Randomized evaluation of controlled-release codeine and placebo in chronic cancer pain

Codeine is widely used in combination with acetaminophen and aspirin for the management of mild to moderate pain. However, there are few controlled clinical trials of single-entity codeine in chronic cancer pain. The purpose of this study was to evaluate the clinical efficacy and safety of controlled-release codeine given every 12 hr in patients with cancer pain. Thirty-five patients with chronic cancer pain were randomized in a double-blind crossover study to controlled-release (CR) codeine or placebo, for 7 days each. Pain intensity was assessed at 0800 hr and 2000 hr using a visual analogue scale (VAS) and a five-point categorical scale, and the use of “rescue” acetaminophen-plus-codeine (300 mg/30 mg every 4 hr as needed) was recorded. Thirty patients completed the study (17 male, 13 female; mean age, 64.4 ± 9.8 years) with a mean daily CR codeine dose of 277 ± 77 mg (range, 200–400 mg). CR codeine treatment resulted in significantly lower overall VAS pain intensity scores (22 ± 0.8 mm versus 36 ± 20 mm, P = 0.0001), categorical pain intensity scores (1.2 ± 0.8 versus 1.8 ± 0.8, P = 0.0001), and pain scores when assessed by day of treatment and by time of day. Daily “rescue” analgesic consumption was significantly lower on CR codeine, compared to placebo treatment (2.2 ± 2.3 versus 4.6 ± 2.8 tablets per day, P = 0.0001). Both patients and investigators preferred CR codeine to placebo (80% versus 3%, P = 0.0014 and 73% versus 7%, P = 0.0160, respectively). These data indicate that CR codeine, given every 12 hr results in significant reductions in pain intensity and the use of “rescue” acetaminophen-plus-codeine in patients with cancer pain. CR codeine provides the benefits of a flexible single entity codeine formulation and the convenience of 12-hr duration of action, which allows patients uninterrupted sleep and improved compliance.     

Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use

The aim of the study was to evaluate post-operative pain and analgesic use after pre-operative or post-incisional i.v. fentanyl plus low dose i.v. ketamine vs. a standard treatment receiving i.v. fentanyl but not ketamine. Men undergoing radical prostatectomy under general anesthesia were randomly assigned in a double-blinded manner to one of three groups. Patients received i.v. fentanyl before incision followed by an i.v. bolus dose (0.2 ml kg⁻¹) and an i.v. infusion (0.0025 ml kg⁻¹ min⁻¹) of 1 mg ml⁻¹ ketamine (group 1) or normal saline (groups 2 and 3). Seventy minutes after incision, patients received i.v. fentanyl followed by an i.v. bolus dose (0.2 ml kg⁻¹) and an i.v. infusion (0.0025 ml kg⁻¹ min⁻¹) of saline (groups 1 and 3) or ketamine (group 2). Pain, von Frey pain thresholds, and cumulative morphine consumption using patient-controlled analgesia (PCA) were assessed up to 72 h after surgery. 143 patients completed the study (group 1, n=47; group 2, n=50; group 3, n=46). Cumulative PCA morphine (mean±SD) did not differ significantly among groups (group 1, 92.3±45.9 mg; group 2, 107.2±58.4 mg; group 3, 103.6±50.4 mg; P=0.08 for groups 1 vs. 2, and groups 1 vs. 3). On day 3, the hourly rate (mean±SEM) of morphine consumption was significantly lower (P<0.0009) in group 1 (0.61±0.013 mg h⁻¹) than group 2 (0.86±0.011 mg h⁻¹) and group 3 (0.89±0.008 mg h⁻¹). Pain scores and von Frey pain thresholds did not differ significantly among groups. Two-week and 6-month follow-ups did not reveal significant group differences in pain incidence, intensity, disability or mental health. Pre-operative, low-dose administration of i.v. ketamine did not result in a clinically meaningful reduction in pain or morphine consumption when compared with post-incisional administration of ketamine or a saline control condition.     

