动机性访谈对慢性心力衰竭患者疾病管理的影响

目的：探讨动机性访谈对慢性心力衰竭患者自我管理行为及服药依从性的影响。方法选择186例慢性心力衰竭患者,采用随机数字表法将其分为动机性访谈组（干预组）94例与对照组92例,干预组采用动机性访谈计划进行院内及院外护理,内容围绕患者自我管理及服药依从性,从访谈中发现患者生活方式存在的问题,并与患者共同协作制定解决方案;对照组仅给予常规护理。入院时和出院后6个月,分别采用心力衰竭患者自我管理量表和高血压药物治疗依从性量表对两组患者自我管理行为及服药依从性进行评估。结果在自我管理水平上,两组患者入院时评分差异均无统计学意义（P ＞0．05）。出院6个月后,干预组药物管理、饮食管理、心理和社会适应、症状管理评分分别为（16．3±2．6）,（13．1±2．3）,（17．2±2．2）,（17．5±2．9）分,高于入院时的（13．5±2．5）,（10．1±1．7）,（13．0±2．0）,（13．9±2．4）分,,差异有统计学意义（t值分别为2．11,2．09,2．17,2．14;P＜0．05）,而对照组各项指标与入院时相比,差异无统计学意义（P＞0．05）;在服药依从性水平上,干预组有忘记服药的经历、有时不注意服药、自觉症状改善时曾经停药、服药自觉症状更坏时曾经停药较入院时均有降低,差异有统计学意义（P＜0．05）,而对照组各项指标与入院时相比,差异无统计学意义（P＞0．05）。结论动机性访谈可促进慢性心力衰竭患者采纳有益于健康的行为和生活方式,且可提高其服药依从性。     

动机性访谈对老年慢性心力衰竭患者服药依从性的影响

目的 探讨动机性访谈干预在提高老年慢性心力衰竭患者服药依从性中的作用。方法 选取2017年 12月-2018年12月我院心内科104例老年慢性心力衰竭患者为研究对象,采用随机数字表法将其分为干预组54例与对照组50例。对照组采用常规护理,干预组实施动机性访谈干预,比较2组服药依从率。 结果 出院1个月及3个月时,干预组服药依从率均高于对照组(χ²=31.906,P＜0.001;χ²=44.795,P＜0.001);且干预组出院后1个月及3个月时,服药依从率比较,差异无统计学意义(χ²=0.641,P=0.104)。结论 动机性访谈可提高老年慢性心力衰竭患者服药依从性,且持续性较好。     

评判性思维的健康教育对急性心肌梗死患者行为依从性的影响

目的探讨评判性思维应用于急性心肌梗死（AMI）患者健康教育中对其行为依从性的影响。方法将CCU住院的75例AMI患者随机分别对照组（n=42）和实验组（n=33）。对照组实施常规健康教育,实验组实施应用评判性思维的健康教育细化流程、内容及方法;对所有患者出院3个月后行电话随访,比较两组患者行为依从性的差异。结果入院时两组患者膳食评分、服药依从性、活动达标率、吸烟率及饮酒率比较差异均无统计学意义（P〉0．05）;出院3个月后实验组膳食评分的四分位间距为2．00分,对照组为2．00分,两组比较差异有统计学意义（z=-2．573,P=0．010）;实验组始终服药患者29例,对照组19例,两组比较差异有统计学意义（Z=-3．553,P=0．000）;实验组活动达标率为81．8％,高于对照组59．5％,也高于入院时47．1％,差异均有统计学意义（X2=4．320,6．667;P〈0．05）。结论将评判性思维应用于心肌梗死患者健康教育中,可提高患者的行为依从性,提高健康教育效果,值得临床推广应用。     

动机性访谈对酒精依赖患者负性情绪的影响

目的 探讨动机性访谈对酒精依赖患者负性情绪的影响,提高患者对治疗的依从性,降低复饮率和再住院率。 方法 将69例酒精依赖患者按入院先后顺序分为实验组(35例)和对照组(34例),均给予常规治疗及护理。实验组每周至少进行动机性访谈1次,连续8周。2组患者入院时、出院时分别给予焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。 结果 出院时实验组SAS和SDS评分均低于对照组。1年后随访,复饮率和再住院率实验组明显低于对照组。 结论 动机性访谈能有效消除酒精依赖患者负性情绪,提高治疗依从性,降低复饮率和再住院率。     

