加强护理意识对输尿管镜取石术患者术后生活质量的影响

目的：探究加强护理意识对输尿管镜取石术患者术后生活质量的影响。方法选取2011年7月至2014年1月在我院进行输尿管取石术的患者80例作为研究对象，分为对照组和观察组，每组40例患者，对照组患者采用常规的护理方法，观察组患者在常规护理的基础上加强护理意识，对两组患者护理效果和术后生活质量进行比较。结果观察组患者术后生活质量的良好率（90.00％）明显高于对照组患者（50.00％），观察组患者对护理服务的满意率（90.00％）明显高于对照组（52.50％），观察组患者治疗后不良反应的发生率（10.00％）明显低于对照组患者（40.00％），两组比较差异具有统计学意义（P＜0.05）。结论对进行输尿管镜取石术的患者在护理工作中加强护理意识有很大的作用，可以提高患者治疗后的生活质量，减少术后不良反应的发生率，值得在临床中推广应用。     

不同手术方式治疗阑尾炎的术后护理效果观察

目的：观察不同手术方式治疗阑尾炎的术后护理效果。方法选择2011年6月至2014年6月我院收治的阑尾炎患者106例,随机分为观察组和对照组各53例。对照组给予常规开腹手术治疗,观察组给予腹腔镜手术治疗,术后对两组患者进行护理干预。对干预后两组患者的胃肠功能恢复情况、临床疗效、相关并发症发生率及护理满意度进行比较。结果干预后观察组患者的肠鸣音恢复时间及首次排气时间均明显短于对照组,差异有统计学意义（ P＜0．05）;观察组的总有效率（96．2％）明显高于对照组（83．0％）,差异有统计学意义（P＜0．05）;观察组的相关并发症总发生率（5．7％）明显低于对照组（17．0％）,差异有统计学意义（P＜0．05）;干预后观察组的护理满意率（94．3％）明显高于对照组（79．2％）,差异有统计学意义（P＜0．05）。结论对腹腔镜手术治疗的阑尾炎患者术后实施护理干预,可明显改善胃肠功能,提高患者的临床疗效和护理满意度,降低相关并发症发生率,值得临床推广应用。     

无痛宫腔镜检查术中与术后不良反应的观察与护理

目的:研究在无痛宫腔镜检查术患者术后不良反应中的采用护理干预的应用效果。方法:样本选自本院2016年1月至2018年1月收治的60例无痛宫腔镜检查术患者,遵循随机的原则将其分为对照组与观察组,对照组患者采用护理中常规护理干预,观察组患者采用护理干预干预,比较两组患者护理满意率、不良反应发生率等状况。结果:1)观察组患者与对照组患者护理满意率分别为96.7%与53.3%,组间差异显著(P <0.05;2)观察组患者与对照组患者不良反应发生率分别为16.7%与53.3%,组间差异显著(P <0.05);3)观察组患者与对照组患者生活质量各项评分组间差异显著,其中观察组较为优异(P <0.05)。结论:在无痛宫腔镜检查术患者不良反应中采用护理干预,有利于提高患者护理满意率,改善不良反应发生情况。     

预见性护理干预在宫腔镜术后并发症预防中的应用

目的:探讨预见性护理干预对预防宫腔镜术后并发症发生的临床应用效果。方法:选择2013年1月~2014年1月我院就诊进行宫腔镜手术患者136例作为研究对象。随机将其等分为观察组和对照组,对照组采取常规护理,观察组在此基础上实行预见性护理干预,比较两组患者术后并发症发生率、住院治疗时间、患者对护理工作满意情况。结果:观察组术后并发症发生率明显低于对照组,住院时间明显短于对照组,患者对护理工作满意率明显高于对照组,差异有统计学意义(P0.05)。结论:预见性护理干预能够有效降低患者术后并发症,保证临床治疗效果。     

护理干预对痔疮手术后尿潴留的效果探讨

目的：探讨对痔疮手术患者实施护理干预的临床价值。方法选取2013年1月至2014年1月郑州人民医院肛肠外科收治的行痔疮手术患者82例,将其分为观察组与对照组,各41例,对照组给予常规护理,观察组实施整体护理干预,观察两组患者术后尿潴留的发生情况。结果观察组的尿潴留发生率为2.44%,明显优于对照组的26.83%,差异有统计学意义（P<0.05）。结论对痔疮手术患者实施护理干预,能有效减少术后尿潴留的发生,值得临床推广应用。     

