健康教育行为评价与健康教育合格率相关性的分析

We chose the evaluation of health education from patients to nurses as the method of nursing care management, and analyzed the relation between the evaluation and the passed rate of health education. Now we summarize them as below. 1 Subjects and methods 1.1 Subjects The patients were came from two regions in department of internal medicine from September 1998 to December 2000.Their ages were from 18 to 55.They all had elementary or secondary education, and were farmer or worker.They received II Grade nursing care and had no handicap in communications.     

Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center

BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.     

Celiac crisis,a rare occurrence in adult celiac disease: A systematic review

BACKGROUND Celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.     

综合康复治疗腰椎间盘突出症

1 Materials and methods 1. 1 Materials 80 cases of lumbar disk hernia, 52 male,28 female .Ages ranged from 23 to 58,39.2 on average,suffering durance from 5 days to 12 years,averagely 4.3 years.48 cases had obvious history force damages,32 cases without.All the patients were examined by CT,the hernia location was:L3～ 4 6 cases,L4～ 5 38 cases, L5～ S1 30 cases respectively,6 cases suffer from more than one level.Randomly the patients were divided into two groups (rehabilitation and control ),each with 40 patients.The age,suffering durance,gender,and clinical diagnosis of the two groups have no statistical difference,P >0.01,and can be compared.     

防坠床床单的制作与临床应用研究

Objective To search for a effective and comfortable method approaching to prevent the patient fall down from the bed. Methods Make a kind of bed sheet which can prevent the patient from falling down from the bed, then the result of the two protection tools was observed. Results The two protection tools had no difference in the rate of falling down, but there had different in the complications of the protection tools and satisfaction of the patients, the accompanies and the nurses (P＜0.05), anti - fall down bed sheet was superior to bedrails. But the two had its forte and defect. Conclusions Anti - fall down bed sheet can be used broadly, it has not complication of protection tools and the patients, accompanies and the nurses are satisfied with it. It is an effective protective measure to replace the bedrails or to go with it.     

Clinical evaluation of endoscopic resection for treatment of large gastric stromal tumors

BACKGROUND Gastric stromal tumor is a digestive tract mesenchymal tumor with malignant potential, and endoscopic techniques have been widely used in the treatment of gastric stromal tumors, but there is still controversy over their use for large gastric stromal tumors(≥ 3 cm).AIM To evaluate the clinical long-term efficacy and safety of endoscopic resection for large(≥ 3 cm) gastric stromal tumors.METHODS All patients who underwent endoscopic resection or surgery at our hospital from 2012 to 2017 for pathologically confirmed gastric stromal tumor with a maximum diameter of ≥ 3 cm were collected. The clinical data, histopathologic characteristics of the tumors, and long-term outcomes were recorded.RESULTS A total of 261 patients were included, including 37 patients in the endoscopy group and 224 patients in the surgical group. In the endoscopy group, the maximum tumor diameter was 3-8 cm; the male: Female ratio was 21/16; 34 cases had low-risk tumors, 3 had intermediate-risk, and 0 had high-risk; the mean follow-up time was 30.29 ± 19.67 mo, no patient was lost to follow-up, and no patient received chemotherapy after operation; two patients with recurrence had low-risk stromal tumors, and neither had complete resection under endoscopy. In the surgical group, the maximum tumor diameter was 3-22 cm; the male: Female ratio was 121/103; 103 cases had low-risk tumors, 75 had intermediate-risk, and 46 had high-risk; the average follow-up time was 38.83 ± 21.50 mo, 53 patients were lost to follow-up, and 8 patients had recurrence after operation(6 cases had high-risk tumors, 1 had intermediate-risk, and 1 had low-risk). The average tumor volume of the endoscopy group was 26.67 ± 26.22 cm^3(3.75-120), all of which were less than 125 cm^3. The average volume of the surgical group was 273.03 ± 609.74 cm^3(7-4114). Among all patients with a tumor volume < 125 cm^3,7 with high-risk stromal tumors in the surgical group(37.625 cm^3 to 115.2 cm^3)accounted for 3.8%(7/183); of those with a tumor volume < 125 cm^3, high-risk patients accounted for 50%(39/78). We found that 57.1%(12/22) of patients with high-risk stromal tumors also had endoscopic surface ulcer bleeding and tumor liquefaction on ultrasound or abdominal computed tomography; the ratio of tumors positive for both in high-risk stromal tumors with a volume < 125 cm^3 was 60%(3/5).CONCLUSION Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a tumor diameter ≥ 3 cm and a volume of < 125 cm^3 without endoscopic surface ulcer bleeding or CT liquefaction.     

