A 10-year follow up of a paging service for people with memory and planning problems within a healthcare system: How do recent users differ from the original users?

In 2003 Wilson, Scott, Evans, and Emslie published a report of a new healthcare resource; a paging system designed to reduce the everyday problems of people with neurological deficits who experience memory and/or planning problems. The system was established following several research studies carried out to evaluate its effectiveness. Information was collected on the first 40 clients recruited to the service. The purpose of the present study is to determine how the service might have changed over a 10-year period. The most recent users of the service (N?=?40) have been compared with the original cohort of 40 clients. In addition, in 2007 clients were given the opportunity to use their mobile telephones to receive messages; 17 chose to do so. There was no difference in age between the telephone users compared to the pager users, but those using a pager were less likely to have sustained a traumatic brain injury (TBI) and were more likely to be longer post-insult. There were no significant differences in the gender or ages of the people using the pager compared with those using the telephone service. However, the mean overall time since injury for the last 40 referrals was 9.48 years compared to 4.56 years for the original cohort. Both cohorts comprised several diagnostic groups; clients with TBI formed the largest subgroup, followed by those with stroke. This is typical of patients seen for rehabilitation, with other diagnostic groups forming a smaller percentage. We wanted to determine whether the range of diagnoses was similar over the 10-year period. Despite slight differences, we found a similar range of patients referred. In both cohorts the most frequent messages sent each week related to medication (27.9% in the first compared to 28.6% in the second). More messages were sent regarding mood management in the second cohort. No such messages were sent to the first 40 clients, whereas over 27 per week were sent to the last 40. Fewer health authorities (N?=?21) were referring after 10 years in comparison with 26 referrers for the first cohort.     

中西结合对创伤性截瘫术后尿潴留的护理效果分析

目的考察中西结合护理手段对创伤性截瘫患者术后尿潴留的临床护理效果，为患者提供安全、经济、高效的护理方法。方法收集河北省怀安县人口和计划生育局2008年3月～2012年5月间收治的90名创伤性截瘫患者为研究对象，分为A、B两组。在脊髓休克期与脊髓功能恢复期分别使用不同的中西结合护理手段对创伤性截瘫患者进行护理，治疗一定时间后对护理效果进行考察。结果脊髓休克期内的患者接受间歇导尿与中药利尿饮的护理治疗后，患者经导尿后的尿残余量与护理前相比，有明显下降，泌尿道感染率接近零。A组护理前残余尿量为（336．42±51．21）mL，2、4周后，护理后残余尿量分别为（163．46±39．81）、（336．42±51．21）mL；B组护理前残余尿量为（340．17±47．26）mL，护理后残余尿量分别为（103．24±25．49）、（89．64±31．69）mL，且数据间差异有高度统计学意义（P〈0．01）。脊髓功能恢复期内的A、B两组患者，经过中西结合护理后，2周与1个月后患者自行排尿后尿残余量与护理前相比均有显著下降，A组下降为（103．11±23。57）、（91．83±29.13）mL，B组下降为（103．24±25．49）、（89．64±31．69）mL，且数据间差异有高度统计学意义（P〈0．01），膀胱功能改善的总有效率为100％。结论中西结合的护理手段对创伤性截瘫患者的尿潴留症状具有较好的临床护理效果，且有安全、高效、经济等优点，值得临床推广应用。     

经颅手术修补外伤性脑脊液漏

目的探讨经颅手术修补外伤性脑脊液漏的术前定位、手术方法及疗效。方法对2009年1月至2011年9月间18例外伤性脑脊液漏患者资料进行回顾性分析;包括术前检查、手术方式、术后疗效及随访情况。结果急诊手术一期修补12例,术后脑脊液立即停止漏出6例,术后明显减少且2～4 d内停止漏出5例,术后死亡1例;延迟性脑脊液漏修补6例,术后漏出全部停止;所有出院患者随访均无复发。结论术前准确定位漏口,选择合适的手术方法可使外伤性脑脊液漏的修补获得较好的临床疗效。     

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.MethodsMajor trauma patients admitted to ICU over a 5 year period to June 2011 after ladder falls >1 m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n = 58) fell >1 m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3 m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p = 0.02), higher AIS head code (p = 0.01), higher heart rate and lower mean arterial pressure (p < 0.01) in the initial 24 h period in ICU, and were ≥55 years of age (p = 0.05). Only 46% of patients available for follow-up were living at home at 12 months without requiring additional care.ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12 months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.     

