人工流产后关爱服务对降低再次意外妊娠风险的效果评价

【】目的: 探讨人工流产后关爱服务对降低再次意外妊娠风险的影响。方法:选择2016年6月－2016年12月我院计划生育门诊861例因意外怀孕而自愿接受人工流产的患者,采用随机单双号分组方式,单号作为观察组,自愿接受给予PAC优质服务;双号作为对照组,常规方式处理。术后1、3、6、12个月电话回访了解两组患者对避孕知识的知晓情况,避孕知识的实施情况;有无再次妊娠,并对其进行分析对比。结果:观察组对避孕知识的知晓率,正确实施避孕方法率明显高于对照组,术后6、12个月再次妊娠率明显低于对照组;观察组服务满意度明显高于对照组,差异均具有统计学意义(P均<0.05)。结论:实施人流后关爱服务能提高女性对避孕知识的掌握,降低再次意外妊娠的风险,减少重复流产率,保障女性健康。     

流产后关爱服务对人工流产术后避孕措施的影响

目的探讨流产后关爱服务对提高人工流产术后妇女避孕措施效率的意义。方法选择行人工流产的226例无生育要求的育龄期妇女为研究对象,随机分为对照组和观察组,各113例。对照组常规进行避孕知识健康教育,观察组术后按流产后关爱服务流程进行健康教育干预,术后6个月,对2组产妇进行避孕方式调查和术后月经恢复时间。结果人流术后6个月,观察组产妇选择高效避孕措施比例为72.56%(82/113)高于对照组的31.86%(36/113),差异有统计学意义(P0.01)。观察组选择非高效避孕方式、无避孕措施比例低于对照组,差异有统计学意义(P0.01)。观察组术后月经恢复时间(48.28±12.36)d,短于对照组的(70.36±11.37)d,差异有统计学意义(P0.01)。结论流产后关爱服务有助于提高避孕措施效果,促进术后恢复。     

流产后关爱和避孕咨询服务在人工流产患者中的应用效果

目的：探讨流产后关爱（ PAC）与避孕咨询服务在人工流产患者中的应用效果。方法选取2011年6月至2014年6月我收治的人工流产患者100例,随机分为研究组和对照组,每组50例。对照组采取常规护理及健康知识宣教,研究组在此基础上联合PAC和避孕咨询服务干预。随访1年观察两组流产后健康知识、避孕知识知晓情况和重复流产率。结果研究组患者流产后健康知识知晓率、避孕知识知晓率显著高于对照组（P＜0.05,P＜0.01）,患者就医的总满意率明显高于对照组（P＜0.01）,患者1年内重复流产率低于对照组（ P＜0.05）。结论通过流产后关爱和避孕咨询服务干预,能够有效加强人工流产患者避孕知识的掌握程度,降低意外妊娠率,提高对医疗服务的满意率。     

宫腔镜联合B超行取胚术后关爱服务的应用效果

目的探讨宫腔镜联合B超取胚术后关爱服务的应用效果。方法采用随机数字表法将行取胚术患者分为对照组和关爱组各60例。对照组接受常规的术后服务,观察组实施关爱服务。比较2组患者避孕及流产危害认知状况、避孕落实情况及1年内流产情况。结果关爱组患者避孕及流产危害知识的知晓度高于对照组;关爱组患者恢复性生活时间、再次妊娠时间均长于对照组;关爱组患者1年内流产率低于对照组。结论有计划、有组织地开展计划生育关爱服务,能够有效提高人工流产患者术后生殖健康知识学习效率,有助于患者选择适宜的避孕方式,降低非意愿妊娠。     

探讨流产后关爱服务在人流术患者中的应用效果

探讨流产后关爱服务在人流术中的应用效果。随机抽取100例人工流产患者作为研究对象,平均分为试验组和对照组,为对照组按照传统模式介绍术后的相关注意事项及避孕知识,为试验组实施流产后关爱服务,一段时间后,对比两组的避孕知识知晓率、避孕措施正确使用情况等指标。试验组避孕知识知晓率、避孕措施的正确实施及重复流产等情况均优于对照组,差异性显著(P<0.05)。与传统模式相比,流产后关爱服务能够有效增加人流术患者的避孕知识,提高患者避孕意识,保障患者的生殖健康,降低患者的重复流产率。     

