基于奥马哈系统在慢性乙型肝炎患者实施延续护理中的效果研究

目的探讨奥马哈系统在慢性乙型肝炎患者延续护理中的应用效果,为院外延续护理发展提供依据。方法 以奥马哈系统为理论框架,应用其问题分类系统条目制订评估表。采用方便抽样法,选取2016年10月至12月东台市人民医院感染科住院的60例慢性乙型肝炎患者,评估其从出院前1天至出院后3个月生理、心理和社会功能等方面存在的主要护理问题。针对问题,以干预系统为指引,结合临床实践经验,对患者出院前１天,出院后1周、１个月、2个月、3个月进行连续5次干预活动。干预后从认知、行为和状况（K-B-S)方面进行效果评价。结果 医疗费用支出问题在出院3个月时行为有所改善,差异有统计学意义(P相似文献   

奥马哈系统在慢性阻塞性肺疾病患者延续护理中的应用研究

目的 探讨奥马哈系统在慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease,COPD）患者延续护理中的应用并评价其效果。 方法 依据奥马哈系统构建COPD患者的延续护理方案,对55名住院的COPD患者从出院前3d至出院后3个月进行连续的5次护理干预,比较干预前后患者在各领域护理问题得分的变化。 结果 经延续护理干预,呼吸、感染、住宅、物质滥用和药物治疗方案状况出院后3个月较出院后3d、1个月认知、行为和状况均有改善,差异具有统计学意义（p<0.05）。结论 以奥马哈系统为理论依据的COPD患者延续护理方案,可以改善患者的机体和心理状况,提高生活质量。     

护理干预模式记录卡结合微信平台在永久性肠造口病人延续护理中的应用

[目的]探讨永久性肠造口病人护理干预模式记录卡结合微信平台在首次行肠造口术病人延续护理中的应用效果。[方法]将70例首次行永久性肠造口术出院后的病人随机分为对照组和观察组,每组35例,对照组实施常规延续性护理,观察组在此基础上利用"永久性肠造口病人护理干预模式记录表"结合微信平台进行指导干预。出院时及出院后3个月、6个月应用奥马哈结果评价系统量表和并发症发生率进行效果评价。[结果]出院后3个月,除性生活问题外,观察组病人在其他护理问题认知、行为、状况方面的改善与对照组比较差异有统计学意义(P0.05),6个月时所有护理问题改善与对照组比较差异均有统计学意义且并发症发生率显著低于对照组(P0.05)。[结论]永久性肠造口病人护理干预模式记录卡结合微信平台的延续护理模式能够改善病人护理问题的护理结局,降低并发症发生率。     

应用奥马哈系统评价糖尿病延续护理的干预效果

目的应用奥马哈系统对糖尿病延续护理干预的效果从认知、行为、状况3个方面进行评价。方法采用方便抽样法,选取43例糖尿病患者实施延续性护理干预,干预时机为入院至出院后1个月,并从认知、行为和状况3个方面进行效果评价。结果除皮肤问题的状况评分差异无统计学意义外(P0.05),其他护理问题干预前后的认知、行为、状况差异均有统计学意义(P0.05)。结论奥马哈系统可量化糖尿病延续护理干预效果,为延续护理实践提供参考依据。     

奥马哈系统在骶神经调节器植入术患者延续性护理中的应用效果

目的探讨奥马哈系统在骶神经调节器植入术患者延续护理中的应用效果。方法以奥马哈系统为理论依据构建患者的延续护理方案,对35例行骶神经调节器植入术的患者,从Ⅰ期术后出院当天至Ⅱ期术后1个月进行连续7次护理干预活动,比较干预前、后患者在各领域主要护理问题的认知、行为和状况评分变化情况。结果经延续护理干预,至Ⅱ期术后1个月,患者在生理、心理、健康相关、环境领域、较临时刺激器植入术后当天均有改善,差异有统计学意义(P<0.05)结论以奥马哈系统为理论依据的骶神经调节器植入术患者延续护理方案,可以提高患者的护理结局,促进患者回归社会。     

