乳腔镜下乳腺癌保乳根治术的护理配合

[目的]总结乳腔镜下乳腺癌保乳根治术的护理配合措施。[方法]回顾性分析30例乳腔镜下乳腺癌保乳根治术病人的临床资料。[结果]本组病人均手术成功,无严重并发症发生。[结论]加强护理配合是乳腔镜下乳腺癌保乳根治术手术成功的重要保证。     

The impact of fluctuations in boat velocity during the rowing cycle on race time

In competitive rowing, the fluctuations in boat velocity during the rowing cycle are associated with an increased water resistance of the boat as compared with a boat moving at a constant velocity. We aimed to quantify the influence of the increased water resistance on race time using a mathematical approximation, based on the increase in physiological power being proportional to the 2nd power of boat speed. Biomechanical data (oar force, rowing angle, boat velocity, and boat acceleration) were measured when eight elite coxless pair crews performed a rowing test with a stepwise increasing stroke rate (SR: 20, 24, 28, and 32 min⁻¹) that successively increased the mean boat speed. The results revealed a +4.59 s (SR 24.2) to +5.05 s (SR 31.5) 2000-m race-time difference compared with a boat hypothetically moving without velocity fluctuations. Velocity fluctuations were highly correlated with SR ( r =0.93) because the accelerations of the rowers' body mass and the mass of the counteracting boat increase with SR. The possibilities to reduce velocity fluctuations and therefore race time are limited. For elite rowers, race time may be slightly reduced by a moderate reduction in SR that is compensated by an increased force output for each stroke.     

深入研究预约挂号的服务要素切实提高门诊医疗服务水平

首都医科大学附属朝阳医院结合预约挂号服务的实践,从有所侧重的多元化预约应成为基本服务方式、预约挂号的配套服务措施应更加细致完善、合理的预约“优先”至关重要、预约诊疗服务要求对医院的医疗资源进行最优化的组织管理、预约诊疗服务要求科室对就诊人群进行管理、预约诊疗服务要求在门诊诊疗活动中灵活应用并保证医疗核心制度的落实等六个方面对影响预约挂号的各种要素进行了分析阐述。     

保留肋骨经肋间隙入路在中下胸椎手术中的应用研究

目的：探讨保留肋骨经肋间隙入路在中下胸椎手术中的应用价值。方法对40例中下胸椎疾病患者采用保留并不断肋骨经肋间隙入路进行手术（A组）,并与采用传统后外侧断肋入路进行手术（B组）的40例患者进行比较,观察两组在切口长度、手术视野纵向直径、开胸时间、关胸时间、胸内操作时间、术中出血量、引流管放置时间、术后引流量、术后疼痛视觉模拟评分（VAS）、术前和术后1周呼吸功能及术后住院时间等各项指标的差异。结果A组手术切口长度、开胸时间、关胸时间、术中出血量、引流管放置时间、术后引流量、术后住院时间均优于B组,差异均有统计学意义（P＜0.05）。A组术后1月的疼痛VAS评分优于B组,差异有统计学意义（P＜0.05）,但术后3个月的疼痛VAS评分两组差异无统计学意义（P＞0.05）。两组术前肺功能评分比较差异无统计学意义（P＞0.05）。A组术后1周的肺功能评分优于B组,差异有统计学意义（P＜0.05）。两组在手术视野纵向直径、胸内操作时间比较差异均无统计学意义（P＞0.05）。结论采用保留肋骨经肋间隙入路治疗胸椎疾病,具有进胸快、手术视野暴露充分、出血量少、关胸简便、术后疼痛轻、恢复快、生活质量高等优点,有推广价值。     

门诊和住院信息系统无缝对接的信息化预约住院系统的研究

目的：探讨门诊和住院信息系统无缝对接的信息化预约住院系统在综合性医院的应用,使有限的床位资源能被合理、有序、高效地利用,最大限度地满足患者的住院需求。方法：将2011年1月1日-2011年11月30日的预约住院患者分为传统预约组（对照组）,将2012年1月1日-2012年11月30日的预约住院患者分为信息化预约组（观察组）,并排除因医保费用办理进出院的患者,以确保临床资料具有科学性和可比性。观察预约住院人数、平均预约住院天数、床位使用率、平均住院日、医护工作者满意度、患者满意度等指标情况。结果：在预约住院人数和床位使用率基本不变的情况下,观察组的平均预约住院天数、平均住院日、医护工作者满意度、患者满意度均较对照组有统计学差异。结论：充分利用信息技术,更合理、高效、有序地收治患者,是妥善解决住院矛盾、构建和谐医患关系的重要手段。     