整体护理干预在重症哮喘呼吸内科治疗中的应用效果

目的：探讨支气管重度哮喘呼吸内科治疗采取整体护理干预的临床效果,提高支气管哮喘重度发作护理水平及患者满意度。方法将我院呼吸内科2013年1～12月收治的支气管哮喘重度发作患者80例随机分为对照组和观察组各40例,对照组采取常规护理,观察组采取整体护理干预。对两组护理效果、患者满意度进行对比分析。结果观察组总有效率为95％,患者总满意率为97.5％;对照组总有效率和患者总满意率均为80％,观察组在总有效率、患者满意率上明显高于对照组,差异有统计学意义（P＜0.05）。此外,观察组并发症明显低于对照组（P＜0.05）。结论对支气管哮喘重度发作患者采取整体护理干预能明显提高治疗有效率及患者满意率,降低并发症发生率,改善患者生活质量,值得临床进一步应用。     

输尿管结石 URSL术后综合护理干预对泌尿系结石治疗效果的影响

目的：探讨输尿管结石URSL术后综合护理干预对泌尿系结石治疗效果的影响。方法选取我院行输尿管结石URSL术的泌尿结石患者136例作为研究对象，按随机数字表法分为对照组和观察组各68例，对照组采用常规护理，观察组采用综合护理干预，比较两组的临床疗效。结果观察组患者手术所需时间、住院天数、术后感染率均少于对照组，观察组患者的满意度（91．18％）明显优于对照组的（55．88％），观察组患者术后生活质量的良好率（89．71％）明显优于对照组的（52．94％），两组比较差异具有统计学意义（P＜0．05）。结论对泌尿系结石采用输尿管结石URSL术后进行综合护理干预有较好的临床疗效，可以促进患者早日康复，降低术后感染率和不良反应的发生率，值得在临床中推广应用。     

实施护理干预措施对慢性阻塞性肺疾病患者的临床研究

目的：探讨护理干预措施对慢性阻塞性肺疾病患者的护理效果。方法收集本院2011年1月至2013年1月接诊的500例慢性阻塞性肺疾病患者的临床病例资料,对观察组250例患者实施了护理干预措施,而对照组250例患者采用常规护理措施,对两组患者的护理效果进行分析与比较。结果护理后,观察组患者SGRQ呼吸评分较对照组患者出现了明显改善,组间差异具有统计学意义（ P＜0.05）,而且观察组患者总满意率为95.00％,而对照组患者的总满意率为80.00％,观察组患者的总满意率明显高于对照组患者,组间差异具有明显统计学意义（ P＜0.05）。结论采用护理干预对慢性阻塞性肺疾病患者具有十分重要的作用可有效提高患者的生活质量和对护理的满意度,有利于患者的预后,值得临床应用。     

护理干预对肛肠术后患者留置尿管拔除后再发尿潴留的影响研究

目的探索系统化护理干预对肛肠手术后患者留置尿管拔除后再发尿潴留的预防效果。方法选取我院2013年1月~2014年1月行肛肠手术后并留置尿管的100例患者作为研究对象,随机分成观察组和对照组,每组50例。对照组患者采用常规护理措施,观察组患者在对照组常规护理的基础上采用系统化护理干预。比较两组患者尿管拔除后再发尿潴留和再行导尿的发生率。结果观察组患者再发尿潴留及再行导尿的发生率明显低于对照组;尿路感染率也明显低于对照组,均具有统计学意义(P0.05)。结论系统化护理干预可有效降低肛肠术后留置尿管拔除后再发尿潴留及再行导尿的发生率,有利于减少尿路感染发生率及其它并发症的发生,值得推广。     

护理干预在雾化吸入联合无创呼吸机在呼吸衰竭患者中的应用效果

目的：探究护理干预在雾化吸入联合无创呼吸机在呼吸衰竭患者中的应用效果。方法选取2013年1月至2014年1月在我院确诊为呼吸衰竭并采用雾化吸入联合无创呼吸机治疗的患者120例作为研究对象,将患者随机分为对照组和观察组,每组各60例患者。对照组的呼吸衰竭患者在治疗过程中采用常规的护理方法,观察组患者在治疗过程中采用护理干预的护理方法,对两组不同护理方法的应用效果进行探究。结果对照组患者并发症发生率（43．33％）明显高于观察组患者的并发症的发生率（15．00％）,差异具有统计学意义（ P＞0．05）。观察组患者对护理方案的满意率（85．00％）明显好于对照组患者对护理方案的满意率（46．67％）,两组比较,差异具有统计学意义（P＜0．05）。结论对雾化吸入联合无创呼吸机在治疗呼吸衰竭的患者中采用护理干预的方法能够消除患者的消极情绪,积极配合医生进行治疗,还能够减少并发症的发生,更加安全、有效,同时能够提高患者对护理的满意率,有助于建立和谐的护患关系,值得在临床中推广应用。     

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.