基于奥马哈系统的护理实践在直肠癌肠造口病人中的临床应用

[目的]探讨基于奥马哈系统的护理实践在直肠癌造口病人中的临床应用。[方法]基于奥马哈系统,运用护理程序发现问题、跟踪问题、解决问题,对40例直肠癌造口手术病人从入院至术前、手术至出院前、出院后3个月内3个阶段进行连续跟进,分析并评价主要护理问题及护理结局的变化。[结果]从入院至出院后3个月内,发生率超过30%的护理问题有皮肤、排便功能、消化-水合、社交、角色改变、精神健康、营养、睡眠、个人照顾。出院后3个月,皮肤、排便功能、消化-水合、社交、角色改变、精神健康、营养、睡眠和个人照顾的认知、行为、状况改善效果明显(P0.05);消化-水合的认知、行为改善效果明显(P0.05),状况无明显改善(P0.05)。[结论]基于奥马哈系统的护理实践反映了直肠癌造口手术病人入院至出院后3个月内的常见护理问题和干预方向,可以改善直肠癌造口手术病人的护理结局。     

基于奥马哈系统的个案管理应用于肠造口患者的效果研究

目的探讨基于奥马哈系统的个案管理对肠造口患者造口适应能力及并发症发生率的影响。方法将2017年4月至12月拟行肠造口手术128例结直肠癌患者随机分为对照组和实验组,对照组65例实施围手术期常规护理,实验组63例实施基于奥马哈系统的个案管理,比较出院后6个月两组患者的健康状况评分、造口并发症发生率和造口适应能力。结果干预后实验组患者的健康状况明显改善、造口并发症发生率下降、造口适应能力提高,差异均具有统计学意义(P0.01或P0.05)。结论基于奥马哈系统的个案管理有效改善了肠造口患者的健康问题,降低了并发症发生率,提高了患者的造口适应能力,进而提高了患者的生活质量。     

全髋关节置换术患者连续性护理模式的构建及应用

目的构建全髋关节置换术患者连续性护理模式,在认知、行为及状况3个方面给患者不间断的干预,以达到良好的护理结局。方法以奥马哈系统为理论框架构建全髋关节置换术患者连续性护理模式,并对40例全髋关节置换术患者从入院至术前、手术至出院前、出院后3个月内的3个阶段进行连续性跟进。结果经采用全髋关节置换术患者连续性护理模式进行评估和评价,所有患者出院后都存在身体活动及自我照顾问题,患者疼痛状况的改善有统计学意义(F=3.51,P<0.05),对邻里、工作场所安全问题的认知改善有统计学意义(P<0.05),而行为和状况的改善无统计学意义(P>0.05)。结论以奥马哈系统为理论依据的全髋关节置换术连续性护理模式,可以提高全髋关节置换术患者的护理结局,改善患者的生活质量。     

奥马哈系统在脑卒中病人社区康复护理中的应用

目的:应用奥马哈系统对出院后一个月内的社区脑卒中病人居家康复效果从认知、行为、状况3个方面进行结局评价.方法:采用方便取样方法选取25例脑卒中病人进行3次社区家庭访视,社区护士应用奥马哈系统评估护理问题,并在实施针对性干预后从认知、行为和状况(K-B-S)方面进行结局评价.结果:脑卒中病人卫生的认知和行为干预效果不明显,疼痛的状况改善不明显及排使功能的行为和状况干预效果不明显(P＞0.05).其他健康问题干预前后的认知、行为、状况差异具有统计学意义(P＜0.05或P＜0.01).结论:对出院后一个月内的脑卒中病人进行社区康复护理干预后,应用奥马哈系统从认知、行为、状况3个方面进行结局评价,可明确干预效果,为评价社区护士康复护理干预效果提供依据.     

基于奥马哈系统的延续护理在PICC带管出院患者中的应用研究

目的探讨基于奥马哈系统的延续护理在经外周静脉置入中心静脉导管(PICC)带管出院患者中的应用效果。方法采用方便抽样法,选取选取2019年8～11月就诊于山西医科大学第一医院静脉通路中心的47例PICC带管出院患者实施延续护理,分别在第1、2、3化疗周期进行评估干预并从认知、行为及状况3方面进行效果评价。结果带管出院期间,常见护理问题13个,干预前后患者的认知、行为、状况差异均有统计学意义(P<0.05)。结论基于奥马哈系统的护理实践反映了PICC带管出院患者的常见护理问题,奥马哈系统可量化PICC带管出院患者延续护理的干预效果,为延续护理的临床实践提供参考依据。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

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.     

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.