小儿手烧伤瘢痕畸形的整形外科治疗

Background: Cicatricial deformation in child burn of hand often leads to severe squaelae. According to different causes of disease , different plastic surgery were adopted .The key of operation lies in skin repairing , articulation dealing, and thumb correcting, which aim is to resume normal longitudinal and transverse arcs ,holding and clenching ability.     

饮食指导对血液透析患者营养状态及日常生活活动能力的影响

Background: The shoulder and hand symptoms are secondary complaints characterized by swelling and pain of the hand of the sick side after stroke. According to statistics, its rate is 12.5％～ 73.0％ among patients with hemiplegia. Most of them happens in 1～ 3 months after stroke and the pain will hamper the complete rehabilitation of the patients. If it not treated in time, it would cause permanent deformities of hands and fingers and hamper hand function and daily living activities.     

“X” plastic operation and postoperative rehabilitative treatment of hand proximal interphalangeal joint flexion contraction deformity

Background:The contraction deformity of hand proximal interphalangeal joint flexion often occurs after different injury of palmar digital skin,which has effections on hand functions in different extent (varying degrees) and brings many difficults to patients in their life and work.And marked effect are achieved when “X” plastic operation and postoperative recovery therapy are put into use.Objective:To investigate “X” plastic operation and curative effect of postoperative rehabilitative treatment of contraction deformity of hand proximal interphalangeal joint flexion.Unit:First Clinical Medical College of Harbin Medical Universkty.Subjects:4 patients,3 males and 1 females,all the deformity of six fingers were caused by deep trauma of hand skin,timely ranged from 0.5 to 8 years.Intervention:In the location of finger flexion contraction “X” incision was done across the joint,which reached deeply the surface of flexor aponeurosis and fully slacked contraction.After X-shaped incision,two side triangular flaps were formed,which should not be separated in order to prevent necrosis of tips.Two triangular flaps crisscrossed and were connected to finger flexion joint.One or two new surface of wound left over by proximal and distal ends of flaps can be done with free skin grafting of thick graft of thick faint graft.After operation the affected fingers were bandaged and fixed.The patients should be told passive flexion and extension of finger joint in early postoperative period and active floxion and extension in later period.The mobility should be refined to the range of joint sour and endurance.The child can be fixed for three months with plaster model or small splint according to the conditions and assigned with floxion and extension.Results: Flaps growed well after operation and all survived.Following up three cases half one year and founding that no one case recurred up to now ad the flaps were extending and the function of flexion and extension were good.Conclusion: Two side flaps caused by this operation can easily acrossly connect to the joint of flexion surface and can gradually extend with the flexion and extension of joint.It achieve marked effect that other operations cannot achieve.Early rehabilitative training after operation can not only add patients‘ confidence,make them fully realize the importance of practices,but also improve the early recovery of joint function.     

Scaphoid metastasis as the first sign of occult gastroesophageal junction cancer:A case report

BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.     

Treating effects of comprehensive treatment on post-stroke shoulder and hand symptoms

Background：The shoulder and hand symptoms are se condary complaints characterized by swelling and pain of the hand of the sick side after stroke．According to statistics，its rate is １２．５％～７３．０％among patients with hemiplegia．Most of them happens in１～３months after stroke and the pain w ill hamper the complete rehabilitation of the patients．If i t not treated in time，it would cause permanent deformities of hands and fingers and hamper hand function and daily living activitie s…     

神蜂精刮痧治疗周围性面瘫42例

Background: Peripheral facial paralysis is a common disease with facial nerve paralysis, facial mimetic muscle dyscinesia, and deviation of the eye and mouth. It is commonly considered that peripheral facial paralysis might be correlated with virus infection, rheumatism, ischemia, immunity. Pathological changes included edema, denaturation, atrophy, and ischemia of facial nerve. In traditional Chinese medicine, peripheral facial paralysis is caused by stagnation of qi and blood, malnutrition of channels and vessels, and cizhongbusou. Curing rheumatism, warming yang and supplementing qi, relaxing stagnation, regulating qi and blood should be emphasized in treatment. Guasha belongs to massage and is characterized by easy operation, and reliable therapeutic effect. Guasha can stimulate nerve strongly, improve metabolism, and enhance immunity and promoting blood circulation. " Head is the center of all yangs" . According to principle of acupoint selection along channels, guasha of channels distributed in neck, shoulder, hand, and region with yang channels of hand and foot, in combination with external wasp cream with antiinflammation and removing stagnation, self local massage,and functional exercise of facial muscles are effective in improving blood circulation of head and face,remove edema of facial nerve,promote recovery of facial muscles.     