A pain monitoring program for nurses: effects on nurses' pain knowledge and attitude

One of the reasons for inadequate pain treatment in hospitalized patients is that nurses have insufficient knowledge about pain and pain management. To address this problem, a Pain Monitoring Program (PMP) for nurses was developed, implemented, and evaluated. The PMP consisted of two components: educating nurses about pain, pain assessment, and pain management, and implementing daily pain assessment by means of a numeric rating scale. The effects of the PMP were measured in a one-group pretest–post-test design. The results show that nurses have knowledge deficits and prejudices with regard to pain and pain management. Age and additional pain courses in pain partly predict nurses' pain knowledge. After nurses were educated, the average score on the Pain Knowledge Questionnaire increased from 69.1% (SD = 13.2) at pretest to 75.8% (SD = 11.5) at post-test (P < 0.001). Nurses' attitudes changed with regard to their level of knowledge and skills in relieving pain, willingness to assess pain on a daily basis, and attention to patients' pain complaints. It can be concluded that the PMP is effective in improving nurses' knowledge of pain management and focusing nurses' attention to patients' pain complaints.     

Effects of morphine on the dyspnea of terminal cancer patients

We report, an open, uncontrolled study designed to assess the effects of subcutaneous (SC) morphine on dyspnea of terminal cancer. Twenty patients with dyspnea caused by restrictive respiratory failure received an SC dose of morphine of 5 mg (5 patients who were not receiving narcotics), or equivalent to 2.5 times their regular dose (15 patients who were receiving narcotics for pain). Dyspnea (D) and pain (15 cases) were measured before the dose and every 15 min for 150 min after the injection using a visual analog scale 0–100. Respiratory rate (RR), respiratory effort (RE) (score 1–6), arterial saturation of O₂ (SO₂) and end-tidal PACO₂ were determined before and 45 min after SC morphine. D, RR, RE, SO₂, and PACO₂ were 68 ± 32, 32 ± 7; 3.5 ± 1.8, 87 ± 10, and 31 ± 12, respectively, before SC morphine, and 34 ± 25 (P < 0.001), 31 ± 9 (P:NS), 3.2 ± 1.9 (P:NS), 86 ± 11 (P:NS), and, 33 ± 9 (P:NS), respectively, 45 min after SC morphine. Nineteen of 20 patients (95%) reported improved dyspnea after morphine. We conclude that morphine appears to improve dyspnea without causing a significant deterioration in respiratory function in terminal cancer patients. Double-blind placebo controlled studies are needed in this population.     

Excel表格提醒功能结合在线文档编辑在用物管理中的应用

目的 探讨Excel表格提醒功能结合在线文档编辑在临床无菌物品及药品管理中的应用效果。方法 2017年6月—2018年5月科室采用传统方法进行物资清点及管理,2018年6月-2019年5月科室用采用Excel表格提醒功能结合在线文档编辑进行科室无菌物品及药品管理。比较Excel表格提醒功能结合在线文档编辑使用前后,护士清点药品和物品的耗时,无菌物品过期发生率、药品过期发生率和近期药品未及时更换发生率,及护士对无菌物品、药品管理的满意度。结果 应用Excel表格提醒功能结合在线文档编辑后,护士清点物品和无菌药品所需时间均明显短于应用前(t=10.168,P=0.005;t=11.738,P=0.003),无菌物品、药品过期发生率和近效期药品未及时更换发生率均低于应用前(χ²=11.640,P=0.001;χ²=6.186,P=0.029;χ²=20.195,P＜0.001),护士对无菌物品及药品管理的满意度高于应用前(P<0.05)。结论 应用Excel表格提醒功能结合在线文档编辑,可以有效降低无菌物品、药品的管理缺陷发生率,提高了护理工作效率,促进了护理工作的创新。     

基于家庭医护平台延续性护理模式的构建及应用

目的 基于家庭医护信息化管理平台（以下简称平台）,构建居家延续性护理模式,并评价其应用效果,以期提高出院患者居家护理质量。 方法 平台由监控平台和操作平台构成。操作平台包括：①患者端APP,包括服务项目页面和个人信息页面,支持用户注册、项目选择、项目预约和评价;②护士端APP,包括提供服务项目、服务申请显示、安全中心及个人信息页面,支持护士注册、接单和安全监控。监控平台负责用户管理、服务项目维护、数据管理及安全监控。利用平台实施出院后患者居家护理服务。调取2018年10月—2019年3月患者满意度和健康知识掌握率等数据,评价平台效果。结果 共231名护士、109例患者完成注册,进行居家护理164次,陪诊8次;接受延续性护理服务后,患者满意度为93.9%,明显高于出院时患者86.2%的满意度（χ ²=4.623,P=0.032）;接受延续性护理服务后,患者对健康知识掌握率为97.7%,明显高于住院患者87.6%的健康知识掌握率（χ ²=14.545,P<0.001）,无投诉和不良事件发生。 结论 家庭医护信息化管理平台可充分发挥临床护士的专业价值,为出院患者提供系统、规范、安全、优质的居家护理服务,明显提高了居家患者满意度和健康知识掌握率,为患者提供了高效、便捷的就医途径。     

