规范化疼痛管理在癌痛规范化治疗示范病房中的应用效果

目的：探讨规范化疼痛管理在癌痛规范化治疗示范病房中的应用效果。方法选择2013年7月至2014年6月在我院癌痛规范化治疗示范病房治疗的50例中晚期癌痛患者和21例护理人员作为研究对象,与2011年2月至2012年1月未实施癌痛规范化管理的38例中晚期癌痛患者和21例护理人员进行比较,管理前的设为对照组,管理后的设为观察组。比较两组护理人员专业成就感评分及理论知识考核成绩和患者的癌痛缓解程度。结果观察组护理人员专业成就感评分(16.76±5.98)分和专业知识考核成绩(95.26±23.82)分明显高于对照组的护理人员专业成就感评分(10.56±3.19)分和安全知识考核成绩(79.31±19.83)分,差异均有统计学意义( P<0.05)。观察组患者的癌痛缓解率(96.00%)明显优于对照组(68.42%),差异有统计学意义( P<0.05)。结论在癌痛规范化治疗示范病房中实施规范化癌痛管理可以有效提高护理人员的专业成就感及理论知识的掌握情况,显著缓解癌痛患者的疼痛。     

护理团队在老年癌症患者疼痛规范化护理中的作用

目的探讨癌痛护理团队在老年癌痛患者疼痛规范化护理中的作用。方法 48例老年癌症患者随机分为对照组和实验组,各24例。对照组予以常规护理和疼痛管理,实验组在对照组基础上设立疼痛护理团队,实施规范化护理措施。观察2组干预前后疼痛改善情况,对比2组护理满意度评分及不良反应发生情况。结果干预后,2组疼痛评分均降低,且实验组疼痛评分低于对照组,差异有统计学意义(P0.05)。实验组不良反应发生率低于对照组,差异有统计学意义(P0.05);实验组护理满意评分(90.24±3.32)分,高于对照组的(70.13±3.43)分,差异有统计学意义(P0.01),结论护理团体使老年癌症患者疼痛护理措施更为规范。     

无痛病房规范化管理对控制晚期癌症患者疼痛的影响

目的:探讨无痛病房规范化护理对控制晚期癌症患者疼痛的影响。方法:将我院肿瘤科2012年2月~2013年9月收治的中重度癌痛患者152例作为研究对象,按照无痛病房管理的实施时间分为对照组和观察组,均采用三阶梯镇痛治疗,对照组62例给予常规疼痛管理;观察组90例给予无痛病房规范化管理,2周后比较两组患者癌痛缓解率和满意度。结果:观察组患者癌痛缓解率及护理服务满意度明显高于对照组,差异有统计学意义(P0.05)。结论:无痛病房规范化管理提高了癌痛患者治疗依从性,有效控制了癌痛,对实现癌痛患者的无痛化管理目标起到了积极的促进作用,并提高了患者满意度。     

延续性护理干预对出院肿瘤患者癌痛的控制效果评价

目的探讨延续性护理干预对出院肿瘤患者癌痛控制的价值。方法选取2017年1月—12月于本院使用阿片类止痛药的190例出院肿瘤患者为研究对象。按照随机数字表法分为观察组及对照组,每组各95例。对照组出院时给予健康教育及服药指导,出院1周内进行电话回访;观察组实施延续性护理。观察患者及家属的癌痛知识掌握程度、止痛药物依从性、疼痛强度及护理满意度。结果观察组患者及家属癌痛知识评分为(88.22±7.45)分、止痛药物应用依从性为94.47%%、护理满意度为98.95%,均明显高于对照组的(70.18±8.27)分、75.79%、90.53%;观察组的NRS评分为(3.11±1.08)分,低于对照组的(4.21±1.24)分,差异均有统计学意义(P 0.01)。结论延续性护理干预,能够提高癌痛患者的服药依从性,使药物治疗癌痛的效果得到提高,值得临床应用和推广。     

癌痛规范化治疗示范病房护士癌痛评估规范性的调查研究

目的了解癌痛规范化治疗示范病房护士癌痛评估规范性的现状。方法从福建省、江苏省、浙江省、河南省及广西壮族自治区6所三级甲等医院癌痛规范化治疗示范病房抽取2017年6月—9月住院的479例癌痛患者病历,采用自设的"癌痛评估评价项目和计分标准"对病历中的疼痛评估状况进行评价。结果 479份病历中,410(85.59%)份病历癌痛评估合格,69(14.41%)份病历癌痛评估不合格;癌痛评估各维度标准化得分分别为:常规评估(98.80±8.85)分、量化评估(99.48±5.09)分、全面评估(93.57±14.12)分、动态评估(92.41±16.15)分;不同学历、职称、工作年限护士的疼痛评估合格率有差异(P<0.05)。结论癌痛规范化治疗示范病房中护士对癌痛患者进行癌痛评估的合格率较高,要注意加强护士全面、动态地进行癌痛评估的能力,学历较高(本科及以上学历)、职称较高、工作年限较长的护士能够更规范地进行癌痛评估。     

