护理干预对老年性白内障患者术后并发症的影响

目的探讨老年性白内障患者围手术期实施护理干预对于施行白内障超声乳化吸除联合人工晶体植入术术后并发症和患者满意度的影响。方法选择2011年11月~2012年8月间在本院眼科中心行白内障超声乳化吸除加人工晶体植入术的老年白内障患者180例,在符合医学伦理学及临床护理规范的前提下,随机抽取90例作为实验组,90例作为对照组,实验组在健康教育中实施护理干预措施,对照组采用常规护理。比较两组疾病知识知晓程度、手术并发症发生率及患者满意度情况。结果实验组的手术疾病知识知晓程度及满意度高于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论对白内障超声乳化吸除加人工晶体植入术的老年性白内障患者在健康教育中实施护理干预,可降低手术并发症发生率,提高患者满意度,具有较好的临床推广价值。     

医保监管下临床路径在老年性白内障的应用分析

目的 分析医保监管下临床路径对老年性白内障实施白内障超声乳化+人工晶体植入术的应用效果.方法 在医保监管下,利用医院HIS系统提供的病案、收费的数据资料及病人满意度测评结果,将择期住院行自内障超声乳化+人工晶体植入术病人分为两组,根据老年性白内障临床路径标准住院流程实施临床路径,将实施临床路径前老年性白内障患者87例设为对照组,将实施临床路径后老年性白内障患者83例设为观察组,回顾性分析对比两组病人的平均住院天数、住院费用和病人满意度测评.结果 实施临床路径的观察组平均住院天数和费用下降,病人满意度增加.结论 在白内障手术病人中应用临床路径,可有效的降低住院天数和住院费用,提高病人满意度.     

临床护理路径应用于糖尿病合并白内障人工晶体植入术的临床研究

目的探讨临床护理路径应用于糖尿病合并白内障患者超声乳化人工晶体植入术的临床效果。方法将糖尿病合并白内障患者66例随机分为观察组和对照组。对照组患者32例实施常规护理;观察组患者34例为临床路径护理。全部患者均行白内障超声乳化联合人工晶体植入术。比较2组患者的住院时间、住院费用,并发症发生率。结果观察组患者平均住院时间、平均住院费用、并发症发生率均比对照组减少,差异有统计学意义(P0.05)。结论临床护理路径应用于糖尿病合并白内障患者行超声乳化联合人工晶体植入术可改善患者预后,加快患者康复。     

临床护理路径在老年性白内障手术患者中的应用

目的观察对老年性白内障手术患者的实施临床护理路径管理的效果。方法将需要进行囊外晶体摘除加人工晶体植入术的老年性白内障患者，随机分成实验组和对照组各30例。对照组采用传统的常规护理，实验组患者实施临床护理路径，记录住院天数、住院费用及观察并发症发生率，问卷调查护理质量满意度及疾病相关知识的掌握情况。结果实验组患者的平均住院天数、平均住院费用、并发症的发生率低于对照组（p〈0．05），满意度及对疾病相关知识的掌握情况较对照组明显提高（p〈0．05）。结论临床护理路径应用于进行囊外晶体摘除加人工晶体植入术的老年性白内障患者中，可缩短住院天数，降低医疗费用，降低并发症的发生，提高患者护理质量满意度和对疾病相关知识的掌握。     

老年性白内障超声乳化并人工晶体植入术156例的临床护理

目的总结老年性白内障超声乳化及人工晶体植入术的临床护理方法。方法回顾性分析156例老年性白内障超声乳化并人工晶体植入术患者的术前准备及术中、术后的护理资料。结果本研究156例患者术前全身状况控制良好,术中前房均维持稳定,手术顺利,无并发症发生;术后有17例（眼）伴有角膜水肿、6例虹膜轻度反应及1例前房少量渗出等手术应激反应。术后总脱盲率达100％。结论对行老年性白内障行超声乳化并人工晶体植入术患者,除做好常规的护理外,术前应充分观察、控制患者的血压、血糖等全身情况;同时应加强心理疏导及沟通,做好健康宣教,这有利于手术顺利进行及术后视力的改善、提高,并可降低并发症的发生,提高护理质量及增加患者满意度。     