CSF and plasma morphine concentrations in cancer patients during chronic epidural morphine therapy and its relation to pain relief

Seventeen patients with advanced cancer pain, treated with chronic epidural morphine, were studied. Minimum plasma and CSF morphine concentrations (Css_min) were determined at pharmacokinetic steady state. A linear relationship was found between epidural morphine dose and concentrations obtained in plasma (r = 0.92) as well as CSF (r = 0.90). The line for best fit was much steeper for CSF than for plasma. The CSF/plasma concentration gradient of morphine at Css_min was 132 ± 31 (mean ± S.E.M.). Large interindividual variations of morphine concentrations in CSF were found. It is suggested that the variations are due to substantial differences in transdural morphine diffusion between individuals. No correlation was found between pain relief, evaluated with a visual analog scale, and CSF morphine concentrations at pharmacokinetic steady state, when calculated in 9 patients. Mean duration of treatment was 104 days (range 14–366) and the daily dose was increased from 18 ± 2 to 87 ± 31 mg/day (mean ± S.E.M.). A total of 39 epidural catheters were inserted in 14 patients. The catheters were patent for 2–223 days with a mean of 38 days. When re-examined later during treatment, 2 out of 8 patients demonstrated decreased CSF morphine concentrations in spite of increased doses given. One patient with extremely high dose demand is reported on separately and data supporting the concept of a combined spinal and systemic brain morphine effect in such cases are presented. Side effects were not a major problem but the possibility of infectious complications should be considered during chronic epidural morphine therapy.     

Knowledge and Attitudes of Health-Care Providers Toward Cancer Pain Management: A Comparison of Physicians, Nurses, and Pharmacists in the State of New Hampshire

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.     

Changes in attitudes and perceptions about research in physical therapy among professional physical therapist students and new graduates

BACKGROUND AND PURPOSE: The physical therapy profession, through its published educational accreditation standards and its normative model of professional education, has addressed the importance of educating physical therapist students in the basic principles and application of research. The purpose of this study was to conduct a longitudinal study of students relative to (1) their perception of knowledge with respect to research, (2) their perception of what source should be used (evidence-based practice or traditional protocols) for clinical decision making, and (3) their perception of what should be used in a clinical setting for patient management. SUBJECTS: Thirty-six students during the final year of their professional program from a sample of 115 physical therapist students who requested 2 consecutive physical therapist classes completed the entire sequence of pretest and posttest survey administrations. Seventy-nine students did not complete the entire sequence. METHODS: A 10-item 5-point Likert-type questionnaire was designed by the authors to probe the students' attitudes and perceptions about research, their level of comfort and confidence in reading and applying research findings published in the literature, and their personal habits regarding reading the professional literature. An expert panel consisting of internal and external reviewers was used for construction of the questionnaire. The questionnaire was completed by the students immediately preceding their research methods course, immediately after the completion of that course, and following the second research course, which included statistics and development of a research proposal. The subjects also completed the questionnaire after 1 year of physical therapy practice. Friedman's analysis of variance was used as an omnibus test to detect differences across time. In addition, a follow-up analysis using the Wilcoxon signed-rank procedure to examine differences between baseline data and data obtained during each follow-up was done for all items to determine whether a difference occurred at a time other than at the final posttest survey administration. RESULTS: The students showed differences on 5 of the 10 items on the questionnaire during the study. DISCUSSION AND CONCLUSION: These items related to reading peer-reviewed professional journals, critically reading professional literature, relevance and importance of evidence-based clinical practice, and level of comfort with knowledge in research.     

