基于跨理论模型的社区家庭访视护理对老年高血压患者服药遵从行为的影响

目的 探讨基于跨理论模型的家庭访视护理对社区老年高血压患者服药遵从行为的影响。 方法 在宁夏银川市某医院下属的社区卫生服务站中,选取符合纳入排除标准的社区老年高血压患者 129 例,分组后实验组患者接受为期 6 个月基于跨理论模型的社区家庭访视护理干预,对照组患者则给予常规家庭访视护理干预。 干预前后比较两组患者血压、服药遵从行为改变阶段、服药依从性得分。 结果 实验组社区老年高血压患者服药遵从行为阶段改变优于对照组（ P＜0.05 ）;服药依从性得分高于对照组（ P＜0.05 ）,且收缩压和舒张压控制幅度优于对照组（ P＜0.05 ）。 结论 基于跨理论模型的社区家庭访视护理干预模式可较好地改变老年高血压患者的服药遵从行为改变阶段,提高其服药依从性,帮助患者有效控制血压。     

家庭访视护理对社区老年高血压病人服药依从性的影响

[目的]探讨家庭访视护理对社区老年高血压病人服药依从性的影响。[方法]选取我社区登记在册的老年高血压病人进行研究,按照随机数字表法进行分组,对照组65例,行常规社区干预,观察组65例,采用以提高病人依从性为目标的健康访视护理,比较两组的干预效果。[结果]干预后4周、8周观察组血压水平均明显优于对照组(P0.05);干预后,两组病人遵医行为总分及各条目评分比差异有统计学意义(P0.05);干预后,观察组病人在家庭功能各领域得分均明显优于对照组(P0.05)。[结论]采用家庭访视护理方式对社区老年高血压病人进行干预可显著改善病人血压水平及遵医行为,并可提高病人的家庭功能。     

基于跨理论模型的社区家庭访视护理对老年脑卒中患者主动参与功能锻炼依从性的效果研究

目的探讨基于跨理论模型的社区家庭访视护理对老年脑卒中患者主动参与功能锻炼依从性效果。方法选取老年脑卒中患者288例按出院单双号分组,单号为试验组,双号为对照组。对照组进行常规家庭访视护理,试验组在对照组的基础上进行基于跨理论模型的社区家庭访视护理策略,评估患者所处行为改变阶段,实施与该行为阶段相匹配的行为干预措施。干预后比较两组患者依从功能锻炼行为、功能锻炼依从性及干预前后两组患者生活自理能力。结果干预后试验组依从功能锻炼行为、功能锻炼依从性优于对照组患者(P0.01),生活自理能力得分高于对照组(P0.01)。结论基于跨理论模型的社区家庭访视护理提高了患者主动参与功能锻炼依从性和生活自理能力。     

社区高血压患者用药的卫生宣教

目的探讨对社区高血压患者用药的卫生宣教及其行为干预在有效控制血压上的价值。方法对合肥市西园新村社区已用药治疗半年以上的100名高血压患者随机分组,实验组和对照组各50名,实验组做为期4周的有关药物治疗的卫生宣教和行为干预,比较干预前后两组患者的问卷调查和血压测量的结果。结果在药物治疗行为和血压控制方面,两组患者差别有显著性意义(P<0.05)。结论对社区高血压患者药物治疗进行具体、长期的指导,可提高服药的依从性,提高对高血压的控制率。     

基于行为阶段理论的社区家庭访视对老年糖尿病患者服药依从性的影响

目的探讨基于行为阶段理论的家庭访视护理对社区老年糖尿病患者服药依从性的影响。方法选取64例老年糖尿病患者为对照组,64例为试验组。对照组给予常规家庭访视护理干预,试验组给予基于行为阶段理论的社区家庭访视护理干预。干预前、干预后3个月、6个月对两组老年糖尿病患者服药依从性、血糖进行比较;干预前后对两组老年糖尿病患者的服药遵从行为改变阶段进行比较。结果干预后3个月、6个月试验组患者服药依从性得分均高于对照组(P0.01或P0.05);干预后3个月、6个月试验组患者空腹血糖、餐后2 h血糖、糖化血红蛋白均低于对照组;干预后试验组服药遵从行为阶段改变优于对照组(P0.01或P0.05)。结论基于行为阶段理论的社区家庭访视护理可较好地改变老年糖尿病患者的服药遵从行为改变阶段,提高服药依从性,帮助控制血糖。     

