可视音乐联合诱导式护理对肘部骨折患儿治疗依从性和焦虑性情绪障碍的影响

目的探讨可视音乐联合诱导式护理对肘部骨折患儿治疗依从性和焦虑性情绪障碍的影响。方法选取2018年2月至2019年2月我院医治的肘部骨折患儿100例作为研究对象,随机将其等分为对照组和观察组,对照组给予常规护理干预,观察组给予可视音乐联合诱导式护理干预。比较两组患儿护理干预前后的焦虑性情绪障碍评分及护理干预后的治疗依从性。结果干预前,两组焦虑性情绪障碍评分比较,差异无统计学意义(P 0. 05),干预后,观察组患儿的焦虑性情绪障碍评分显著低于对照组,差异有统计学意义(P 0. 05);干预后观察组患儿治疗依从性显著高于对照组,差异有统计学意义(P 0. 05)。结论对肘部骨折患儿给予可视音乐联合诱导式护理干预,能有效改善焦虑性情绪障碍,提升治疗依从性,值得推广。     

精细化护理干预对缓解患儿围手术期焦虑恐惧情绪及疼痛的影响

目的探讨精细化护理干预对缓解患儿围手术期焦虑恐惧情绪及疼痛的作用。方法选取我院101例需要进行手术的患儿随机分为对照组和观察组,对照组50例,观察组51例。围手术期,对照组给予常规的护理,观察组给予精细的护理干预,观察两组患儿干预前后的心率(HR)、呼吸(R)、平均动脉压(MAP);术前访视时,静脉穿刺、麻醉诱导医疗操作时的改良耶鲁术前焦虑评分;静脉穿刺时的主、客观疼痛评分;医疗操作的依从性;一次性静脉穿刺的成功率及家属对护理服务的满意度。结果干预前两组患儿HR、R、MAP比较无统计学差异(均P0.05);干预后观察组患儿HR、R、MAP与对照组比较差异有统计学意义(均P0.01)。改良耶鲁术前焦虑评分,干预前,两组患儿比较无统计学差异(P0.05);干预后,观察组患儿改良耶鲁术前焦虑评分显著低于对照组(P0.01)。观察组患儿静脉穿刺疼痛的主观评分、客观评分显著低于对照组(均P0.01);观察组患儿医疗操作的依从性评分、一次性静脉穿刺的成功率高于对照组(均P0.01)。干预后观察组家属的满意度与对照组比较差异显著(P0.01)。结论围手术期,精细的护理干预能使患儿生命体征平稳,并能缓解患儿术前焦虑,静脉穿刺时的疼痛感,增加其对医疗操作的依从性,提高静脉穿刺的成功率和家属对护理的满意度。     

聚焦解决模式在腹腔镜卵巢囊肿切除术患者中的应用

目的:探讨聚焦解决模式在腹腔镜卵巢囊肿切除术患者中的应用效果。方法:将120例腹腔镜卵巢囊肿切除术患者随机分为观察组和对照组各60例,对照组围术期采用常规护理措施,观察组在常规护理基础上采用聚焦解决模式进行护理干预。比较两组患者手术情况、护理满意度、并发症发生率、感染率、焦虑情绪评分。结果:观察组住院时间(4.54±0.66)d,对照组住院时间(6.32±0.65)d,两组比较差异有统计学意义(P0.01);观察组护理满意度高于对照组,术后感染率低于对照组,两组比较差异有统计学意义(P0.05);观察组干预后焦虑自评量表(SAS)评分低于干预前,且低于对照组干预后(P0.01)。结论:聚焦解决模式应用于腹腔镜卵巢囊肿切除术患者,可降低患者感染率,缩短康复时间,缓解患者焦虑情绪,值得临床推广。     

护理干预对脑外伤住院患者照顾者焦虑及抑郁情绪的影响

目的探讨护理干预对脑外伤住院患者照顾者焦虑及抑郁情绪的影响。方法对观察组和对照组各40例照顾者进行焦虑抑郁量表（HADS）评定,并对观察组实施相应的护理干预措施。对护理干预后的焦虑、抑郁各维度评分,进行比较分析。结果护理干预后前5项焦虑维度评分观察组低于对照组,差异有统计学意义（P＜0.01）,后2项焦虑维度评分差异无统计学意义（P＞0.05）;护理干预后D6、D8、D10、D14等抑郁维度评分观察组低于对照组,差异有统计学意义（P＜0.01）,其余3项抑郁维度评分差异无统计学意义（P＞0.05）。结论护理干预能明显缓解脑外伤住院患者照顾者的焦虑情绪,但不能明显缓解其抑郁情绪。     

强化护理干预对手足口病合并脑炎患儿治疗效果及预后的影响

目的探讨强化护理干预在手足口病合并脑炎患儿治疗中的应用效果。方法将80例重症手足口合并脑炎患儿随机分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用强化护理干预,比较患儿的治疗依从性、效果、预后以及家长的护理满意度。结果观察组的治疗依从性、总有效率高于对照组,高热、皮疹、神经内系统症状等消失时间均短于对照组,差异有统计学意义(P0.05)。观察组的并发症少于对照组,住院时间短于对照组,预后评分高于对照组,家长的护理满意度高于对照组,差异有统计学意义(P0.05)。结论强化护理干预能够提高手足口病合并脑炎患儿的临床疗效,加速症状缓解,改善患儿的预后。     