颅脑损伤在手术室中的护理救治流程

创伤已成为青壮年人群的“第一杀手”［1］，是社会劳动力丧失的主要原因。而在创伤人群中，颅脑损伤居全身各部位损伤中的第二位，仅次于四肢损伤，但其病死率和致残率均居首位，平均为30％～40％［2］，其主要死亡原因为急性顽固性高颅压、大面积脑缺血、脑水肿，目前最有效的治疗方法为手术。近年来，本院全军战创伤中心建立和完善严重创伤救治绿色通道，提高了创伤急救人员的素质和相关科室的急诊意识，使严重创伤患者的救治成功率大为提高。我科护理组人员根据该项工作的经验，结合本科室工作特色，进一步梳理和规范了有关工作流程，使其操作性更强，更易于本专科人员学习和掌握。手术室救治流程再造后，患者到达医院至手术开始的时间，从2008年的82．6min缩短到现在的48．6min，手术室护理救治流程再造促进了“绿色通道”的建设，并取得了显著成效。现将我科手术室护理救治流程再造汇报如下。     

拳击运动伤的诊治

目的 拳击运动职业化已过百年,由于反复用力击打头部,拳击运动所带来颅脑创伤引起国内外神经外科医生重视,本文旨在对拳击运动伤的诊治和机制进行回顾性研究.方法 总结笔者经治的拳击运动伤54例,通过对其治疗效果进行总结分析,并检索国内外文献进行研究.结果 54例患者4例因CT示明确的颅内病变入院治疗后好转,余急症和门诊患者经对症治疗后症状多数消失或缓解,仅4例好转不明显.结论 拳击运动伤的损伤情况与拳手承受击打的力度和从业时间有直接的关系,特别是慢性损伤近似于Alzheimer病,应该引起重视,进一步研究其相互关系.     

外伤性血尿患者膀胱痉挛的护理干预

目的探讨护理干预对降低外伤性血尿患者膀胱痉挛发生率的作用.方法回顾性分析昆明市延安医院2010年4月至2012年9月之间不同方式护理干预处理的外伤性血尿147例患者的护理经验.结果改进护理措施处理78例患者中有18例发生过膀胱痉挛,发生率为23%;采用常规护理措施的69例患者中计有27例发生过膀胱痉挛,发生率为39%.两者相比差异有统计学意义(P<0.05).结论改进护理干预可有效降低外伤性血尿患者膀胱痉挛的发生率.     

右旋美托咪啶在创伤性脑损伤中应用的研究进展

背景 右旋美托咪啶( dexmedetomidine,DEX)是新型的高选择性α2肾上腺素受体激动剂,具有镇静、镇痛和抗交感等作用,其特点为镇静易于唤醒,且对呼吸无抑制作用.脑损伤患者需要适当镇静降低脑氧耗,减少继发性脑损伤,同时又要求易于唤醒便于临床医生判断神智.目的 综述DEX在创伤性脑损伤(traumatic brain injury,TBI)中应用的研究进展,为该药在临床工作中的应用提供参考.内容 从作用机制、对脑损伤的影响及临床应用3个方面论述DEX对TBI的影响.趋向 DEX具有镇静、抗交感、抗凋亡等多种神经保护作用,且其无呼吸抑制,不影响对患者神智判断,这些特性似乎使其成为较有前景的脑创伤镇静剂.但目前DEX在脑创伤动物模型或患者中研究甚少,我们仍然不清楚其在脑创伤动物模型或患者的综合作用如何.