基于ERAS理念的HAPA模型健康教育在肝切除术中的应用效果

目的 探讨基于加速康复外科（ERAS）理念的健康行动过程取向（HAPA）模型健康教育在肝切除术中的应用效果。方法 选取2020年1月至2022年6月在湖北省荆州市第一人民医院行肝切除术的患者90例,按照随机数字表法,分为干预组和对照组,每组45例。对照组给予常规健康教育,干预组给予基于ERAS理念的HAPA模型健康教育,比较两组患者术后身体体征恢复情况、自我效能感、健康行为、自我管理能力差异。结果 干预组患者首次活动时间为（23.87±4.32）min、首次进食时间为（9.87±2.67）h、首次通气时间为（45.28±4.32）min、引流管拔管时间为（22.45±4.25）h、住院时间为（10.53±2.85）d,均短于对照组,差异均有统计学意义（P<0.05）;干预后,干预组患者自我效能感量表、健康促进生活方式量表Ⅱ、成年人健康自我管理能力测评量表评分均高于对照组,且干预前后各指标差值比较,差异均有统计学意义（P<0.05）。结论 肝切除术患者采用基于ERAS理念的HAPA模型健康教育干预,能够提高术后身体体征恢复效率,改善患者自我效能感、健康行为及自我管理能力。     

First experience in healthy volunteers with technetium-99m l,l-ethylenedicysteine,a new renal imaging agent

Animal studies have indicated that technetium-99m l,l-ethylenedicysteine (^99mTc-l,l-EC) may be a promising tracer agent for renal function studies. We have performed a paired study with ^99mTc-mercaptoacetyltriglycine (^99mTc-MAG₃) and ^99mTc-l,l-EC in six male volunteers. In both cases, iodine-131-labelled o-iodohippurate was co-injected as an internal biological standard. The analog images between 0 and 30 min p.i. were of identical diagnostic value for both tracer agents. The two renograms were similar in all volunteers. The mean 1-h plasma clearance for ^99mTc-MAG₃ and 99 mTc-l,l-EC was significantly different, respectively 382.9 ± 17.1 ml/min per 1.73 m² versus 460.2 ± 47.7 ml/min per 1.73 m² (P<0.003). The urinary excretion after 30 min p.i. was 69.4% ± 5.6% of the injected dose for ^99mTc-MAG₃ versus 66.5% ± 2.5% for ^99mTc-l,l-EC (P>0.05) and after 60 min p.i. respectively 83.1% ± 3.9% versus 79.8 % ± 4.3 % (P > 0.05). ^99mTc-l,l-EC has a very low plasma protein binding (31% ± 6.8%) as compared to ^99mTc-MAG₃ (88% ± 5.2%) and a larger volume of distribution. Although the exact mechanism responsible for the high plasma clearance of ^99mTc-l,l-EC is not yet fully known, we conclude that this new agent merits further clinical evaluation in patients to establish its value as a renal radiopharmaceutical. Correspondence to: A. Verbruggen     

215例正常新生儿瞬态诱发耳声发射测试分析及随访研究

目的：进一步了解正常新生儿瞬态诱发耳声发射（TEOAE）的特征，为新生儿听力筛查提供帮助。方法：采用ILO96型耳声发射仪，对出生后0（出生当天）-8d的215例（425耳）正常新生儿进行TEOAE测试，并跟踪随访结果：TEOAE总检出率为89%，检出率与检测时的天龄有一定的关系。新生儿出生后0-3d检出率平均为72%，4-8d为97%，分娩方式，左右耳，孕龄36至41周间的差异对检出率无明显影响；女性的检出率显著高于男性，快速扫描较TEOAE测试敏感，经随访确诊有1耳听力损害。结论：新生儿听力筛查应在出生后≥4d出院前进行；分娩方式对耳蜗功能无明显影响；人耳蜗毛细胞的成熟是在怀孕36周以前；快速扫描不能代替TEOAE测试；对于1耳或双耳未检出TEOAE的受测者必须跟踪随访和复检，并结合ABR测试尽早确诊。     

健康教育在住院精神病人康复中的作用

目的探讨健康教育在住院精神病人康复中的作用。方法实验组78例,采用药物与健康教育相结合的方式;对照组82例,单用药物治疗。对两组的治疗结果采用《护士用住院病人观察量表》(NOSIE)评定。结果实验组与对照组的病情康复程度存在显著性差异(P<0.05)。结论健康教育对精神患者的康复有一定的促进作用。     

