浅谈脑出血患者的病情观察

1意识状态的观察意识状态的变化,是最早反应脑损伤程度的一项重要指标。因此,在临床各项观察中,患者意识状态的改变极为重要,要准确分清嗜睡、朦胧、浅昏迷、深昏迷等不同意识障碍的程度。在护理中,可借助答话情况、呼唤反应、对疼痛刺激反应(针刺、压眶反应等)的防御反应如何;还可以通过吞咽、咳嗽、角膜反射等了解意识障碍的程度,特别是要注意脑疝的发生,脑疝的前驱症状表现头痛剧烈、呕吐频繁、烦躁不安和意识迟钝、嗜睡、血压急骤升高、脉压差大、脉搏缓慢、颈项强直,呈潮式呼吸等。此外,脑出血后患者常出现周身不适、头痛、难以入睡的情况,这时候,给予镇静安眠药物后,更应注意意识状态的改变,防止入睡后发生脑疝。2瞳孔的观察2.1双侧瞳孔等大等圆,对光反射灵敏常为出血量较少,病情较轻。2.2双侧瞳孔极度缩小,对光反射无法测验伴有不同程度的昏迷、高热、常提示脑干的桥脑段损伤。2.3双侧瞳孔大小或形态多变患者呈深昏迷状态、高热,常提示为脑干的中脑段损伤。2.4双侧瞳孔不等大一侧瞳孔进行性散大,固定,提示有颅内压增高、脑疝的发生,常需要进行紧急抢救。2.5双侧瞳孔极度散大,对光反射消失伴有生命体征的改变,提示病情危重,表示患者已近于死亡。观察瞳...     

应用生物发光法判断温缺血断肢再植时限

目的探索一种能较短时间内判断温缺血断肢再植时限的方法。方法应用生物发光法连续测定兔离断肢体骨骼肌ATP的含量,同时对每一标本作病理检查。结果温缺血条件下兔离断肢体骨骼肌ATP含量下降程度与骨骼肌的变性程度有明显对应关系,当ATP含量下降95%后,骨骼肌发生不可逆变性,断肢不宜再植。结论应用生物发光法可在较短时间内判断温缺血断肢的再植时限,是一种新的检测方法。     

Estimating the absorbed dose to critical organs during dual X-ray absorptiometry.

OBJECTIVE: The purpose of this study is to estimate a patient's organ dose (effective dose) during performance of dual X-ray absorptiometry by using the correlations derived from the surface dose and the depth doses in an anthropomorphic phantom. MATERIALS AND METHODS: An anthropomorphic phantom was designed and TLDs (Thermoluminescent Dosimeters) were placed at the surface and these were also inserted at different depths of the thyroid and uterus of the anthropomorphic phantom. The absorbed doses were measured on the phantom for the spine and femur scan modes. The correlation coefficients and regression functions between the absorbed surface dose and the depth dose were determined. The derived correlation was then applied for 40 women patients to estimate the depth doses to the thyroid and uterus. RESULTS: There was a correlation between the surface dose and depth dose of the thyroid and uterus in both scan modes. For the women's dosimetry, the average surface doses of the thyroid and uterus were 1.88 microGy and 1.81 microGy, respectively. Also, the scan center dose in the women was 5.70 microGy. There was correlation between the thyroid and uterus surface doses, and the scan center dose. CONCLUSION: We concluded that the effective dose to the patient's critical organs during dual X-ray absorptiometry can be estimated by the correlation derived from phantom dosimetry.     

Spiritual coping strategies: a review of the nursing research literature

AIMS OF THE PAPER: This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care. LITERATURE SEARCH: The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used. THEORETICAL BACKGROUND: Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers. IMPLICATIONS: This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.     

Heat stress and strain in exercise and sport

Heat stress arising from the thermal environment is of concern to sports medicine and to sports administration because of the perceived risk of heat casualties, in particular heat stroke. Many sports organizations recommend environmental indices such as the WBGT for assessing risk and setting environmental limits for training and competition. But the limits are not justified by evidence. This article describes the nature of heat stress in sport and how it may be assessed objectively. Heat stress and the principal human responses to exercise heat stress are reviewed briefly. Metabolic heat production and the thermal environment provoke separate and largely independent physiological strains. Metabolic heat production drives body core temperature, and the thermal environment drives skin temperature; the combined stresses are integrated to drive sweat rate. Control of core temperature depends on adequate sweat production and the capacity of the environment to evaporate the sweat. The nature of exercise heat stress is demonstrated by rational analysis of the physical heat exchanges between the body and the environment. The principles of this analysis are applied to critical review of current practice in the assessment of heat stress in sport. The article concludes with discussion of research to establish methods for objective sport-specific assessment of heat stress.     

