The treatment of hand fractures by the application of casts and splints

The most frequently used method to treat fractures involving the hand is closed reduction and application of a cast orsplint to hold the reduction until healing occurs. This method of fracture treatment is effective and efficient. It does, however, have associated complications from improper application of the casting material. This article reviews basic casting techniques and frequent complications as well as methods to prevent their occurrence.     

Prospective randomised controlled trial on the role of patient information leaflets in obtaining informed consent

BACKGROUND: The aim of this study was to determine whether patient information leaflets help to improve patient recall during the process of informed consent. METHODS: A prospective randomized controlled trial that compared a group of patients who were posted a patient information leaflet with those given verbal consent only was carried out. The study was conducted at the orthopaedic unit of a district general hospital. A total of 110 patients were selected, of whom 57 were randomly allocated to receive patient information leaflets by post and 53 were given verbal consent only. The outcome measure was the recall of information given to the patient. This was tested on admission by using a questionnaire. Each patient was allocated a score out of 10. RESULTS: There was a significant difference between the patients in the group that received patient information leaflets and those in the group that did not (P < 0.0001; confidence interval, 2.0-3.1). CONCLUSION: Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent.     

损伤控制骨科技术在严重多发伤中的应用

目的探讨损伤控制骨科（damage control orthopaedics,DCO）技术在严重多发伤中的应用。方法对2007年9月至2008年9月收治的24例严重多发伤患者应用DCO治疗并进行回顾性分析。结果脊柱骨折伴脊髓压迫4例,早期行简单的椎板切除减压术。骨盆骨折6例,早期骨盆外固定架固定,1例合并大出血行双侧髂内动脉结扎。四肢骨折22例,早期给予简单外固定,7例开放损伤行清创缝合术。术后均在ICU中复苏治疗,待生命体征平稳后再给予确定性手术。复苏期严重多发伤组患者体温、pH、凝血机能与一般多发伤组患者相比无明显差异。本组死亡3例,死亡率12.5%,死亡组创伤严重度评分4350分;1例胸部损伤死于严重创伤后多器官功能障碍综合征,2例重度颅脑损伤死于脑疝,并发症共8例,经过治疗均痊愈。结论对于严重多发伤患者合理应用DCO是安全有效的,可以提高严重多发伤患者生存率。     

A facile,semi-automatic protocol for the design and production of 3D printed,anatomical customized orthopedic casts for forearm fractures

Closed fractures of distal radius and ulna are one of the most common skeletal injuries, occurring at all ages. Temporary arm immobilization through cast is part of the standard treatments. However, traditional casting procedures are time consuming, operator's skill dependent and do not always guarantee a satisfactory outcome. From a clinical perspective, casts are often considered uncomfortable and can be associated to skin lesions. To overcome these limitations, the recent growth of 3D technologies has enabled new standardized casting procedures: additive manufacturing (AM) is a technique that creates highly customized cast models from anatomical 3D data by using digitally controlled and operated material laying tools. Compared with conventional casts, those produced with AM technique could potentially reduce skin complications and satisfy both mechanical and clinical requirements of functionality, comfort, and aesthetics.The objective of this study is to describe the new practical methodology to produce a 3D printable cast for upper arm immobilization. The parametric modelling tool, employed to develop a semi-automatic design system for generating the printable cast model, reduces the complex process of orthosis design to a few minutes and all the manufacturing operations remain unaffected by CAD skills of the operator. Specific hardware and software tools (3D scanner, modelling software and FDM technology) were chosen to mitigate design and production costs while guaranteeing suitable levels of data accuracy, process efficiency and design versatility. To highlight the effectiveness of the proposed solution, a finite element analysis simulation was performed on models with different geometry, highlighting the mechanical strength of generated structures.The final result is a personalized 3D printed cast with a highly ventilated structure that is lightweight but still maintains a high level of strength and provides hygienic benefits, reducing the risk of cutaneous complications, potentially improving treatment efficacy and increasing patient satisfaction.     