加强家庭访视对社区老年高血压患者生活质量的影响

目的 探讨家庭访视在社区老年高血压患者生活中的应用价值,总结慢性疾病的工作经验,为今后提供工作依据; 方法：选取2010年7月至2012年7月间于我服务中心诊断为高血压的老年患者116例,随机分为对照组(58例)和观察组(58例),给予对照组患者常规电话随访,在对照组患者基础上给予观察组患者定期家庭访视干预; 结果：经家庭访视1年后,观察组患者的收缩压、舒张压、SDS评分明显低于对照组患者相应指标,在统计学上有意义(P<0.05);观察组患者的各项健康行为比例、生活质量评分总分均明显高于对照组患者,两组间差异具有统计学意义(P<0.05); 结论 家庭访视对于改善社区老年高血压患者的生活质量及生存质量具有很重要的积极意义,值得推广。     

社区健康教育对原发性高血压患者医嘱依从性的影响

目的:探讨社区健康教育对原发性高血压患者医嘱依从性的影响.方法:将120例原发性高血压患者随机分为对照组和实验组各60例,实验组实施社区健康教育干预,对照组按门诊常规治疗,观察两组医嘱依从性及治疗效果.结果:实验组医嘱依从性、治疗效果明显好于对照组,两组比较具有统计学意义(P＜0.05,P＜0.01).结论:社区健康教育有利于提高原发性高血压患者医嘱依从性,提高患者生活质量,改善医患关系.     

聚焦解决模式在社区高血压患者随访管理中的运用效果分析

目的探讨聚焦解决模式在社区高血压患者随访管理中的运用效果。方法将79例社区高血压患者进行随机分组,其中对照组40例采取传统随访管理方案,干预组39例采取聚焦解决模式随访管理方案。观察3个月,比较2组患者干预前后治疗依从性及血压控制情况。结果干预后干预组患者的遵医用药行为、不良用药行为、不良嗜好管理、总分均好于对照组,且患者收缩压、舒张压及平均动脉压也好于对照组。结论聚焦解决模式可提升高血压患者治疗的依从性,有利于高血压的控制。     

远程护理联合家庭访视对社区压疮高危人群居家护理的效果评价

目的:评价远程护理联合家庭访视对社区压疮高危人群居家护理后的效果。方法:采用便利抽样法在社区选取符合压疮高危人群的患者及主要照顾者120对,分为实验组和对照组各60对,实验组实施远程护理和家庭访视,对照组发放压疮相关资料。3个月后,对两组干预前后效果进行评价。结果:实验组与对照组在主要照顾者压疮基础知识知晓率及相关知识知晓率、照顾行为改变率、高危患者压疮发生率方面比较差异有统计学意义(P0.05)。结论:远程护理联合家庭访视可提高照顾者压疮知识水平,改变其不良照顾行为,降低社区压疮高危人群压疮的发生率。     

基于健康信念模式的社区家庭访视护理对高龄高血压患者的影响研究

目的探讨基于健康信念模式的社区家庭访视护理对老年高血压患者的影响。方法以2015年6月~2016年6月在本社区卫生服务中心建立健康档案的60例老年高血压患者为研究对象,随机分为观察组和对照组各30例,观察组患者给予基于健康信念模式的社区家庭访视护理干预,对照组患者给予社区高血压疾病常规护理管理,干预6个月后评价两组患者的血压、健康行为及并发症发生情况。结果干预后,观察组收缩压及舒张压均显著低于干预前,且明显低于对照组,差异均有统计学意义(P0.01);观察组血压控制达标率(90.0%)明显高于对照组(66.7%),组间比较差异有统计学意义(P0.05);观察组每日食用盐、油、饮酒、吸烟量以及情绪、服药依从性等各种健康行为均显著改善,明显优于干预前,差异均有统计学意义(P0.01),除吸烟量外,观察组各种健康行为人数均明显多于对照组(P0.05);对照组冠心病、脑卒中、肾脏损害发生率明显高于干预前,且明显高于观察组,差异均有统计学意义(P0.05)。结论基于健康信念模式的社区家庭访视护理有助于促进老年高血压患者的血压控制,改善其健康行为,降低并发症发生率,有较高的应用价值。     

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。