临床护士能力测评方法的研究

介绍了护士能力的定义、能力评价内容、能力进阶制度,从临床理论、实践技能、心理测试等方面阐述了临床护士能力评价方法。     

临床护士能力测评方法的研究

介绍了护士能力的定义、能力评价内容、能力进阶制度,从临床理论、实践技能、心理测试等方面阐述了临床护士能力评价方法.     

超短回波时间和零回波时间MRI评估膝关节炎进展

超短回波时间(UTE)和零回波时间(ZTE)MRI可有效显示并定性、定量评估软骨、韧带及骨皮质等短T2结构,对于临床早期诊断膝关节炎有重要意义,由此有望实现软组织及骨骼一站式高分辨成像。本文就UTE和ZTE MR成像原理及其临床评估膝关节炎应用进展进行综述。     

MRI评估膝关节骨性关节炎病变

膝关节骨性关节炎（OA）是以软骨病变、半月板损伤、骨髓病变、滑膜炎、骨赘及韧带损伤等为主要病理特征的退行性关节病。MRI可清晰显示关节软骨及半月板等软组织，直观了解膝关节解剖结构或病变类型，根据OA进展及病理类型选择特异度及敏感度较高的方法，可于膝关节软组织及周围组织发生形态学变化前早期诊断OA。本研究对MRI评估膝关节OA病变中的应用进展进行综述。     

肾虚模型造模方法及相关指标

背景:临床上与肾虚相关的疾病较多,肾虚动物模型往往在这类疾病的实验研究中发挥着重要的作用.选择合适的方法制造肾虚模型必然会对相关疾病的研究提供很大的帮助.目的:全面归纳肾虚模型的各种造模方法、其造模的理论依据、肾虚类型和检测方法及指标意义.方法:电子检索清华同方知网数据库和万方数据库2004/2009收录的肾虚模型相关期刊、会议论文和综述,根据文章的参考文献,对有价值的文献另行检索阅读,分析其造模方法和相关检测指标的研究进展.结果与结论:共纳入肾虚模型相关文献46篇.其造模方法主要分为药物干预、手术切除和模拟中医病因病机等3大类;其模型主要分为肾阳虚模型和肾阴虚模型两类;主要通过肉眼和镜下观察、测量相关数据和生化检测的方法来观察动物内分泌、免疫、生殖系统等变化进行判断.目前对肾虚模型中DNA,RNA,蛋白的变化的研究和探讨有增多的趋势,但目前的指标都不是"金指标".虽然有学者试图找出肾虚的物质基础,但结论没有得到普遍的认可.     

Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis

OBJECTIVE: To determine if women's dress shoes with heels of just 1.5 in (3.8 cm) in height increases knee joint torques, which are thought to be relevant to the development and/or progression of knee osteoarthritis (OA) in both the medial and patellofemoral compartments. DESIGN: Randomized controlled trial. SETTING: A 3-dimensional motion analysis gait laboratory. PARTICIPANTS: Twenty-nine healthy young women (age, 26.7+/-5.0 y) and 20 healthy elderly adult women (age, 75.3+/-6.5 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak external varus knee torque in early and late stance and prolongation of flexor knee torque in early stance. Three-dimensional data on lower-extremity torques and motion were collected during walking while (1) wearing shoes with 1.5-in high heels and (2) wearing control shoes without any additional heel. Data were plotted and qualitatively compared; major peak values and timing were statistically compared between the 2 conditions using paired t tests. RESULTS: Peak knee varus torque during late stance was statistically significantly greater with the heeled shoes than with the controls, with increases of 14% in the young women and 9% in the elderly women. With the heeled shoes, the early stance phase knee flexor torque was significantly prolonged, by 19% in the young women and by 14% in elderly women. Also, the peak flexor torque was 7% higher with the heeled shoe in the elderly women. CONCLUSIONS: Even shoes with moderately high heels (1.5 in) significantly increase knee torques thought to be relevant in the development and/or progression of knee OA. Women, particularly those who already have knee OA, should be advised against wearing these types of shoes.     

Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials

OBJECTIVE: To investigate the structural and symptomatic efficacy and safety of glucosamine in knee osteoarthritis (OA). DATA SOURCES: Clinical trials of glucosamine were identified through electronic searches (MEDLINE, EMBASE, BIOSIS, EMB review, the Cochrane Library) using the key words glucosamine, osteoarthritis, degenerative joint disease, degenerative arthritis, osteoarthrosis, gonarthrosis, knee, disease progression, and clinical trial. The bibliographic databases were searched from their respective inception dates to August 2004. We also hand-searched reference lists of relevant articles. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they were double-blind, randomized, controlled trials that evaluated oral glucosamine long-term treatment in knee OA; lasting at least one year; and reporting as outcome measures the symptom severity and disease progression as assessed by joint space narrowing. Two authors interpreted data independently. Disagreements were resolved through discussion. DATA SYNTHESIS: Glucosamine sulfate was more effective than placebo in delaying structural progression in knee OA. The risk of disease progression was reduced by 54% (pooled RR 0.46; 95% CI 0.28 to 0.73; p = 0.0011). The number-needed-to-treat was 9 (95% CI 6 to 20). The pooled effect sizes for pain reduction and improvement in physical function were 0.41 (95% CI 0.21 to 0.60; p < 0.0001) and 0.46 (95% CI 0.27 to 0.66; p < 0.0001), respectively, in favor of glucosamine sulfate. Glucosamine sulfate caused no more adverse effects than placebo. CONCLUSIONS: The available evidence suggests that glucosamine sulfate may be effective and safe in delaying the progression and improving the symptoms of knee OA. Due to the sparse data on structural efficacy and safety, further studies are warranted.     

