健康教育和心理护理提高特发性脱髓鞘性视神经炎患者治疗效果

目的 观察健康教育和心理护理干预对特发性脱髓鞘性视神经炎(idiopathicdemyelinating optic neuritis,IDON)患者治疗效果的影响,探讨提高IDON疗效的护理措施.方法 采用随机数字表法将2008年10月至2010年10月的238例IDON住院患者分为对照组和干预组各119例,对照组给予常规护理措施,干预组在常规护理措施的基础上加强健康教育和心理护理干预.比较两组患者入院1周后的焦虑、抑郁评分、治疗依从性,出院时的疾病知晓率、护理满意率,以及出院后3个月的疾病复发率.结果 治疗1周后,两组患者的焦虑和抑郁程度均有所下降,而干预组焦虑和抑郁评分均低于对照组,差异有统计学意义(P<0.05);干预组的治疗依从性(89.1%)高于对照组(79.8%),差异有统计学意义(χ2=3.872,P<0.05).干预组患者出院时的疾病知晓率(94.1%)和护理满意率(94.6%)均高于对照组(82.4%和81.5%),差异有统计学意义(P<0 05或P<0.01);出院后3个月,干预组的疾病复发率(0.8%)低于对照组(5.9%),差异有统计学意义(χ2=4.657,P<0 05).结论 在IDON治疗过程中,应重视加强患者的健康教育和心理护理干预,以提高IDON患者的治疗效果,降低疾病的复发率.     

“三制一体”护理模式对推进精神科优质护理服务的影响

目的 探讨“三制一体”护理模式对推进精神科优质护理服务的影响。方法 选取我院2012年4月—2013年3月优质护理服务示范病区100例患者为研究组,普通病区100例同期住院患者为对照组。研究组采用新制定的服务标准,并采用“三制一体”护理模式,对照组采用传统服务标准及护理模式对患者实施护理。对两组患者住院满意度、住院患者家属满意度、住院患者健康教育知识知晓率及护理质量进行比较。结果 研究组的患者住院满意度、住院患者家属满意度、健康教育知识知晓率及护理质量与对照组比较,差异有统计学意义(P<0.05)。结论 精神科“三制一体”护理模式有利于进一步提高护理服务质量,提高患者及家属满意度,提高患者健康教育知识知晓率,是一项推进精神科优质护理服务行之有效的护理工作模式。     

中医特色健康教育在骨伤科门诊患者中的应用

目的探讨中医特色健康教育在中医骨伤科门诊患者中的应用效果。方法选取2013年7~12月中医骨伤科门诊就诊患者120例,随机将患者分为研究组和对照组,每组60例,对照组给予常规健康教育,研究组在常规健康教育的基础上再给予中医特色健康教育。观察两组对疾病认识、康复指导、养生保健、服药知识知晓率的情况及对特色健康教育实施后效果评价满意度。结果研究组对疾病认识、康复指导、养生保健、服药知晓率较对照组高,差异具有统计学意义(P0.05)。研究组对本次的健康教育满意度96.6%高于对照组75%,两组比较差异具有统计学意义(P0.05)。结论通过中医特色的健康教育,能够引导患者养成健康的行为习惯,提高了患者的生活质量。     

胰腺癌手术患者健康教育中应用临床护理路径的效果观察

研究分析临床护理路径用于胰腺癌手术患者健康教育中的应用价值。选择收治的胰腺癌手术患者80例,按照护理方法将其分成研究组(n=40)与对照组(n=40),对照组运用常规健康教育,研究组实施临床护理路径健康教育,比较分析两组患者的知识知晓率、护理满意度及心理状况。经护理干预后,研究组知识知晓率、护理满意度、治疗依从性均明显高于对照组(P<0.05)。研究组与对照组护理前HAMD与HAMA评分差异无统计学意义(P>0.05);护理干预后,研究组HAMD与HAMA评分均明显低于对照组(P<0.05)。临床护理路径用于胰腺癌手术患者健康教育中效果显著,可以明显提高患者的知识知晓率及治疗依从性,提升护理工作的满意度,有效改善患者的心理情绪,值得推广应用。     

以"新起点"健康理念为基础的健康教育对抑郁症患者的效果分析

目的 探讨"新起点"健康理念(即营养、运动、水、阳光、节制、空气、休息、信心)为基础的健康教育方法对抑郁症患者的效果.方法 将90例抑郁症患者随机分为实验组(45例)和对照组(45例).实验组参与"新起点(NEW START)"健康理念健康营活动6周(每周2次);对照组接受常规治疗和护理.对两组患者随访12个月,采用WHO生存质量测定量表简表评价生活质量满意度,自制问卷调查表评定知识掌握情况、健康理念形成率,比较两组患者出院后复发情况.结果 实验组在出院前知识掌握情况评分为(28.23±2.07)分,对照组为(23.10±4.12)分,两组比较差异具有统计学意义(t=2.74,P<0.01);实验组健康理念形成率为86.7%,对照组为66.7%,两组比较差异具有统计学意义(χ2=5.03,P<0.01).12个月末,两组生存质量评分比较,差异具有统计学意义,实验组高于对照组(P<0.05,P<0.01及P<0.001);实验组病情复发累计11例,对照组复发25例,两组比较差异有统计学意义(χ2=9.07,P<0.01).结论 "新起点"健康理念可减轻抑郁症患者的心理压力,提高生存质量,降低疾病复发率.     

