人性化护理在自然分娩产妇中的应用

[目的]探讨人性化护理对孕妇及新生儿的影响。[方法]将2002年在我院住院分娩的1803例产妇作为观察组,将人性化护理贯穿分娩全程;2001年1368例产妇作为对照组,给予常规护理。观察两组剖宫产率、产后大出血率及新生儿窒息率。[结果]观察组产妇剖宫产率、产后大出血率、新生儿窒息率均低于对照组(P<0.05)。[结论]人性化护理能促进自然分娩,提高产科质量。     

激励式护理干预对选择分娩方式的影响

[目的]对产妇施行激励式心理护理,观察其对选择分娩方式的影响。[方法]选取2007年1月—2007年12月在我院经过陪伴分娩的初产妇120例,随机分为实验组和对照组。对照组采取常规护理,实验组实行激励式心理护理。观察激励式心理护理对产妇选择分娩方式、产后出血率、新生儿窒息率的影响。[结果]实验组阴道分娩率明显高于对照组,剖宫产率明显低于对照组,新生儿窒息率低于对照组,经比较差异有统计学意义;两组产后出血发生率比较差异无统计学意义。[结论]激励式心理护理有利于促进自然分娩,降低剖宫产率,有利于降低新生儿窒息率。     

激励式护理干预对选择分娩方式的影响

[目的]对产妇施行激励式心理护理,观察其对选择分娩方式的影响.[方法]选取2007年1月-2007年12月在我院经过陪伴分娩的初产妇120例,随机分为实验组和对照组.对照组采取常规护理,实验组实行激励式心理护理.观察激励式心理护理对产妇选择分娩方式、产后出血率、新生儿窒息率的影响.[结果]实验组阴道分娩率明显高于对照组,剖宫产率明显低于对照组,新生儿窒息率低于对照组,经比较差异有统计学意义;两组产后出血发生率比较差异无统计学意义.[结论]激励式心理护理有利于促进自然分娩,降低剖宫产率,有利于降低新生儿窒息率.     

对产妇实施陪伴分娩的效果观察

[目的]探讨实施陪伴分娩对产妇的影响。[方法]将240例产妇随机观察组和对照组各120例,观察组产妇给予全程陪伴分娩,对照组产妇给予常规的待产分娩。[结果]观察组产妇剖宫产率明显低于对照组（P〈0．05）、在分娩过程中遵医行为明显优于对照组（P〈0．05）、产程明显短于对照组（P〈0．05）、产后出血率及新生儿窒息率明显低于对照组（P〈0．05）。[结论]给予产妇全程的陪伴分娩可以降低剖宫产率、缩短产程、降低产后出血率和新生儿窒息发生率。     

拉玛泽呼吸法在导乐陪伴分娩中的应用

目的探讨拉玛泽呼吸法在导乐陪伴分娩中对产妇及新生儿的影响。方法将649例阴道试产产妇按自愿原则分为对照组320例及观察组329例。对照组予导乐陪伴分娩,观察组在导乐陪伴分娩的基础上配合拉玛泽呼吸法。观察两组产时疼痛情况、产程时间、产后大出血发生率、新生儿窒息及剖宫产率。结果两组产时疼痛、产程时间、产后大出血、新生儿窒息率及剖宫产率等方面比较,差异有统计学意义。结论导乐陪伴分娩中配合拉玛泽呼吸法,能减轻产时疼痛,促进产程进展,减少产后大出血,降低新生儿窒息及剖宫产率。     

陪伴分娩模式对产科质量的影响

[目的]观察陪伴分娩对产科质量的影响。[方法]选择单胎、足月初产妇为观察组,设上一年同期同等条件产妇为对照组,观察陪伴分娩模式对产科质量的影响。[结果]观察组产妇剖宫产率、产后大出血率、新生儿窒息率均有明显下降。[结论]陪伴分娩可明显提高产科质量,提高产科的满意度。     

优质护理在乙型肝炎孕产妇分娩中的应用

[目的]探讨优质护理在乙型肝炎孕产妇分娩中的应用。[方法]将200例足月乙型肝炎初产妇随机分为观察组和对照组各100例,观察组给予优质护理服务及先进的助产理念,对照组采用传统式的助产服务模式。比较两组产妇产程时间、自然分娩和剖宫产情况率、产后出血和新生儿窒息发生情况、产妇满意度。[结果]观察组产妇第一产程、第二产程和总产程时间少于对照组（P均〈0．05）;观察组产妇剖宫产率以及产后出血、新生儿窒息发生率低于对照组（P均〈0．05）;观察组产妇自然分娩率及产妇满意度高于对照组（P〈0．05）。[结论]在乙型肝炎孕产妇分娩中应用优质护理,可缩短产程、促进自然分娩、减少产后出血及新生儿窒息的发生,满足孕产妇的个性化需求,提高产妇的满意度。     

护理干预对产妇分娩方式及产后并发症的影响

[目的]观察护理干预对产妇分娩方式及产后并发症的影响。[方法]将245例初产妇随机分为两组,对照组120例给予常规护理,观察组125例产妇在常规护理基础上给予护理干预。比较两组产妇分娩方式、产后出血情况。[结果]观察组自然分娩率高于对照组,剖宫产率低于对照组;观察组产后出血发生率低于对照组。[结论]护理干预可提高产妇自然分娩率、降低剖宫产率,降低产后出血发生率。     

拉玛泽减痛分娩法对产妇及新生儿的影响

目的 探讨拉玛泽减痛分娩法对产妇及新生儿的影响.方法 将1240例无剖宫产指征的初产妇随机分为观察组和对照组,每组各620例.对照组采用常规护理分娩,观察组在常规护理的基础上实施拉玛泽减痛分娩法进行分娩.观察2组产妇产时疼痛程度、产程的时间、剖宫产率、新生儿窒息及产后出血的发生率.结果 2组产程的时间和产后出血的发生率差异无统计学意义(P>0.05),观察组产时疼痛程度,剖宫产率及新生儿窒息均低于对照组(P<0.05).结论 拉玛泽减痛分娩法能够降低产时疼痛的程度,降低剖宫产率及新生儿窒息率,值得推广应用.     

陪伴分娩模式对产科质量的影响

[目的]观察陪伴分娩对产科质量的影响.[方法]选择单胎、足月初产妇为观察组,设上一年同期同等条件产妇为对照组,观察陪伴分娩模式对产科质量的影响.[结果]观察组产妇剖宫产率、产后大出血率、新生儿窒息率均有明显下降.[结论]陪伴分娩可明显提高产科质量,提高产科的满意度.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.