基于患者需求的“胰管家”健康管理小程序的设计与使用

目的 开发适用于胰腺疾病出院患者的健康管理小程序,并验证其可用性。方法 基于文献调研、患者访谈和医护人员调查,全面整合不同胰腺疾病患者延续性照护及界面呈现需求,设计并开发一款适用于胰腺疾病出院患者的健康管理小程序。该小程序包含就诊服务、消息中心和我的健康3个主模块,3个主模块下设在线咨询、延伸护理、健康课堂、量表测评、信息填报、异常症状等15个分模块。结果 小程序投入使用后有567例患者及其照护者完成注册,每3~7天使用1次、每次约10 min。共咨询健康问题153条。小程序用于胰腺疾病出院患者的可使用性和易学性评价得分分别为（30.31±1.68）和（7.56±0.62）分。结论 此小程序兼具易学性和可使用性,能够促进优质照护全程化、健康教育多元化、信息采集便捷化、医患沟通实时化等,以提高患者延续性照护质量。     

低年资护士的护理安全信息警示管理

目的 探讨对低年资护士实施护理安全信息警示管理的效果.方法 对35名低年资护士在常规护理安全管理的同时给予安全信息警示管理,包括建立护理安全信息警示管理体系,制定并应用护理安全信息周报表,执行安全信息警示管理并反馈等.结果 实施护理安全信息警示管理前后不良事件发生率比较,差异有统计学意义(P<0.05);实施护理安全信...     

Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease

Background. There has been a renewed interest in nitric oxidedonor drugs, such as nitroglycerin, delivered by the inhalationalroute for treatment of pulmonary arterial hypertension (PAH).We investigated the acute effects of inhaled nitroglycerin onpulmonary and systemic haemodynamics in children with PAH associatedwith congenital heart disease. Methods. Nineteen children with acyanotic congenital heart diseaseand a left to right shunt with severe PAH, undergoing routinediagnostic cardiac catheterization were included in this study.Systolic, diastolic and mean systemic as well as pulmonary arterypressures, right atrial pressure and pulmonary capillary wedgepressure (PCWP) were recorded and systemic vascular resistanceindex (SVRI) and pulmonary vascular resistance index (PVRI)were calculated at room air, following 100% oxygen as well asafter nitroglycerin inhalation in all patients. Results. Systolic, diastolic and mean pulmonary artery pressureand PVRI decreased significantly, whereas heart rate, systolic,diastolic and mean systemic arterial pressure, PCWP and SVRIdid not change significantly following 100% oxygen or inhalationof nitroglycerin. Conclusion. Inhaled nitroglycerin significantly decreases systolic,diastolic and mean pulmonary artery pressure as well as PVRIwithout affecting systemic haemodynamics, and thus can be usedas a therapeutic modality for acute reduction of PAH in childrenwith congenital heart disease.     

Confidentiality and security of information

Information about patients should be accurate, available to those who need to see it, and yet remain confidential. These three principles, especially the last two, may be difficult to achieve together. Electronic record systems can use sophisticated processes, such as role-based access, legitimate relationships, and sealed envelopes, to enable appropriate security. Use of patient information is covered by legislation, such as the Data Protection Act, by guidance, such as the Care Record Guarantee, and by local information governance processes, such as the Caldicott guardian and Trust Data Protection Policies. Healthcare professionals must be aware of all these, particularly when keeping information for their own use (e.g. logbooks).     

The impact of early information concerning the surgical operations on anxiety in patients with burns

AimsStress has been linked to poor coping with health-related issues, poor adaptation, a decrease of quality of life, poor recovery and poor wound healing. Therefore, it is important to address patients’ uncertainty and feelings of anxiety. The aim of this study was to examine the effect of providing early treatment information based on an LDI-scan to patients with burns on their feelings of anxiety.DesignAn observational prospective pre-test post-test study.MethodsPatients with intermediate burns (n = 59) admitted to our burn centre in 2016 were evaluated for anxiety using a visual analogue scale (VAS-A) before and after an LDI-scan was made. Two groups were compared: a group that heard whether surgery would or would not be recommended for wound closure (certain group) versus a group that heard to wait and see whether an operation was determined to be helpful (uncertain group).ResultsBefore the LDI-scan was made, both groups showed clinically high levels of anxiety (median VAS scores above 5). After the information gathered with the LDI was discussed with the patient, anxiety dropped significantly (median VAS below 3; p = .001). No significant differences between the groups were observed (p > .05).ConclusionIn contrast to other studies, anxiety was significantly reduced in all our study groups after information was shared. Early communication of knowledge by health care professionals is important regardless whether it includes treatment uncertainty.     

