic recommendations are to fix all large coronoid fracture fragments, as well as small fracture fragments associated with instability. There is little data regarding management of small coronoid fracture fragments. The coronoid process acts as a bony buttress to prevent posterior dislocation and has three soft tissue insertions which lend stability as well: the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament. Injured patients often present with swelling, tenderness and limited range of motion. After obtaining a detailed history and performing a careful physical examination, plain radiographs should be obtained. If present, dislocations are reduced and post-reduction stability is assessed. If the elbow is unstable, management usually consists of a combination of bony and soft-tissue repairs often including coronoid process repair. Loss of motion is the most common complication of these injuries. The current recommendation is to repair virtually all coronoid fractures associated with instability.     

护理质量分析讨论会的临床实践

目的探讨确保护理质量持续改进的方法。方法定期召开全体护士或全体质控小组成员护理质量分析讨论会，进行总结交流、分析改进、信息反馈。结果强化了护士的服务意识，增强了凝聚力，提高了护理售货员的整体素质，使得护理质量管理体系更加完善，提高了护理质量。结论护理质量分析讨论会提高护理质量具有非常重要的促进作用。     

以病例为引导的教学模式在临床护理实习教学中的应用与思考

目的　研究临床护理教学模式 ,提高临床教学质量。方法　以本校 97年级 87名护生为对照组 ,实施以操作为主的学徒式的临床实习教学 ;98年级 94名护生为实验组 ,实施以病例为引导的教学 (CBS)模式。两组毕业考试成绩均分通过u检验进行统计学处理。结果　CBS明显优于对照组的教学法 (P <0 .0 0 1) ,学生愿意接受CBS。结论　CBS调动了学生的学习积极性 ,培养了学生的临床思维 ,提高了学生的综合能力 ,在临床护理教学中有其借鉴价值。     

Ultrasound of the elbow: Examination techniques and US appearance of the normal and pathologic joint

Ultrasound studies are frequently requested for the work-up of patients with local elbow pain, which is generally caused by overuse syndromes, trauma, inflammatory diseases, or neuropathies. The technique used to examine this joint will vary to some extent depending on the precise location of the pain and other clinical findings. The aim of this article is to describe the standard technique used for elbow ultrasound, the normal anatomy of the joint, and the appearance on ultrasound of normal elbow anatomy and the alterations associated with some of the more common disorders affecting this joint.     

Extubation in intensive care units in the UK: an online survey

Aim: To determine the current practice among critical care nurses in the UK with regard to airway management during cuff deflation and extubation. Background: There are a number of techniques used by clinicians to prevent aspiration during cuff deflation and extubation of patients. There are no published clinical studies comparing the different manoeuvres available to clinicians at the time of extubation nor any data to suggest which technique is most commonly used. Methods: All members of the British Association of Critical Care Nurses with an email address were invited to participate in an online survey. Results: A total of 533 (29%) nurses from 184 (84%) intensive care unit (ICUs) in the UK completed the survey. Just under half of the sample (n = 258, 48·4%) had more than 10 years of critical care experience and the vast majority (n = 427, 80·1%) worked in general ICUs. The majority of respondents (n = 461, 86·5%) suction the trachea during cuff deflation and extubation. A further 304 (57%) respondents ask patients to cough as part of extubation. Respondents increase the positive end expiratory pressure setting on the ventilator infrequently as part of routine procedure for extubation (n = 7, 1·3%). Conclusion: The majority of UK critical care nurses either suction the trachea during cuff deflation and extubation of patients and/or simply ask the patient to cough. Further clinical trials are required to identify the most appropriate and safe technique for critically ill patients.     

护理本科生临床实习行为的评价

目的 :评价护理本科生临床实习的认知、情感和动作技能领域行为。方法 :采用问卷调查法 ,对 46名护理本科生临床实习行为进行相关性研究。结果 :学生临床实习行为总体令人满意 ,情感领域行为分值相对较高 ;97级学生动作技能领域行为分值高于 96级学生 (P <0 .0 1) ;认知、情感和动作技能领域行为之间及其与总分均呈正相关 (r =0 .2 18～0 .788,P <0 .0 1)。结论 :临床带教中 ,应重视认知、情感和动作技能领域行为对学生总体实习行为的正性影响     

急诊护理质量与临床实践

如何加强和提高急诊护理质量,我院急诊科进行了一系列积极探索如建立各区护士岗位职责、建立晨交班理论查房与操作考核制度、建立突发事件应急处理预案、拟定各区常见问题解答、建立护士长24h值班制,使急诊护理质量有了明显提高。     

如何运用系统评价结果进行临床实践

循证医学实践需要高质量证据。系统评价/Meta分析通过立题、检索文献、筛选文献、评价文献质量、收集资料、分析资料、解释结果、更新原有评价等严格系统的制作过程,确保研究结果和结论的真实性和可靠性,因此被公认为论证强度最高的证据。然而临床医生在将其具体应用于临床实践之前还需考虑该系统评价结果是否适用于你的患者,是否包含了所有可能的重要结果,其干预措施对患者的诊治益处在临床上是否重要,对患者是否利大于弊,此外,还需要考虑所需治疗费用以及患者的价值取向。循证医学临床实践因需要而产生,同时它也因为真实性、患者的个体化以及疾病的复杂性而不断更新。也正是因为它的缺陷性和不完美性,循证临床实践才具有更广阔的发展空间。     

先天性双侧肘关节强直1例报告

患儿男，16个月。足月顺产，出生后双肘关节形态固定，不能屈曲而就诊。其母怀孕期间否认服药史，无家族史，无外伤史。体检：双侧上肢短小，双肘关节固定，伸屈受限，肘部无皮肤皱褶。