流产后关爱服务在降低重复流产率中的作用

【目的】探讨流产后关爱服务（Post Abortion Care,PAC）在降低重复流产率中的作用。【方法】收集本院2012年1月计划生育门诊行人工流产术的意外妊娠患者408例（对照组）,2012年5～6月计划生育门诊行人工流产术的意外妊娠患者718例（研究组）,对照组按传统模式介绍术后注意事项,研究组由 PAC 专家按PAC服务流程为患者开展流产后关爱服务。干预半年后,对比观察两组患者的避孕知识知晓率、坚持和正确采用有效避孕措施和半年内重复流率进行对比观察。【结果】两组患者术后6个月避孕知识知晓率、坚持和正确使用避孕措施率、术后半年重复流产率,差异有统计学意义（P＜0．05）。【结论】PAC能提高患者避孕意识,降低重复流产率。     

延续护理在门诊人工流产妇女干预中的应用及效果评价

目的 :调查实施延续护理对人工流产妇女降低重复流产率的影响。方法 :选取122例门诊人工流产妇女随机分为干预组和对照组各61例。干预组实施个性化的延续护理,对照组予以流产后常规护理,流产后1个月比较两组患者避孕知识掌握率,6个月后比较避孕措施运用情况、重复流产率。结果 :术后1个月干预组部分避孕知识掌握率高于对照组。术后6个月干预组避孕措施使用率(96.7%)高于对照组(85.2%),干预组重复流产率(1.6%)低于对照组(9.8%),差异均有统计学意义(P0.05)。结论 :延续护理对人工流产后妇女提高避孕知识的掌握,促进避孕措施的落实,降低半年内重复流产率,提高生殖健康水平、保障女性身心健康有一定的效果。     

流产后关爱服务对未婚流产女性的影响

目的观察人工流产后关爱服务对未婚流产女性的影响。方法选择2015年1月至2017年1月在该院妇产科门诊自愿行人工流产术的500例未婚女青年作为研究对象,分为对照组和观察组各250例,对照组给予常规治疗,观察组在常规治疗的基础上给予人工流产后关爱服务。分别观察并记录两组患者手术时长和术后阴道出血的时间;记录两组患者人工流产术后1、3、6、12个月近、远期并发症发生、接受随访、有效避孕、重复流产等情况。结果两组患者手术时间和远期并发症发生率比较,差异无统计学意义(P0.05)。两组患者术后随访阴道流血时间、应答率、近期并发症发病率、高效避孕率及重复流产率差异均有统计学意义(P0.05)。结论人工流产后关爱服务能有效缩短术后阴道出血时间、降低术后近期并发症发病率、提升有效避孕的效果。     

流产后关爱门诊护理对女性重复流产的控制及避孕依从性的影响

目的探讨人工流产后关爱门诊护理服务对女性重复流产的控制及避孕依从性的影响。方法将160例女性人工流产患者分为对照组和试验组,2组均80例。对照组实施传统的人工流产后护理服务,试验组实施流产后关爱门诊护理服务,比较2组患者术后半年的重复流产率、正确使用避孕方法人数和坚持使用正确避孕方法人数。结果试验组患者术后半年重复流产发生率为0%,显著低于对照组(P0.05);试验组患者术后半年正确使用高效避孕方法人数和坚持使用高效避孕方法人数分别71人和70人,显著高于对照组患者(P0.05)。结论采用流产后关爱门诊服务有助于降低女性重复流产的发生率,提高了女性正确使用高效避孕方法的人数和坚持使用高效避孕方法的人数,提高了女性避孕依从性,值得临床推广。     

流产后关爱服务信息管理系统的建立与应用

目的探索流产后关爱服务管理系统在全程追踪随访流产后妇女落实避孕措施的应用方法和效果。方法根据流产后关爱服务全程追踪随访的需求,研发流产后关爱服务信息管理系统,通过系统的首次咨询记录,以及系统的提醒功能,及时查阅各时段应随访的所有患者的个人信息,对患者进行逐一个性化的随访,及时指导落实避孕措施,避免漏访。观察了解流产后关爱服务咨询师对术后1个月、3个月、6个月、12个月的人工流产后患者随访咨询工作的落实情况。结果通过流产后关爱服务信息化管理系统对人工流产后的患者进行全面的随访咨询管理,随访咨询落实率为100%;流产后妇女的高效避孕率提高了24.3%;有效地减少了流产后妇女重复流产的发生。结论流产后关爱服务信息化管理系统能够准确记录患者的真实信息,方便工作人员及时对术后患者进行追踪随访和指导,使流产后随访工作得到有效落实,重复流产率明显下降。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.