健康教练教育对预防性肠造口患者自我护理能力的影响

目的 探讨健康教练教育对提升预防性肠造口患者自我护理能力的作用.方法 将110例直肠癌行预防性肠造口的患者随机分为干预组和对照组各55例.对照组采取个体宣教,每周2次集中授课,1次理论授课,1次实践操作,每月定期随访等常规健康教育;干预组在此基础上采取健康教练教育进行造口管理.比较两组手术前后的肠造口自我护理能力和术后造口并发症发生率.结果 术后第5天、术后1个月末、术后3个月末干预组自我护理能力总分优于同期的对照组(均P＜0.01).术后1个月、术后3个月干预组的刺激性皮炎发生率显著低于对照组(均P＜0.01).结论 健康教练教育能提高预防性肠造口患者的自我护理能力,降低造口并发症的发生.     

An evaluation of patient satisfaction with an information leaflet for trauma survivors

A new leaflet that provided information about posttraumatic reactions and how to deal with them was distributed within 14 days of attendance at the Accident and Emergency Department (ED), Aberdeen Royal Infirmary, to a heterogeneous sample of trauma patients (N = 222). An evaluation form to assess satisfaction with the leaflet was also mailed with the leaflet. A sample of 98 (44%) of the initial patient group responded, and 96% of them reported the leaflet as either very helpful or helpful. Satisfaction with the leaflet was not affected by age, by gender, or by the type of trauma encountered. Overall, the findings confirmed that such a leaflet is well received by trauma patients attending an ED.     

学历、性格与责任护士工作效果的关系探讨

为了解学历、性格与责任护士工作效果之间的关系 ,为系统化整体护理培养、选择责任护士提供依据。随机抽取 10 0名病房责任护士 ,分别按学历、性格类型对工作效果的影响进行分析、比较。结果大专及以上学历者工作效果显著高于中专学历者 (H c=11.5 2 0 ,P<0 .0 1) ;性格内向型者工作效果最低 ,与性格中间型、外向型比较 ,差异有极显著性意义 (P<0 .0 1)。提示护理管理者应激发护士的学习积极性 ,鼓励其提高学历层次及知识面 ;培养护士开朗、善于沟通的良好性格特征     

Tetanus: a review of the literature

Br J Anaesth 2001; 87: 477–87     

Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty

Background

Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established.

Methods

Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl⁻¹ for females and < 13 g dl⁻¹ for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30-day moderate-to-severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred.

Results

A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl⁻¹ was associated with fewer postoperative complications.

Conclusion

Preoperative haemoglobin ≥14 g dl⁻¹ is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.     

食管癌患者支持性照护信息平台的构建与应用

目的 探讨食管癌患者支持性照护信息平台在食管癌患者术后延续护理中的应用效果.方法 将80例患者随机分为观察组和对照组各40例,对照组采用常规护理管理,观察组采用食管癌患者支持性照护信息平台进行管理,比较两组干预前及干预3个月后自我效能、生活质量及营养指标.结果 观察组干预3个月后,癌症自我效能感总分、生活质量总分及营养...     

NICU早产儿母乳喂养链式管理效果评价

目的 观察链式管理对NICU早产儿母乳喂养及喂养并发症的影响。方法 将180例NICU早产儿按入院时间分为对照组和试验组各90例。对照组实施常规NICU母乳喂养策略,试验组在对照组基础上进行链式管理,构建并实施产房、产科和NICU间横向管理和各科室内部纵向管理。结果 最终对照组82例、试验组81例早产儿完成研究。干预后,试验组纯母乳喂养率显著高于对照组,试验组早产儿喂养不耐受、坏死性小肠结肠炎、宫外发育迟缓和新生儿高胆红素血症发生率显著低于对照组(均P<0.05),试验组恢复至出生体质量日龄显著短于对照组,出院体质量显著大于对照组(均P<0.05)。结论 链式管理有利于提高NICU早产儿的纯母乳喂养率,降低喂养并发症发生率,促进新生儿生长发育。     

延续护理信息平台的研发与应用

目的提高延续护理效果,满足患者健康管理需求。方法根据专家咨询患者需求确定延续护理信息系统功能及基本架构,基于医院信息系统(HIS)设计系统模块,延续护理信息系统经调试后在妇产科进行4个月的试运行,对318例患者实施院内外健康教育、出院随访、医患互动、跟踪干预、问卷测评等延伸服务。结果试运行期间,经延续护理信息系统完成健康咨询208例次、提醒用药752例次、推送消息733例次、进行健康干预72例次、发布健康讲座12讲。受访的医护人员及患者或家属85.0%以上认可该系统的便捷性、获益性、稳定性、安全性等。结论基于HIS系统的延续护理信息平台构建合理,基本能满足签约患者延续护理服务需求,有利于出院患者持续有效的健康管理。