护理干预对慢性丙型肝炎病人抗病毒治疗症状及抑郁的影响

[目的]评估护理干预对慢性丙型肝炎病人抗病毒治疗期间症状与抑郁情绪的影响。[方法]将60例接受抗病毒治疗的慢性丙型肝炎病人分为干预组和对照组各30例,干预组在整个抗病毒治疗过程中接受一对一的健康教育、咨询与提醒服务,对照组接受丙型肝炎抗病毒治疗常规护理。分别在干预前、治疗4周、治疗12周、治疗24周时对两组病人进行症状与抑郁评价。[结果]干预组28例顺利完成治疗,对照组21例顺利完成治疗,干预组全程治疗率高于对照组(P0.05)。干预组病人在治疗4周时症状困扰评分低于对照组(P0.05)。干预组病人抑郁评分在治疗4周、治疗12周时低于对照组(P0.05)。[结论]护理干预能有效改善慢性丙型肝炎病人抗病毒治疗早期的症状困扰与抑郁情绪。应提升护士的专业照护能力,规范慢性丙型肝炎病人抗病毒治疗期间的个案管理,帮助病人顺利完成抗病毒治疗。     

个体化教育与心理干预在慢性肾脏病患者中的应用

目的:探讨个体化教育与心理干预在慢性肾脏病(CKD)患者中的应用效果。方法:按照随机分配原则将65例患者分为干预组35例和对照组30例,干预组给予个体化教育与心理干预,对照组给予常规护理。观察比较两组自我效能感量表(GSES)、自我护理能力测量表(ESCA)、肾小球滤过率(e GFR)和肌酐(Cr),分别于开始前和干预12周后收集。结果:干预后干预组GSES评分、ESCA评分与对照组比较差异有统计学意义(P0.05);干预组e GFR、Cr与对照组比较差异有统计学意义(P0.05)。结论:个体化教育与心理干预可改善未经透析治疗的CKD患者的自我效能和自我护理行为。     

以自我效能为中心的护理干预对慢性乙型肝炎病人治疗依从性及自我护理能力的影响

[目的]分析以自我效能为中心的护理干预对慢性乙型肝炎病人治疗依从性及自我护理能力的影响。[方法]将80例慢性乙型肝炎病人按照随机数字表法分为观察组和对照组各40例。住院期间对照组采用乙型肝炎常规护理和基本健康教育,观察组在此基础上进行个体化综合性护理干预。观察并比较两组病人住院期间、随访期间病情变化、抑郁发生率及出院后自我效能、治疗依从性评分。[结果]观察组HBV DNA转阴率、Child-Pugh分级改善均高于对照组,而再入院率低于对照组(P0.05)。末次随访时,观察组抑郁率明显低于对照组(P0.05),且自我效能评分及治疗依从性评分明显高于对照组(P0.05)。[结论]以自我效能为中心的护理干预可改善慢性乙型肝炎病人负性心理情绪,提高治疗依从性和自我护理能力,有利于提高护理质量,降低再入院率。     

延续护理模式结合中医健康教育对高血压病人慢性疾病管理自我效能的影响

[目的]探讨延续护理模式结合中医护理健康教育对出院后高血压病人慢性疾病管理自我效能的影响,以期为提升出院后高血压病人自我管理能力提供参考依据。[方法]将66例出院后高血压病人随机分为对照组和干预组各33例,干预组实施延续护理方案结合中医护理健康教育,对照组仅于出院当日给予中医护理健康教育,比较两组病人出院后慢性疾病管理自我效能。[结果]干预组病人于出院后8周、12周慢性疾病管理自我效能量表得分均高于对照组(P0.01)。[结论]延续护理模式结合中医护理健康教育可提升出院后高血压病人慢性疾病管理自我效能。     

聚焦解决模式在慢性丙型肝炎患者健康教育管理中的应用

目的:总结慢性丙型肝炎患者采用聚焦解决模式实施健康教育的经验方法,对其实施效果进行评价。方法:于2015年5月~2016年5月抽取80例慢性丙型肝炎患者作为研究对象,按照随机数表法将其等分为对照组和干预组,分别采取两种不同的模式为患者展开健康教育并进行12个月的跟踪随访,对照组实施常规护理模式,干预组实施聚焦解决模式。对比两组患者的健康教育实施效果。结果:干预组患者的护理依从性评分、自我护理能力评分均明显高于对照组(P0.05)。干预组患者肝功能异常、症状体征反复、丙型肝炎病毒RNA阳性情况均低于对照组(P0.05)。存在统计学意义。结论:慢性丙型肝炎患者采用聚焦解决模式实施健康教育能够有效提高健康教育的效率,提升慢性丙型肝炎患者的自我护理能力,更好改善患者的生活质量。     

