2种方法预防压疮的效果分析

目的研究液体石蜡对脑血管疾病及颅脑损伤等压疮高危病员的预防效果。方法把120例患者随机分成实验组、对照组。实验组（61例）把石蜡熔化后冷却至40～50℃左右，放在易发生压疮的受压部位；对照组（59例）采取传统翻身按摩法预防压疮，观察2组压疮发生率。结果实验组61例有2例1期压疮发生，对照组59协有10例Ⅰ期压疮发生。通过检验，X^2：6．627，P〈0．05，2组结果差异有统计学意义。结论石蜡热敷预防压疮的发生明显优于翻身按摩法，值得在一临床中推广应用。     

Associative and behavioral tolerance to the analgesic effects of nicotine in rats: tail-flick and paw-lick assays

Rationale Theories of drug tolerance differentiate between associative and behavioral (instrumental) drug tolerance. However, there is little research comparing these two forms of drug tolerance beyond alcohol and morphine.Objective We examined the time course development of associative and behavioral tolerance to the analgesic effects of nicotine.Methods and results Associative tolerance was investigated by giving independent groups of rats one, five, 15, ten or 20 administrations of nicotine either explicitly paired or unpaired with a distinctive context. Associative tolerance, assessed in the tail flick, developed more rapidly and reached greater magnitude when nicotine and distinctive context were explicitly paired than when they were unpaired. This effect was evidenced after the fifth conditioning session and was maintained through the tenth, 15th, and 20th sessions. Contextual tolerance, assessed in the hot plate, was first evident after ten sessions. However, this effect disappeared safter 15 and 20 sessions. A second study examined the acquisition of behavioral tolerance to the disruptive effects of nicotine on the hot-plate response. Animals that practiced the test response while drugged developed greater tolerance than animals receiving as much nicotine and hot-plate practice but with these two conditions explicitly unpaired. This effect was evident in two different environments but did not generalize to the tail-flick test.Conclusions The findings suggest that contextual tolerance to drug effects is test specific, with tail-flick responses depending on cue-associative tolerance processes and hot-plate responses requiring procedures that allow the animal to practice the test response while drugged.     

Sitz Bath: Where Is the Evidence? Scientific Basis of a Common Practice

PURPOSE This study was designed to determine if evidence exists to justify and support the recommendation of sitz bath in the management of anorectal disorders. METHODS A Medline search was conducted using the key words “sitz bath” and “hot bath.” RESULTS Thirty-six articles were found which highlighted the physiology, benefits, risks, complications, and techniques of sitz bath. Most of the studies were published in gynecologic or nursing journals. One randomized study comparing sitz bath to placebo was found. Two articles speculated that sitz bath induces relaxation of the internal sphincter muscle. Cold sitz bath was reported to decrease perineal edema more than warm sitz bath, although patients tended to prefer the latter. Five articles reported complications of sitz bath, including dissemination of herpes, maternal–neonatal Streptococcus outbreak, and skin burns. CONCLUSION A review of the literature demonstrated a lack of scientific data to support the use of sitz bath in the treatment of anorectal disorders. Additional randomized and controlled clinical studies are needed to investigate whether this time consuming recommendation is beneficial to patients. Reprints are not available.     

Pilot evaluation of black cohosh for the treatment of hot flashes in women

Background. Hot flashes cause significant morbidity in postmenopausal women, including women with breast cancer. We undertook a pilot study to estimate the effectiveness of black cohosh to reduce hot flashes. Methods. Women who reported significant hot flashes (≥ 14 per week) were enrolled. Black cohosh was given in the form of the commercial product Remifemin. The first week was a no-treatment baseline period, and therapy was given for the subsequent 4 weeks. Hot flash data were collected by daily questionnaires during baseline and treatment weeks. Adverse effects were recorded. Results. Twenty-one women completed the study. Their mean age was 56 years (range, 38-80). Thirteen patients had a history of breast cancer. Six patients were taking tamoxifen or raloxifene. Patients reported an average of 8.3 hot flashes per day during the baseline week. The reduction in mean daily hot flash frequency was 50% (95% CI, 34%-65%), while weekly hot flash scores were reduced 56% (95% CI, 40%-71%) at completion of the study. Overall, patients reported less trouble with sleeping, less fatigue, and less abnormal sweating. No patients stopped therapy because of adverse effects. Conclusions. Black cohosh appeared to reduce hot flashes and had a low toxicity. The efficacy found in this trial seems to be more than would be expected by a placebo effect (20%-30% hot flash reduction in previous trials). These results suggest that further evaluation of this black cohosh preparation with a phase III randomized trial is indicated.     

(-)-Linalool produces antinociception in two experimental models of pain

Linalool is a monoterpene compound commonly found as a major component of the essential oils of several aromatic plant species, many of which are used in traditional medical systems as analgesic and anti-inflammatory remedies. We previously reported that (-)-linalool, the natural occurring enantiomer, plays a major role in the anti-inflammatory activity displayed by different essential oils, suggesting that linalool-producing species are potentially anti-inflammatory agents. In this study, the antinociceptive activity of (-)-linalool was examined in two different pain models in mice: the acetic acid-induced writhing response, a model of inflammatory pain, and the hot plate test, a model of supraspinal analgesia. Moreover, the effect of (-)-linalool on spontaneous locomotor activity (25, 50, 75 and 100 mg/kg) was evaluated. The results show that this compound induced a significant reduction of the acid-induced writhing at doses ranging from 25 to 75 mg/kg. Such effect was completely reversed both by the opioid receptor antagonist naloxone and by the unselective muscarinic receptor antagonist atropine. In the hot plate test, only the dose of 100 mg/kg of (-)-linalool resulted in a significant effect. (-)-Linalool induced a dose dependent increase of motility effects, thus ruling out the confounding influence of a possible sedative effect. The more pronounced effect of (-)-linalool on the writhing test with respect to the hot plate test is consistent with the observation that (-)-linalool possesses anti-inflammatory activity. Finally, the activation of opioidergic and cholinergic systems appears to play a crucial role in (-)-linalool-induced antinociception.     