防坠床床单的制作与临床应用研究

Objective To search for a effective and comfortable method approaching to prevent the patient fall down from the bed. Methods Make a kind of bed sheet which can prevent the patient from falling down from the bed, then the result of the two protection tools was observed. Results The two protection tools had no difference in the rate of falling down, but there had different in the complications of the protection tools and satisfaction of the patients, the accompanies and the nurses (P＜0.05), anti - fall down bed sheet was superior to bedrails. But the two had its forte and defect. Conclusions Anti - fall down bed sheet can be used broadly, it has not complication of protection tools and the patients, accompanies and the nurses are satisfied with it. It is an effective protective measure to replace the bedrails or to go with it.     

Hepatoid adenocarcinoma of the stomach: Thirteen case reports and review of literature

BACKGROUND The aim of the present study was to examine the clinical characteristics of hepatoid adenocarcinoma of the stomach (HAS) and its diagnosis,treatment,and prognosis.CASE SUMMARY A retrospective analysis of 13 HAS cases was performed.The mean age of the 13patients was 66.08 years,and 10 of the 13 patients were male.Prior to treatment,the alpha-fetoprotein levels in the serum were elevated in 7 patients,the tumour was located in the distal or gastric body in 11 patients,and the gastroscopy pathological results showed that 3 patients had poorly differentiated tumours and that 8 patients had moderately/poorly differentiated tumours.Abdominal CT scans showed local stomach wall thickening,and enlarged lymph nodes were visible around the stomach in 8 patients.Of the 13 patients,11 underwent radical surgery.The clinical pathological staging was as follows:Stage Ⅱ in 2 cases;stage Ⅲ in 8 cases;and stage Ⅳ in 1 case.A total of 3 patients were lost to follow-up.Otherwise,as of the last follow-up,3 patients had survived for 56 mo,and the other 7 patients failed to achieve long-term survival (survival period of 1-56 mo).CONCLUSION HAS is a special type of gastric cancer,and the prognosis of HAS has improved compared with past prognoses.Measurement of alpha-fetoprotein,early diagnosis,active surgical treatment,and application of new diagnostic and treatment techniques are conducive to improving the prognosis of HAS.     

Investigation of litigation in trauma orthopaedic surgery

BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.AIM To review the cases of medical complaints in orthopedic patients who had been involved in a traumatic accident.METHODS A retrospective multi-center review of trauma orthopaedic-related malpractice lawsuits from 2010 to 2021 was conducted utilizing the regional medicolegal database. Defendant and plaintiff cha...     

Effect of extracorporeal shock wave lithotripsy for the postoperative residual bilestone of choledocholithiasis

Objective To explore the effect of extracorporeal shock ware lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis,Method Inject contrast medium of biligrafin via T-tube,After accurate apposition with X-ray,take lithotripsy with extracorporeal shock ware .In some cases T-tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100%,The removing rate of bilestones was over 90% with washing method,Choledochoscope was used in 6 cases,and 48 patients were completely healed In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is and effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.     

卵磷脂络合碘治疗外伤性玻璃体出血48例临床分析

目的 探讨口服卵磷脂络合碘治疗外伤性玻璃体出血的疗效。方法 对2005年2～7月在中山眼科中心就诊的门诊及收住院治疗的48例（48只眼）外伤性玻璃体出血患者，给予口服卵磷脂络合碘为主的药物治疗，并对伴有不同眼前段并发症及并发症的患者分别给予必要的手术及辅之以地塞米松、甘露醇静脉滴注或皮质类固醇口服。结果本组病例中治愈32例，好转104例，无明显变化的6例，总有效率为87．5％，治疗时间最短的1个月，最长的半年，对所有患者进行最终观察3个月到半年，均未发生继发性出血，有轻度玻璃体务索形成者为4例，遗留有轻度飞蚊症者6例，视力48例病人中42例病人提高至0．2以上。在应用卵磷脂络合碘过程中，未发现有因用药本身所致的不良反应和副作用。结论 口服卵磷脂络合碘治疗外伤性玻璃体出血疗效可靠，且给药方便．患者较易接受。     

