直流电中药离子导入治疗小儿哮喘的临床观察与护理

目的:研究直流电中药离子导入治疗小儿哮喘的临床效果与护理方法.方法:选择3-12岁哮喘患儿60例,随机分为直流电中药离子导入组与西药组,治疗前后检测各组哮喘生命质量(AQLQ)、EOS(嗜酸粒细胞)、IgE.结果:直流电中药离子导入组治愈率高于西药组,AQLQ、EOS、IgE也有显著的变化.结论:直流电中药离子导入治疗小儿哮喘临床疗效显著,临床护理很重要.     

美蓝在口腔鳞状细胞癌前哨淋巴结活检中的应用

目的：探讨美蓝在口腔鳞状细胞癌前哨淋巴结（sentinel lymphnode,SLN）活检中的应用,为临床N0患者是否作颈部淋巴结清扫提供依据。方法：用美蓝对30例口腔鳞状细胞癌临床N0患者行前哨淋巴结定位活检,通过与区域淋巴结清扫标本的比较来评价前哨淋巴结活检的准确性。结果：前哨淋巴结定位活检总成功率为93.3%（28/30）,准确率92.9%（26/28）,假阴性率为11.1%（2/18）,灵敏度为83.3%（10/12）,特异性100%（16/16）。结论：前哨淋巴结活检在口腔鳞状细胞癌中能很好地反映淋巴结的转移情况,对指导淋巴结清扫的合理性和必要性有一定的临床应用价值。     

Assessing Retention in a Free Diabetes Clinic

The PATH Clinic in Birmingham, Alabama, is a free clinic for uninsured patients with uncontrolled diabetes. In its first 22 months, more than 25% of patients were lost to follow-up. This report shares reasons for patients becoming lost to follow-up. Investigators used patient records for quantitative analyses and phone interviews for qualitative analysis. Sociodemographic factors were not associated with patients’ likelihood of becoming lost to follow-up. Qualitative results show that these patients had uncertainty regarding appointment dates, complicated life circumstances, and transportation barriers. Results indicate that social interventions may improve patient compliance and retention and should be tested.     

公立医院临床服务类科室交叉成本的分摊方式探索

随着医疗业务内容的不断发展和变化,公立医院已设置的四大类核算单元和三级医疗成本分摊体系,但仍无法解决临床服务类科室交叉成本分摊的问题,因此造成了临床科室收支不配比的情况。通过分析公立医院临床服务类科室交叉成本的特点及其产生原因,进而采用按收入占比的方法进行临床服务类科室交叉成本分摊。其中,核算单元的准确划分、提高成本核算数据的准确性,对完善医院全成本核算体系、加强医院成本费用分析、开展医疗项目成本核算和医院未来发展具有重要意义。     

Developing a culture of nursing research through clinical-academic partnership

Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence-based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical-academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical-academic partnership.     

Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong

Background Heart failure (HF) is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged ≥ 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male (51.3%), almost half were smokers (46.2%), and the majority received ≤ six years of formal education. Most of the HF patients (87.2%) belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15 ± 20.31 mL. The HF patients who attended the clinic (n = 38, 75.13 ± 5.89 yrs) were significantly younger than those who did not attend the clinic (n = 40, 79.53 ± 6.96 yrs) (P = 0.04), and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio (OR): 7.40; P < 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality (n = 4) than those who did not attend (n = 14). However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A significant reduction in systolic blood pressure [F (2, 94) = 3.39, P = 0.04] and diastolic blood pressure [F (2, 94) = 8.48, P < 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.     

基于临床用药实际的不同状态下仙茅多次给药后血药浓度变化

目的: 观察仙茅作用于正常、虚寒两种不同状态大鼠后,其入血成分苔黑酚葡萄糖苷的血药浓度变化差异,探讨仙茅在正常与虚寒状态下体内药代与生物学效应的相关性。 方法: SD雄性大鼠随机分为两组,即正常组和虚寒组。连续14 d肌注氢化可的松粉针剂20 mg·kg^-1·d^-1塑造虚寒大鼠模型。模型成功后,正常/虚寒大鼠连续7 d给予仙茅水提液30 g·kg^-1,最后1次给药后,分别于多点动物交叉眼眶取血,采用高效液相法检测苔黑酚葡萄糖苷血药浓度,并计算药物代谢参数。 结果: 虚寒组大鼠在给药后20 min,其血药浓度高于正常组大鼠,直到120 min达最大血药浓度,其高水平状态一直维持到300 min;且虚寒组大鼠达峰时间(T_max)、血药浓度-时间曲线下面积(AUC)明显升高(P<0.05)。 结论: 虚寒组大鼠体内苔黑酚葡萄糖苷浓度始终处于高水平状态,可能为其生物学效应的更好发挥提供了物质基础。