全人照护管理在重症肺炎患儿临床护理中的应用

目的 探讨全人照护管理在重症肺炎患儿临床护理中的应用效果。方法 将96例重症肺炎患儿按随机数字表法分为观察组和对照组,各48例。对照组实施常规护理干预,观察组在对照组基础上实施全人照护管理,观察住院全程,出院后随访1个月。于干预前及干预后(出院当天),采用儿童医疗恐惧调查表调查患儿的医疗恐惧情况,采用Frankl依从量表、Houpt行为量表评估患儿的治疗配合度,采用儿童生活质量测定量表评估患儿的生活质量,统计患儿住院时间以及发热、喘息、咳嗽、肺啰音等临床症状持续时间。结果 干预后两组儿童医疗恐惧调查表的医疗环境恐惧、医疗操作恐惧、人际关系恐惧和自我恐惧维度评分均较干预前显著降低(P<0.01),观察组显著低于对照组(P<0.01)。干预后两组Frankl依从量表、Houpt行为量表评分较干预前显著升高(P<0.05),观察组显著高于对照组(P<0.05或0.01)。观察组发热、喘息、咳嗽、肺啰音持续时间及住院时间均显著短于对照组(P<0.01)。干预后两组儿童生活质量测定量表的生理功能、情感功能、社会功能、角色功能维度评分均较干预前显著升高(P<0....     

循证护理干预对口腔正畸患儿治疗效果的影响研究

目的探讨循证护理对儿童口腔正畸治疗依从性及口腔健康状况的影响。方法选取2016年9月—2017年12月于本院接受口腔正畸治疗的120例患儿为研究对象,采用随机数字表法将其分为对照组与观察组,每组各60例。对照组实施常规护理,观察组采取循证护理。比较两组患儿的治疗依从性、口腔健康评分及随访情况。结果观察组的治疗依从性各项评分及总评分均明显高于对照组,差异有统计学意义(P 0.001);护理前,两组患儿口腔健康评分比较,差异无统计学意义(P 0.05);护理后,两组口腔健康评分均高于护理前,且观察组高于对照组,差异均有统计学意义(P 0.05);观察组随访期间各项指标均明显优于对照组,差异有统计学意义(P 0.05)。结论对口腔正畸治疗患儿实施循证护理,有助于提高患儿的治疗依从性和治疗配合度,改善其口腔健康状况,值得临床推广应用。     

笑气-氧气吸入镇静结合计算机程控给药系统对儿童牙科畏惧症患者的治疗效果观察

目的观察笑气-氧气吸入镇静结合口腔无痛局麻仪对儿童牙科畏惧症患者的治疗效果。方法选取128例无法配合常规治疗的儿童牙科恐惧症患者,以笑气-氧气吸入镇静结合计算机程控给药系统对其进行儿童牙科治疗,手术过程中监测患者的血压(BP)心率(HR)及血氧饱和度(Sp O2),进行改良中文版儿童牙科畏惧调查表(CFSS-DS)评分、Frankl治疗依从性和Houpt行为量表评分。结果在操作过程中,BP、HR、Sp O2无明显变化(P0.05)。治疗前后CFSS-DS评分差异无统计学意义,Frankl治疗依从性和Houpt行为量表评分有显著性提高,差异有统计学意义(P0.05)。结论笑气-氧气吸入镇静结合计算机程控给药系统对儿童牙科畏惧症患者,具有良好的镇静、镇痛、抗焦虑作用,无严重不良反应。     

PRECEDE模式健康教育对固定正畸患者治疗效果的影响

目的:探讨PRECEDE模式健康教育对固定正畸患者治疗效果的影响。方法:将153例正畸初诊患者根据就诊日期(单、双日)随机分为观察组68例和对照组85例,对照组采用常规口腔卫生指导,观察组在此基础上进行针对性的PRECEDE模式健康教育;对两组的效果进行比较。结果:两组第一次托槽脱落率、牙面脱矿率及患者的复诊依从性比较差异有统计学意义(P0.05)。结论:实施PRECEDE模式健康教育的患者有助于改善口腔卫生状况,降低患者托槽脱落率和牙釉质脱矿率,提高患者的依从性。     

趣味游戏干预对牙科龋齿充填患儿配合程度的影响

目的 评价趣味游戏干预对牙科龋齿充填患儿配合程度的影响。 方法 将2017年10月-2018年3月口腔科门诊行乳牙龋齿充填治疗的63例患儿作为对照组,采用传统口腔科护理;2018年4-9月口腔科门诊行乳牙龋齿充填治疗的66例患儿设为观察组,在传统护理的基础上联合趣味游戏干预,采用Frankl临床行为分级评定量表、改良儿童畏惧调查表-牙科分量表(children fear survey schedule-dental subscale,CFSS-DS)、笑脸评分法及FLACC(face, legs, activity, crying, consolability)量表对患儿进行评价。 结果 观察组患儿配合程度明显高于对照组(Z=-4.146,P<0.001),CFSS-DS评分明显低于对照组(t=28.297,P＜0.001)。观察组患儿治疗中主观察疼痛评分与客观疼痛评分均低于对照组(t=-13.276,P<0.001; t=-8.294,P＜0.001)。 结论 趣味游戏干预可缓解牙科龋齿充填患儿紧张、畏惧情绪,减轻疼痛并提高其配合程度。     

