胫骨平台骨折术后早期康复治疗对患膝功能恢复的作用

目的：研究胫骨平台骨折术后早期康复治疗对膝关节功能恢复的作用。方法：胫骨平台骨折术后患者47例。对照组23例，术后采取固定等常规治疗；康复组24例，早期采取综合康复治疗。采用HSS膝关节功能评估系统分别评估术后6个月及12个月的膝关节功能。结果：按照HSS评分，康复组膝关节功能优良率于术后6、12个月分别是75．0％和87．5％，均显著高于对照组（P〈0．05）。结论：早期综合康复治疗对胫骨平台骨折术后膝关节功能恢复有效。     

胫骨平台骨折患者术后早期功能锻炼依从性调查及影响因素分析

目的:分析胫骨平台骨折患者术后早期功能锻炼的影响因素,探讨提高胫骨平台骨折患者术后早期功能锻炼依从性的方法。方法:选取2015年1月~2017年5月于本院就诊的53例胫骨平台骨折患者作为研究对象,对胫骨平台骨折患者术后早期功能锻炼依从性及其影响因素进行回顾性分析。结果:不同年龄以及不同文化程度胫骨平台骨折患者早期康复锻炼依从性比较,具有统计学意义(均P0.05)。经过术后早期功能锻炼依从性影响因素分析,功能锻炼知识缺乏、害怕疼痛,害怕内固定物脱落,缺乏他人帮助与支持是影响胫骨平台骨折患者术后早期功能锻炼依从性的因素。结论:胫骨平台骨折患者术后早期功能锻炼需要加强对患者功能锻炼知识宣教,年龄小于45岁以及文化程度较低的患者给予有针对性的护理措施,有助于胫骨平台骨折患者术后快速康复。     

胫骨干骺端截骨延长术后护理

胫骨干骺端截骨延长术，是治疗骨骺板已融合的青少年或成人下肢短缩畸形的一种较理想的下肢延长手术。为减轻或避免术后并发症，提高功能效果，术后护理极为重要。本文介绍１０８例胫骨干骺端截骨延长术后在延长前、后及延长期的护理要点，重点是功能锻炼的方法及预防针道感染。     

胫骨干骺端截骨延长术后护理

胫骨干骺端截骨延长术，是治疗骨骺板已融合的青少年或成人下肢短缩畸形的一种较理想的下肢延长手术。为减轻或避免术后并发症，提高功能效果，术后护理极为重要。本文介绍１０８例胫骨干骺端截骨延长术后在延长前、后及延长期的护理要点，重点是功能锻炼的方法及预防针道惑染。     

硬膜外麻醉下膝关节功能障碍的康复治疗

１资料与方法１．１资料膝关节功能障碍２４例，男２１例，女３例。年龄（３１±２．１）岁；左膝１０例，右膝１４例；病程０～３月１７例，３～６月６例，６月～１年１例；胫骨下１／３骨折术后４例，髌骨骨折术后１３例，胫骨平台骨折术后２例，胫骨平台骨折合并膝交叉...     

经皮微创钢板治疗胫骨平台骨折患者的早期康复护理

目的探讨早期康复护理对经皮微创钢板治疗胫骨平台骨折患者术后功能恢复的影响。方法对40例胫骨平台骨折患者术前予康复训练指导；术后针对患者具体情况实施起始康复、继续康复、促进康复、后期康复的四阶段康复护理干预。结果术后3月按膝关节功能评分标准评定，优14例、良19例、尚可6例、差1例。结论早期康复护理有利于患者术后膝关节屈曲度增加，减少并发症，缩短住院天数，提高患者的生活质量。     

关节镜下治疗胫骨髁间棘骨折病人的术后护理

为探讨关节镜下治疗胫骨髁间棘骨折术后早期康复护理的效果，对43例胫骨髁间棘骨折病人术后给予功能锻炼指导，配合局部熏洗、弹拨、引伸、屈曲等理伤手法，并使用下肢关节康复治疗仪CPM和骨伤治疗仪治疗，促进了病人的康复。     

胫骨平台骨折术后早期康复训练和护理对膝关节功能恢复的作用

手术治疗胫骨平台骨折22例，根据骨折类型及内固定的情况，术后加强护理，早期开始膝关节活动训练及延迟负重训练。21例患者平均随访1．7年。根据Hohl膝关节功能评分评定疗效，优良率为90、5％。表明术后早期正确的康复训练方法对胫骨平台骨折复位的维持及膝关节功能的恢复有重要作用。     