Pediatric Emergency Assessment Tool (PEAT): A Risk-adjustment Measure for Pediatric Emergency Patients

OBJECTIVE: To develop a multivariable model predicting the level of care required by pediatric patients for use as a risk-adjustment tool in the evaluation of emergency medical services for children. METHODS: A random 10% sample of records of all visits over a 12-month period to a suburban, university-affiliated pediatric emergency department (PED) was selected and abstracted. The outcome variable, level of care received, was categorized in three levels: routine care only (R); diagnostic or therapeutic procedures performed in the ED but patient not admitted (EDT); and admission to hospital (ADM). Predictor variables included information routinely elicited and recorded at the time of triage. Using multinomial logistic regression, a predictive model was derived from a subset of 70% of the selected visits, and was validated in the remaining 30%. RESULTS: The total sample included 2,287 visits. The overall rate of each outcome was R-37%, EDT-53%, and ADM-10%. The final regression model included the following predictors significantly associated with the outcome: age, past medical history, temperature, abnormal respiratory rate or pulse oximetry in triage, chief complaint, and triage level (model likelihood ratio chi-square, 14 df = 332, p < 0.00001, R(2) = 0.14). The number of outcomes was well predicted by the model in both subsamples. Analysis of variance showed a significant association between Pediatric Emergency Assessment Tool (PEAT) score (weighted sum of the predicted probabilities of EDT and ADM) and both ED charges and time spent in the ED (p < 0.001). CONCLUSIONS: A model based on easily and routinely measured variables can accurately predict the level of care rendered in the PED. The predicted probabilities from such a model correlate well with other outcomes of care and may be useful in adjusting for differences in risk when evaluating quality of care.     

The Health and Economic Consequences of Moderate Alcohol Consumption in Germany 2002

Objective:  Moderate alcohol consumption is associated with both positive and negative health effects. This study aims to estimate the positive and negative consequences on mortality, years of potential life (YPL), quality-adjusted life-years (QALYs), resource utilization, and societal costs attributable to moderate alcohol consumption in Germany in 2002.
Methods:  The concept of attributable risks and a prevalence-based approach was used to calculate age- and sex-specific alcohol attributable mortality and resource utilization for a wide range of disorders, and avoided mortality and resource utilization for diabetes mellitus, coronary heart disease, stroke, and cholelithiasis. The literature provided prevalence of moderate alcohol consumption in Germany by age and sex and relative risks. Direct costs were calculated using routine utilization and expenditure statistics. Indirect costs were calculated using the human capital approach.
Results:  Due to moderate alcohol consumption, 14,457 lives, 205,691 YPL, and 179,964 QALYs were lost, whereas 29,918 lives, 300,382 YPL, and 258,284 QALYs were gained. Up to an age of 55 to 60 (62.5–67.5) years, more lives were lost than gained among men (women), whereas in older age groups more lives were gained than lost. Moderate alcohol consumption caused €3049 million of direct and €2630 million of indirect costs, whereas €2094 million of direct and €2604 million of indirect costs were avoided.
Conclusion:  Despite considerable uncertainty, moderate alcohol consumption seems to result in an overall net effect of gained lives, YPL, and QALYs, realized among the elderly, but overall increased societal costs. Thus, moderate alcohol consumption should still be seen critical, especially among youths.     

Self‐monitoring of blood glucose changed non‐insulin‐treated Type 2 diabetes patients’ beliefs about diabetes and self‐monitoring in a randomized trial

Aims To determine whether differences in beliefs about diabetes and its treatment resulted from different intensities of self‐monitoring of blood glucose (SMBG) in non‐insulin treated patients with Type 2 diabetes in the Diabetes Glycaemic Education and Monitoring (DiGEM) trial. Methods Patients (n = 453) were randomized to usual care, less‐intensive SMBG and more intensive SMBG. Beliefs about diabetes were measured with a standard questionnaire (the revised Illness Perceptions Questionnaire; IPQ‐R). Changes in beliefs were analysed using analysis of covariance (ancova) with adjustment for baseline values. Mediation analyses assessed whether differences in behavioural outcomes between groups could be attributed to differences in beliefs. Results Completed questionnaires were returned by 339 patients (74.8%). Respondents were mean (± sd ) age 65.9 ± 10 years and with diabetes duration of 4.8 ± 4.7 years (median 36, range 1–384 months). Concerns about the consequences of diabetes increased in both self‐monitoring groups, relative to control subjects [P = 0.004; Cohen's d standardized effect size = 0.19 less intensive and d = 0.36 more intensive monitoring]. No other beliefs about diabetes differed between groups. Beliefs about the importance of self‐testing increased in both self‐monitoring groups relative to the usual‐care group (P < 0.001; d = 0.57 less intensive and d = 0.63 more intensive monitoring). Changes in psychological well‐being did not differ between groups, but control patients reported greater increases in general (P = 0.014) and specific (P < 0.001) dietary adherence than did patients in the self‐monitoring groups. These outcomes were not mediated by intervention‐related changes in beliefs. Conclusions Despite changes in some beliefs about diabetes differing between groups there were no corresponding changes in self‐reported health behaviours. This suggests that changes in illness beliefs resulting from SMBG do not cause changes in diabetes‐related health behaviours.     

从心身疾病浅析糖尿病从肝论治

心身疾病是指与心理社会因素有密切关系的躯体疾病,糖尿病是典型的心身疾病之一。肝主疏泄,调畅气机、情志,与糖尿病的发生发展关系密切,因而从肝论治成为其治疗的基本法则之一。这种疗法适应现代社会人们生活压力增大,心身疾病发病率逐渐升高的趋势。