心肌梗死病人的护理体会

心肌梗死是指因冠状动脉供血急剧减少或中断,使相应的心肌严重而持久的缺血导致心肌坏死。临床表现为持久的胸骨后剧烈疼痛,血清心肌酶增高,心电图进行性改变;可发生心律失常、休克或心力衰竭,属于冠心病的严重类型。本病病人男性多于女性,其发病的危险因素有原发性高血压、高脂血症、糖尿病、吸烟等。近年来,发病的年龄趋于年轻化。2003年1月至2004年1月,我科共收治心肌梗死病人40例。现将护理体会汇报如下。1临床资料1.1一般资料本组病例40例,男32例,女8例,其中年龄35岁～40岁8例,41岁～50岁20例,51岁～60岁7例,61岁～70岁3例,71岁～80岁2…     

穿透性心脏损伤的诊治经验

心脏穿透性损伤可引起大量失血和／或心包填塞，迅速导致死亡。文献报道中约有62％～84％的病人送至医院时即已死亡。其他病人大都有心包填塞，由于心包内压力增加，暂时控制了心肌上伤口的出血，阻止血液大量丢失。但心包填塞如不及时处理，填塞症状继续加重也会导致严重休克而死亡。及时手术治疗，可使患者获得生存。我院1988年至2005年收治6例，现将诊治经验报道如下。     

规范手术室实习生的带教与体会

目的:使实习护生在手术室尽快进入实习状,态完成实习计划。方法实行专人带教集体培训。结果实习生反应良好,出科理论及操作考试优秀率显著提高。结论实行规范带教,使其实习效果明显提高,值得推广使用。     

81例直接动静脉内瘘的护理体会

直接动静脉内瘘是永久性血管通路,要求能提供足够的血流量(250ml/min),又不至于发生动脉瘤或血栓形成,位置浅表易穿刺,不影响患者的日常生活,可长期使用而无明显副作用,完全可靠的血管通路,适用于长期维持性血液透析的患者。是患者的“生命线”,在临床工作中内瘘的护理尤为重要,现将临床护理总结如下。1临床资料2005年6月至2007年6月间,在我院行直接动静脉内瘘手术以直接动静脉内瘘为血管通路,行维持性血液透析患者81例,男49例,女32例。除1例因血管条件差,内瘘手术失败,80例动静脉内瘘均于4周~5周成熟,血流量达250ml/min~350ml/min以上,动静脉内瘘保护良好,正常使用。2护理2.1术前准备卫生宣教向患者及家属详细介绍血液透析的治疗方法和血管造瘘的目的,带领患者现场参观透析,观看病友成熟的动静脉内瘘,讲解手术方法,以解除思想顾虑,使之树立与疾病做长期斗争的信心,自愿接受并积极配合治疗。保护造瘘侧肢体皮肤的完整清洁,保护造瘘侧肢体的血管,不在造瘘侧肢体行动静脉穿刺。2.2手术后护理抬高术侧肢体,包扎松紧适度,勿受压以利于肢体血液回流,保持手术创面干燥,防止感染。告知患者严禁在造瘘侧肢体测量血压...     

Methodologic Concerns Regarding Estimates of Physical Violence in Sexual Coercion: Overstatement or Understatement?

Self-report measures of sexual violence that ask women whether they have experienced threats of physical violence have attracted criticism in recent years; detractors claim that these measures lead researchers to overestimate the prevalence of sexual violence. Our study explored this issue by collecting data on the prevalence of threats versus force in the context of sexual aggression. Female undergraduates at two universities (n ₁ = 69; n ₂ = 111) were asked about their experiences with sexual coercion using a revised version of the Sexual Experiences Scale (Koss and Gidycz, 1985). Four of the original items were modified to distinguish between sexual contact that occurred as a result of a perpetrator using physical force and sexual contact that occurred because a perpetrator threatened physical violence. Analyses of the revised items revealed that the use of physical force was at least as likely as threats and that for some types of sexual acts, physical force was actually more likely than verbal threats. Furthermore, prevalence figures for three of the four types of sexual acts considered were not significantly altered by collapsing threat of force with use of force. Implications for future research on women's experiences of sexual coercion are discussed.     