骨关节炎患者高敏C反应蛋白测定的临床意义

目的:了解高敏C反应蛋白(hs-CRP)对骨关节炎(OA)患者病情评估的作用。方法:用免疫增强透射比浊法检测20例活动期膝关节OA患者和23例放射学(无症状)膝OA患者的hs-CRP水平,并与20例正常人相比较。结果:有膝关节疼痛的活动期OA患者的hs-CRP水平明显高于放射学无症状OA患者(P<0.01),且两组患者的血清hs-CRP水平均高于正常对照组(分别为P<0.01及P<0.05)。20例活动期患者经治疗症状减轻后hs-CRP水平明显下降(P<0.05),但仍高于正常对照组(P<0.01)。结论:hs-CRP是评估OA活动性及监测其治疗效果的一种敏感的血清学指标。     

伸膝迟滞测量评价骨关节炎患者伸膝装置功能系统的应用价值

背景:伸膝迟滞是伸膝装置系统的病变或其他原因引起的主动完全伸膝表现延迟的现象.对于伸膝迟滞的检查和测量,临床上通常采用目测的方法进行.目的:通过对骨关节炎患者伸膝迟滞情况进行测量,评估其伸膝装置系统的功能.设计、时间及地点:对比观察,于2004-10/2005-03在北京协和医院完成.对象:选择在北京协和医院就诊的人工全膝关节置换围手术期的膝关节骨关节炎患者47例,共66患膝,所有患者对治疗及试验方案均知情同意.方法:通过目测法和Cybex NormTM770系统检查测试.根据测量方法,将患者分为3组.应用目测法观察明显伸膝迟滞的患者18例36膝设为目测组;目测法观察无伸膝迟滞,应用Cybex NormTM770系统检测出伸膝迟滞的患者22例23膝设为Cybex系统组;应用目测法观察以及通过Cybex NormTM770系统均未检出伸膝迟滞的患者7例7膝设为无伸膝迟滞组.由同一位临床医生分别为每位患者填写手术前膝关节HSS评分表,并记录术后下地时间和术后出院时间.主要观察指标:平均伸膝迟滞的角度、平均伸膝装置的扭力、膝关节HSS评分的平均值、术后下地时间及术后出院时间.结果:47例患者的66个膝关节全部施行人工全膝关节置换治疗,置换后无并发症、合并症出现.手术切口均为一期愈合.3组患者的平均伸膝迟滞角度与HSS评分比较差异具有显著性意义(P<0.05).目测组及Cybex系统组患者的平均伸膝迟滞角度、平均膝关节屈,伸肌力比值及术后平均下地时间差异具有显著性意义(P<0.05).结论:与目测法相比,Cybex NormTM770测量系统可以获得在临床检查中表现不明显的伸膝迟滞症状学诊断.在骨关节炎患者的人工全膝关节置换围手术期,应用伸膝迟滞测量评价伸膝装置的功能状态,及时对症治疗,有助于恢复膝关节功能.     

腕关节3D LAVA动态增强在判断类风湿性关节炎疾病进程的价值研究

目的：探讨3.0T MRI LAVA动态增强检查在判断类风湿性关节炎（RA）疾病进程的价值.方法：收集临床确诊的RA患者35例,其中关节炎活动期20例,缓解期15例,进行碗关节MRI平扫加动态增强扫描,并将采集的动态增强图像进行后处理,每位患者选取碗关节周围滑膜异常强化6个感兴趣区,获得动态增强时间信号曲线,分别计算每个感兴趣区的滑膜强化率并取平均值,同时测量6个感兴趣区的滑膜厚度并取平均值.将活动期和缓解期患者的滑膜强化率、滑膜厚度差异进行统计学比较,将所有患者的滑膜强化率及滑膜厚度与血沉（ESR）、C反应蛋白（CRP）的相关性进行统计学研究.结果：活动期的时间信号曲线为快速上升平台型,缓解期的时间信号曲线为缓慢上升型.活动期患者的平均滑膜强化率（2.27±0.56）与缓解期患者的平均滑膜强化率（1.04 ±0.42）差别有统计学意义,P＜0.01;活动期平均滑膜厚度（（5.9±0.4）mm）与缓解期滑膜平均厚度（（2.9±0.6）mm）差别具有统计学意义,P＜0.01..患者的滑膜强化率分别与ESR及CRP呈正相关（相关系数R值分别为0.778和0.816,P值分别为0.02和0.01）,滑膜厚度与ESR及CRP具有一定相关性（相关系数R值分别为0.506和0.402,P值均为0.05）.结论：动态增强MRI时间信号曲线形状、滑膜强化率及滑膜厚度对判断RA的活动性具有较高价值.