不同手术时机治疗98例老年髋部骨折患者的临床效果分析

目的探讨不同手术时机治疗老年髋部骨折患者的临床疗效。方法本文选择我院2016年3月～2018年3月收治的98例患者随机分为观察组(n=49)和对照组(n=49)。两组均进行手术治疗,观察组伤后到手术时间4～6 h,对照组伤后到手术时间2～3周。观察比较手术时间、术中出血量、住院时间、术后1周及3个月Harris评分及术后并发症发生情况。结果治疗后,观察组住院时间为(6.53±2.01)d与对照组的(7.32±1.87)d比较缩短(t=-2.014,P=0.047)。术后1周,两组Harris评分与治疗前比较均显著升高(t=-9.507,P=0.000;t=-9.131,P=0.000);且观察组Harris评分(89.02±20.73)显著高于对照组(81.11±16.42)(t=2.094,P=0.039)。术后3个月,观察组Harris评分(84.65±15.41)显著高于对照组(76.92±13.22)(t=2.665,P=0.009)。观察组术后并发症发生率(14.29%)显著低于对照组(32.65%)(χ~2=4.602,P=0.032)。结论在充分评估患者可以耐受手术的前提条件下,及时早期手术治疗老年髋骨骨折临床疗效显著,可有效缩短患者住院时间,改善患者髋关节功能,减少术后并发症,提高患者生活质量,值得推广应用。     

异丙酚与七氟醚麻醉对老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较

目的探讨异丙酚与七氟醚麻醉对老年老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较。方法选取2015年1月～2017年12月择期输尿管镜手术治疗的老年患者80例,分为异丙酚组和七氟醚组各40例,分别采用异丙酚静脉麻醉和七氟醚吸入麻醉。观察两组患者麻醉术后苏醒质量指标,并评估麻醉前(T0)、术后4 h(T1)、术后12 h(T2)及术后24 h(T3)认知功能的变化,并比较两组不良反应情况。结果异丙酚组患者的自主呼吸恢复时间、睁眼时间和拔管时间明显短于七氟醚组(P0.05)。两组患者T1和T2时MMSE评分均较T0时明显下降(P0.05);且七氟醚组患者下降幅度较异丙酚组更明显(P0.05);两组患者T3时MMSE评分均恢复至T0时水平(P0.05)。观察组与对照组分别出现不良反应3例(7.50%)、5例(12.50%),症状均较轻,两组比较差异无统计学意义(χ2=0.14,P0.05)。结论与七氟醚吸入麻醉相比,异丙酚静脉麻醉用于老年输尿管镜患者术后具有苏醒速度快、呼吸恢复快、拔管时间早、认知功能影响较少及安全性较好等优点。     

早期护理干预在预防老年非小细胞肺癌患者术后肺部感染及呼吸衰竭中的应用效果评价

目的研究分析早期护理干预在预防老年非小细胞肺癌患者术后肺部感染及呼吸衰竭中的应用效果。方法选择2017年3月～2018年3月期间我院收治的的老年非小细胞肺癌患者60例,根据红蓝球分组的方式分为对照组和观察组,每组各30例。对照组接受常规护理,观察组联合早期护理干预,对两组患者的护理效果进行比较。结果观察组患者肺部感染发生率与呼吸衰竭发生率均显著低于对照组,差异有统计学意义(P0.05);两组患者护理前ALB、TCH、TG以及TLC比较,差异无统计学意义(P0.05);护理后两组患者的各项指标均较护理前改善,且观察组改善幅度最为明显,差异有统计学意义(P0.05);观察组患者住院时间明显较对照组少,护理满意度评分则明显较对照组高,差异有统计学意义(P0.05)。结论早期护理干预在预防老年非小细胞肺癌患者术后肺部感染及呼吸衰竭中效果显著。     

Meeting women’s demand for contraceptives in Ghana: Does autonomy matter?

This study addressed a basic conceptual gap in research on the relationship between women’s autonomy and contraceptive behavior and included intention to use while measuring the unmet demand for family planning. The study used data from the 2014 Ghana Demographic and Health Survey. The weighted sample included 2,017 sexually active, non-pregnant, fecund women in unions, aged 15–49 years, who wanted to delay conception for at least 2 years. The relation of household decision-making autonomy to current contraceptive use and intention was assessed, adjusting for women’s socio-demographic, partner, and couple characteristics. About half of the women studied had a met demand for contraception, and over a third had no intention to use a contraceptive method in the future. In adjusted multinomial logistic regression models, household decision-making autonomy was not significantly associated with met contraceptive demand for contraceptives, but was associated with their intentions to use contraception (p = .05). Formal education, age, wealth, and region of residence were significantly associated with having a met demand. In Ghana, women’s household decision-making autonomy appears to have modest relation to contraceptive uptake. Programs to improve meeting contraceptive demand should consider contextual factors and place differences in contraceptive uptake.     

