手足口病的流行病学特征分析和护理策略

目的：探讨手足口病的流行病学特征和护理策略。方法：回顾性分析2012年1月至12月我院感染科手足1：7病患者521例的临床资料。结果：发病年龄以6岁以下多见,占97．31％,其中1—3岁发病率最高;男性多于女性,以散居儿童为主,占72．2％;发病高峰6-7月份;患儿发病前有可疑流行病学接触史;针对521例患儿的病情,进行发热、饮食、口腔、皮疹护理,呼吸机辅助呼吸的患儿做好气道管理,密切观察病情,做好健康宣教,严格执行消毒隔离制度。结论：掌握本病的流行特点,做好健康宣教工作,降低人群发病率;采取有效的治疗和护理策略,促进疾病早期愈合,提高危重症患儿救治率,降低死亡率。     

静脉血栓患者炎性因子和凝血指标的关系

目的探讨重症监护病房高危静脉血栓患者炎性指标和纤维蛋白原、D-二聚体关系及防治措施。方法对128例重症监护病房高危静脉血栓患者(实验组)和65例正常对照者(对照组)分别进行高敏-C反应蛋白和纤维蛋白原、D-二聚体检测;应用肝素(5000U,每天3次,静脉注射)或低分子量肝素(100U/kg,皮下注射),华发林(2～3mg,口服),5d前后检测上述指标变化。结果实验组的高敏C-反应蛋白、纤维蛋白原、D-二聚体高于对照组,差异具有统计学意义(P<0.05～0.01);应用肝素、低分子量肝素或华发林后,上述指标显著性降低(P<0.05或<0.01)。结论重症监护病房高危静脉血栓患者存在明显的高凝状态,采用抗凝尤其是低分子肝素可改善血液流变学、降低血液黏度,高敏C反应蛋白、纤维蛋白原和D-二聚体可作为抗凝的有效指标。     

慢性胰腺炎患者生活质量与社会支持的相关性

目的 探讨慢性胰腺炎患者生活质量与社会支持的相关性.方法 选取100例慢性胰腺炎患者,采用社会支持评定量表和应用汉化版简明健康调查量表（SF-36）评估患者的生活质量,分析两者的相关性.结果 慢性胰腺炎患者生活质量下降,与中国常模相比有显著差异（P＜0.05）;社会支持与生活质量呈显著正相关（r=0.759,P＜0.01）.结论 慢性胰腺炎患者的生活质量与社会支持密切相关,社会支持高的患者生活质量也高;护理过程中应充分重视并有效利用社会支持系统,以提高慢性胰腺炎患者的生活质量.     

GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice

ObjectivesThe aim of the study was to identify general practitioners’ (GPs) strategies to avoid unnecessary diagnostic imaging when encountering patients with such expectations and to explore how patients experience these strategies.Design, setting and subjectsWe conducted a qualitative study that combined observations of consultations and interviews with GPs and patients. A total of 24 patients visiting nine different GPs in two Norwegian urban areas were included in the study. Of these, 12 consultations were considered suitable for studying GP strategies and were therefore selected for a more thorough analysis.Main outcome measuresGPs’ communication strategies to avoid unnecessary medical imaging and patients’ experiences with such strategies.ResultsFive categories of strategies were identified: (1) wait and see – or suggest an alternative; (2) the art of rejection; (3) seek support from a professional authority; (4) partnership and shared decision-making and (5) reassurance, normalisation and recognition. The GPs often used multiple strategies. Factors related to a long-term doctor–patient relationship seemed to influence both communication and how both parties experienced the decision. Three important factors were evident: the patient trusted the doctor, the doctor knew the patient’s medical history and the doctor knew the patient as a person. The patients seemed to be generally satisfied with the outcomes of the consultations.ConclusionGPs largely combine different strategies when meeting patients’ expectations of diagnostic imaging that are not strictly medically indicated. Continuity of the doctor–patient relationship with good personal knowledge and trust between doctor and patient appeared crucial for patients to accept the doctors'' decisions.