Alexithymia and pain in temporomandibular disorder

Objective

To clarify the relationship of global alexithymia and its facets with pain, assessed prospectively using experience sampling methods (ESMs), in temporomandibular disorder (TMD).

Methods

People with painful TMD (n=49), pain-free somatic controls (24 people with disk displacement), and healthy controls (n=28) completed measures of alexithymia (Toronto Alexithymia Scale-20 [TAS-20]) and depressed mood. Patients with painful TMD used ESM to record jaw pain multiple times daily for a week.

Results

The somatic and the healthy controls were equivalent on alexithymia and were combined. The painful TMD group had higher difficulty in identifying feelings but lower externally oriented thinking (EOT); only the latter effect remained after covarying depressed mood. Among patients with painful TMD, the TAS-20 total and EOT correlated positively with pain severity after controlling for depressed mood.

Conclusion

Findings highlight the complex relationships of alexithymia and its facets to TMD pain. Research should examine alexithymia facets separately and distinguish between methods that compare groups on alexithymia (e.g., pain patients versus controls) and those that correlate alexithymia with pain severity within a group.     

Modeled cost-effectiveness of the experience corps baltimore based on a pilot randomized trial

The Experience Corps^® program was designed to harness the social capital of an aging society to improve outcomes for public elementary schools. The objectives of this article are (1) to model the cost-effectiveness of the Experience Corps Baltimore using data from a pilot randomized trial, including costs, older adults’ health status, and quality of life and cost data from the Medical Expenditure Panel Survey, and (2) to describe the relationship between children experiencing increased expected lifetime earnings through improved educational attainment resulting from exposure to the Experience Corps Baltimore volunteers and the program’s costs and cost-effectiveness. On average, each quality adjusted life year (QALY) gained by older adults in Experience Corps Baltimore costs $205,000. The lower bound of the 95% confidence interval for the cost-effectiveness is $65,000/QALY. The upper bound is undefined as 15% of the simulations indicated no QALY improvements, If 0,3% of students exposed to the Experience Corps Baltimore changed from not graduating to graduating, the increased lifetime earnings would make the incremental cost-effectiveness ratio $49,000/QALY. If an additional 0,1% changed to graduating from high school, the program would be cost-saving. Using conservative modeling assumptions and excluding benefits to teachers, principals, and the surrounding community, the Experience Corps Baltimore appears expensive for the older adults’ health improvements, but requires only small long-term benefits to the target children to make the program cost-effective or cost-saving.     

魏稼教授的飞针手法与临床应用

魏稼教授师承徐少廷的飞针法,并融入古代“凤凰展翅”与“饿马摇铃”补泻法的临床经验。根据明代杨继洲《针灸大成》载,前者属于捻转泻法,而后者则属于捻转加提插补法。“凤凰展翅”泻法操作重点是：二指夹持针柄,朝一个方向一捻一放4-8次,如瑞鸟展翅状;“饿马摇铃”补法的操作要点是：二指持针柄缓慢轻微摇摆50次,如饿马无力之状。文中附有治验病例。论证了以此法治疗三叉神经痛,胆石症合并胆囊炎,支气管哮喘等均有满意疗效。     

罗诗荣老中医学术特长与临证经验

该文全面总结了全国名老中医,国务院特殊津贴者。罗诗荣主任医师从事针灸临床五十余年的学术特长与临证经验。罗老临床诊疗重视督肾证治。善用“铺灸”疗法;针灸取穴,善用“五输”“原”穴;针灸治病,辨病辨经相得益彰;针刺施治。重视治神,得气,守气,临证治疗妙用温灸。     

借鉴新加坡经验办好惠民医院

惠民医院在全国各地的兴办已有1年，在取得明显效果的同时，也出现了一些问题和难点。通过借鉴新加坡的经验，针对存在的问题提出解决建议，以推进惠民医院建设，缓解因“看病难、看病贵”问题引起的负面影响。