Examining the contraceptive decisions of young,HIV-infected women: A qualitative study

This study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically and horizontally HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with ≥1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from health-care providers and input from family and friends influenced their contraceptive choices. They also considered a particular method’s advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women’s contraceptive decisions were influenced by factors other than those related to their infection.     

Implementing Substance Use Screening in Family Planning

Although substance use has negative health effects on women, especially during the reproductive years, family planning practices in which nurse practitioners are key care providers, generally do not adequately screen and intervene for alcohol and drugs. Screening, brief intervention, and referral to treatment (SBIRT) can limit the effects of substance use on women and families. This study explored barriers and facilitators to SBIRT through qualitative analysis of focus groups with family planning providers. Results suggest family planning providers are favorable to implementation. Barriers include training and organizational support; facilitators include use of electronic health records and setting patient expectations.     

Ankle power biofeedback attenuates the distal-to-proximal redistribution in older adults

BackgroundCompared to young adults, older adults walk slower, with shorter strides, and with a characteristic decrease in ankle power output. Seemingly in response, older adults rely more than young on hip power output, a phenomenon known as a distal-to-proximal redistribution. Nevertheless, older adults can increase ankle power to walk faster or uphill, revealing a translationally important gap in our understanding.Research questionOur purpose was to implement a novel ankle power biofeedback paradigm to encourage favorable biomechanical adaptations (i.e. reverse the distal-redistribution) during habitual speed walking in older adults.Methods10 healthy older adults walked at their preferred speeds while real-time visual biofeedback provided target increases and decreases of 10 and 20% different from preferred ankle power. We evaluated the effect of changes in ankle power on joint kinetics, kinematics, and propulsive ground reaction forces. Pre and post overground walking speed assessments evaluated the effect of increased ankle power recall on walking speed.ResultsBiofeedback systematically elicited changes in ankle power; increasing and decreasing ankle power by 14% and 17% when targeting ±20% different from preferred, respectively. We observed a significant negative correlation between ankle power and hip extensor work. Older adults relied more heavily on changes in ankle angular velocity than ankle moment to modulate ankle power. Lastly, older adults walked almost 11% faster when recalling increased ankle power overground.SignificanceOlder adults are capable of increasing ankle power through targeted ankle power biofeedback – effects that are accompanied by diminished hip power output and attenuation of the distal-to-proximal redistribution. The associated increase in preferred walking speed during recall suggests a functional benefit to increased ankle power output via transfer to overground walking. Further, our mechanistic insights allude to translational success using ankle angular velocity as a surrogate to modulate ankle power through biofeedback.     

上海市金山区妇产科医务人员对孕产妇精神障碍的识别和处理

目的了解上海市金山区妇产科医务人员对孕产妇常见精神疾病的识别率和处理能力,为有针对性地开展培训提供依据。方法通过分层随机抽样选取了全区98名妇产科医务人员开展《孕产妇常见心理行为问题案例分析》问卷调查。结果调查对象中90.4%的受访者能够正确识别产后抑郁症,仅13.8%的调查对象能够正确识别精神分裂症,52.1%的调查对象能够正确识别孕期焦虑症;多因素分析显示助产士对孕产妇常见心理行为问题的识别率最高,护士最低;产后随访医生正确选择处理方式率高于职业类型的其他受访者,社区卫生服务中心的人员正确选择处理方式率高于其他类别医院受访者,识别得分越高的人员正确处理能力较高。结论金山区产科和妇保医务人员对产后抑郁症的识别率较高,对焦虑症和精神分裂症的识别率较低;对孕产妇心理行为问题的正确处理能力较差。     

2015—2018年河南省农村育龄妇女宫颈癌筛查认知度调查及其影响因素分析

目的 探讨2015—2018年河南省农村育龄妇女宫颈癌筛查认知度调查及其影响因素。方法 选取到郑州大学第三附属医院就诊的农村200名育龄期妇女作为此次调查的对象。采用问卷调查的形式进行研究。结果 本次调查共发放问卷200份。196位育龄期妇女《宫颈癌筛查信念量表》得分82~127分。 单因素分析结果显示农村育龄妇女宫颈癌认知度与年龄、婚姻状况、月收入、受教育程度、生殖道疾病史、免费宫颈癌筛查接触史、宫颈癌宣教接触史、产次以及社会支持水平显著相关。多因素分析结果显示年龄、月收入、生殖道疾病史、宫颈癌宣教接触史、受教育程度以及社会支持水平为河南省农村育龄妇女宫颈癌筛查认知度的独立性影响因素。结论 河南省农村育龄妇女宫颈癌筛查认知度水平仍有较大的提高空间,其主要受年龄、月收入、生殖道疾病史、宫颈癌宣教接触史以及社会支持水平的影响,临床上可针对上述因素进行干预以提高该地区育龄妇女宫颈癌筛查的认知度,降低宫颈癌的患病风险。