大陷胸汤灌肠治疗流出急性肾衰的观察与护理

目的 探讨中药大陷胸汤高位保留灌肠对流行性出血热（EHF）急性肾衰的治疗作用。方法 将60例EHF急性肾衰患者随机分为对照组与治疗组各30例，对照组予以常规治疗，治疗组在常规治疗的基础上加用大陷胸汤高位保留灌肠，观察两组患者治疗前后的疗效。结果 治疗组治愈23例，好转6例，无效1例，总有效率96．7％；对照组治愈17例，好转7例，无效6例，总有效率80．0％；两组疗效比较，有显著差异性p〈0．05（x^2=4．630）。结论 大陷胸汤高位保留灌肠治疗EHF急性肾衰疗效显著，且简便、安全、经济、病人乐于接受等优点。     

Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Patient Outcomes

OBJECTIVE: To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. STUDY DESIGN: Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources. DATA COLLECTION: Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use. PRINCIPAL FINDINGS: Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes. CONCLUSIONS: This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.     

颈椎病与中医辨证关系的探讨(附100例分析)

目的:探讨颈椎病与中医分型的辨证关系。方法:对100例该病的影像表现与中医分型进行系统分析。结果:主要临床表现颈部活动受限,颈、肩、背部疼痛,常伴头痛、头晕、视物模糊、耳鸣等症状。风寒型以软组织所致颈曲改变为主。肝肾亏虚型、痰湿交阻型以骨质增生、椎间隙及椎间孔狭窄为主。结论:X线、CT是本病首选检查方法,能与中医辨证有机结合,对中西医治疗有重要意义。     

Noninvasive Intracranial Cerebral Flow Velocity Evaluation in the Emergency Department by Emergency Physicians

Transcranial Doppler (TCD) is an accepted modality for the evaluation of cerebral blood flow velocities. OBJECTIVES: The purpose of this study was to test the feasibility of bedside TCD measurement in the emergency department (ED) with critically ill, intubated patients. METHODS: A prospective convenience sample of patients presenting to a university hospital over a two-month period underwent TCD evaluation of the middle cerebral artery. Intubated patients with head trauma and any patient requiring tracheal intubation were eligible. A 2-MHz Doppler probe was positioned over the temporal bone to acquire blood flow velocities. An emergency medicine resident and research assistant obtained measurements. Continuous TCD tracings were recorded on a video cassette recorder tape for quality assurance review and data collection. Vital signs and therapeutic interventions were also recorded. Flow velocities were measured in cm/s; the peak Resistance Index (RI) was calculated for each patient. RESULTS: A total of 30 patients were enrolled in the study. Adequate tracings were obtained in 25 patients (83%) without a disruption of resuscitation. Tracings could not be obtained in five patients; they were listed as TCD failures. However, in two of these patients, adequate flow velocity tracings were obtained after resuscitation. Four patients were evaluated during tracheal intubation. One patient was monitored successfully during cardiopulmonary resuscitation. The median time required for data acquisition was 1.9 minutes. The mean highest RI for those who expired was 0.84. For those who survived, the mean highest RI was 0.52. The difference of 0.32 was statistically significant (p = 0.04). CONCLUSIONS: Noninvasive blood flow velocity monitoring of the middle cerebral artery using TCD is feasible in the ED when performed at the bedside on intubated patients with traumatic brain injury and others during tracheal intubation and resuscitation.     

识时度势保持特色力求发展--中西医合校的回顾与思考

新疆医科大学为全国第二家中西医合并院校.在新疆进行中西医合校,实属时势所使,事在必行.强弱相合,处于弱势的中医学院只有坚持相对独立,才能保证于合校后发扬中医药特色、办好中医药教育.中西医合校,给原本弱小的新疆高等中医药教育事业的发展带来了诸多可供凭借和利用的积极因素,同时也存在不少负面影响.新疆医科大学在实践中认清了中西医同校的优势与缺憾,采取扶持和爱护中医的策略,不断尝试规避冲突、化解矛盾、趋利祛弊、务期和谐,终喜事业有成,使高等中医药教育得以在新疆生存,并越过低谷,走上健康发展之路.     

When the standards aren't standard: Evidence-based medicine in the Russian context

This paper examines the uses of evidence-based medicine (EBM) in post-Soviet Russia through the use of semi-structured interviews. It asks what it means to talk about practicing evidence-based medicine in a setting where the context of practice presents considerable barriers to the implementation of EBM principles. Drawing on interviews with Russian physicians, medical students and users of the healthcare system, the paper argues that in post-Soviet Russia EBM serves as a strategic discourse for segments of the medical profession. With the collapse of the U.S.S.R. the healthcare system has been going through a period of crisis, and Russian physicians are finding that they have to redefine their professional identity with respect to the domestic and the international context and have to seek new sources for legitimating their professional position. The western origins of EBM endow this rhetoric with considerable power in the Russian context and render it a very useful tool in the project of redefinition.     

中药肾区渗透并常规治疗高血压性肾损害40例疗效观察

目的：观察中药肾区皮肤外敷渗透加西药常规治疗高血压肾损害结果。方法：将部分中药粉碎微细化处理，将另部分中药液化处理．粉液混合装袋醋浸后外敷在肾区皮肤上，用药物导入仪肾区靶点式导人人体。并用一般西医常规治疗。结果：平均治疗3周血肌酐下降23％，BUN下降26％，24h蛋白尿下降23％，尿量增加16％，收缩压下降9％，舒张压下降7％。结论：中药的肾区皮肤外敷渗透加西医常规治疗效果明显高于一般常规治疗。     

Treatment of calcaneal fractures: the available evidence

Abstract Calcaneal fracture is the most common of the tarsal fractures and represents 1%–2% of all fractures. The fractures may be divided into extra-articular (not affecting the joint) and intra-articular (involving the talo-calcaneal and calcaneal cuboid joints) types. The management of heel fractures includes nonoperative and operative treatments, but no clear consensus has been reached. The choice of operative treatment is still controversial with many factors influencing the final clinical outcome. Many studies have assessed the outcome of treatment of calcaneal fractures, but there is a general disagreement on their management. The objective of this study was to collect and evaluate the scientific evidence reported in the literature supporting the different treatments for calcaneal fractures.     

End-of-life Models and Emergency Department Care

Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.     

长托宁用于全麻术前用药的效果观察

目的:观察长托宁作为全麻病人麻醉前用药对心血管系统和呼吸道分泌物的影响.方法:随机选择20例需全麻手术病人,在麻醉诱导前静注长托宁0.015 mg/kg,观察注药前、后5、10、20分钟各时点的血压、心率、脉搏氧饱和度及口干程度以及术中术毕口腔和呼吸道分泌物情况.结果:病人使用长托宁后5、10、20分钟的血压、心率与使用前相比有下降趋势,但无统计学意义(P＞0.05),脉搏氧饱和度未见明显改变,用药10分钟病人有轻度口干,术毕拔除气管导管时口腔及呼吸道分泌物较少.结论:长托宁用于全麻病人麻醉前给药效果满意.