个体化健康教育指导对门诊慢性盆腔炎患者健康知识水平及护理满意度的影响

目的 探究个性化教育指导对门诊慢性盆腔炎患者健康知识水平及护理满意度的影响.方法 选取我院门诊2020年5月至2022年5月收治的慢性盆腔患者70例,采用随机数字表法分为对照组和观察组,每组各35例.对照组患者采用传统健康教育指导干预,观察组患者采用个体化健康教育指导干预.比较两组疾病知识掌握程度、焦虑自评量表评分、抑郁自评量表评分、自我效能感评分及满意度.结果 观察组对疾病知识的掌握程度高于对照组(P＜0.05).观察组患者焦虑自评量表评分、抑郁自评量表评分低于对照组(P＜0.05).观察组患者自我效能感评分高于对照组(P＜0.05).观察组患者护理满意度高于对照组(P＜0.05).结论 个体化健康教育指导用于门诊慢性盆腔炎患者,可提高其随疾病的了解程度,缓解不良情绪,自我效能感和满意度显著提升.     

团体认知行为干预在住院慢性肾病患者中的应用

目的:探讨团体认知行为干预对慢性肾病患者自我护理能力及代谢指标的影响。方法:选择2014年11月~2016年10月收治的慢性肾病患者96例为研究对象,随机等分为观察组和对照组,对照组给予慢性肾脏病常规护理与健康教育,观察组进行团体认知行为干预,随访12周,比较两组自我护理能力及相关代谢指标。结果:随访12周后,观察组健康知识、自我护理技能、自我责任感、自我概念评分均明显高于对照组(P0.05);血肌酐、尿素氮、24 h尿蛋白定量均明显低于对照组(P0.05)。结论:团体认知行为干预有助于提高慢性肾病患者自我护理能力,调节代谢指标,改善肾功能。     

规范康复随访流程在出院慢性心力衰竭患者心脏康复随访中的应用效果研究

目的探讨规范康复随访流程在出院慢性心力衰竭患者心脏康复随访中的应用效果。方法将102例出院慢性心力衰竭患者分为对照组与干预组,对照组出院时接受常规康复指导和出院后随访,干预组采用依据临床护理路径管理模式制订的随访手册进行干预。两组患者分别于干预前、干预后第6周、第12周、第24周采用慢性病自我效能量表和心力衰竭生活质量量表进行调查。结果干预组的自我效能和生活质量得分均高于对照组(P0.01),且随着时间的延长均呈逐步升高趋势(P0.01)。结论应用规范康复随访流程对出院慢性心力衰竭患者进行心脏康复随访,可提升患者依从性,明显提高自我效能,改善生活质量。     

氟伐他汀对合并高胆固醇血症的慢性丙型肝炎的抗病毒疗效的影响

目的：观察氟伐他汀对合并高胆固醇血症的慢性丙型肝炎的抗病毒疗效的影响。方法选取2006年9月至2008年9月合并高胆固醇血症慢性丙型肝炎60例,观察组30例,对照组30例,所有患者均予聚乙二醇干扰素α-2a＋利巴韦林治疗;观察组患者加用氟伐地汀;用药后4、12、24、36、48周及停药后12周、24周复查病毒RNA定量。结果氟伐他汀治疗合并高LDL血症的慢性丙型肝炎的患者的早期病毒学应答（EVR）、治疗结束时病毒学应答（ETVR）和持续病毒学应答（SVR）均显著高于对照组（53.3%vs.46.7%,85.1%vs.63.3%,81.5%vs.53.3%,P＜0.05）。结论氟伐他汀有利于提高合并高胆固醇血症的慢性丙型肝炎患者的抗病毒疗效。     

多媒体互动健康教育模式在肝内外胆管结石患者微创治疗中的应用

目的:探讨多媒体互动健康教育模式在肝内外胆管结石患者微创治疗中的应用效果。方法:将2018年7月1日～2020年6月30日住院行肝内外胆管结石微创治疗的80患者随机分为观察组和对照组各40例。对照组采用常规护理干预,观察组在对照组基础上采用多媒体互动健康教育模式干预。比较两组干预前后焦虑[采用焦虑自评量表(SAS)]抑郁[采用抑郁自评量表(SDS)]情绪、自我效能、术后清醒及术后12、24 h时疼痛[采用视觉模拟评分法(VAS)]情况、康复指标及护理满意度。结果:干预后,观察组SAS、SDS评分均低于对照组,且自我效能高于对照组(P0.05);两组术后12、24 h的VAS评分均低于术后清醒时,且观察组低于对照组(P0.05);观察组术后下床活动、进食时间早于对照组,且住院时间短于对照组(P0.01);观察组护理满意度高于对照组(P0.01)。结论:对行肝内外胆管结石微创治疗患者采用多媒体互动健康教育模式干预,可提高患者的自我效能,改善其焦虑、抑郁情绪,有利于其术后恢复,提高患者护理满意度。     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.