超声造影在肾损伤血肿和活动性出血诊断中的应用

目的 探讨超声造影在肾损伤血肿和活动性出血诊断中的应用价值.方法 对28例肾损伤患者分别行常规超声和超声造影检查,其中肾穿刺活检术后损伤24例,闭合性肾损伤4例,计算两种方法对肾损伤血肿及活动性出血的检出率,所有病例均经CT检查或超声随访检查证实.结果 常规超声对肾血肿的检出率为67.86%(19/28),超声造影对肾血肿的检出率为92.86%(26/28),高于常规超声(P＜0.05),且造影后血肿范围更明确.常规超声难以诊断肾损伤血肿内的活动性出血,超声造影诊断26.92%(7/26)肾血肿伴活动性出血.超声造影特征为肾血肿形成时,血肿区始终无造影剂进入;肾血肿伴活动性出血时,造影剂自受损血管溢出,形成不规则的异常增强区.结论 超声造影有助于诊断肾损伤血肿,准确计算血肿范围和判断活动性出血,对发现肾穿刺活检术后合并的血肿及出血具有特殊应用价值.     

休克指数及CRAMS创伤评分法在腹部闭合伤早期抗休克治疗中的效果研究

目的 验证休克指数及CRAMS创伤评分法的应用在腹部闭合伤患者早期抗休克治疗中效果的研究。方法 (1) 将45例腹部闭合伤患者按随机数字表法分为干预组和对照组,两组均接受腹部闭合伤抗休克常规治疗,干预组按照干预策略既定的方案进行抗休克指数的监测及CRAMS创伤评分法查看两组之间的存活率是否存在统计学差异。（2）回顾45例腹部闭合伤病例,将其分为腹腔出血组和腹腔无出血组,探讨休克指数,CRAMS创伤评分法诊断出血的灵敏度。 结果 (1) 干预组与对照组相比,在腹腔脏器闭合性损伤时把休克指数与CRAMS创伤评分法相结合,与单纯的依靠收缩压和心率相比,在统计学上无明显差异。（2）通过对45例病例2个指标的灵敏度分析,监测休克指数与CRAMS创伤评分法对于判断腹腔内出血的灵敏度高于监测心率和收缩压。 结论 据试验结果我们可以推断：结合休克指数与CRAMS创伤评分法在腹部闭合伤患者抗休克的治疗中较单纯依靠心率和收缩压更具有临床意义。在急诊科,我们可以增加对于腹部闭合伤患者抗休克治疗时的休克指数与CRAMS创伤评分法的监测,可提高对于腹部闭合伤患者的病情判断、指导抢救及预后。     

Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?

OBJECTIVE: The occurrence of fetal intracranial hemorrhage before labor has been repeatedly observed. The aim of this study was to evaluate the sonographic appearance of fetal intracranial hemorrhage in relation to its location. Possible causative factors were also evaluated. DESIGN: Five consecutive cases of fetal intracranial hemorrhage were identified at a single ultrasound unit between 1996 and 1999. In utero magnetic resonance imaging was also performed in four of these cases. Autopsy was performed after pregnancy termination or intrauterine fetal death (one case of each), and neurological follow-up was initiated in the three surviving infants. RESULTS: Hydrocephaly was the predominant sonographic finding associated with intraventricular or subependymal hemorrhage; sonography provided the correct diagnosis in the former (two cases), whereas magnetic resonance imaging was necessary in the latter. Massive intraparenchymal hemorrhage was depicted as an irregular echoic mass, whereas extradural hemorrhage had a cystic appearance. History of minor maternal physical trauma without maternal or placental injury was elicited in all cases. Ultrasound examinations performed before or shortly after the trauma were available in all cases and showed normal fetal anatomy. CONCLUSIONS: The sonographic appearance of fetal intracranial hemorrhage is variable, depending on its location. Even though sonography detected an intracranial anomaly in all cases, magnetic resonance imaging was necessary to establish the hemorrhagic nature of isolated subependymal and extradural hemorrhage. The similarity of histories involving minor maternal physical trauma in all cases, together with the absence of any known factor predisposing to fetal hemorrhage, may suggest that trauma is at least a contributing factor to the pathogenesis of fetal intracranial hemorrhage.     

不典型新生儿颅内出血的临床特征

目的探讨不典型新生儿颅内出血的临床特征,提高早期诊断的准确率.方法2000～2005年间,我科共有152例新生儿颅内出血病例住院治疗,其中不典型颅内出血65例.对所有的病例资料作回顾性分析,对比典型与不典型新生儿颅内出血的临床表现和预后情况.结果65例不典型病例多表现为意识、肌张力、原始反射等方面轻度异常,伴蛛网膜下腔出血者最多（46例）.其分娩方式和产伤人数与典型病例组无显著性差异（P＞0.05）;早产儿比例显著较高（P＜0.05）;窒息程度较轻（P＜0.05）;治愈52例,预后较好（P＜0.05）.结论不典型新生儿颅内出血多见于早产儿,早期病情相对较轻,临床表现不明显,易导致误诊漏诊,临床医师应给予足够重视.     

