高龄股骨转子间骨折两种治疗方法的临床观察

目的:探讨手术治疗高龄股骨转子间骨折的安全性、合理性。方法:股骨转子间骨折患者65例,其中采用动力髋螺钉(DHS)治疗32例,男14例,女18例;年龄65~79岁,平均(70.6±2.3)岁;EvansⅠ型2例,Ⅱ型7例,Ⅲ型15例,Ⅳ型8例。采用单边外固定支架治疗33例,男14例,女19例;年龄68~90岁,平均(74.2±3.8)岁;EvansⅠ型3例,Ⅱ型15例,Ⅲ型11例,Ⅳ型1例,Ⅴ型3例。临床观察包括术中出血量、手术时间、骨折愈合时间、术后并发症及髋部运动功能等。结果:所有病例均获随访,时间1~34个月,平均19个月。两组手术时间、术中出血量、术后并发症发生率差异有统计学意义(P<0.05)。平均愈合时间DHS组为(13.0±2.7)周,外固定支架组为(12.3±3.0)周,差异无统计学意义。Sanders髋关节功能评价:DHS组优19例,良6例,可3例,差2例;外固定支架组优12例,良8例,可8例,差5例。两组优良率差异有统计学意义(P<0.05)。结论:围手术期外固定支架组较DHS组安全简便,术后疗效DHS组优于外固定支架组。     

A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people

Little research has examined the care older people receive in the acute surgical setting. Although pain assessment and management are judged to be a priority in nursing, often pain, in older people, is undermanaged for a variety of reasons. Factors such as stoicism, communication and ageism can shape both the patients’ and nurses’ attitude towards the perception of pain which subsequently affects pain management. Through a review of the literature, this paper aims to: (i) identify how healthcare professionals contribute to the assessment and control of postoperative pain in older people and (ii) explore potential barriers to achieving more advantageous pain control in this group. It is suggested that to improve pain management there is a need to individualize pain assessment for older people and to assist clinicians with enhancing their education and decision‐making abilities in this field. This may best be achieved by supporting a programme of change to develop the skills of staff and encouraging learning through reflective practice. There is however a need for further research in this area.     

A population-based study of repeat hospital admissions due to interpersonal violence for children aged 0–9 years

To assess the magnitude and nature of interpersonal violence resulting in hospitalisation of children and to identify subgroups at risk of repeat hospital admissions, a population-based, retrospective study of all violence hospitalisations in Western Australia for children aged 9 years or less was undertaken, using the 1990–2004 linked data retrieved from the Western Australian Mortality Database and the Hospital Morbidity Data System.
Of the 747 patients aged <10 years incurring 834 hospitalisations for the consequences of violence during the study period, 570 (76%) were less than 4 years of age. A total of 43 deaths from violence were recorded and 74 (9%) patients were admitted for more than one episode of violence. Victims aged 0–4 years from rural (hazard ratio [HR] = 2.72; 95% confidence interval [CI] 1.35, 5.43) and remote parts (HR = 2.79; 95% CI 1.25, 6.25) of the state were at increased risk of a subsequent admission for violence compared with those residing within the metropolitan area. Indigenous children aged 5–9 years were significantly more likely (HR = 3.57; 95% CI 1.14, 11.13) to incur a second hospitalisation for violence than their non-Indigenous counterparts. The identification of young victim subgroups at high risk of repeat hospitalisations is important for developing intervention strategies to reduce the burden of interpersonal violence. Young children aged 0–4 years living in rural and remote locations and Indigenous children aged 5–9 years should be specifically targeted for attention.     

老年人食管癌的外科治疗

1材料和方法1.1研究对象1999年3月至2003年2月的238例食管癌根治手术患者,男157例,女81例。年龄60～84岁,平均(66±3.5)岁。其中年龄≥70岁患者36例,包括男24例,女12例,平均(75±3.4)岁。病变长度2.5～8cm。病变位于食管上段19例,中段141例,下段78例。病理类型:鳞癌206例,腺癌2     

老年人前瞻性记忆损害的研究

目的 了解健康老年人前瞻性记忆改变的情况,初步探讨老年人基于事件的前瞻性记忆(EBPM)和基于时间的前瞻性记忆(TBPM)损害程度的区别.方法 建立前瞻性记忆的神经心理学测验方法,测试教育程度相匹配的40名健康老年人和40名健康成年人的EBPM和TBPM.结果 与成年组[EBPM(6.25±1.60)分;TBPM(5.38±0.87)分]相比,老年组的EBPM[(2.50±0.85)分和TBPM(4.93±1.07)分]均较成年组差(P＜0.01,P＜0.05),而EBPM损伤指数的差异亦有统计学意义(P＜0.01).老年组前瞻性记忆的EBPM和TBPM存在双分离.结论 老年人存在前瞻性记忆的损害,EBPM损害较TBPM损害更为显著.EBPM和TBPM的双分离表明其可能有不同的神经机制,推测额叶可能特异性地参与了EBPM.     