手部高压注射伤损伤机制及治疗进展

High pressure injection injury (HPII) is a rare injury of hands. It is reported by Ress in 1973 firstly.It is easy to be neglected with potential dangers,and happens mainly at non dominant hand.The slight clinical manifestation in early stage,such as small wound in the end of finger,usually conceals the range and degree of damage,which could lead to severe results even to finger amputating.Early decompression and debridement are main treatments[1,2].The studies of HPII are rare in our country[1,2].We review the advance of HPII as follows. 1 Incidence rate and the causes.     

Plastic surgery treatment on cicatricial deformation in child burn of hand

Background:cicatricial deformation in child burn of hand often leads to severe squaelae.According to different causes of disease,different plastic surgery were adopted.The key of operation lies in skin repairing,articulation dealing,and thumb correcting,which aim is to resume normal longitudinal and transverse arce,holding and clenching ability.Objective:To investigate plastic surgery treatment on cicatricial deformation in child burn of hand.Unit:first People‘s Hospital of Yancheng City.Subjects:34 cases of burn were investigated including 23 males,11 females,aged 5-12 years old.Cicatricial reason:deep degree Ⅱ burn,19 cases;degree Ⅲ burn 11 cases;electric injury,4 cases.Scar type:hypertrophic scar,21 cases,areophic scar,13 cases.portion:dorsum of hand,22 cases,palm,12 cases.Time from healing to dealing:within 6 months,9 cases,within 1 year,8 cases,1-2 years,13 cases,over 3 years,4 cases.Intervention:Before operation,hypertrophic scar and adhesive web-space were cleaned with soap solution,1:5000 bromogeramine,30 min per time,twice a day.Anesthesia:general anesthesia to simple cicatricial contracture,scar removing,relaxing and free graft were adopted,full split thickness graft of palm,intermediate split thickness graft of dorsum of hand.To severe contracture,besides complete removing and full and intermediate split thickness graft,repairing of extensor tendon and articulate surgery,proximal finger joint was fixed at functional position when function couldn‘t be resumed.Tourniquet was used routinely,great saphenous venous and dorsal cutancous branch of radioulnar nerve avoiding exposing extensor tendon,fixed with plaster support and kirschner pins for some cases.Direct skin flap was used after incision and relaxing in 19 cases,skin flap graft was combined with repair in 15 cases.To scar contracture of part between thumb and index finger,because soft tissue had a good condition in this part,“Z”plastic operation was adopted for linar scar,local transfering of dorsal skin flap i 5 cases.To slight false web-space and adhesion,“Z”plastic operation was adopted,“M”or “T” skin flap repair to severe deformation and reconstructing of web-space with free skin graft when necessary.Result:Following up for 3-6 months,hand function recovered completely,improved obviously in 12 cases,no obvious effect was found in cases of deep burn.Conclusion:Different plastic surgery has an obvious effect on child hand bur,but the recovery of function needed long and effective rehabilitation therapy.     

Treatment of facial peripheral paralysis with wasp cream guasha in 42 cases

Peripheral facial paralysis is a common disease with facial nerve paralysis,facial mimetic muscle dyscinesia,and deviation of the eye and mouth.It is commonly considered that peripheral facial paralysis might be correlated with virus infection,rheumatism,ischemia,immunity.Pathological changes included edema,denaturation,atrophy,and ischemia of facial nerve.In traditional Chinese medicine,Peripheral facial paralysis is caused by stagnation of qi and blood,malnutrition of channels and vessels,and cizhongbusou.Curing rheumatism,warming yang and supplementing qi,relaxing stagnation,regulating qi and blood should be emphasized in treatment.Guasha belongs to massage and is characterized by easy operation,and reliable therapeutic effect.Guasha can stimulate nerve strongly,improve metabolism,and enhance immunity and promoting blood circulation.“Head is the center of all yangs”.According to principle of acupoint selection along channels,guasha of channels distributed in neck,shoulder,hand,and region with yang channels of hand and foot,in combination with external wasp cream with antiinflammation and removing stagnation,self local massage,and functional exercise of facial muscles are effective in improving blood circulation of head and face,remove edema of facial nerve,promote recovery of facial muscles.     