成人佩戴固定矫治器对牙龈健康的影响--附48例报告

目的:探讨正畸固定矫治器对牙龈健康的影响。方法:正畸患者48例为观察组,在佩戴固定矫治器1周、2周和4周时检查牙龈,进行牙龈指数测定和菌斑指数测定。并与随机选取的45名在校大学生(对照组)作同期对照。结果:戴固定矫治器者的牙龈指数和菌斑指数均明显高于对照组(P<0.05),且随时间的推移,观察组的牙龈指数和菌斑指数自身比较有明显增加(P<0.05);戴固定矫治器者牙龈炎的发生率明显高于对照组(P<0.01),且有随时间延长而上升的趋势(P<0.05)。结论:正畸固定矫治器对牙龈健康有负面影响。     

护理干预对手足口病患儿态度行为及依从性的影响

目的:探讨护理干预对手足口病患儿态度行为及依从性的影响。方法:将186例手足口病患儿按就诊顺序随机分为对照组88例和观察组98例,对照组实施常规护理,观察组在此基础上加强护理干预。采用Achenbach儿童行为量表和中国儿童气质量表(CPTS)对两组患儿干预前后态度、行为评分及治疗依从性进行评估并比较。结果:两组患儿干预后态度、行为评分优于干预前(P<0.05,P<0.01),观察组干预后态度、行为评分及治疗依从性均优于对照组(P<0.05)。结论:有效的护理干预可明显改善手足口病患儿的态度行为并提高其依从性,有助于促进患儿的身心健康。     

青少年口腔正畸的依从性分析与干预效果研究

目的探讨青少年口腔正畸的依从性与干预效果。方法选择接受正畸治疗的青少年患者118例为研究组,接受正畸治疗的成年患者55例为对照组,对两组进行依从性评估。将研究组以1∶1随机配比分为干预组和非干预组,每组各59例,对非干预组采用常规的口腔健康宣教;对干预组则进行认知、行为、心理3方面进行个体化的干预,评价干预效果。结果青少年口腔正畸患者依从性不如成年患者,研究组按时预约复诊比率、配合使用口外装置(口外弓、橡皮圈)的比率显著低于对照组,正畸过程中断治疗比率高于对照组(P均0.05)。从干预效果看,干预组托槽脱落率、带环脱落损坏率和弓丝折断率显著低于非干预组,总疗程长度短于非干预组,口腔卫生良好率显著高于非干预组(P均0.05)。结论青少年口腔正畸的依从性较成年人差,个体化干预能提高青少年患者的行为依从性,并提高治疗效果。     

护理干预对牙科焦虑症固定正畸患者治疗依从性的影响

目的：探讨护理干预对牙科焦虑症固定正畸患者治疗依从性的影响。方法将100例牙科焦虑症固定正畸患者随机分为干预组和对照组各50例,对照组给予常规护理,干预组在常规护理的基础上加强心理护理、饮食护理、口腔卫生保健的护理干预。观察比较两组患者在整个治疗过程中软垢指数、按时复诊及托槽脱落情况有无差别。结果治疗期间,干预组软垢指数、按时复诊、托槽脱落情况均显著优于对照组,两组比较差异均具有统计学意义（均P＜0．05）。结论护理干预能有效提高固定正畸患者的治疗依从性,从而减少因治疗依从性不佳、不配合导致的矫治并发症的发生。     

基于健康信念模式的健康教育在糖尿病合并牙周炎病人口腔基础治疗中的应用

[目的]探讨口腔卫生健康教育在糖尿病合并牙周炎病人口腔基础治疗中的应用效果。[方法]将我院2016年1月—2016年12月收治的60例糖尿病合并牙周炎的病人随机分为观察组和对照组,每组30例。对照组给予常规健康教育,观察组给予健康信念模式的健康教育。比较两组治疗依从性、复诊率、口腔卫生健康知识掌握情况及治疗效果等。[结果]观察组治疗依从性、复诊率高于对照组,口腔卫生健康知识掌握情况好于对照组,差异均有统计学意义(P0.05)。观察组治疗后的菌斑指数、牙龈出血指数、牙周袋深度均小于对照组,差异均有统计学意义(P0.05)。[结论]基于健康信念模式的健康教育能够增加糖尿病合并牙周炎病人的口腔卫生知识,提高治疗依从性,改善治疗效果。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."