Attitudes of healthcare professionals regarding different modalities used to manage acute postoperative pain

The education and perceptions of healthcare professionals regarding pain are important in acute postoperative pain management. A survey was designed to assess healthcare providers’ knowledge and beliefs regarding the use of epidural analgesia (EA) or patient controlled analgesia (PCA) for acute postoperative pain management.Completed questionnaires were obtained from 46 (72%) third and fourth year medical students (MS) prior to their lecture on pain management. Forty-seven percent of the MS felt that EA provided superior analgesia to PCA. Seventy percent of the MS believed that naloxone had a longer duration of action than morphine. Completed questionnaires were received from 38 (63%) anesthesiology house officers (HO) from all levels of clinical anesthesia (CA) training. Sixty-eight percent of the HO felt that EA provided superior analgesia to PCA. The HO correctly responded that the duration of naloxone was shorter than morphine. Completed questionnaires were received from 20 (59%) post anesthesia care unit (PACU) nurses (RN). Fifty percent of the RN reported that EA provided superior analgesia to PCA. Eighty percent of the RN responded correctly that naloxone had a shorter duration than morphine. Our data suggests that lack of knowledge and fear of side effects may negatively affect pain management [Acute Pain 4 (1) (2001) 17].     

Augmenting the critical care data base of junior medical students with an emergency medicine lecture curriculum: a controlled study

A mandatory lecture course in emergency medicine, consisting of 13 lectures, was given to junior medical students over 3 years at Texas Tech University Regional Academic Health Center--El Paso. The performance of the students on a 25-question pretest and posttest was compared to a statistically similar group of their classmates on geographically separate campuses of Texas Tech University School of Medicine undergoing an otherwise comparable junior year clinical curriculum. Both groups exhibited improvement in posttest scores from pretest score values; additionally, students exposed to the lecture series at Texas Tech--El Paso performed significantly higher on the posttest, compared to the other campuses. We conclude that some emergency medicine material is successfully learned by junior medical students during their required third year clerkships; however, important learning objectives within the domain of emergency medicine can be most successfully taught if a mandatory junior year lecture course in emergency medicine is also incorporated into the third year curriculum.     

Lecture versus Web tutorial for pharmacy students' learning of MDI technique

OBJECTIVE: To compare pharmacy students' acquired knowledge and ability to assess metered-dose inhaler (MDI) technique after a traditional lecture versus a Web-based MDI technique tutorial. METHODS: All 42 third-year PharmD students completed a baseline MDI technique knowledge test and were then randomized into 1 of 3 groups. The Web group completed the tutorial on the college dispensing laboratory computers; the lecture group participated in the MDI technique excerpt of the asthma therapeutics lecture; and the control group participated in a 15-minute discussion of participants' hobbies. Afterward, participants in each group completed an identical MDI technique knowledge posttest. Students then observed a standardized mock patient perform MDI technique, documenting steps that were conducted incorrectly. MDI technique knowledge test and MDI technique evaluation test scores were compared between groups using repeated measures ANOVA. RESULTS: There was no significant difference in the baseline MDI technique knowledge test scores between groups. The post-MDI technique knowledge test scores for the Web and lecture groups did not differ significantly (p = 0.38), and both were significantly different from the control group (p < 0.001). MDI technique knowledge scores increased significantly for the Web and lecture groups from pre- to post-assessment, but did not change for the control group. A 2-way repeated measures ANOVA analysis demonstrated no significant interaction of subject and group characteristics. The MDI technique evaluation scores for the Web and lecture groups were not significantly different (p = 0.50), and both were significantly different from the control group (p 相似文献   

检验医学生实习前生物安全理论培训效果的评估

目的 评估检验医学生实习前生物安全理论强化训练的效果。方法 收集湖南三所大学实习前医学检验专业学生共220名,按不同学校、同学校不同年级、同班级培训前后方法进行分组,按照基本概念、微生物危害评估、实验室个人防护装备、生物安全操作技术规范四个方面内容进行培训,并于培训前后进行无记名现场问卷调查,通过比较评价培训前后效果。结果 三所大学培训前差异无统计学意义(χ2 =0.081～3.135,P值均>0.05)。同一所大学湖南中医药大学两个年级学生,培训前学生对各部分考核存在差异(P=0.000),基本概念和微生物危害评估掌握较好(P=0.000,0.000); 培训后学生对各部分考核也存在差异(P=0.000),基本概念和生物安全操作技术规范掌握较好(P=0.000,0.002)。同一所大学湖南中医药大学检验专业2008级和2009级的学生培训前后,发现前者除实验室个人防护装备使用外其他均无差异(χ2=0.096～2.408,P值均>0.05); 而后者除基本概念外其他均存在差异(χ2=4.821～12.27,P值均<0.05)。结论 生物安全强化培训对动手操作技能有良好的作用,要根据学生的具体情况有的放矢培训,使学生真正受益,保证学生的实验室安全。     