Key points

• GPs usually combine a broad range of strategies to avoid unnecessary medical imaging
• The patients appeared generally satisfied regardless of the strategy the strategy used by the GPs and even where their referral request were rejected
• Factors related to a long-term doctor–patient relationship appeared decisive

     

口腔颌面组织瓣修复术后口腔护理方法的研究

目的观察口腔颌面组织瓣修复术后患者在改良口腔护理方法下的疗效。方法将我院口腔颌面组织瓣修复术后80例患者随机分为两组各40例。对照组采取常规口腔护理方法,实验组则以改良口腔护理方法施护。对比分析两组患者口腔的清洁度、舒适度、组织瓣缝合口分泌物、术区红肿、疼痛程度。结果实验组痊愈率82.5%,优于对照组的57.5%,差异有统计学意义（P〈0.05）。相比于对照组,实验组患者口腔的清洁度、舒适度更好,组织瓣缝合口分泌物更少,术区红肿、疼痛程度更轻,组间差异有统计学意义（P〈0.05）。结论改良后的口腔护理能对口腔颌面组织瓣修复术后患者的口腔感染进行更有效的预防,舒适度更佳,有利于患者尽早康复,值得临床护理广泛应用。     

Referral for a Bariatric Surgical Consultation: It is Time to Set a Standard of Care

Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician’s responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.     

风湿免疫疾病中的并发症预防治疗与护理

目的：对于风湿免疫疾病中的并发症预防治疗与护理的讨论与分析。方法对于该院患有风湿免疫性疾病的100例患者随机分为两组,分别为对照组和观察组,每组50例患者。对照组50例患者进行常规的护理,观察组50例患者在常规护理的基础上对患者进行关于疾病有针对性的护理干预,对两组患者的疾病后的并发症的发生情况进行比较。结果经过对两组患者的疾病并发症进行比较后,观察组患者中出现并发症的患者有2例,并发症发生率为4.0%,对比对照组患者中出现疾病并发症的患者有15例,并发症发生率为30.0%,观察组患者明显并发症发生率更低,差异有统计学意义（P<0.05）。结论在对两组患者的疾病并发症的发生率进行比较后发现,对于患者在常规护理干预后进行有针对性的护理干预,有助于降低并发症的发生,具有很大的临床意义和价值,值得在临床上推广使用。     

产学研合作模式下长三角生物医药产业一体化协同创新发展研究——基于专利合作及基金项目合作

长三角一体化上升并发展为国家战略后，国内鲜有探讨长三角地区生物医药产业一体化协同发展的研究，长三角作为我国生物医药产业的重要地区，已初步形成产业集群的发展模式。本研究基于专利及基金项目合作的产学研模式，利用社会网络分析方法（SNA）对长三角地区生物医药产业中专利和国家自然科学基金重大项目合作进行分析研究。研究表明，长三角地区生物医药领域的产学研合作还处于发展阶段，一体化程度也有待提高；高校及科研院所更倾向于与企业合作开展发明专利，与高校合作开展基金项目研究。长三角地区三省一市间的生物医药产业发展也存在一定差距，建议长三角地区采取产学研深度融合模式，相关龙头科研机构建立开放式创新平台，医药类高校借助学科优势培养创新型人才，采取“揭榜挂帅”等方式进行关键核心技术攻关。     

校园网络环境下的病理生理学自主学习模式研究

目的探讨校园网络环境下的病理生理学自主学习模式。方法随机选取学院2012级临床医学6-7班、10-11班分别为对照组(传统教学模式)和教改组。教改组实施以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式,对学生考核成绩进行对比分析和问卷调查。结果教改组学生成绩高于对照组,学生的自主学习能力明显提高(P<0.05)。结论以网络为依托的"联组-整合、自主探究、合作交流"的自主学习模式可以实现以学助教,有利于学生的终身发展。     

Cribado e intervención breve en consumo de alcohol

La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.Palabras clave: Alcohol, Intervención breve, Prevención, Atención Primaria