重症甲型H1N1流感患者的气道管理

<正>甲型H1N1流感是由甲型H1N1流感病毒感染引起的急性呼吸系统传染病。少数病例病情进展迅速,出现呼吸衰竭、多脏器功能不全或衰竭。这些病人除需一般抗病毒治疗外,常需要机械通气治疗。     

How to run an effective and efficient dermato‐oncology unit: a Dutch approach

The worldwide incidence of skin cancer (especially non‐melanoma skin cancer) has risen dramatically over the last decades. Skin cancer, including pre‐malignant lesions, is becoming a chronic disease. Adjustments in skin cancer health care need to be made. A disease management system for skin cancer is mandatory in order to avoid waiting lists and insure adequate treatment quality with ever growing numbers of patients requiring treatment. At the Catharina Hospital Eindhoven adjustments are being made on several levels of the dermato‐oncology unit in collaboration with Eindhoven University of Technology. The model combines technological improvements, training health care workers, training of general practitioners and prevention of skin cancer. We discuss our ideas and clinical experiences with managing a dermato‐oncology unit.     

Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review

BackgroundHigh profile accounts of failures in patient care reflect an urgent need for transformational development in healthcare. Appreciative Inquiry is promoted as an approach to exploring and bringing about change in social systems. Appreciative Inquiry has been used extensively in North American business since the late 1980s. The application of Appreciative Inquiry may have merit in the complex world of human health experiences.ObjectivesTo identify, evaluate and synthesise the evidence about the impact of Appreciative Inquiry on changing clinical nursing practice in in-patient settings.DesignAn integrative review and narrative synthesis.SettingIn-patient settings including paediatrics, maternity and mental health.ParticipantsNurses of all grades, patients, carers, relatives, other healthcare professionals including allied healthcare staff, management and students.Data sourcesAn electronic search of the following electronic databases was performed in January 2015 and updated in July 2015: MEDLINE, EMBASE, Cochrane Library (Cochrane database of systematic reviews), Cumulative Index of Nursing and Allied Health Literature, PsychINFO, PsychARTICLES, Amed, Assia, Scopus and Web of Science. Hand searching of reference lists of included studies was undertaken. Limits were set to include literature published in English only and publications from 1990 to July 2015.Review methodsThree reviewers independently assessed eligibility for inclusion and extracted data. Full text articles were systematically appraised using a standardised data extraction instrument in conjunction with criteria to assess whether change using Appreciative Inquiry is transformational.ResultsEight studies (reported in 11 papers) met the inclusion criteria. Overall, these studies demonstrate poor application of Appreciative Inquiry criteria in a nursing context. This makes judgement of the impact difficult. One study achieved transformation against agreed criteria for Appreciative Inquiry. Other included studies demonstrated that Appreciative Inquiry is being perceived as a gateway to knowledge translation rather than transformative change in practice.ConclusionsAppreciative Inquiry offers potential for nurse practice development and change but not without cognisance of the pivotal components. If Appreciative Inquiry is to be perceived as a legitimate research endeavour, there must be engagement and attention to rigour. Findings suggest caution is required against the choreography of Appreciative Inquiry where participant experiences are moulded to fit a previously drafted master plan. Further research is needed to explore the role of expert facilitation in securing and sustaining successful outcomes of Appreciative Inquiry.     

End-of-life decision-making in individuals with Locked-in syndrome in the acute period after brainstem stroke

Locked-in syndrome (LIS) is commonly associated with a poor prognosis, particularly if the aetiology is stroke. Dealing with individuals with LIS and a poor prognosis raises the issue of introducing end-of-life discussions with the patient and/or family in the acute period of the illness. Existing literature regarding LIS provides little guidance about end-of-life decision-making in the acute management phase. We aim to provide some guidance for clinicians holding end-of-life discussions in the acute management period. We report two cases of relatively young individuals with LIS secondary to brainstem stroke. Both cases had a very poor prognosis and end-of-life discussions were commenced by the treating team in the acute phase. Despite the severity of their conditions, in neither case were end-of-life discussions well tolerated by the family in the weeks following admission. We suggest that LIS patients and their families, who have chosen to persist with full medical management after diagnosis of LIS, should be provided with sufficient time to adjust to the catastrophic changes that have occurred before further end-of-life discussions are pursued. Education and support are likely to be highly beneficial in the acute period post stroke as they allow the patient and family to develop a realistic understanding of the likely outcomes of their decisions.     

A pharmacotherapy review of the novel,oral antithrombotics

Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications.     

生殖中心全流程管理中的护理

本文介绍了生殖中心全流程管理的概念及生殖中心护士角色功能,提出全流程管理中的辅助生殖护理必须基于患者需求及生殖临床需求。具体实施步骤:分析全流程管理各环节患者需求及临床需求,明确护理任务;根据护理任务确定全流程管理各环节所应具备的护理核心能力;系统培训与考核后,确保全流程管理各环节护理"人岗匹配";落实基于生殖中心患者需求及临床需求的护理;实施与绩效考核挂钩的护理质量评价与反馈。解读生殖中心全流程管理中"知其然知其所以然"护理思维、"防患于未然"的护理意识、"细致入微、润物无声"的护理艺术、"勤于思考、勇于创新"的护理文化。     

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??Food allergy related digestive disease refers to damage of digestive tract mucosa caused by allergy??and digestive tract symptoms are the main manifestation. Including oral allergy syndrome??anaphylaxis??food protein-induced enteropathy??food protein-induced enterocolitis syndrome??food protein-induced proctocolitis??celiac disease??eosinophilic esophagitis??eosinophilic gastroenteritis. The diagnosis was based on history??manifestation??and food chanllenge. Skin prick test and specific serum IgE test are helpful for screening IgE mediated food allergy. Endoscopy should be based on different disease conditions. The management principles of these diseases include avoiding diet??choosing proper nutrition substitute??following up??carrying out nutrition monitoring and evaluation??and rationally using medicine.     

Malignant liver tumours

The liver is commonly affected by both primary and metastatic malignancy. The surgical management of liver tumours must be carefully considered to ensure good oncological outcomes and to avoid serious complications of liver surgery. Primary tumours of the liver include hepatocellular carcinoma and cholangiocarcinoma. The resectability of primary liver tumours is dependent on thorough preoperative staging. Primary liver tumours pose a major global health burden, particularly in Asia and in countries affected by epidemic viral hepatitis. Metastatic disease commonly affects the liver and often hepatic resection in such circumstances provides the best chance of prolonging life and disease free survival. This review discusses recent advances, in addition to the epidemiology, diagnosis and management of both primary and secondary liver tumours.