NRP-1和NRP-2在结直肠癌组织中的表达水平及临床意义

目的 探讨神经纤毛蛋白1(neuropilin-1,NRP-1)和NRP-2在结直肠癌组织中的表达水平及临床意义。方法 选取2014年12月～2015年9月期间湖北省恩施州中心医院65例结直肠癌患者和65例肠息肉患者作为研究对象,选择于同期健康检查的65例健康女性作为正常对照组。采用实时荧光定量技术(RT-PCR)检测入组对象血清NRP-1和NRP-2水平。结果 经RT-PCR检测,结直肠癌组NRP-1水平(36.51±4.62 μg/ml)高于肠息肉组(8.19±4.08 μg/ml)和健康对照组(7.92±4.05 μg/ml),差异有统计学意义(F=50.32,P=0.000),结直肠癌组NRP-2 mRNA水平(24.59±3.26 μg/ml)高于肠息肉组(5.47±1.11 μg/ml)和健康对照组(5.19±1.05 μg/ml),差异有统计学意义(F=49.36,P=0.000)。肠息肉组和健康对照组NRP-1和NRP-2 mRNA水平比较,差异无统计学意义(t=1.15,1.07,P=0.762,0.789)。经RT-PCR检测,随着患者病理分期的增加、分化程度的降低,结直肠癌组血清NRP-1和NRP-2 mRNA水平呈升高趋势,伴肝转移和淋巴结转移的结直肠癌患者,血清NRP-1和NRP-2 mRNA水平高于未出现肝转移和淋巴结转移的结直肠癌患者(P<0.05)。结直肠癌患者血清NRP-1和NRP-2 mRNA水平呈正相关(r=0.415,P=0.015)。结论 结直肠癌血清NRP-1,NRP-2水平高于肠息肉及健康人群。血清NRP-1和NRP-2水平与结直肠癌的临床病理及预后密切相关,NRP-1,NRP-2可能共同起作用。     

血清CA125,HE4及ROMA指数对卵巢癌诊断价值的临床研究

目的 探讨血清CA125,HE4及ROMA指数对卵巢癌临床诊断价值,提高绝经前、后卵巢癌诊断的准确率。方法 采用化学发光法对307例卵巢癌患者,271例卵巢囊肿患者和289例健康对照者进行血清CA125和HE4水平的检测,计算ROMA指数,并进行统计学分析。结果 ①卵巢癌组血清CA125,HE4水平和ROMA指数均较健康对照组和卵巢囊肿组显著升高,差异具有统计学意义(P<0.05)。②绝经前ROMA指数(Pre-ROMA)对卵巢癌诊断效能敏感度最高(100%),与CA125,HE4相比,差异具有统计学意义(χ2=10.69,P<0.05)。HE4的特异度和阳性预测值均为100%,与CA125,Pre-ROMA相比,差异具有统计学意义(χ2=19.74,11.05,P<0.05)。Pre-ROMA指数的阴性预测值(100%)高于HE4,差异有统计学意义(χ2=12.50,P<0.05)。③在绝经后卵巢癌诊断效能的比较中,CA125的敏感度和阴性预测值(92.77%和93.62%)高于HE4,差异均具有统计学意义(χ2=7.48,6.28,P<0.05)。HE4的特异度和阳性预测值(92.78%和90.41%)高于Post-ROMA,差异均具有统计学意义(χ2=7.34,6.05,P<0.05)。④以卵巢囊肿和正常对照组为参照,HE4和Pre-ROMA诊断绝经前卵巢癌的AUC分别为0.574和0.573,差异具有统计学意义(P<0.05),而CA125差异无统计学意义(P>0.05)。⑤以卵巢囊肿和正常对照组为参照,HE4,Post-ROMA和CA125诊断绝经后卵巢癌的AUC由大到小分别为0.677,0.665及0.641,差异均具有统计学意义(P<0.05)。结论 ①血清CA125对绝经后卵巢癌患者诊断具有更高的敏感度; ②血清HE4对绝经前和绝经后卵巢癌患者均具有很好的临床诊断效能; HE4对卵巢癌的诊断特异度较CA125更高; ③HE4和CA125联合检测,并计算ROMA指数对绝经前和绝经后卵巢癌患者均具有很好的临床诊断效能,可显著提高单项检测对绝经前卵巢癌的诊断敏感度和阴性预测价值。     

