个性化健康教育对2型糖尿病患者自我管理行为及血糖控制效果的影响分析

目的探究2型糖尿病应用个性化健康教育对患者血糖控制和自我管理行为情况的影响。方法选取2017年10月～2018年3月我院收治的2型糖尿病患者66例,按照入院前后时间分为观察组和对照组各33例。对照组开展一般护理,观察组在此基础上开展个性化健康教育,分析比较两种干预方案的临床效果,比较两组干预前后血糖水平及C-DMSES评分。结果干预后,观察组糖化血红蛋白、餐后2h血糖、空腹血糖水平均优于对照组,差异有统计学意义(P<0.05);干预后观察组C-DMSES评分优于对照组,差异有统计学意义(P<0.05)。结论 2型糖尿病应用个性化健康教育,有助于提升自我管理行为质量,进而有效控制血糖。     

糖尿病并发症体验式健康教育的效果研究

目的 探讨糖尿病并发症体验式健康教育对糖尿病患者血糖控制、自我管理行为的影响。方法 便利抽取2016年1月—8月在我院内分泌科住院的2型糖尿病患者134例作为研究对象,随机分为试验组68例和对照组66例,试验组接受常规健康教育和糖尿病并发症体验式健康教育,对照组接受常规健康教育,比较两组干预前后血糖控制及自我管理行为的差异。结果 校正了年龄、性别、糖尿病病程、血压、血脂、文化程度、对应干预指标干预前的基线,试验组干预后空腹血糖、餐后2 h血糖、糖化血红蛋白、自我管理行为的改善程度均优于对照组（P<0.05）,差异有统计学意义。结论 糖尿病并发症体验式健康教育明显改善了糖尿病患者的自我管理行为,优化了糖尿病患者的血糖控制结果。     

基于代谢性疾病管理中心平台健康教育在出院后2型糖尿病患者中的应用

目的评价基于国家标准化代谢性疾病管理中心(National Metabolic Management Center,MMC)平台在出院后2型糖尿病患者综合管理中的应用效果观察。方法选择2017年11月-2018年4月在本院内分泌科住院的150例2型糖尿病患者为研究对象,按入院先后次序编号,根据随机数字表法,将150例患者随机分为对照组和试验组各75例。两组患者在住院期间均接受常规的综合护理,对照组出院后采用电话随访和糖尿病门诊教育、健康讲座进行干预;试验组在对照组基础上基于MMC平台实施健康教育,评价两组患者干预前后自我管理行为和血糖值的差异。结果干预后,试验组患者足部护理、饮食控制、血糖监测、规律锻炼、糖尿病知识、遵嘱用药评分和自我管理行为总分均高于对照组;试验组空腹血糖、餐后2h血糖和糖化血红蛋白值均低于对照组,差异均有统计学意义(P0.001)。结论基于MMC平台健康教育在提高出院后2型糖尿病患者的自我管理行为,改善患者空腹血糖、餐后血糖及糖化血红蛋白水平均较常规健康教育方法具有显著优势,有利于糖尿病控制。     

随访干预对2型糖尿病患者疾病控制的影响

目的探讨随访对糖尿病患者疾病控制效果的影响。方法将接受了糖尿病教育的160例糖尿病出院患者按出院顺序随机分为干预组和对照组各80例。干预组患者出院后定期随访（包括电话随访）,观察时间为12个月,对照组患者出院后无定期随访。比较2组患者干预后健康行为,自我管理能力和认知水平的改善状况及空腹血糖、糖化血红蛋白情况。采用t检验及Χ^2检验。结果干预组健康行为、自我管理能力和认知水平提高程度均显著优于对照组;对照组出院6、12个月后空腹血糖水平与出院时及同一时段干预组比较明显增高;干预组出院6、12个月糖化血红蛋白水平与出院时相比明显降低。结论出院随访是将医院健康教育延伸到患者家里的有效手段,指导并督促2型糖尿病患者独立担负起后续指标控制的责任,对患者血糖控制、提高生活质量、促进身心健康起到积极的作用,值得推广。     

个性化健康教育对94例2型糖尿病患者血糖控制效果的观察

目的:评价个性化健康教育对2型糖尿病患者血糖控制水平、饮食、运动状况的效果。方法:对门诊94例2型糖尿病患者进行3个月个体化健康教育,比较教育前后患者血糖、糖化血红蛋白水平以及饮食运动状况。结果:接受个体化健康教育后,患者的空腹血糖、餐后2b血糖、糖化血红蛋白值均较教育前显著降低(P0.01)教育后患者饮食、运动合格率优于教育前(P0.05)。结论:个体化健康教育促进2型糖尿病患者自我管理行为的建立与提高,有利于患者降低血糖,掌握健康饮食和科学运动。     