临床护理路径在糖尿病性白内障患者围手术期中的应用

目的:探讨糖尿病性白内障手术患者实施临床护理路径的效果。方法:将糖尿病性白内障患者120例随机分为实验组和对照组。对照组63例实施常规护理;实验组57例为临床路径护理。均行白内障超声乳化联合人工晶体植入术。分析两组患者住院天数、住院费用,并发症发生率、患者满意度及疾病相关知识的掌握情况。结果:实验组平均住院天数、平均住院费用、并发症发生率均较对照组少,差别有统计学意义(P0.01),护理质量满意度及疾病相关知识掌握情况优于对照组,差别有统计学意义(P0.05)。结论:临床护理路径应用于糖尿病性白内障患者行超声乳化联合人工晶体植入术效果好。     

舒适护理在高龄白内障患者超声乳化吸除及人工晶体植入术中的应用

目的探讨舒适护理对高龄白内障患者超声乳化吸除联合人工晶体植入术舒适程度的影响,为临床治疗、健康教育和临床护理提供相应的依据,并制订提高高龄白内障患者超声乳化吸除联合人工晶体植入术舒适程度的相应对策。方法将2011年1~3月在本院行白内障超声乳化吸除联合人工晶体植入术患者145例作为对照组,采用常规手术室护理,将2011年4~6月在本院行白内障超声乳化吸除联合人工晶体植入术患者178例作为观察组,在常规手术室护理的基础上采用舒适护理,比较分析2组患者术中配合能力、舒适程度、对护理工作的满意度。结果观察组患者术中配合能力、舒适程度、满意度显著高于对照组。结论舒适护理应用于高龄白内障患者超声乳化吸除联合人工晶体植入手术中的临床效果满意,能够提高高龄患者术中配合能力,增进患者的舒适度,提高患者及家属对手术室护理工作的满意度以及护理人员的信任度。     

临床护理路径在老年性白内障行超声乳化手术患者中的应用

目的建立完善的老年性白内障行超声乳化术 后房型人工晶体植入术患者的临床护理路径。方法将120例随机分为实验组和对照组各60例。对照组采用传统的常规护理,实验组实施临床护理路径。结果实验组健康知识评分和满意度显著高于对照组(P<0.05),平均住院日、术后住院天数、并发症的发生率明显低于对照组(P<0.05)。结论临床护理路径为整体护理提供了更有效的指导,提高了工作效率和患者的满意度,缩短了住院天数,降低并发症的发生率,从而有利于护理质量的提高。     

临床路径在农村合作医疗白内障患者中的应用

目的研究临床护理路径应用于新型农村合作医疗（新农合）白内障手术患者的实施效果。方法对住院择期行白内障超声乳化联合人工晶体植入术患者分为新农合组（观察组）和非新农合组（对照组）各108例，对照组实施传统治疗和护理，观察组实施临床护理路径，比较2组的护理效果。结果观察组患者的平均住院日及平均住院费用均低于对照组（p〈0.05）；而健康知识掌握及患者住院满意度情况均高于对照组（p〈0.01）；2组术后并发症差异无统计学意义（p〉0.05）。结论临床护理路径应用于新合白内障手术患者能缩短住院日，降低住院费，同时能提高患者对健康教育知识的掌握和对住院满意度。临床护理路径值得在新农合患者中推广应用。     

老年性白内障超声乳化手术的临床护理

目的 探索老年性白内障超声乳化及人工晶体植入术的临床护理。方法 总结443例(501眼)超声乳化白内障摘除及人工晶体植入术时责任护士的临床护理操作程序。结果 以患者为中心的整体护理有利于手术的顺利进行,更有利于患者术后视力的提高,降低并发症的发生,提高护理质量和患者满意度。     

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。