肾上腺钝性损伤的CT分析

目的：探讨腹部钝性伤所致肾上腺损伤的CT征象。方法：回顾分析15例因腹部钝伤而行CT检查示有肾上腺损伤的资料，其中男性13例，女性2例。9例行CT平扫及增强检查，6例平扫；11例行CT随访。结果：15例肾上腺损伤均为单侧性损伤并伴同侧胸腹部损伤，位于右侧11例（73％），左侧4例，1例伴肾上腺肿瘤。10例CT主要表现为肾上腺区类圆形或卵圆形血肿（67％），3例（20％）表现为伤侧肾上腺增粗，1例（7％）表现为肾上腺区较弥漫的出血，1例原有肾上腺肿瘤存在。10例（67％）肾上腺邻近脂肪内出血呈条束状或局限性密度增高影，3例（20％）后肾周间隙的出血表现为类似膈脚增厚改变。结论：肾上腺损伤右侧远多于左侧，常伴有同侧胸腹腔和腹膜后损伤，肾上腺血肿有时需与肾上腺原发肿瘤相鉴别，鉴别主要方法是随访及增强CT检查。     

早期小骨窗开颅治疗高血压脑出血疗效分析

目的:探讨早期小骨窗开颅手术治疗高血压脑出血的临床效果.方法:回顾性分析我科2007年1月至2009年7月应用早期小骨窗开颅手术治疗高血压脑出血23例的临床资料.结果:23例中术后存活22例,1例死于肺部感染.结论:早期小骨窗开颅手术是治疗高血压脑出血的有效方法之一.     

Unsuspected upper cervical spine fractures associated with significant head trauma: role of CT

Several recent studies report the sensitivity of computed tomography (CT) to be far greater than that of traditional plain film radiographic studies for evaluation of cervical spine fractures and spinal cord pathology. Nevertheless, plain films continue to be the standard screening examination. CT is used only if fractures are demonstrated or suspected on plain film survey. Recently, three patients with significant head and neck trauma (all three patients had intracranial hemorrhage) had cervical spine evaluation by computed tomography and standard plain film views. CT demonstrated significant C1-C2 fractures, while plain films were completely normal in all three cases. Prospectively studying the next 50 patients with significant head trauma, we added a few more slices to the routine head scan protocol to cover the first three cervical vertebrae. This added very little time or cost to the procedure. The additional CT images demonstrated four upper cervical fractures that could not be seen on plain films, even in retrospect. Our findings suggest that routine inclusion of the upper cervical spine with head CT is appropriate in the evaluation of patients with significant head trauma as defined by intracranial hemorrhage or skull fracture.     

低场MRA在烟雾病筛查及初步诊断的价值

目的探讨低场MRA在烟雾病筛查及初步诊断的价值。方法选择性地对34例可疑病人进行低场MRA检查并进行分析,选择对象：符合无高血压、无糖尿病、无头颅外伤史、年龄≤55岁,且MRI、CT发现脑梗死、脑出血、脑萎缩及蛛网膜下腔出血等,或临床症状反复、明显,以及临床疑诊脑血管病变。结果34例MRA中5例显示颈内动脉颅内段、大脑中动脉及大脑前动脉近段不同数目、不同程度狭窄或／和闭塞,经高场MRA或DSA证实为烟雾病：1例显示前交通动脉动脉瘤,4例显示脑底动脉环解剖变异,24例未见明显异常,此29例排除烟雾病。结论因地制宜地合理应用低场MRA对烟雾病筛查及初步诊断有实用价值.     

脑出血灶周脑组织MMP-2和MMP-9的表达

目的观察急性脑出血患者灶周脑组织基质金属蛋白酶-2（MMP-2）、MMP-9的表达及其意义。方法选择42例采用外科手术治疗的急性脑出血患者破碎脑组织病理标本;另选30例脑外伤患者出血灶周破损脑组织作为对照。用免疫组化法测定脑组织MMP-2、MMP-9阳性细胞表达情况。结果两组患者脑组织MMP-9和MMP-2阳性细胞表达明显升高。42例急性脑出血早期患者灶周脑组织MMP-9、MMP-2阳性细胞表达分别为39例和37例;而30例脑外伤出血患者脑组织MMP-9、MMP-2阳性细胞表达分别为28例和27例,两组比较差异均无显著性（P均〉0.05）。结论MMP-2和MMP-9参与了人类急性脑出血脑水肿的形成。