随访干预对2型糖尿病患者疾病控制的影响

目的 探讨随访对糖尿病患者疾病控制效果的影响.方法 将接受了糖尿病教育的160例糖尿病出院患者按出院顺序随机分为干预组和对照组各80例.干预组患者出院后定期随访(包括电话随访),观察时间为12个月,对照组患者出院后无定期随访.比较2组患者干预后健康行为,自我管理能力和认知水平的改善状况及空腹血糖、糖化血红蛋白情况.采用t检验及χ2检验.结果 干预组健康行为、自我管理能力和认知水平提高程度均显著优于对照组;对照组出院6、12个月后空腹血糖水平与出院时及同一时段干预组比较明显增高;干预组出院6、12个月糖化血红蛋白水平与出院时相比明显降低.结论 出院随访是将医院健康教育延伸到患者家里的有效手段,指导并督促2型糖尿病患者独立担负起后续指标控制的责任,对患者血糖控制、提高生活质量、促进身心健康起到积极的作用,值得推广.     

同伴支持在社区2型糖尿病病人自我管理中的应用

[目的]探讨同伴支持在社区2型糖尿病病人中的应用效果.[方法]将80例社区2型糖尿病病人以社区为单位分成两组,对照组病人采用常规社区管理,观察组在常规社区管理的基础上,采用同伴支持教育;于干预前及干预结束后3个月、6个月观察比较两组病人的空腹血糖、餐后2h血糖、糖化血红蛋白,并应用自我管理行为量表调查两组病人的自我管理行为总分及各维度得分.[结果]两组病人培训后空腹血糖、餐后2h血糖及糖化血红蛋白均有所下降（P＜0.05）,自我管理行为总分有所提高（P＜0.05）;培训后观察组清晨空腹、餐后2h血糖及糖化血红蛋白低于对照组（P＜0.05）,观察组自我管理行为总分显著高于对照组（P＜0.01）.[结论]采用同伴教育对社区2型糖尿病病人进行管理,可改善其自我管理行为,有利于控制血糖水平.     

同伴支持在社区2型糖尿病病人自我管理中的应用

[目的]探讨同伴支持在社区2型糖尿病病人中的应用效果。[方法]将80例社区2型糖尿病病人以社区为单位分成两组,对照组病人采用常规社区管理,观察组在常规社区管理的基础上,采用同伴支持教育;于干预前及干预结束后3个月、6个月观察比较两组病人的空腹血糖、餐后2h血糖、糖化血红蛋白,并应用自我管理行为量表调查两组病人的自我管理行为总分及各维度得分。[结果]两组病人培训后空腹血糖、餐后2h血糖及糖化血红蛋白均有所下降(P0.05),自我管理行为总分有所提高(P0.05);培训后观察组清晨空腹、餐后2h血糖及糖化血红蛋白低于对照组(P0.05),观察组自我管理行为总分显著高于对照组(P0.01)。[结论]采用同伴教育对社区2型糖尿病病人进行管理,可改善其自我管理行为,有利于控制血糖水平。     

丈夫参与自我管理教育对妊娠期糖尿病病人血糖和自护能力的影响

[目的]探讨丈夫参与自我管理教育在妊娠期糖尿病管理中的应用效果。[方法]将100例妊娠期糖尿病病人按丈夫的参与意愿分为观察组48例和对照组52例。对照组对病人实施糖尿病基本知识、饮食控制、运动调节、足部护理、定期监测血糖等自我管理教育。观察组在常规自我管理教育的基础上,要求丈夫参与自我管理教育及家庭自我护理管理。观察两组病人干预前及干预后3个月空腹血糖、餐后2h血糖、糖化血红蛋白及自我管理行为的变化。[结果]观察组空腹血糖、餐后2h血糖、糖化血红蛋白、自我管理行为能力比较差异均有统计学意义(P0.01)。[结论]丈夫参与自我管理教育对妊娠期糖尿病病人的血糖控制和自我管理行为能力的提高具有明显促进作用。     

动机性访谈对2型糖尿病患者自我管理行为改变阶段的影响

目的探讨运用动机性访谈(MI)对社区2型糖尿病患者自我管理行为改变阶段干预的效果,为社区糖尿病患者自我管理行为干预和管理提供依据。方法采用随机数字表法选取3个社区80例2型糖尿病患者分为试验组和对照组各40例,实验组采用动机性访谈和行为改变理论相结合的糖尿病健康教育模式,对照组接受常规健康教育方法。干预前及干预6个月后,分别评估两组患者糖化血红蛋白、自我管理行为改变阶段、自我管理行为。结果干预前比较两组的年龄、性别等社会人口资料结果显示差异无统计学意义(P0.05),干预后6个月两组患者糖化血红蛋白、自我管理行为改变阶段、自我管理行为各指标差异均具有统计学意义(P0.01)。结论从动机性访谈入手实施以行为转变理论为指导的健康教育,能有效促进2型糖尿病患者自我管理行为改变,改善其血糖水平。     

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.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.