疼痛规范化管理模式在癌痛病人中的应用效果

[目的]探讨疼痛规范化管理模式在癌痛病人中的应用效果。[方法]将160例癌痛病人按照时间顺序分为观察组和对照组各80例,对照组给予疼痛常规护理,观察组给予疼痛规范化管理,干预12周后比较两组病人的疼痛程度和对护理工作的满意度。[结果]观察组病人疼痛程度低于对照组,对护理工作的满意度(45.63分±4.20分)高于对照组(36.45分±4.12分),差异有统计学意义(P0.01)。[结论]应用疼痛规范化管理模式可减轻癌痛病人的疼痛程度,提高病人对护理工作的满意度。     

口服阿片类药物病人个案信息化管理模式的应用研究

目的:探讨个案信息化管理模式在口服阿片类药物病人延续护理中的应用效果。方法:通过便利抽样法选取2020年1月—2020年12月于江苏省某三级综合医院肿瘤科住院的180例癌痛病人为研究对象,随机分为试验组与对照组,每组90例。两组病人住院期间均接受个案管理,出院后对照组病人接受常规个案管理,试验组接受个案信息化管理。干预12个月后,比较两组病人阿片类药物正确执行率、爆发痛发作次数、疼痛知识得分和满意度得分。结果:干预12个月后,试验组病人阿片类药物正确执行率(82.5%)高于对照组(48.6%),比较差异有统计学意义(P<0.05);疼痛知识得分(94.38±4.93)分和满意度得分(96.88±3.76)分均高于对照组的(65.34±9.00)分、(68.99±8.44)分,比较差异有统计学意义(P<0.05);干预后6个月、干预后9个月和干预后12个月试验组病人爆发痛发作次数少于对照组,比较差异有统计学意义(P<0.05)。结论:个案信息化管理模式有利于提高病人疼痛相关知识水平,减少阿片类药物服药偏差和爆发痛发作次数,有利于提高病人满意度。     

现象到本质式分析法在提高癌症患者癌痛教育质量的价值研究

目的研究现象到本质式分析法在提高癌症患者癌痛教育质量的价值。方法纳入我院NRS评分4分癌症疼痛患者236例,以随机数字表法分为观察组和对照组,各118例,对照组实施常规癌痛教育法。观察组实施现象到本质式分析法。观察两组止痛效果、疼痛知识掌握程度、生活质量及医护满意度。结果观察组疼痛缓解程度、疼痛知识评分及疼痛知识掌握达标率分别为(83.57±1.49)%、(96.54±0.79)分、97.46%,均高于对照组(79.86±1.53)%、(94.32±1.37)分、89.83%(P0.05);观察组生活质量评分、医护满意度评分分别为(45.49±8.87)分、(8.83±0.79)分,均优于对照组(59.53±9.69)分、(8.64±0.68)分(P0.05)。结论采用现象到本质式分析法可优化临床教育路径在癌痛患者癌痛教育中的应用效果,优化癌痛教育质量。     

规范化流程护理在肿瘤晚期病人护理中的应用效果

[目的]观察规范化流程护理在肿瘤晚期病人护理中的应用效果。[方法]将68例肿瘤晚期病人采用随机数字表法分为观察组和对照组,每组34例,对照组采用常规护理,观察组采用规范化流程护理,比较两组病人护理效果。[结果]观察组、对照组视觉模拟评分法(VAS)评分分别为(5.62±1.22)分和(6.51±1.46)分,疼痛持续时间分别为(9.04±2.31)h和(13.58±3.56)h,治疗依从性分别为94.12%和73.53%,健康知识掌握率分别为97.06%和79.41%,经比较差异均有统计学意义(P0.05)。[结论]规范化流程护理有利于缓解肿瘤晚期病人癌痛程度,缩短癌痛持续时间,有利于病人掌握健康知识,提高病人治疗依从性。     

呼吸内科病房实施护理风险管理对护理质量的效果分析

目的分析在呼吸内科病房中引进护理风险管理模式对本科室护理质量水平的影响。方法选取本院呼吸内科于2011年9月～2012年8月收治的46例患者,设为研究组,给予护理风险管理;选取本院呼吸内科于2010年9月～2011年8月收治的46例患者,设为对照组,给予常规护理管理。对2组进行护理质量评分,包括基础护理质量、消毒隔离及病房管理评分;同时记录2组患者的护理满意度,并做好对比。结果研究组基础护理质量评分为（93.6±3.4）分、消毒隔离评分为（98.4±1.3）分、病房管理评分为（98.6±1.2）分,对照组护理质量相对应的评分分别为（84.7±2.9）分、（90.3±2.1）分、（84.1±4.2）分,2组之间差异有统计学意义（P<0.05）。研究组非常满意36例,不满意2例,满意度为95.7%,对照组非常满意22例,不满意13例,满意度为71.7%,2组之间差异有统计学意义（P<0.05）。结论在呼吸内科病房中,开展护理风险管理可以有效提高患者护理满意度,同时还可明显提高临床护理质量,是一套科学、合理、有效的方案,值得进一步推广。     

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.