自发性脑出血后锥颅血肿吸吸引对远期神经功能的影响

Background:Clear of hematoma and decrease of intracerebral pressure are necessary in the treatment of spontaneous cerebral hemorrhage.Conservative therapy is characterized by stable effect and less risks,which is effective in treating small hematoma with stable vital signs.Clinical practice indicated surgery had no define effect on hematoma.Neurological therapists concerned the way of clearing cerebral hematoma and decrease of cerebral pressure and reducing brain injury.Now drainage of spine and brain hematoma has been accepted,which treat hematoma according to rules of hematoma development.Directional CT,computer imitated orientation,hand pushed revolved drill skull and microcatheter drawing could effectively clear hematoma and long term effect is define.     

"Roll-bar" for protective posture splint limits potential trauma to dorsal hand grafts

The expectation of excellent functional and cosmetic outcomes adds to the challenges of managing the burned hand. The initial fragility of the grafted surface warrants extra measures of protection. A "roll-bar " attached to a splint over a grafted area can serve as protection against mechanical trauma. Two "intrinsic plus " protective posture splints were fabricated; one had a roll-bar extending from the D2 ray to the distal forearm. Three simulated patients wearing each of the splints attempted to contact the bed rail from supine. Pictures, transferred ink, observation, and subjective comments were used to establish percentage of the surface at risk because of bed rail contact and its ease. Without the roll-bar 100% of the dorsal surface of the hand was accessible to contact with the bed rail. With the roll-bar all subjects were prevented from contact to the dorsum of the hand and contact to the dorsal fingers was less than 40% in all subjects, decrease of risk at the wrist was also significant. The roll-bar can prevent mechanical trauma to grafts on the fingers and dorsum of the hand because of contact with the bed rail. The ease of the application and the potential benefits to patient outcome make it an appropriate addition to the protective posture splint when seeking to minimize area of the surface at risk.     

Hand hygiene practices of home visiting community nurses: perceptions, compliance, techniques, and contextual factors of practice using the World Health Organization's "five moments for hand hygiene"

In this observational study, the perceptions, compliance, techniques, and contextual issues of hand hygiene practices among community clinicians (nurses) during 103 hand hygiene opportunities (based on the World Health Organization "Five Moments for Hand Hygiene") in 40 patient care episodes were examined. Compliance with standard hand hygiene practices was generally poor, with many contextual influences making compliance difficult. Clinician preferences and convenience are important considerations in hand hygiene compliance. Improving home-visiting community clinicians' hand hygiene practices requires addressing contextual issues related to the availability of hand hygiene equipment, such as alcohol-based hand rubs, as well as hand hygiene in-service education to update knowledge on hand hygiene for everyday practice in community settings.     

The use of the Millard "crane" flap for deep hand burns with exposed tendons and joints.

Deep hand burns with exposed tendons and joints are rare but devastating injuries. They cannot be grafted and require flaps. Abdominal or groin flaps are commonly used, but they are bulky and require separation of the digits. We tried the Millard "crane" flap for these burns and compared our patients' results with those of patients who had received standard abdominal skin flaps. Eleven deep hand burns that had been treated with flaps were evaluated. Six patients had been treated with the crane flap and 5 had been treated with conventional abdominal skin flaps. All crane procedures provided graftable wound beds. The total active ranges of motion of all 11 patients 6 months after the surgical procedures showed no statistical difference. The crane method also provides good cosmetic results. None of the hands treated with crane flaps required procedures to separate the digits or debulk the flaps, but all of the hands treated with conventional abdominal skin flaps required these types of procedures.     

医疗机构《医院消毒卫生标准》应用评价研究

目的研究现行《医院消毒卫生标准》的贯彻、执行情况和存在的问题,提出修订建议。方法以问卷调查形式对22个省市359家医疗机构进行相关调查。结果所调查的医疗机构中,凡涉及该标准的指标每次都使用的单位占56.4%,经常使用的单位占36.5%,只偶尔使用的单位占3.7%,几乎不使用该标准的单位占3.1%。有81.8%的被调查人员认为现行的诊疗环境分类合理;有50%以上被调查者认为应增加室内空气、物体表面、医务人员手消毒卫生要求,设置致病性微生物指标和目标性微生物检测指标。结论本研究较全面地了解了现行《医院消毒卫生标准》的执行情况和修订内容的建议,为修订提供了第一手素材和依据。     

The effectiveness of hand acupuncture and moxibustion in decreasing pain and "coldness" in Korea women who have had hysterectomy: a pilot study.

