康复操在老年髋部骨折患者术后功能恢复中的应用

目的:探讨康复操对髋部骨折术后患者康复效果的影响。方法:选择老年髋部骨折术后患者100例,将患者随机等分为观察组和对照组,对照组给予一般性的出院指导,观察组在对照组基础上,在患者术后6个月内进行康复操的护理干预。比较患者术后1,3,6个月的Harris髋关节评分。结果:观察组Harris髋关节评分显著高于对照组(P0.05)。结论:康复操的护理干预能够提高老年髋部骨折术后髋关节的功能。     

持续性护理促进老年全髋关节置换术后患者功能恢复的效果

目的探讨持续性护理干预对促进老年全髋关节置换术后患者功能恢复的作用。方法便利选取2011年5月至2013年5月在庆元县人民医院接受髋关节置换术的64例老年髋部骨折患者,采用随机数字表法分为干预组和对照组各32例。对照组接受髋部骨折术后常规护理;干预组在接受常规护理的同时,给予以功能锻炼和心理支持为核心的院内外持续性护理干预。分别于患者出院时及出院后1、3个月,比较两组患者的Harris髋关节评分、Barthel指数及老年抑郁量表(geriatric depression scale,GDS)评分。结果出院时,两组患者的Barthel指数、Harris髋关节总评分差异均无统计学意义(P0.05),干预组Barthel指数及Harris髋关节总评分在出院后1、3个月时均明显高于对照组(均P0.05)。出院时、出院后1个月,两组患者的GDS评分差异无统计学意义(P0.05),干预组GDS评分在出院后3个月明显低于对照组(P0.05)。结论以功能锻炼和心理支持为核心的持续性护理干预可以有效改善老年全髋关节置换术后患者髋关节功能、日常生活能力和抑郁症状,有助于促进患者的身心康复。     

持续性护理对老年髋部骨折患者术后功能恢复及生活质量的影响

目的:探讨老年髋部骨折患者应用持续性护理对术后功能恢复及生活质量的影响,以丰富临床护理经验。方法:选取2013年6月至2015年12月在我院就诊的老年髋部骨折患者70例,根据入院治疗顺序随机分成对照组与观察组各35例,对照组给予常规护理,观察组则使用持续性护理。经护理后,统计两组的Harris髋关节功能评分以及生活质量评分等,并进行对比。结果:经护理后观察组出院时、出院1个月以及出院3个月的Harris髋关节功能评分均显著高于对照组,差异具有统计学意义(P0.05);观察组的各项生活质量评分情况均显著优于对照组,差异具有统计学意义(P0.05)。结论:老年髋部骨折患者应用持续性护理可促进髋关节功能恢复,提高患者生活质量,值得推广。     

老年髋部骨折患者护理干预效果分析

【目的】评价综合护理干预对老年髋部骨折患者术后肢体功能恢复的效果。【方法】将80名老年髋部骨折患者分为实验组（40名）和对照组（40名）。对照组患者接受髋部骨折患者术后常规护理。实验组患者在接受常规护理的同时,给予功能锻炼和心理支持为主的院内院外护理干预,采用Harris髋关节评分、Barthel指数对两组患者入院时及出院时、出院后1个月、出院后3个月进行评价。【结果】实验组Harris髋关节总评分在出院后1个月、3个月时高于对照组（P〈0．05）;不同手术方式Harris髋关节总评分有明显差异（P〈0．01）;实验组Barthel指数评分高于对照组（P〈0．01）;全髓置换术病人术后日常生活能力预后水平高于内固定手术病人。【结论】以功能锻炼和心理支持为主的护理干预可有效改善老年髋部骨折患者术后髋关节功能、日常生活能力。综合护理干预是促进患者术后康复的有效方法。     

家居音乐康复操在老年髋部骨折出院病人中的应用

[目的]探讨家居音乐康复操在老年髋部骨折出院病人中的应用效果。[方法]选取我院骨科出院的120例老年髋部骨折病人随机分为对照组和干预组,对照组采取常规护理措施,干预组在常规护理的基础上予以家居音乐康复操干预,出院后1个月和3个月比较两组病人的Harris髋关节功能评分和Barthel指数。[结果]出院后1个月和出院后3个月,干预组病人的Harris髋关节功能评分和Barthel指数高于对照组(P0.05)。[结论]在老年髋部骨折出院病人中应用音乐康复操,可改善病人的髋关节功能和自理能力。     

