住院脑血管病老年患者跌倒效能影响因素的研究

目的 调查住院脑血管病老年患者的跌倒效能及其影响因素.方法 采用修订版跌倒效能量表(MFES)、Morse跌倒危险评估量表(MFS)、Berg平衡功能量表(BBS)及步态评估量表(TGA)等,利用调查问卷与观察测评相结合的方式,对113例住院脑血管病老年患者进行调查.结果 脑血管病老年患者跌倒效能为(7.85±2.57)分.得分最低的项目为“上下楼梯”和“乘坐公共交通工具”;得分最高的项目为“伸手到箱子或抽屉里拿东西”和“从椅子上起落”.3个因素对跌倒效能有显著影响:右上肢肌力、Berg平衡功能、步态等.结论 为了帮助脑血管病老年患者树立预防跌倒的自信能力,医护人员需要在改善患者平衡能力和步态的基础上,进一步对患者进行心理疏导,适宜地、有针对性地提高患者的跌倒效能,从而有效地预防跌倒的发生.     

老年心血管疾病住院患者跌倒效能现状及相关因素分析

目的:调查老年心血管疾病住院患者跌倒效能现状并分析其影响因素,以便提供相应的心理支持,有效降低跌倒发生率。方法:采用修订跌倒效能量表(MFSE)、中文版跌倒危险评定量表(MORSE)、日常生活能力量表、老年抑郁量表(GDS)及跌倒相关因素量表,采用便利抽样的原则对青岛市某三甲医院150例心内科住院患者进行调查。结果:本组老年心血管疾病住院患者跌倒效能平均分为(8.20±2.28)分,其中过马路、乘坐交通工具得分最低;其中患者居住方式、Morse量表得分、心功能分级、日常生活能力得分、抑郁得分与跌倒效能高低密切相关(P0.05)。结论:在日常工作中,护理人员应鼓励老年心血管疾病患者根据心功能状态进行身体锻炼并辅以心理支持,从而降低跌倒发生率。     

眼科中老年住院患者跌倒效能现状及影响因素分析

目的 探究眼科中老年住院患者跌倒效能的现状,并对影响因素进行分析,提出相应的干预方式.方法 采用方便抽样的方法,抽取济南市某三甲医院眼科中老年住院患者73例,分析其跌倒效能现状及影响因素.结果 眼科中老年住院患者跌倒效能平均得分为(7.30±2.20)分,41.4％的眼科中老年住院患者属于跌倒效能低.随着眼科住院患者年...     

老年患者营养状况与跌倒风险的相关性分析

目的调查老年患者营养状况与跌倒风险,分析其相关性。方法对在门诊就诊年龄≥60岁的老年患者采用简易营养评价精法(MNA-SF法)、卫生部《老年人跌倒干预技术指南》中的老年人跌倒风险评估量表等调查问卷的方式,评价老年患者的营养状况与跌倒风险,并进行相关性分析。结果共纳入70例老年患者,其中高龄老年患者(≥80岁)56例。70例老年患者中,营养不良者占25.7%(18/70),其中高龄患者占营养不良者94.4%(17/18)。跌倒高度风险的老年患者占18.6%(13/70),其中高龄患者占跌倒高度风险者69.2%(9/13)。营养不良的老年患者中,跌倒高度风险者占33.3%(6/18),有3次及以上跌倒史者占16.7%(3/18)。经分析,有跌倒史者营养评分(10.72±2.19)分小于无跌倒史者营养评分(12.67±1.57)分,当跌倒次数≥3次时,营养评分均值为(9.75±2.363)分,远低于平均水平(12.17±1.93)分(P0.05)。结论老年患者营养不良和跌倒的发生率均较高,且跌倒风险与营养状况相关。     

疗养机构老年慢性病患者预防跌倒的认知和行为现况调查分析

目的调查疗养机构老年慢性病患者预防跌倒的认知和行为现况,并探讨其影响因素,为更好地预防跌倒提供建议。方法采用一般资料调查表和预防跌倒的认知与行为调查问卷,对在疗养机构内住院疗养的1 386名65岁及以上的老年慢性病患者进行调查。结果老年慢性病患者预防跌倒认知的得分为(55.78±11.46)分;预防跌倒行为的得分为(42.99±7.06)分;年龄、跌倒史、有无照顾者、认知障碍、感觉障碍、服用药物以及伴随疾病与预防跌倒认知和行为得分密切相关。结论通过健康教育,提高老年慢性病患者对预防跌倒的认知和行为。     

老年住院患者预防跌倒知信行的调查研究

目的调查老年住院患者对预防跌倒的知识、态度、行为情况,为预防跌倒提供参考建议。方法选取某三级医院2016年1月至2016年6月住院期符合纳入标准的老年患者共368名,通过自制问卷进行知信行调查。结果患者跌倒预防知识得分(42.21±15.34)分,态度得分(16.35±7.13)分,行为得分(48.18±8.68)分,知识与行为(r=0.346,P0.03)呈正相关、知识与态度(r=0.321,P0.05)呈正相关、态度与行为(r=0.415,P0.02)呈正相关。结论老年住院患者的年龄在预防跌倒知信行方面差异无统计学意义,文化层次高、有培训经历的老年患者对预防跌倒的知识、态度、行为相对较好,因此应加强对老年住院患者预防跌倒的知识的健康教育,帮助树立防止跌倒信念,促进行为规范。     

