3R护理对老年血管性痴呆的影响

目的：确定３Ｒ护理方法对于改善老年血管性痴呆生活质量的作用;方法：对老年血管性痴呆病人３４例实施３Ｒ护理训练并以同期３１例老年血管性痴呆病人对照观察,２组病人均进行ＷＡＩＳ－ＣＲ（简式）,ＩＡＤＬ－ＦＡＱ,ＦＩＭ（１４￣１８）及ＲＢＭＴ－Ｒ４种量表综合评估病人生活质量的各种相关指标;３Ｒ护理组训练后生活质量有显著改善。     

老年血管性痴呆30例社区护理干预

目的:探讨老年血管性痴呆患者的社区护理干预方法。方法:将60例老年血管性痴呆患者随机分为对照组和观察组各30例,对照组采用常规护理,观察组在此基础上实施社区护理干预,比较两组干预后相关指标(生活自理、沟通依从、配合训练、问题行为、合理饮食)。结果:观察组相关指标均优于对照组(P<0.05)。结论:社区护理干预可明显提高老年血管性痴呆患者的生活处理能力,改善生存质量。     

3R护理法对老年血管性痴呆病人康复的影响

目的:探讨3R护理法在血管性痴呆病人中的应用效果.方法:将98例血管性痴呆病人随机分为观察组和对照组,观察组采用3R护理法,对照组采用常规护理法,比较两组病人简易精神状态检查(MMSE-R)、韦氏智力量表(简式)(WAIS-RC)和行为记忆测验(改良)量表(RBMT-R)的评分结果.结果:两组病人的MMSE-R,WAIS-RC及RBMT-R量表评分比较有统计学差异(P＜0.05),观察组各项评价指标较对照组明显改善.结论:采用3R护理法有利于血管性痴呆病人的康复,能有效改善病人的智力、记忆、认知功能和生命质量.     

对老年血管性痴呆实施3R强化护理的研究

目的 探讨改善老年血管性痴呆（VD）生活质量的有效护理方法。方法 65例老年VD患者分为强化护理组与对照组,强化护理组34例、实施往事记忆提取（Reminiscence)、记忆空间定位（Reality)和记忆再激发（Remotivation)的强化护理训练（简称3R强化护理）。对照组31例,实施内科常规护理。对两组患者实施护理前,护理训练计划完成后分别测定与记忆、智能有关的4种量表：IADL－FAQ、FIM（14－18）、WAIS－RC（简式）、RBMT－R。结果 强化护理组与对照组测定的四种量表相比,在护量前无明显差异（P＞0．05）,实施护理计划后差异有显著性（P＜0．01）。结论 3R强化护理能有效地改善老年VD患者的生活质量。     

3R护理法在老年血管性痴呆患者中的应用研究

目的评价对老年血管性痴呆患者施行3 R护理法的临床效果.方法选择1999年3月～2004年11月我科老年血管性痴呆患者56例,并随机分为2组,实验组采用3 R护理法,对照组采用常规护理法.并通过简易精神状态检查(MMSE-R)及社会适应功能障碍调查表(FAQ)进行精神状态(定向力、记忆力、语言、回忆、注意力及计算力)以及社会适应功能障碍评定临床护理效果.结果入院8周后各因子项得分及症状改善情况实验组明显优于对照组;对照组没有明显变化.结论 3 R护理法在痴呆患者的康复护理疗效上具有明显的优势,能明显促进痴呆患者的认知能力及生活自理能力的改善,值得在护理领域推广与应用.     

对社区老年血管性痴呆病人实施护理干预的效果观察

[目的]探讨护理干预对社区老年血管性痴呆病人康复的影响.[方法]通过对某社区老年血管性痴呆病人实施饮食、行为、心理、家庭护理干预,观察老年血管性痴呆病人康复的情况.[结果]病人的生活质量、社会生活能力有所提高.[结论]护理干预对老年血管性痴呆病人康复有积极的作用.     

老年痴呆并髋部骨折病人围术期改良3R护理干预研究

[目的]探讨改良的个性化3R护理对老年痴呆髋部骨折病人围术期生活质量及术后康复的影响。[方法]将96例轻中度痴呆老年髋部骨折病人随机分成实验组与对照组,各48例,实验组进行改良的个性化3R护理,对照组采用骨科手术病人常规护理。护理前后采用功能活动问卷(FAQ)、功能独立性评定(FIM)、中国修订韦氏智力量表(WAIS-RC)、行为记忆测验量表(RBMT-2R)进行测评。[结果]两组干预后FAQ、FIM、智商(IQ)、RBMT-2R评分比较差异有统计学意义(P<0.01)。[结论]个性化改良3R护理能有效改善老年痴呆骨折手术病人围术期生活质量,有助于病人术后康复。     

对社区老年血管性痴呆病人实施护理干预的效果观察

[目的]探讨护理干预对社区老年血管性痴呆病人康复的影响。[方法]通过对某社区老年血管性痴呆病人实施饮食、行为、心理、家庭护理干预,观察老年血管性痴呆病人康复的情况。[结果]病人的生活质量、社会生活能力有所提高。[结论]护理干预对老年血管性痴呆病人康复有积极的作用。     

循证护理对老年脑血管患者生活质量及血管性痴呆的预防作用

目的探讨循证护理对老年脑血管患者生活质量及血管性痴呆的预防作用。方法随机选取本院就诊的100名老年脑血管患者为研究对象分为对照组和观察组,各50例,对照组患者实施基础护理措施,观察组患者实施循证护理措施,比较2组患者的生活质量以及2年后患者血管性痴呆的发生率。结果观察组患者生活质量的各项指标均优于对照组(P0.05);观察组患者2年后轻、中度以及重度血管性痴呆发发生率均低于对照组(P0.05);观察组患者死亡率低于对照组(P0.05)。结论对老年脑血管患者实施循证护理方式可有效提高患者的生活质量,降低血管性痴呆的发生率和死亡率。     

综合性护理干预对老年血管性痴呆患者的治疗效果浅析

目的探讨综合性护理在干预老年血管性痴呆中的效果。方法选取2014年10月~2015年12月武汉市中医医院脑病一科的62例老年血管性痴呆患者,随机分为对照组(常规护理)及观察组(综合性护理)各31例,比较两组简明精神状态量表(MMSE)、常识-记忆-注意测验(IMCT)量表、巴氏指数(BI)及活动能力量表(ADL)评分。结果两组护理干预后ADL评分均下降明显,且观察组下降较对照组明显(P0.05);两组护理干预后MMSE、IMCT及BI均升高明显,且观察组升高较对照组明显(P0.05)。结论综合性护理措施可提高老年血管性痴呆的治疗效果并改善患者的生活质量,具有较高的临床价值。     

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。