糖尿病前期及糖尿病病人营养及运动健康教育需求调查

目的 了解糖尿病前期病人及糖尿病病人对营养、运动健康教育需求,为病人实施个性化、全程、优质的健康教育模式提供理论依据.方法 自行设计调查问卷,对12 所医院626例糖尿病前期病人及糖尿病病人,进行健康教育需求调查,并分析年龄、医疗费用及文化程度对其健康教育需求的影响.结果 (1)病人最希望了解的糖尿病营养健康教育内容是饮食治疗的意义,其次是食物选择方法、营养素分配与餐次、食物交换份法、热量计算方法和食物血糖生成指数的概念(P=0.000).(2)病人最希望了解的运动健康教育内容是运动疗法的意义,其次是运动疗法的注意事项、运动处方的内容(P=0.000).(3)健康教育中有5项内容与文化程度相关(P＜0.05),高学历病人需求明显(P＜0.05).该5 项需求分别是:了解食物血糖生成指数的概念,了解食物选择方法,了解运动疗法的意义,了解运动处方的内容及了解运动疗法的注意事项.(4)营养健康教育需求中"了解食物选择方法"、运动健康教育需求中"了解运动疗法的意义"均与患病时间相关(P＜0.05),患病时间短的病人需求更明显(P＜0.05).结论(1)病人认为健康教育需求重要性排序是从易到难的,建议将容易理解的项目排在前面,而相对较难理解的排在后面;并对病人需要了解的重要术语及相关知识做出通俗的解释,如食物交换份法、食物血糖生成指数.(2)在教育前,护士充分评估病人的影响因素,重点评估文化程度、患病时间,以便有针对性地给予健康教育.     

糖尿病医学营养治疗个体化应用的健康促进模式

目的：探讨构建糖尿病医学营养治疗个体化应用的最佳健康促进模式.方法：选择2003-12/2004-12在深圳市第二人民医院住院的2型糖尿病患者60例,采用小组工作组法,通过营养教育实施以循证医学营养治疗为基础、食物血糖生成指数（GI）和＂份＂食物交换为核心的医学营养治疗个体化应用,有效控制血糖及相关并发症,为保证其＂知、信、行＂的贯彻,定期（1,3和6个月）对患者及其家属以糖尿病沙龙的形式返院进行强化辅导和评价.评价内容包括患者对糖尿病知识掌握情况,糖尿病控制达标率和患者教育前后血糖、血脂的指标变化.结果：60例患者均进入结果分析.①糖尿病知识掌握情况：患者对按份食物交换方法掌握达100%,GI概念与食物选择、医学营养治疗的目标意义、营养素分配与选择等的知晓率较教育前显著提高（X^2=8.573,P＜0.01）.②糖尿病控制达标率由原来的5%提高到96%.③教育6个月后患者血糖、糖化血红蛋白、三酰甘油和胆固醇等指标均较教育前显著下降（P＜0.01）.结论：为患者提供科学、便捷、经济、有效的饮食治疗和护理健康促进模式,引导患者应参治疗过程能获得最佳的糖尿病治疗效果.     

糖尿病个体化营养治疗疗效观察

目的 探讨糖尿病个体化营养治疗疗效.方法 对120例2型糖尿病患者,制定个体化营养治疗方案,个体化指导,建立个人健康档案并随访.6月后对营养治疗效果进行评价,评价内容包括患者对糖尿病知识掌握情况、患者个体化营养治疗前后各指标变化.结果 个体化营养治疗6月后,患者对饮食治疗目的、食物选择、分类食物的摄取量及食物交换法等知识的知晓率较治疗前显著提高,P＜0.01;患者血糖、糖化血红蛋白、甘油三酯、胆固醇等指标均较治疗前显著下降,P＜0.05.结论 糖尿病营养治疗采用个体化治疗的方法疗效显著.     

糖尿病医学营养治疗个体化应用的健康促进模式

目的:探讨构建糖尿病医学营养治疗个体化应用的最佳健康促进模式。方法:选择2003-12/2004-12在深圳市第二人民医院住院的2型糖尿病患者60例,采用小组工作组法,通过营养教育实施以循证医学营养治疗为基础、食物血糖生成指数(GI)和“份”食物交换为核心的医学营养治疗个体化应用,有效控制血糖及相关并发症,为保证其“知、信、行”的贯彻,定期(1,3和6个月)对患者及其家属以糖尿病沙龙的形式返院进行强化辅导和评价。评价内容包括患者对糖尿病知识掌握情况,糖尿病控制达标率和患者教育前后血糖、血脂的指标变化。结果:60例患者均进入结果分析。①糖尿病知识掌握情况:患者对按份食物交换方法掌握达100%,GI概念与食物选择、医学营养治疗的目标意义、营养素分配与选择等的知晓率较教育前显著提高(χ2=8.573,P<0.01)。②糖尿病控制达标率由原来的5%提高到96%。③教育6个月后患者血糖、糖化血红蛋白、三酰甘油和胆固醇等指标均较教育前显著下降(P<0.01)。结论:为患者提供科学、便捷、经济、有效的饮食治疗和护理健康促进模式,引导患者应参治疗过程能获得最佳的糖尿病治疗效果。     