住院老年患者跌倒预防“知-信-行”的调查研究

目的：调查住院老年患者跌倒预防知识、态度、行为的现状,为采取综合性护理干预措施提供科学依据,以降低住院老年患者跌倒发生率。方法：整群抽取我院2012年1-4月住院的老年患者122例作为研究对象,应用自行设计的住院老年患者预防跌倒知识、态度、行为调查问卷进行调查研究。结果：住院老年患者跌倒预防知识问卷得分为（35．40±9．09）分（0～60分）;跌倒预防态度问卷得分为（26．10±4．57）分（0～44分）;跌倒预防行为问卷得分为（27．70±5．02）分（0～48分）。住院老年患者跌倒预防的知识水平与跌倒预防的相关态度呈正相关（r=0．415,P〈0．01）;跌倒预防的知识水平与跌倒预防的相关行为评分无明显相关关系（P〉0．01）;态度与行为评分呈正相关（r=0．387,P〈0．01）。结论：住院老年患者跌倒预防知识缺乏,自我防护意识较弱。护士应加强对住院老年患者跌倒预防知识的健康教育,帮助其建立跌倒预防的健康信念,才能有效地促进跌倒预防健康行为的形成。     

基于老年综合评估的结构化护理方案在老年人院外跌倒预防中的应用

[目的]探讨基于老年综合评估(CGA)的结构化护理方案在老年病人院外跌倒预防中的应用效果。[方法]将75例老年病人按照入院时间的先后顺序分为常规组(40例)和CGA组(35例),常规组实施跌倒的常规干预,CGA组实施基于CGA的结构化跌倒护理方案。随访6个月,比较两组病人跌倒的发生情况及预防跌倒效能。[结果]住院期间两组病人均未发生跌倒事件,出院后6个月内,常规组发生跌倒7例(17.50%),CGA组发生跌倒1例(2.85%),两组病人跌倒发生率比较差异有统计学意义(χ2=6.728,P0.05)。常规组老年病人预防跌倒效能得分为(4.35±2.20)分,CGA组老年病人预防跌倒效能得分为(6.29±2.45)分,两组病人跌倒效能得分比较差异有统计学意义(t=-4.96,P0.01)。[结论]跌倒风险的复杂性决定了跌倒干预的综合性,通过CGA制订并实施了精准化的跌倒结构化方案,有效降低了老年病人院外跌倒的发生。     

老年脑卒中患者跌倒效能与社会支持的相关性研究

目的了解老年脑卒中患者跌倒效能与社会支持水平,分析二者相关性。方法采用便利抽样法选取2019年5—9月辽宁省某三级甲等医院老年脑卒中患者246例,采用一般资料调查表、社会支持评定量表和跌倒效能量表进行问卷调查。相关性分析采用Pearson相关分析。结果 246例老年脑卒中患者跌倒效能条目均分为(5.71±2.25)分,室内活动维度条目均分为(6.24±2.13)分,室外活动维度条目均分为(4.82±2.56)分。老年脑卒中患者社会支持总分(29.75±7.29)分,3个维度得分由高到低依次为主观支持(16.28±3.56)分,客观支持(7.41±2.35)分,对支持利用度(6.02±2.86)分。老年脑卒中患者跌倒效能总分与社会支持总分呈密切正相关(r=0.544,P0.001)。结论老年脑卒中患者跌倒效能处于中等偏低水平,具有良好社会支持水平的老年脑卒中患者,其跌倒效能水平也较高。因此,护士帮助其改善社会支持状况,从而有效提高跌倒效能水平,降低跌倒风险。     

脑卒中住院病人及其照顾者预防跌倒知识和行为现状调查及影响因素分析

[目的]调查脑卒中住院病人及其照顾者预防跌倒知识和行为现状,并分析其影响因素。[方法]便利选取山西省某三级甲等医院2019年1月—2019年5月神经内科住院的脑卒中病人110例及其照顾者110人,采用一般资料调查表和预防跌倒知识和行为结局量表进行调查,以多元线性回归分析病人跌倒行为的影响因素。[结果]住院脑卒中病人预防跌倒知识、行为得分分别为(44. 75±4. 77)分和(41. 92±5. 49)分;照顾者预防跌倒知识、行为得分分别为(41. 51±4. 18)分和(40. 03±3. 38)分;文化程度、性别、是否偏瘫、是否有跌倒史是脑卒中病人预防跌倒行为的影响因素(P0. 01);性别、文化程度、担任照顾者时间、病人是否有跌倒史是照顾者预防跌倒行为的影响因素(P0. 01)。[结论]医护人员应根据病人及其照顾者的情况加强宣教,提高其预防跌倒知识,增强跌倒防范行为,提升生活质量。     

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.     

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.