Low levels of essential fatty acids are related to impaired delayed skin hypersensitivity in malnourished chronically ill elderly people

Abstract Essential fatty acid (FA) deficiency, which may accompany protein-energy malnutrition (PEM), has been associated with impaired inflammatory reactions. We evaluated this relationship by analysing FA profiles and delayed cutaneous hypersensitivity in 20 malnourished elderly non-cancer patients and in 20 age-matched control patients. As indicated by serum cholesterol and serum triglycerides, the lipid levels were decreased by about one-third in the subjects with PEM. In comparison with the controls, there was a reduction in the ω 3 FA (e.g. eicosapentanoate) in total serum lipids (mgl^-1) and serum phospholipids (%) of 40% and 47%, respectively. Reductions in serum ω 6 FA (e.g. linoleate and arachidonate) levels corresponded to the drop in total FA concentrations (30%). The cutaneous hypersensitivity was impaired in 14 of the malnourished patients. The magnitude of the skin reaction was positively correlated ( P < 0·05) to the concentrations of eicosapentanoate in serum lipids and serum phospholipids, as well as to the linoleate concentration in total serum lipids. Six of the malnourished patients took part in a nutritional intervention programme for 3 months. In parallel with an improvement in the nutritional status there was a 35% increase ( P < 0·05) in the total ω 3 FA serum concentration. Negative skin tests became positive and the median skin induration enlarged threefold ( P < 0·05). Thus, deficiency of ω 3 FA might be one factor contributing to cutaneous anergy in elderly malnourished patients.     

Dietary intake in the elderly estimated by a 24 hour recall and a food frequency questionnaire

Two hundred and thirty-five tenants living in sheltered housing in Scotland were surveyed to identify the extent of under-nutrition and the social factors which contribute to its development. A validated 24 h recall and the nutrient checklist published by NAGE were used to evaluate patterns of dietary intake. A questionnaire was developed which included scales designed to measure depression, social engagement, cognitive function, mobility and functional ability. The results show considerable evidence of a number of major nutrients in which there were low intakes. In order to express the extent of poor nutrition, a nutrient score was developed where points are awarded based on the number of nutrients falling below the Lower Reference Nutrient Intake, the Estimated Average Requirement or below half the daily Estimated Average Requirement.     

28例青年人胃癌的临床及病理分析

对２８例青年人胃癌的临床及病理分析结果表明，其发病具有症状隐匿、病程短、进展快的特点，本组病例从出现症状到漏诊在６个月内为５７．１％（１６例），首发症状以上腹部疼痛、吐血、黑便多见，病理特征以结节蕈伞型、高分化腺癌多见。     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

银杏外种皮多糖对衰老模型小鼠学习记忆能力及脑内酶系活力的影响

目的探讨银杏外种皮多糖 (Ginkgobilobaencarppolysacharides ,GBEP)对衰老模型小鼠学习记忆能力及脑皮质MDA、海马SOD活力的影响。方法用腹腔注射D 半乳糖制造衰老模型 ,以低、高GBEP浓度给实验组灌胃 ,对照组和衰老组灌等量生理盐水 ,连续 6周后进行水迷宫、爬杆、负荷实验 ,观察小鼠学习记忆能力的变化 ,测定脑MDA含量 ,海马SOD的活力。结果低浓度、高浓度银杏外种皮多糖有对抗D 半乳糖减退学习记忆能力的作用 (P <0 .0 5 ) ,使脑内MDA含量下降 ( 1.70± 0 .3 4vs 2 .97± 0 .74,P <0 .0 1) ,海马中SOD活力升高 ( 5 6.0 0± 16.0 6vs 44 .0 2± 15 .68,P <0 .0 1)。结论银杏外种皮多糖可提高动物学习记忆能力 ,增强抗氧化能力 ,延缓衰老进程。