梅花钉髌下进路治疗胫骨骨折

目的：总结和探讨梅花钉治疗胫骨骨折的疗效和临床应用经验。方法：采用改良梅花钉经髌下进路行胫骨内固定术74例，随访8～24个月73例。结果：全部病例术后骨折对位对线良好，除2例合并髌骨骨折存在曲膝功能轻度障碍外，其余病例膝、踝关节功能良好。术后切口感染3例，梅花钉折弯1例，折断1例。结论：改良梅花钉髌下进路治疗胫骨骨折进路优，操作简单，功能恢复早，疗效满意，并发症少且价格低，适合于基层医院应用。     

单侧多功能外固定架治疗胫骨骨折的护理

我科2005-02～2006-02应用单侧多功能外固定架治疗胫骨骨折19例，术后效果较好。护理体会如下。1临床资料1．1一般资料本组均为男性，年龄18～65（平均36）岁。其中胫骨粉碎性骨折5例，胫腓骨内畸形愈合10例，胫骨骨不连4例，均采取单侧多功能外固定支架治疗。术后效果满意，患肢功能恢复良好。     

Improving the accuracy of intraocular pressure readings

AIM: To discover whether a protocol for calibration can improve the accuracy of intraocular pressure measuerements. METHOD: A protocol for checking the calibration of equipment was implemented in an ophthalmic outpatient department. After seven months, calibration checks were compared with those done on equipment in other ophthalmic areas that were not following a protocol. RESULTS: There was a statistically significant association between errors and areas not following the protocol (p = 0.02). In comparing errors found in the area using the protocol with all other areas, a significant difference was evident at the test point of 20 mmHg (p = 0.003). CONCLUSION: Using a protocol significantly reduces calibration errors.     

A multiple muscle strength testing protocol

A quick test (QT) protocol was developed to allow for the rapid testing of multiple muscle groups in order to profile body strength. Maximum muscle strength was also obtained using a standard test (ST) protocol. The ST protocol consisted of three five-second trials with a one-minute rest between trials and no more than four muscle groups tested per day. The QT protocol allowed only a five-second rest between trials. Thirteen subjects were evaluated using both protocols. Subjects were positioned either sitting or supine, depending on the muscle groups being evaluated. Stabilization was provided to minimize substitution patterns. Measurements were obtained using a load cell and a computerized recording system. Using the QT protocol and testing 13 muscle groups in one session vs five sessions with the ST protocol resulted in an average reduction of 4% in strength values for the QT protocol. The results suggest that the clinical use of the QT protocol may not significantly reduce the accuracy of repeated measurements even though values obtained may be slightly lower than those obtained using the ST protocol.     

Implications of rigid adherence to a protocol of investigation for patients undergoing thyroidectomy

Rationale, aims and objectives Protocols may improve patient care by standardizing investigations performed. In pre‐operative surgical patients this should ensure all patients undergo essential investigations while limiting unnecessary tests. Previous studies have shown poor protocol adherence within 6 weeks of implementation unless strictly enforced. With this in mind, we analysed clinical and financial implications of rigid adherence to a protocol of pre‐operative investigation for patients undergoing thyroidectomy in a single centre. Methods A protocol for investigation of patients undergoing thyroidectomy was introduced, with investigations being performed at the surgical out patient clinic. Where already performed by the referring doctor, they were not to be repeated. Protocol adherence was measured over a 6‐month period and strictly enforced to try to ensure 100% compliance. Results 35 consecutive patients underwent thyroidectomy over the study period. Compliance with the protocol was obtained for between 86% and 100% of tests required by the protocol. In addition, numerous tests specified by the protocol were performed more than once, and additional tests outside the protocol were done, with an average excess cost per patient of £121.38. Conclusions A protocol for pre‐operative investigation of a common surgical procedure can be achieved. Rigid enforcement of the protocol can lead to over‐investigation because of concerns about test omission, with associated financial implications. Furthermore, a rigid protocol does not always prevent performance of unnecessary investigations.     

