慢性阻塞性肺疾病病人吸入用药依从性的Meta分析

目的:系统评价慢性阻塞性肺疾病病人吸入给药依从性及影响因素。方法:检索中、英文数据库,有关慢性阻塞性肺疾病病人吸入给药依从性及影响因素的文献,用Stata 16.0软件分析。结果:纳入23篇文献,包括20 596例病人,吸入药物依从率为41%[95%CI(35.0,47.0)]。Meta分析显示,抑郁、不良反应、吸烟、文化程度低、无医疗保险、使用时间<2年是吸入药物依从性低的影响因素(OR值分别为0.45,0.30,0.31,0.35,0.16,0.51);年龄<70岁、定期复查、疗效满意、了解药物知识、每日用药次数为1次、居住在城市则是保护因素(OR值分别为2.17,4.31,9.45,5.83,4.71,1.66)。结论:慢性阻塞性肺疾病病人吸入给药依从性低,应及时评估影响因素,制定个性化干预策略,改善吸入给药依从性。     

信息-动机-行为技巧模型护理干预在慢性阻塞性肺疾病患者中的应用

目的探讨信息-动机-行为技巧模型的护理干预对慢性阻塞性肺疾病患者吸入给药装置依从性的影响效果。方法选择2014年1月至2017年1月我院接受治疗的100例慢性阻塞性肺疾病患者作为研究对象,根据双色球抽签的方式将患者等分为对照组与试验组,对照组实施常规护理干预,试验组实施信息-动机-行为技巧模型护理干预,并对两组患者的吸入给药装置依从性情况进行分析与比较。结果经过护理干预后,试验组吸入给药装置依从性评分明显高于对照组(P0.05);试验组的用药自我效能评分高于对照组(P0.05);且试验组生活质量改善情况明显优于对照组(P0.05)。结论对于慢性阻塞性肺疾病患者,实施信息-动机-行为技巧模型的护理干预能有效改善吸入给药装置的依从性,提高患者的生活质量,值得临床推广与应用。     

糖尿病患者依从性的研究进展

糖尿病是一种常见病、多发病,但是患者依从性较差.本文从依从性的定义、评估工具、依从性现状、依从性对疾病的影响、依从性的影响因素及干预等六个方面综述了依从性的研究进展.     

慢性肾脏疾病患者治疗依从性的调查

目的 了解慢性肾脏疾病患者治疗依从性的现状及其影响因素,探讨提高慢性肾脏疾病患者治疗依从性的对策.方法 以2010年3-6月在上海市某三级甲等医院肾内科住院治疗的147例慢性肾脏疾病患者为调查对象,采用自行设计的问卷调查其治疗依从性及影响因素.结果 慢性肾脏疾病患者的药物依从性最好,日常生活习惯依从性最差;不同年龄、经济负担、家庭支持情况及疾病认知程度的慢性肾脏疾病患者的治疗依从性差异有统计学意义(P<0.05).结论 护理工作中应针对慢性肾脏疾病患者的治疗依从性特点及其影响因素采取有效的干预措施,以提高患者的治疗依从性、延缓疾病的进展.     

移动医疗在慢性气道疾病患者吸入治疗依从性管理中的应用进展

移动医疗在慢性气道疾病护理中的应用愈发广泛,文章对移动医疗在慢性气道疾病患者吸入治疗依从性管理中的应用形式、影响和局限性等内容进行综述,以期为移动医疗在吸入治疗管理中的应用提供参考,提高患者依从性,进一步达到控制疾病的目的。     

老年COPD患者药物依从性的研究进展

慢性阻塞性肺疾病(COPD)具有高患病率、高致残率和高病死率的特点, 严重威胁老年人健康, 而药物作为COPD治疗的重要形式, 依从性差会严重影响治疗效果。本文从老年COPD患者出发, 对其药物依从性现状、影响因素和干预措施等方面进行综述, 以期为老年COPD患者药物依从性相关研究提供参考。     

慢性阻塞性肺疾病患者激素吸入治疗依从性及影响因素分析

目的：探讨慢性阻塞性肺疾病患者糖皮质激素吸入治疗的依从性及影响因素。方法利用依从性指数调查2011年5月～2012年8月收治的100例 COPD 患者在急性加重期和稳定期采用激素吸入治疗的依从性程度并分析影响因素。结果仅有9例患者的依从性指数为好,占总数的9％;影响患者吸入性治疗的原因包括认为药物作用不大、忘记用药、经济困难、吸入治疗的方法未掌握。结论慢性阻塞性肺疾病患者在住院期间能保持对药物的依从性高,但是当出院后依从性下降,护理人员对患者加强健康宣教、呼吁患者的家庭给予鼓励和帮助,有利于提高激素吸入治疗的依从性。     

癌症患儿父母恐惧疾病进展的研究进展

癌症患儿父母普遍存在恐惧疾病进展,严重的恐惧心理不仅会影响其身心健康,还会降低家庭功能和患儿的治疗依从性。该文主要围绕癌症患儿父母恐惧疾病进展的定义、发生现状、评估工具、影响因素及干预方法等方面进行综述,以期为医护人员开展相关研究、制订针对性的干预方案提供参考。     

深静脉血栓形成患者居家自我管理的研究进展

深静脉血栓形成患者需要长期抗凝治疗以防止血栓蔓延或血栓复发。自我管理可以增强患者对疾病的认知和抗凝治疗依从性, 降低复发率。本研究从深静脉血栓形成患者自我管理的现状、评估工具、干预方法、影响因素等方面进行综述, 为提高深静脉血栓形成患者的居家自我管理能力提供参考依据。     

图示法在小儿雾化吸入健康教育中的应用

<正>雾化吸入疗法是解除支气管痉挛、消除炎症、稀释痰液及改善通气的重要手段~([1]),具有高效、方便、副作用小等优点,是小儿呼吸道疾病较为理想的一种给药途径。在患儿雾化吸入治疗中,患儿雾化吸入的依从性是影响治疗效果的重要因素~([2])。儿科患儿治疗护理的决定权由家属负责,而临床中常采用口头宣教形式,宣教资料文字较多且凌乱。由于家长理     

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.     

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.     

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.     

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.