手术室内亲情护理对病人术后情绪及预后的影响

[目的]探讨手术室内亲情护理模式对病人术后情绪、预后等的影响。[方法]将120例择期手术病人随机分为对照组和观察组各60例,对照组实施常规护理,观察组给予亲情护理模式。观察两组病人术后并发症情况,应用汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评估术后病人的情绪状态,采用问卷调查统计两组病人对医护人员满意度,用依从性调查表对两组病人依从性进行评估。[结果]经护理干预后,观察组病人在按时服药、坚持锻炼身体及按时复查等治疗依从性表现优于对照组(P0.05);观察组病人对医护人员的满意度高于对照组(96.67%vs 65.00%,P0.05);两组病人在护理干预前HAMA和HAMD评分差异无统计学意义(P0.05),干预后两组病人的HAMA和HAMD评分均降低(P0.05),且观察组低于对照组(P0.05);观察组病人的住院时间和并发症发生率均低于对照组(P0.05)。[结论]手术室亲情护理模式可有效缓解病人的焦虑、抑郁情绪,提高病人的护理满意度和治疗依从性,有利于预后。     

心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响

目的探讨心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响。方法选取62例慢性乙型病毒性肝炎患者按将数字表法分为对照组和观察组,各31例。对照组采用一般的基础护理方法,观察组在对照组基础上再实施心理干预,对比2组患者干预前后焦虑与抑郁的发生率、SAS与SDS评分情况以及干预后患者用药依从性情况。结果护理干预前,2组患者焦虑和抑郁的发生率差异无统计学意义(P0.05);护理干预后,观察组焦虑发生率12.90%、抑郁发生率16.13%,显著低于对照组焦虑发生率48.39%、抑郁发生率51.61%,差异有统计学意义(P0.05)。护理干预前,2组患者SAS和SDS评分差异无统计学意义(P0.05);护理干预后,观察组SAS和SDS显著低于对照组,差异有统计学意义(P0.05)。观察组护理干预后用药依从性显著高于对照组,差异有统计学意义(P0.05)。结论对慢性乙型病毒性肝炎患者实施心理干预的效果显著,可有效减轻患者焦虑及抑郁情绪,促进患者康复。     

医院-社区-家庭三位一体化护理在手足口病患儿中的应用效果分析

目的 探讨医院-社区-家庭三位一体化护理在手足口病患儿中的应用效果。方法 选取2018年5月～2019年7月在息县中心医院儿科治疗的手足口病患儿98例,根据患儿入院时间分为观察组和对照组各49例。对照组行常规护理,观察组行医院-社区-家庭三维一体化护理,比较两组患儿家属疾病认知度、患儿护理依从性。结果 观察组干预后患儿家属疾病认知度评分高于对照组,差异有统计学意义(P0.05);干预后,观察组患儿饮食、用药、行为依从性均高于对照组,差异有统计学意义(P0.05)。结论 对手足口病患儿应用医院-社区-家庭三位一体化护理,可有效增强患儿家属的疾病认知,提高患儿护理依从性。     

基于沙盘游戏的心理干预对高龄产妇负性情绪及护理质量的影响

目的探讨基于沙盘游戏的心理干预对高龄产妇负性情绪及护理质量的影响。方法选取我院2017年1月至2019年10月收治的96例高龄产妇为研究对象,随机将其等分为对照组与观察组,对照组给予常规心理护理,观察组在对照组基础上给予基于沙盘游戏的心理干预,两组共干预4周。比较两组干预后的焦虑与抑郁情绪、治疗依从性和护理满意度。结果干预后,观察组SDS评分、SAS评分均低于对照组,差异有统计学意义(P 0.05);观察组治疗依从性、护理满意度均优于对照组,差异有统计学意义(P 0.05)。结论基于沙盘游戏的心理干预有助于缓解高龄产妇焦虑、抑郁情绪,提高治疗依从性与护理满意度,值得临床推广应用。     

循证护理模式下医养结合联合家庭干预在儿童重症手足口病患儿中的应用效果

目的 探讨循证护理模式下医养结合结合家庭干预对重症手足口病患儿的应用效果.方法 回顾性分析2020月7月至2022年7月我院收治的90例重症手足口病患儿的临床资料.按照护理方案分为接受常规护理干预的对照组39例和接受循证护理模式下医养结合结合家庭干预的观察组51例.比较两组患儿护理依从性,临床恢复相关指标及负性情绪变化.结果 观察组患儿的用药依从率、饮食依从率、行为依从率均明显高于对照组(P＜0.05).观察组退烧时间、口腔疼痛缓解时间、口腔溃疡愈合时间、皮肤疱疹消退时间(P＜0.05).观察组SCAS评分明显显著低于对照组(P＜0.05).结论 循证护理模式下医养结合结合家庭干预,可有效提高重症手足口病患儿的治疗依从性,加快康复进度,降低患儿负性情绪,改善总体预后.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.