Public Health Nurses'' Responses to Domestic Violence: A Report from the Enhanced Domestic Abuse Intervention Project

Public health nurses (PHNs) can play an important role in the detection of domestic violence. This study examines whether the introduction of a domestic violence assessment protocol by public health nurses in a maternal and child health visiting program increases the identification and referral rates of women experiencing domestic violence. Data collected from case files during the baseline year prior to the initiation of the protocol were compared to case file information after the protocol had been implemented. When the protocol was used, there was a higher rate of identification, although the difference was not statistically significant. Significantly more women, however, were provided with information about domestic violence resources after the protocol was in place, and significantly more women were referred to services in the second year after the protocol had been implemented. This study provides support for the use of a domestic violence protocol to improve the public health nursing response to domestic violence.     

Pressure sores: evaluation of the systematic use of special surfaces for managing pressure sores in the intensive care unit of the Tarrasa Hospital, Spain

Pressure sores are a major challenge for healthcare systems. Patients admitted to intensive care units are an important risk group for pressure sores. Systematic use of a protocol employing special surfaces to manage pressure is a basic measure for preventing pressure sores in institutionalized patients. In a study carried out in the Intensive Care Unit of the Hospital of Terrassa (Spain), the incidence of pressure sores before and after introducing a prevention protocol that included the systematic use of special surfaces to manage pressure was compared. The incidence of pressure sores in patients admitted in 1998 and 1999 was studied. Sore locations were recorded. The results of three periods were examined: before introducing the protocol (6.4% incidence), after introducing a protocol (1.1%), and after use of the protocol was consolidated (0%). The results of the study suggest that the systematic use of special surfaces to manage pressure, in accordance with a prevention protocol, is a basic measure for reducing the incidence of pressure sores in patients admitted to intensive care units.     

Management of mild fetal pyelectasis: a comparative analysis.

OBJECTIVE: The purpose of this study was to compare 2 protocols for the antenatal management of isolated mild fetal pyelectasis and perform a cost analysis. METHODS: A retrospective analysis of unilateral and bilateral mild fetal pyelectasis followed at our institution from 2003 to 2006 was conducted. Fetuses with additional congenital anomalies or aneuploidy were excluded. Chi(2) analysis was used, and P < .05 was considered significant. RESULTS: Two hundred forty-four cases were identified, of which the majority were male (75.4% versus 24.6%). Eighty-eight patients were reevaluated every 4 weeks (protocol 1). The remaining 156 patients were reevaluated once in the third trimester (protocol 2). The mean number of ultrasound examinations in protocol 1 was 3.24, at a cost of $1187, compared with protocol 2, at $798. Resolution occurred in 59%, stabilization in 29%, and progression in 12%. There were no cases of progression to severe pyelectasis or a need for in utero intervention in either group. CONCLUSIONS: Mild fetal pyelectasis can be managed with 1 additional third-trimester ultrasound examination without a compromise in patient care. Average cost savings were $389 per patient for protocol 2, suggesting a benefit from this protocol over protocol 1.     

Time Efficiency and Diagnostic Agreement of 2-D Versus 3-D Ultrasound Acquisition of the Neonatal Brain

The purpose of this study was to compare acquisition time efficiency and diagnostic agreement of neonatal brain ultrasound (US) scans obtained with a 3-D volume US acquisition protocol and the conventional 2-D acquisition protocol. Ninety-one consecutive premature neonatal brain ultrasound scans were prospectively performed on 59 neonates with the conventional 2-D acquisition protocol. Immediately after the 2-D study, a coronal 3-D ultrasound volume was acquired and later reconstructed into axial and sagittal planes. All 59 neonates were imaged in the neonatal intensive care unit to rule out intracranial hemorrhage. Total time for 2-D and 3-D acquisition protocols was recorded, and a two-tailed t-test was used to determine if study durations differed significantly. One pediatric neuroradiologist reviewed the reformatted 3-D images, tomographic ultrasound images. Results were compared with the clinical interpretation of the 2-D conventional study. The mean scanning time for the 2-D US acquisition protocol was 10.56 min (standard deviation [SD] = 7.11), and that for the 3-D volume US acquisition protocol was 1.48 min (SD = 0.59) (p ≤ 0.001). Inter-observer agreement revealed k values of 0.84 for hydrocephalus, 0.80 for germinal matrix hemorrhage/intraventricular hemorrhage, 0.74 for periventricular leukomalacia and 0.91 for subdural collection, hence near-perfect to substantial agreement between imaging protocols. There was a significant decrease in acquisition time for the 3-D volume ultrasound acquisition protocol compared with the conventional 2-D US protocol (p = <0.001), without compromising the diagnostic quality compared with a conventional 2-D US imaging protocol.     