This pilot study compared the relative effectiveness of hand acupuncture and moxibustion in relieving pain and decreasing "coldness" in certain body parts experienced by subjects who have undergone a hysterectomy. The study participants were 10 women between 40 and 65 years, whose hysterectomies had been performed within 5 years before the study. The 10 subjects were divided randomly into two independent experimental groups, with one group being treated with hand moxibustion, whereas the other group received hand acupuncture therapy. The visual analogue scale evaluation tool was used to measure the pain and digital infrared thermographic imaging to measure "coldness" and blood circulation. When measuring the degree of pain, it was noted that pain scores decreased conspicuously over time. The responses of the two groups did not differ significantly, but moxibustion therapy was found to increase the temperature of internal parts of the body (i.e., abdominal and waist areas), whereas acupuncture affected the peripheral parts of the body.     

《护理研究》随机对照临床护理试验性文献评价

为了解1987年－2000年《护理研究》临床护理试验性论文的现状,并向中国循证医学（Cochrane)中心输送基线资料,根据“Cochrane协作网手册1997”对随机对照试验和临床对照试验的定义,逐页手工检索《护理研究》中临床护理研究论文,结果：在14卷61期中共刊登临床试验论文2108篇,其中85篇采用随机对照实验（RCT）,占4．0％,有盲法3篇（占RCT论文的3．5％）;1995年以后显著高于1995年以前,认为《护理研究》刊载的临床PCR论文数量有不断增加的趋势,但存在的问题仍较多。     

以人为本在护理工作中的应用

本文结合护理工作,全面理解“以人为本”的思想内涵,探讨“以人为本”的思想应用于护理管理和临床护理实践中.作者认为,护理管理者与护理人员建立合作的伙伴关系,营造良好的文化和团队精神,配备合理的人力,运用激励机制等是人性化管理的体现.表现良好的服务态度,落实健康教育,提供精湛的护理技术,创造优美的环境是人性化护理服务的体现.     

Is there one optimal medical treatment and evacuation chain for all situations: "scoop-and-run" or "stay-and-play"

In 2006, the Ministry of Defense of the Netherlands initiated a targeted agenda program for the World Congress on Disaster and Emergency Medicine in Amsterdam in 2007 (15WCDEM). The issue to be discussed was if there is one "golden" treatment and evacuation system that is applicable for different military and civilian situations. And, if there is not such a system, which parameters are important to construct the most optimal system for each different situation. This issue is related to the applicability and evidence base of the standards of the North Atlantic Treaty Organization. A group of experts started a website discussion on the issue during December 2006. During the 15WCDEM, several other participants were active in the discussion. Using the different experiences and the outcome of the discussions, it was concluded that there is not one "golden" medical emergency system, there are no "golden" timelines, and no "golden" skills. A medical system should be flexible and be able to adjust on each specific, local situation. First responder and non-medical people with medical skills (first responders) are essential in the front line of the emergency medical systems. More research is needed on the medical techniques and skills that are most effective early in the treatment and evacuation systems. Lessons learned from the military system are relevant for the civilian emergency medical services and vice-versa. The World Association for Disaster and Emergency Medicine can be an important platform to share and exchange information between these two systems. The target of the platform should be to obtain a generic picture of the important elements in prehospital emergency medical care.     

Strategies used by clinical nurse specialists in "difficult" clinician-patient situations

The purpose of this study was to describe strategies used by clinical nurse specialists when caring for patients involved in "difficult" clinician-patient situations. Clinical nurse specialist members of the National Association of Clinical Nurse Specialists were surveyed to identify frequently used and high-priority strategies. Subjects (N = 234) identified strategies from a wide spectrum of activities, with agreement found between highest and lowest frequently used and priority approaches. Respect for the patient and ability to focus on the issue at hand emerged in the highest reported strategies.     

"Knowing more about the other professions clarified my own profession"

The purpose of this study was to compare which learning outcomes relating to an Interprofessional Training Unit (ITU) experience were found to be most important by students and by alumni. A cohort of 428 students in the ITU was asked to write three short statements describing the most important learning outcomes from the ITU. Alumni from the same cohort were after graduation asked the same question. Furthermore, they were asked to fill out a 12-item questionnaire. The statements concerning learning outcome were analysed qualitatively and categorized. The number of statements in each category was counted and tested for statistical difference between students and alumni. Students stated "uniprofessionalism" as the most important learning outcome followed by "interprofessionalism", "professional identity" and "learning environment". Alumni on the other hand stated "professional identity" as most important learning outcome followed with "interprofessionalism", "learning environment" and "uniprofessionalism". The study indicated that over time the perceived outcome of learning experiences from an ITU change in priority.