家庭康复护理干预对老年髋部骨折患者术后功能恢复的影响

目的 探讨家庭康复护理干预对髋部骨折患者术后功能恢复的作用。方法 选取79例老年髋部骨折手术后患者,随机分为对照组40例和实验组39例。对照组给予一般性出院指导;实验组在对照组基础上在患者术后6个月内进行家庭康复护理干预。比较2组患者术后1、2、6个月时相点的Harris髋关节评分。 结果 实验组患者术后Harris髋关节评分明显高于对照组。 结论 家庭康复护理干预能够提高老年髋部骨折患者术后功能的恢复。     

快速康复优质护理在超高龄髋部骨折患者中的应用

目的:探讨快速康复优质护理在超高龄髋部骨折患者中的应用方法及效果。方法:将43例超高龄髋部骨折患者随机分为观察组23例和对照组20例,对照组给予骨科常规护理,观察组在此基础上给予快速康复优质护理,比较两组护理效果。结果:观察组术后并发症发生率低于对照组(P0.05),临床有效率高于对照组(P0.05),出院时、出院1个月Harris髋关节评分高于对照组(P0.05)。结论:快速康复优质护理可减少超高龄髋部骨折患者的术后并发症,提高临床有效率,改善髋关节功能。     

互联网+随访管理系统促进区域性老年髋部骨折术后康复研究

目的 探究互联网+随访管理系统促进区域性老年髋部骨折术后康复的应用效果。方法 选取2019年1月至2021年1月我院收治的40例接受常规术后康复+随访管理系统老年髋部骨折患者纳入对照组;另将同期40例采用常规术后康复联合互联网+随访管理系统的老年髋部骨折患者纳入研究组。两组连续干预3个月。比较出院时、出院后1个月、出院后3个月的Harris髋关节评分量表评分(HHS)和自我管理能力实施量表(ESCA)评分,比较干预3个月结束时护理满意度、并发症发生率。结果 干预3个月期间,两组并发症发生情况比较,差异无统计学意义(P>0.05);出院后1、3个月时,两组HHS评分逐渐升高,且研究组高于对照组,差异有统计学意义(P<0.05);出院后1、3个月时,两组ESCA评分逐渐升高,且研究组高于对照组,差异有统计学意义(P<0.05);干预3个月结束时,研究组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论 互联网+随访管理系统可促进区域性老年髋部骨折患者术后康复,提高自我管理能力和护理满意度,且不增加术后并发症。     

持续家庭式康复治疗对老年髋部再骨折患者的影响

目的探讨持续家庭式康复治疗对老年髋部再骨折患者的影响。方法选取老年髋部再骨折手术患者45例,随机分为2组。对照组患者给予常规康复治疗,实验组患者给予持续家庭式康复治疗,比较2组患者出院后不同时刻的髋关节功能Harris评分、HAMA以及HAMD等评分,比较2组患者术后各种并发症的发生率。结果实验组患者出院3、6个月后的髋关节Harris评分显著高于对照组患者(P0.05),HAMA和HAMD评分显著低于对照组患者(P0.05)。实验组患者深静脉血栓、褥疮、肺感染、心血管意外、胃肠症状以及泌尿系统感染等发生率显著低于对照组患者(P0.05)。结论持续性家庭式康复治疗可促进老年髋部再骨折术后患者髋关节功能恢复,缓解患者的焦虑和抑郁情绪,降低术后并发症的发生率。     

适时模式的全程照护在老年髋部脆性骨折患者中的应用

目的：探讨适时模式的全程照护在老年髋部脆性骨折患者中的应用效果。方法：将2021年1月1日～2022年1月31日收治的160例老年髋部脆性骨折患者随机分为观察组和对照组各80例，对照组给予常规干预，观察组在对照组基础上实施适时模式的全程照护。两组在院内均接受了医疗干预并延续至出院后6个月，最终有134例患者纳入研究，其余26例患者未能坚持完成研究，造成临床资料缺失。比较两组老年髋部脆性骨折健康知识掌握程度、依从性、髋关节功能Harris评分、二次骨折发生率。结果：干预后，两组危险因素、运动知识、钙知识掌握情况评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);观察组抗骨质疏松药物规范治疗依从率、饮食方案实施依从率、腰背肌肉平衡锻炼执行率、行为习惯改变依从率均高于对照组(P<0.01,P<0.05);两组出院前1 d、出院后3个月、出院后6个月Harris评分均升高(P<0.01),且观察组高于同期对照组(P<0.01);观察组出院后3、6个月二次骨折发生率低于对照组(P<0.05)。结论：适时模式的全程照护在老年髋部脆性骨折患...     

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。