The Effect of Ultrasound on the Mechanical Pain Threshold of Healthy Subjects

The purpose of this study was to examine the effect of ultrasound on threshold to pain produced by a pressure dolorimeter. Twenty healthy, pain-free subjects (12 men, 8 women) who were naive to ultrasound received five minutes of continuous 1.1 MHz ultrasound at 1.0 W/cm² on the dorsal aspect of one forearm. The other arm acted as the control and received sham ultrasound. A pressure dolorimeter was used to measure pain threshold on the treated area and on an untreated area of both arms, before and after the ultrasound. A three-way ANOVA revealed an interaction among arm (control versus experimental), site (treated versus untreated) and time (before versus after treatment). Newman-Keuls post hoc analysis demonstrated a significant (p < 0.05) increase in pain threshold from before (mean = 1.53 kg/cm², SE = 0.08) to after (1.93 ± 0.12 kg/cm²) treatment only on the dorsal aspect of the experimental arm. There were no changes in pain threshold on the treated site of the control arm (1.49 ± 0.07 − 1.56 ± 0.08 kg/cm²) or on the untreated site on the experimental (1.95 ± 0.12 − 1.96 ± 0.13 kg/cm²) or control (1.95±0.13 − 1.94±0.13 kg/cm²) arm. It is concluded that, in healthy subjects, continuous ultrasound can raise the threshold of pressure-induced pain.     

血清CEA,CYFRA21-1,NSE水平在肺癌诊断与分型中的应用价值

目的 探讨血清癌胚抗原(CEA),细胞角蛋白19片段(CYFRA21-1),神经元特异性烯醇化酶(NSE)水平在肺癌诊断、分型中的应用价值。方法收集79例肺癌患者,75例肺部良性疾病患者和163例健康体检者的空腹血清,采用电化学发光法检测血清CEA,CYFRA21-1和NSE水平,比较三项指标在肺癌诊断中的敏感度、特异度及阳性率,并比较在发生转移和未发生转移的肺癌患者血清CEA,CYFRA21-1和NSE水平。结果 与健康组和肺部良性疾病患者组相比,肺癌患者血清CEA,CYFRA21-1和NSE水平均明显升高,差异具有统计学意义(χ2=48.208～104.889,P<0.01)。联合两项或三项血清标志物的检测能明显提高对肺癌诊断的敏感度,但特异度有所下降。在不同病理类型的肺癌中,血清CEA,CYFRA21-1和NSE水平分别在腺癌、非小细胞肺癌、小细胞肺癌中的阳性率较高。发生转移的肺癌患者中的血清CEA水平高于未转移的肺癌患者(Z=-3.056,P=0.002)。结论 联合检测血清CEA,CYFRA21-1和NSE水平在不同病理类型肺癌诊断及转移中具有一定临床价值。     

智能化疼痛管理决策与质量监测系统在跟骨骨折内固定手术患者中应用

目的 探讨智能化疼痛管理决策与质量监测系统在跟骨骨折内固定手术患者中的应用效果。方法 选取2019年1-6月收治的跟骨骨折内固定术患者40例为对照组,行常规性疼痛干预,选取2019年7-12月骨科收治的跟骨骨折内固定术患者42例为研究组,应用智能化疼痛管理决策与质量检测系统对患者实施疼痛管理,比较2组干预前后疼痛评分、睡眠质量、术后锻炼依从率、并发症发生率、足踝功能恢复情况及患者满意率。结果 研究组干预后数字疼痛评分量表(numerical rating scale, NRS)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)、并发症发生率均低于对照组(t=5.464,P<0.001;t=16.940,P<0.001;χ²=5.550,P=0.018),术后锻炼依从率、Morrey评分、MaryLand评分及满意率均高于对照组(χ²=9.217,P=0.002;t=12.906,P<0.001;t=10.687,P<0.001;χ²=6.717,P<0.001)。结论 智能化疼痛管理决策与质量监测系统能有效减轻患者跟骨骨折内固定术后的疼痛感,提高锻炼的依从性,降低并发症的发生率,有利于患者术后的康复,提高患者的满意度。