电话随访在农村高血压患者服药依从性及疗效中的影响

目的：探讨电话随访对农村高血压患者服药依从性及疗效的影响。方法将2014年1月至2014年5月收治的136例农村高血压患者分为对照组和实验组,各68例,2组患者均为首次住院即予降压药物治疗,并告知服药方法和注意事项,对实验组患者出院后7天、1个月、2个月、3个月时加以电话随访进行护理干预。结果实验组患者服药依从性及疗效明显高于对照组,差异有统计学意义（ P＜0．05）。结论对农村高血压患者出院后加以电话随访进行护理干预,有助于提高患者服药依从性,有效控制血压,延缓并发症,提高患者的生活质量。     

在彝族地区开展优质护理对肺结核患者服药依从性的影响

目的：探讨在彝族地区开展优质护理对肺结核患者服药依从性的影响。方法将100例肺结核患者按其住院顺序分为实验组和对照组各50例。对照组患者给予常规护理,实验组患者则在此基础上给予优质护理。于患者出院后3个月对两组患者进行服药依从性调查。结果实验组服药依从性优于对照组（Z=-3.629,P<0.01）。结论在彝族地区开展优质护理能更好地提高肺结核患者的服药依从性,值得临床推广。     

动机性访谈对促进非瓣膜性房颤患者服用华法令的依从性的调查

目的通过对非瓣膜性房颤患者实施动机性访谈(MI),评价患者服用华法令的依从性。方法将80例老年房颤患者随机分为对照组和干预组,各40例。对照组给予常规护理,干预组在此基础上给予MI干预。随访6个月,对干预前、出院时、出院后1个月、3个月6个月时进行问卷调查法分别评估MI对非瓣膜性房颤患者服用华法令的依从性的效果。结果与对照组比较,干预组经MI干预后出院时、1个月、3个月及6个月患者服药依从意愿和信心显著提高(P0.05)。结论 MI可促进非瓣膜性房颤患者服用华法令的依从性。     

早期个体化家庭访视对糖尿病患者的影响

目的：探讨早期个体化家庭访视对糖尿病患者的影响。方法：将91例糖尿病患者随机分为家庭访视组（实验组）47例及对照组44例。对实验组进行为期1年共12次家庭访视，对照组行常规出院指导及随访。并对两组患者出院后血糖，治疗、服药依从性，足部自我护理及并发症的情况进行比较。结果：出院后1个月、6个月、12个月实验组血糖低于对照组（P〈0．01）。出院后6个月、12个月实验组服药依从性、足部自我护理情况与对照组比较有极显著性差异（P〈0．01）。结论：对糖尿病患者实施早期个体化家庭访视，可促进患者血糖达标，提高服药依从性及足部自我护理行为。     

健康教育干预老年高血压89例效果观察

目的 探讨健康教育对老年高血压患者生活习惯、服药依从性及治疗效果的影响。方法将入院老年高血压疗养员随机分为健教组45例和对照组44例，健教组在药物治疗的同时进行健康教育，而对照组则行单纯药物治疗。结果健康教育后，健教组患者生活习惯有明显改善，服药依从性增强，血压控制率提高。健教组疗养员出院时服药依从性与对照组相比差异有显著性，分别为86．7％和68．2％（P〈0．05）；出院后3个月回访服药依从性健教组和对照组分别为75．6％和52．3％（P〈0．05）。出院后3个月回访血压控制率分别为77．8％和47．7％（P〈0．01）。结论健康教育是一种有效的治疗疾病的手段，可以改变高血压患者的不良生活习惯，养成有益的健康生活方式，提高服药依从性和血压控制率。     

动机性访谈对食管癌放疗同步口服替吉奥化疗患者依从性的影响

目的 探讨动机性访谈对食管癌同步口服替吉奥化疗患者依从性的影响。方法 选取2014年4月28日至2019年3月17日收治的60例食管癌放疗同步口服替吉奥化疗患者为研究对象,随机分为对照组和研究组,各30例。对照组实施常规护理,研究组采取动机访谈护理,两组均持续干预6个月。比较两组患者的服药依从性。结果 研究组的服药依从性明显高于对照组,差异有统计学意义（P＜0.05）。结论 动机性访谈可提高患者的服药依从性。     

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.