原位保留甲状旁腺血供及甲状旁腺自体移植术

目的 介绍甲状腺肿瘤手术中保护甲状旁腺血供及甲状旁腺自体移植的方法及疗效.方法 46例全甲状腺切除或近全切除手术中,血管化甲状旁腺保留24例,单纯自体甲状旁腺移植5例,1～2枚甲状旁腺血管化保留同时其余甲状旁腺Ⅰ期自体移植17例.结果 应用此法行全甲状腺切除或近全切除患者中,有2例原位血管化保留甲状旁腺及3例血管化保留+自体甲状旁腺移植患者术后48～72 h内出现一过性低血钙,予以补钙后3 d左右恢复正常.2例单纯甲状旁腺自体移植患者术后出现低血钙,服用钙尔奇D/罗盖全4周～8周后复查血钙维持在正常水平.术后出现永久性甲状旁腺功能低下的仅1例(2.2%).结论 血管化甲状旁腺保留及自体甲状旁腺移植可大大降低全甲状腺切除或近全切除手术导致甲状旁腺功能低下的发生率.     

Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME)

BackgroundElite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries.PurposeTo compare elite collegiate female athletes who were able to successfully return to sport for at least one season following ACLR to their teammates with no history of ACLR with regard to self-reported knee function, kinetics, and kinematics during a double limb jump-landing task.Study DesignCross-Sectional StudyLevel of EvidenceLevel 3MethodsEighty-two female collegiate athletes (17 ACLR, 65 control) completed the knee-specific SANE (single assessment numeric evaluation) and three trials of a jump-landing task prior to their competitive season. vGRF data on each limb and the LESS (Landing Error Scoring System) score were collected from the jump-landing task. Knee-SANE, vGRF data, and LESS scores were compared between groups. All athletes were monitored for the duration of their competitive season for ACL injuries.ResultsAthletes after ACLR reported worse knee-specific function. Based on vGRF data, they unloaded their involved limb during the impact phase of the landing, and they were more asymmetrical between limbs during the propulsion phase as compared to the control group. The ACLR group, however, had lower LESS scores, indicative of better movement quality. No athletes in either group sustained ACL injuries during the following season.ConclusionDespite reporting worse knee function and demonstrating worse kinetics, the ACLR group demonstrated better movement quality relative to their uninjured teammates. This functional profile may correspond to short-term successful outcomes following ACLR, given that no athletes sustained ACL injuries in the competition season following assessment.     

知名专家团队层级转诊预约系统设计与实现

以首都医科大学附属北京同仁医院为例,分析转诊需求,制定转诊规则与流程,设计包含知名专家团队成员维护、转诊权限维护、预约号源配置等功能的知名专家团队层级转诊预约系统,分析存在的不足并提出改进建议,指出该系统有助于完善就诊流程,提高医疗效率。     

Pathogenic weight-control methods and self-reported eating disorders in female elite athletes and controls

To determine the use of pathogenic weight-control methods and prevalence of self-reported eating disorders (ED) among female elite athletes and non-athletic controls, the Eating Disorder Inventory (EDI) and a self-developed questionnaire were administered to the total population of Norwegian female elite athletes ( n =603) and age- and home community-matched controls ( n =522). The response rate in both athletes and controls was 86%; 97% of the athletes and 90% of the controls had body mass index (BMI) values within or below the optimal level (20–25). Athletes had a significantly lower mean BMI 20.8 (95% confidence interval (CI), 20.7–20.9) than controls 21.5 (95% CI 21.3–21.7). A similar fraction of the athletes (31%) and controls (27%) were dieting. Most athletes dieted to enhance performance (73%); most controls dieted to improve appearance (83%). Significantly more athletes (11%) than controls (7%) used pathogenic weight-control methods. Athletes competing in aesthetic and endurance sports were the leanest groups, and athletes competing in aesthetics, endurance- and weight-dependent sports most frequently reported the use of the more severe pathogenic weight-control methods. A similar fraction of athletes (22%) and controls (26%) were classified as being at risk of developing ED based on the subscale scores of the EDI. However, a higher fraction of athletes in aesthetics-, endurance-, and weight-dependent sports than athletes in technical sports, ballgames, power sports and non-athletic controls were classified as being at risk of developing ED. In contrast to previous reports, our results demonstrated that a number of athletes also competing in sports where the participants are considered less weight-conscious were using pathogenic weight-control methods (technical 10% and ballgames 8%). A similar percentage of athletes (12%) and controls (11%) actually reported having an ED.