IPAD对提高血液病患者健康教育知晓率的效果评价

目的 探讨应用IPAD对血液病患者进行健康教育知晓率的效果评价.方法 选取2016年1~6月住院患者100例,随机分为研究组和对照组各50例.对照组接受常规健康教育,研究组由责任护士使用IPAD进行健康教育.结果 研究组患者使用IPAD的健康教育知晓率的效果评价与对照组比较差异有统计学意义(P<0.01).结论 应用IPAD能提高血液病患者健康教育知晓率.     

日清日高管理模式在护理健康教育中的应用

目的 增强临床护士进行健康教育的能力,提高病人的健康教育知晓率、依从性和满意度.方法 选择急诊留观病房病人220名作为研究组,应用日清日高管理模式实施健康教育.评价病人健康教育知晓率、依从性和满意度并与对照组比较.结果 研究组病人的健康教育知晓率、依从性和满意度与对照组比较有统计学意义(P<0.05).结论 日清日高管理模式应用于护理健康教育是可行并且有效的.     

思维导图式健康宣教在脑肿瘤患者中的应用效果

目的探讨思维导图式健康宣教在住院脑肿瘤患者中的应用效果。方法选取2018年2月20日—10月20日本院收治的100例脑肿瘤患者为研究对象,将患者按照时间先后顺序分为对照组和研究组,每组各50例。对照组患者采用常规的口头健康宣教方式,研究组患者在对照组的基础上采用思维导图的健康宣教方式。比较两组患者对健康宣教的满意度以及对相关疾病基本知识的知晓情况。结果对照组患者对健康宣教方式的满意度为80.0%,研究组为94.0%,差异有统计学意义(P0.05);对照组患者对疾病基本知识的知晓率为84.0%,研究组为96.0%;差异有统计学意义(P0.05)。结论思维导图的健康宣教方式能显著提高住院脑肿瘤患者对健康知识宣教的满意度,提高患者对疾病相关知识的知晓率,值得在临床中借鉴使用。     

个性化护理在肝硬化患者中应用效果的研究

目的:探讨个性化护理在肝硬化患者中的应用效果。方法:选取在我院治疗的肝硬化患者180例,按时间顺序分为对照组和研究组,每组90例,对照组中患者实施常规护理,研究组中患者实施个性化护理。患者入院时及出院时分别填写焦虑自评表(self-rating anxiety scale,SAS)、抑郁自评表(self-rating depression scale,SDS)、中文版健康量表(Chinese version of health scale,SF-36)及护理满意度调查问卷;记录患者的住院时间及住院期间并发症的发生情况。结果:研究组中患者的SA S、SDS评分(33.73±4.18、30.19±3.79)明显低于对照组(42.12±4.49、39.75±3.63),差异具有统计学意义;研究组中患者的SF-36评分明显高于对照组,差异具有统计学意义;研究组中患者的住院时间、具有不良习惯的人数及并发症的发生率明显低于对照组,且研究组中患者对护理的满意度(95.3%)明显高于对照组(78.6%),差异具有统计学意义。结论:个性护理干预有利于降低肝硬化患者的SDS及SAS,提高患者生活质量评分及对护理的满意度,降低并发症的发生率,减少患者的不良习惯,缩短住院时间,对临床治疗具有积极影响。     

路径化健康教育在膀胱造瘘患者护理中的应用

目的在医疗临床路径和实施方案的启发下制定膀胱造瘘患者住院期间及出院后延续护理的健康教育路径表(以下简称路径),通过临床护理实践观察,探讨路径化健康教育对膀胱造瘘患者的护理效果。方法选取2015年1月~2016年12月住院的膀胱造瘘术患者为研究对象,将2015年1~12月的21例患者作为对照组,2016年1~12月的21例患者作为观察组。对照组按专科护理常规实施健康教育;观察组在常规护理基础上实施路径化健康教育。观察每组患者平均住院日、对护理工作完全满意度、住院期间至出院后3个月健康知识完全掌握率、住院期间至出院6个月并发症发生率。结果观察组患者的平均住院日(6±1.9)d少于对照组的(8±2.7)d;患者完全满意度(95.23%)高于对照组(61.90%);健康知识掌握率(90.47%)高于对照组(71.42%),差异均有统计学意义(P0.05)。结论对膀胱造瘘患者实施路径化健康教育,有助于缩短平均住院日,提高患者健康知识知晓率,尽快实现自我护理,减少手术后并发症,提高生活质量及患者对护理工作的满意度。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.