The role of serotonin in hot flushes

Hot flushes are experienced in those periods of the female life when estrogen levels are low. Hormone replacement therapy is thus the first choice for treatment of hot flushes. However this treatment is not always accepted or contraindicated for a variety of reasons. Estrogen (and progestogen) strongly interact with a number of neurotransmitters and this has led to a range of non-hormonal treatments including compounds that act via the noradrenergic or dopaminergic systems as well as herbal remedies. These treatments (which are shortly reviewed) are not always successful. Surprisingly, apart from treatment with some selective serotonin (5-HT) reuptake inhibitors (SSRI's), up till now, little attention is given to the strong interaction of estrogens with the serotonergic system. These interactions are shortly reviewed. Based on these interactions, a hypothesis on the genesis of hot flushes is postulated. Especially the 5-HT_2A receptor subtype may play a key role in the occurrence of hot flushes. A number of arguments that support this hypothesis are discussed.     

The Hot Flash Related Daily Interference Scale: A Tool for Assessing the Impact of Hot Flashes on Quality of Life Following Breast Cancer

To assess the psychometric properties of the Hot Flash Related Daily Interference Scale (HFRDIS), a sample of breast cancer survivors and an age-matched comparison group completed a questionnaire packet and 2-day prospective hot flash diary at an initial time point and again 6 months later. There were 71 breast cancer survivors and 63 comparators at Time 1, and 54 survivors and 46 comparators at Time 2. The HFRDIS was internally consistent, with alphas of 0.96 at times 1 and 2. Validity was supported through 1) correlations with other hot flash variables, 2) correlations with measures of affect and mood, 3) significant differences between women with hot flashes and those without, and 4) demonstrated sensitivity to change over time. The HFRDIS is a psychometrically sound measure for assessing the impact of hot flashes on daily activities and overall quality of life in clinical practice or research protocols.     

护士对出入量的认知与记录准确性的相关性分析

记录液体出入量（简称出入量）是指将患者24h内的摄人量与排泄量详细地记录在护理记录单上，为临床了解病情，协助诊断，决定治疗方案提供重要依据。因而准确记录出入量是一项十分重要的基础护理工作。由于出入量所包含项目的多样性，在实践中记录出入量容易产生误差，存在着漏记、记量不准确等现象。为进一步分析出入量记录存在误差的原因，     

Benefits of hormone replacement therapy in postmenopausal women

PURPOSE: To provide an overview of current research regarding hormone replacement therapy (HRT) and to assist healthcare providers to better educate patients about potential benefits of this therapy. DATA SOURCES: A systematic review of healthcare literature was conducted with 602 articles selected from CINAHL, Medscape, Pubmed, and Medline databases. Keywords directing the search included hormone replacement therapy, benefits of hormone replacement therapy and trends, hormone replacement therapy and osteoporosis, hormone replacement, and menopause symptoms. CONCLUSIONS: According to the literature, HRT can assist women with postmenopausal symptoms. In addition, research shows that HRT can help some postmenopausal women with selected comorbid conditions such as osteoporosis, type II diabetes, certain cardiovascular pathologies, and colorectal cancer. The decision as to who should use any form of HRT needs to be based on the individual woman's needs, quality of life, and potential risks versus benefits. IMPLICATIONS FOR PRACTICE: HRT has been a benefit to many women in the treatment of postmenopausal symptoms. Recent studies have shown that HRT, whether it is combined estrogen and progestin therapy, or estrogen-only therapy, can help postmenopausal women with osteoporosis and some selected comorbid conditions. Recent research indicates that some women are dying from comorbid conditions rather than breast cancer. Although the research regarding HRT in some areas may be limited, further research adds to existing knowledge and offers new ideas and possibilities in the treatment of postmenopausal symptoms and selected comorbid conditions. Certainly HRT can improve quality of life and possibly longevity for selected women. Ongoing research is needed to further validate such benefits, as well as to further explore the risks and benefits of long-term HRT. Increased knowledge about HRT will help healthcare providers better educate patients about the potential benefits of HRT, while providing documentation about who should take selected types of HRT or whether alternative treatment is preferred.     

Moclobemide in the treatment of hot flashes in postmenopausal women

This randomized, prospective, double-blind study evaluated the efficacy and tolerability of moclobemide, a reversible, selective inhibitor of monoamine oxidase-A, in reducing the frequency and severity of hot flashes. Thirty post-menopausal women were enrolled, and 28 were allocated to 5 weeks of treatment with moclobemide 150 mg (group 1, n = 10), moclobemide 300 mg (group 2, n = 11), or placebo (group 3, n = 9). Data on hot flashes were recorded in a daily diary. Mean reductions in the hot flash severity score were 24.4% in the placebo group, 69.8% in group 1, and 35.0% in group 2. This large difference suggests that the beneficial effects were not due to a placebo effect. Moclobemide may be a new nonhormonal option for reducing the incidence, severity, and duration of hot flashes in postmenopausal women who do not wish to take estrogen or have contraindications to its use.