A feasibility study of urinary catheter removal protocol following transurethral prostatectomy procedure in older patients

We hypothesized that older patients who underwent a urinary catheter removal protocol would not have an increased risk of postoperative complications. We further hypothesized that the revised protocol would be more suitable for clinical application. This study aimed to develop a urinary catheter removal protocol after Transurethral Resection of the Prostate and to assess the feasibility of the protocol to support catheter removal and promote recovery of self-voiding function. Delayed catheter removal after Transurethral Resection of the Prostate was associated with urinary tract infection and longer hospital stays. However, no strategy has been described to promote recovery of self-voiding function after catheter removal after Transurethral Resection of the Prostate. The urinary catheter removal protocol was developed through expert consensus, including strategies for caring for urinary catheters, assessment of urinary catheter removal, and strategies after urinary catheter removal. Moreover, a quasi-experimental design was adopted in the urology ward of a tertiary care medical centre in southern Taiwan. Patients aged ≥65 years who underwent Transurethral Resection of the Prostate were included. A total of 13 patients (intervention = 5; control = 8) were included in the feasibility evaluation. A urinary catheter removal protocol after Transurethral Resection of the Prostate was developed and the consensus among experts on the urinary catheter removal protocol was 99%. There were no significant differences in terms of bleeding, urine retention, urinary tract infection, or re-catheterization between the two groups. However, in the intervention group, the pain score decreased significantly on the second day after Transurethral Resection of the Prostate. This revised urinary catheter removal protocol after Transurethral Resection of the Prostate may be suitable for clinical applications. However, small size reduces the statistical power of the findings and further studies are needed to examine the current protocol does not have an increased risk of postoperative complications.     

Developing an Evidence-Based Nursing Protocol Using Early Epinephrine Administration for Anaphylaxis Caused by Computed Tomography Contrast Agents

The objective of this study is to develop an evidence-based nursing practice protocol to cope with anaphylaxis by identifying the effect of early administration of epinephrine on the recovery of patients when anaphylaxis occurs due to computed tomography (CT) contrast agents, and to evaluate its feasibility. Anaphylaxis caused by CT contrast agents is a life-threatening systemic hypersensitivity reaction compared to normal allergic reactions, requiring immediate administration of epinephrine and other emergency drugs; however, no practical guidelines have been established for such emergency management, requiring the development of evidence-based nursing practice protocols. The study design is a methodological and cross-sectional study that aims to develop an evidence-based nursing practice protocol. An evidence-based nursing practice protocol for anaphylaxis management generated by contrast agents was developed in accordance with the 3-step (12 more specific steps) development of clinical practice guideline based on the literature of the final 12 selected (including 2 guidelines). It was applied to practice after implementing the training of the medical staff on the final protocol developed, and evaluated the effectiveness of anaphylaxis management for 6 months before and after the application of the protocol. Based on the analysis of the evidence, we make six recommendations for managing anaphylaxis caused by contrast agents based on early administration of epinephrine and apply the protocol to clinical practice. After protocol application, awareness of anaphylaxis and onset time of epinephrine administration was accelerated, but significant differences were not confirmed. In the case of anaphylaxis due to CT contrast agents, evidence-based coping protocols were created. The developed protocol should be continued for use in practice, with continued assessment of its effectiveness.     

Evaluation of a drug therapy protocol in an HMO.

Effective means of affecting physician prescribing behavior must be developed if the quality of health care is to be improved. A drug therapy protocol for otitis media, containing a rationale for drugs, doses and days of therapy by patient age, was developed by a physician panel at one site (EI) of an HMO, and implemented at both EI and a second site (EII); a third site was a control. A comparison of prescribing during two phases, before and after implementation of the protocol, suggested that the protocol had a greater influence at site EI than site EII, and that it had a greater influence on the panel physicians than on other prescribers at site EI. Questionnaire responses indicated that clinical experience and personal involvement were the most important protocol use influences. If participation is critical to protocol compliance, the protocol method to improve the quality of health care is severely limited.