糖尿病病人医学营养治疗教育执行现状与对策

[目的]了解糖尿病病人医学营养治疗教育执行情况,为提高糖尿病病人的营养状况提供对策。[方法]采用自行设计的问卷对在内分泌科病房住院的167例糖尿病病人进行调查。[结果]接受过医学营养治疗教育的病人占75.45%,但对医学营养治疗为预防和治疗糖尿病的基础知晓率仅为0.60%;高达93.41%的病人仍担心血糖升高而不敢进食水果或甜食,73.05%的病人对于按照医护人员给予的医学营养治疗建议而进行自我管理感到苦恼或难以坚持;67.07%的病人平时会关注自己的营养状态,52.69%的病人平时会遵照医生或临床营养师的建议搭配每日食谱,高达85.03%的病人平时会为了控制血糖而吃素食并减少肉类食物的摄入,而因生活不规律而发生低血糖和两餐间、睡前或夜间发生低血糖的比例分别占49.10%和55.09%。[结论]糖尿病病人医学营养知识掌握程度不高,应加强糖尿病营养专科护士培训力度,开展深层次的营养知识健康教育。     

成都市某三甲医院2型糖尿病患者健康教育需求调查

目的了解四川省成都市某三甲医院2型糖尿病患者健康教育需求的内容及方式。方法自行设计糖尿病患者健康教育需求调查表,对371例2型糖尿病门诊患者进行健康教育需求调查。结果371例患者对健康教育较为迫切的需求分别为药物治疗（95.69%）、血糖监测（85.44%）、饮食（85.18%）;最受欢迎的宣教人员和方式分别为三级医院医护人员（81.67%）、入户（76.55%）和电话随访指导（78.98%）。结论应根据患者的不同需求,重点宣传,采用灵活多样的方式进行健康教育,同时加强基层培训,加大新兴传媒的宣传力度,制定糖尿病健康教育手册,加强患者自我管理能力,提高其生活质量。     

2型糖尿病患者对互联网健康教育需求的质性研究

目的 了解2型糖尿病患者对互联网健康教育的需求。方法 采用半结构式访谈法收集14例2型糖尿病患者对互联网健康教育的需求,并进行分析。结果 2型糖尿病患者对互联网教育的需求提炼为3大主题:互联网健康教育内容、互联网健康教育方式、互联网健康教育的阻力因素。结论 互联网健康教育平台的设计应建立在充分了解患者需求的基础上,内容设计应满足患者对糖尿病相关知识的需求,重视饮食教育、最新研究成果分享、糖尿病患者的心理疏导,同时开展个体化的健康教育方式,并不断提高互联网平台的严谨性,以满足患者的需求。     

食物血糖生成指数概念用于2型糖尿病营养教育的效果观察

目的观察食物血糖生成指数概念用于2型糖尿病营养教育的效果。方法将179例2型糖尿病患者,按住院号尾数单双号分为观察组(86例)和对照组(93例)。对照组实施常规健康教育及食物交换份法饮食教育,观察组在对照组基础上增加食物血糖生成指数概念指导患者食物选择,制定个体化饮食治疗处方。比较两组患者营养教育的干预效果。结果观察组对饮食知识知晓率高于对照组(均P0.05),观察组餐后血糖水平低于对照组(P0.05)。结论食物血糖生成指数概念指导能有效提高糖尿病患者饮食治疗知晓率,降低餐后血糖水平。     

门诊个体化健康教育处方对2型糖尿病干预的研究

目的评价糖尿病专科护士门诊个体化健康教育处方对2型糖尿病患者的相关知识掌握情况及血糖的影响,结合门诊满意度调查,以探讨专科护士门诊个体化健康教育处方对2型糖尿病干预的价值。方法选择100例门诊2型糖尿病患者,在不改变原治疗方案的前提下,通过评估患者个体情况,了解患者存在的问题,开出个体化健康教育处方,其内容由评估所得个体情况,个体化饮食处方、运动处方,针对性的用药指导和病情监测等组成。采用问卷调查了解患者糖尿病知识掌握情况及对糖尿病专科护士门诊满意度,评估个体化健康教育处方的作用。结果接受个体化健康教育3个月后患者糖尿病相关知识掌握情况及空腹血糖及餐后2h血糖都比实施前只接受集体大讲堂教育时有明显改善,患者总满意度94％。结论在2型糖尿病综合防治上偏重个体化指导干预,实施门诊个体化教育处方模式,是符合人性化护理服务理念,提高健康教育质量的重要有力措施。     

门诊个体化健康教育处方对2型糖尿病干预的研究

目的 评价糖尿病专科护士门诊个体化健康教育处方对2型糖尿病患者的相关知识掌握情况及血糖的影响,结合门诊满意度凋查,以探讨专科护士门诊个体化健康教育处方对2型糖尿病干预的价值.方法 选择100例门诊2型糖尿病患者,在不改变原治疗方案的前提下,通过评估患者个体情况,了解患者存在的问题,开出个体化健康教育处方,其内容南评估所得个体情况,个体化饮食处方、运动处方,针对性的用药指导和病情监测等组成.采用问卷调查了解患者糖尿病知识掌握情况及对糖尿病专科护士门诊满意度,评估个体化健康教育处方的作用.结果 接受个体化健康教育3个月后患者糖尿病相关知识掌握情况及空腹血糖及餐后2 h血糖都比实施前只接受集体大讲堂教育时有明显改善,患者总满意度94%.结论 在2型精尿病综合防治上偏重个体化指导干预,实施门诊个体化教育处方模式,是符合人性化护理服务理念,提高健康教育质量的重要有力措施.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。