构建健康和谐医患关系的实践与思考

通过对构建健康和谐医患关系内涵和重要性的研讨，结合医疗单位注重和谐医患关系建设的实践，提出构建健康和谐医患关系的若干思考：要坚持公共医疗卫生公益性质和人本理念，注重医疗服务的公平要求，大力建设文明、创新的医院文化．加强医德实践与健全规章制度，强化医疗质量管理与深化人性化医疗服务，执行医药物价收费政策与降低医疗服务费用，形成让患者满意和社会放心的医疗服务环境，定能构建起健康和谐的医患关系。     

健康人动脉结构及功能改变与室间隔厚度的相关性研究

目的 研究健康人中动脉结构和功能改变与心室间隔厚度的关系.方法 以颈动脉内膜中层厚度( IMT)和肱动脉血流介导的血管舒张反应(FMD)二指标反应动脉结构和功能改变.采用超声多普勒测定68例健康人(男16人,女52人)的IMT、FMD和室间隔厚度( IVST).结果 健康人中IVST与IMT呈正相关(r=0.394,P=-0.001),与FMD呈负相关(r=0.337,P＜ 0.01),IVST也与年龄和收缩压呈正相关.以IVST为因变量的多因素回归分析显示,IMT和FMD是其独立影响因素.结论 健康人中IMT、FMD和IVST相关,动脉结构和功能改变影响心室间隔厚度.     

The more the better? A meta-analysis on effects of combined cognitive and physical intervention on cognition in healthy older adults

Both cognitive intervention and physical exercise benefit cognitive function in older adults. It has been suggested that combined cognitive and physical intervention may induce larger effects than cognitive or physical intervention alone, but existing literature has shown mixed results. This meta-analysis aimed at assessing the efficacy of combined intervention on cognition by comparing combined intervention to control group, cognitive intervention and physical exercise. Eligible studies were controlled trials examining the effects of combined intervention on cognition in older adults without known cognitive impairment. Twenty interventional studies comprising 2667 participants were included. Results showed that the overall effect size for combined intervention versus control group was 0.29 (random effects model, p = 0.001). Compared to physical exercise, combined intervention produced greater effects on overall effect size (0.22, p < 0.01), while no significant difference was found between combined intervention and cognitive intervention. Effects of combined intervention were moderated by age of participants, intervention frequency and setting. The findings suggest that combined intervention demonstrates advantages over control group and physical exercise, while evidence is still lacking for superiority when compared combined intervention to cognitive intervention. More well-designed studies with long follow-ups are needed to clarify the potential unique efficacy of combined intervention for older adults.     

Nut consumption and age-related disease

Current knowledge on the effects of nut consumption on human health has rapidly increased in recent years and it now appears that nuts may play a role in the prevention of chronic age-related diseases. Frequent nut consumption has been associated with better metabolic status, decreased body weight as well as lower body weight gain over time and thus reduce the risk of obesity. The effect of nuts on glucose metabolism, blood lipids, and blood pressure is still controversial. However, significant decreased cardiovascular risk has been reported in a number of observational and clinical intervention studies. Thus, findings from cohort studies show that increased nut consumption is associated with a reduced risk of cardiovascular disease and mortality (especially that due to cardiovascular-related causes). Similarly, nut consumption has been also associated with reduced risk of certain cancers, such as colorectal, endometrial, and pancreatic neoplasms. Evidence regarding nut consumption and neurological or psychiatric disorders is scarce, but a number of studies suggest significant protective effects against depression, mild cognitive disorders and Alzheimer’s disease. The underlying mechanisms appear to include antioxidant and anti-inflammatory actions, particularly related to their mono- and polyunsaturated fatty acids (MUFA and PUFA, as well as vitamin and polyphenol content). MUFA have been demonstrated to improve pancreatic beta-cell function and regulation of postprandial glycemia and insulin sensitivity. PUFA may act on the central nervous system protecting neuronal and cell-signaling function and maintenance. The fiber and mineral content of nuts may also confer health benefits. Nuts therefore show promise as useful adjuvants to prevent, delay or ameliorate a number of chronic conditions in older people. Their association with decreased mortality suggests a potential in reducing disease burden, including cardiovascular disease, cancer, and cognitive impairments.