中国结直肠癌肝转移诊断和综合治疗指南（2018版）

正第一部分诊疗指南肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移(colorectal cancer liver metastases)是结直肠癌治疗的重点和难点之一。15%～25%的结直肠癌病人在确诊时即合并肝转移,另有15%～25%的病人将在结直肠癌根治术后发生肝转移,其中绝大多数(80%～90%)的肝转移灶初始无法获得根治性切除。结直肠癌肝转移也是结直肠     

急诊护理中的暴力风险因素分析及预防对策分析

目的探讨急诊护理中导致暴力事件的风险因素,并针对因素研究相关对策。方法将急诊科56名护理人员纳入研究范围,在研究开始初期对其工作调查,了解其工作情况和所遇暴力事件类型,并对暴力风险进行预测,以了解导致暴力风险的因素,对调查中所涉及暴力风险因素进行评估,针对有价值因素提出干预方法用以研究预防措施,最终对预防结果进行评价。结果护理人员的综合能力、职业道德、工作经验、法律意识、抢救水平、器械熟悉度以及患者就诊环境、缺少系统支持等问题都是导致暴力发生的因素,在进行了急诊科室护理人员系统教育后的第二次调查中,由上述问题导致的暴力发生明显减少,其他难以人为单方面改善的因素仍可导致暴力事件发生,对此采取了加大安保力度、增加安保人员等方式来保证急诊科医护人员的安全。结论急诊科护理人员在工作中遭受暴力危害较多,应及时发现导致暴力的因素,积极寻找应对措施能有效降低暴力发生率,改善护患关系,保障护理人员的安全。     

What Are the Determinates of Asthma Control?

The evolution of our understanding of treatment of asthma begins with assessment of severity which is primarily related to the natural history of the disease. Control is defined as normalizing of the physiologic abnormalities and lessening economic and social burden of the disease. This paper reviews the factors that influence the variability and determinants of asthma control. The tools to validate and access asthma control should be employed in daily clinical practice.

Therefore, it is important to determine asthma control based on a multidimensional approach including physiologic assessment, global assessment of functionality, daytime symptoms, nighttime symptoms, healthcare utilization, and adherence to therapy.     

Changes in Life Satisfaction as a Function of Stay in a Residential Setting

ABSTRACT

Various authors have argued for the inclusion of well-being measures in order to assess children's quality of life in residential settings. In the present study, twenty-two children admitted to a residential treatment program were administered a multidimensional life satisfaction scale. The children were re-administered the instrument again approximately four months later. Results revealed that the present sample reported positive satisfaction ratings across all life satisfaction domains. Further, significant positive increases on their Global, Friends, Self, and Total satisfaction scores were noted upon re-administration. Implications of the findings, as well as suggestions for future research, are discussed.     

综合康复治疗儿童肱骨髁上骨折致肘关节活动障碍的疗效观察

目的：研究综合康复治疗儿童肱骨髁上骨折致肘关节活动障碍的疗效。方法对17例肱骨髁上骨折致肘关节活动障碍患儿进行综合康复治疗,治疗前后分别进行关节活动度测量及 HSS2（Hospital for Special Surgery Scoring System）肘关节评定标准评定。结果治疗3个月后关节活动度显著改善（P＜0.001）;按照 HSS2标准,所有患儿均达“优秀”。结论综合康复治疗儿童肱骨髁上骨折致肘关节活动障碍有显著疗效。     

鼻腔胚胎型横纹肌肉瘤6例并文献复习

<正>横纹肌肉瘤(rhabdomyosarcoma,RMS)是最常见的软组织恶性肿瘤之一,好发于儿童和青少年,主要发生于头颈部、腹膜后和泌尿生殖系统。成人横纹肌肉瘤很少见[1],而胚胎型横纹肌肉瘤(embryonalrhab-domyosarcoma,ERMS)是最常见的亚型,占横纹肌肉瘤的50豫~60豫,而成人鼻腔ERMS临床上更为罕     

中医药高等院校学生综合量化成绩相关要素初探

初步探索中医院校学生综合量化成绩相关要素,为未来提取中医药院校素质教育构成要素奠定基础。通过定性访谈获得中医院校学生综合量化成绩可能相关要素,通过案例对照研究设计获得中医院校学生综合量化成绩相关要素。结果共回收有效问卷200份,有17个要素与学生综合量化排名具有相关性。如专业了解程度;前途愿景;专业喜欢程度;中医经典掌握程度;背诵中医经典原文;跟师后认真研究病例并提出问题;学习勤奋刻苦程度;学习态度;学习计划;自主学习课外知识;阶段学习总结;关注西医进展研究;参加专业实习;专业知识技能掌握情况;阅读课外经典数量;科研思维;情绪调控能力。结果表明中医院校学生综合量化成绩与学生各方面素养有密切的关系,主要表现为学生的综合能力,包括良好的人文素养、健康素质、专业素质、传统文化素养、科学文化素养等方面相关要素。     

综合护理干预模式在预防小儿急性白血病PICC相关并发症中的作用

目的 观察综合护理干预模式在预防小儿急性白血病PICC相关并发症中的作用.方法 随机选取2014年1月-2016年6月于我院就诊的PICC置管急性白血病患儿104例,按照护理方式的不同,采用数字随机法均分为观察组与对照组,各52例,观察组给予综合护理干预,对照组给予常规护理干预,对比2组的并发症发生情况.结果 观察组并发症发生率明显低于对照组(P<0.05);观察组患儿的护理满意度明显优于对照组(P<0.05);观察组护理后情绪功能评分(60.12±9.87)、肢体功能评分(70.45±9.12)、认知功能功能评分(80.43±9.79)、社会功能评分(47.53±10.01)均明显优于对照组,具有统计学意义(P<0.05).结论 综合护理干预能够减少急性白血病患儿PICC相关并发症发生率,提高患儿的护理满意度.     

湖州地区慢性病患者合理用药的影响因素及预防措施

目的 分析湖州地区慢性病患者合理用药的影响因素,并制定预防措施。方法 采取系统抽样与典型抽样结合法对本院2018年4月～2019年4月门诊部收治的1283 例慢性病患者基本情况及处方药相关资料进行调查研究。本院每个月4、14 及24 号作为样本取样日,在患者接受门诊后采用系统抽样法,随机选择门诊患者1283例进行问卷调查,根据问卷调查相关资料及用药合理性相关依据将其分为合理用药组和不合理用药组,记录两组患者基本资料,分析影响合理用药的相关因素,并制定相应的预防措施。结果 1283 例慢性病患者中,合理用药1040 例（81.06%）,不合理用药243 例（18.94%）;合理用药组与不合理用药组医师工作年限、医师职称、药师是否参加合理用药培训及拿药地点比较,差异有统计学意义（P＜0.05）;医师工作年限、医师职称、药师是否参加合理用药培训及拿药地点均为用药合理性的保护因素（OR＜1,P＜0.05）。结论 医师工作年限≥10年、医师职称为副主任医师及以上、药师参加合理用药培训、拿药地点为院内处方药房均可促进合理用药,因此临床中应严格规范医师在职继续教育,针对工作年限较短及职称较低医生积极开展专业性培训,严格要求患者在院内处方药房拿药,以提高临床合理用药率。     

Measuring common outcome measures and their concepts using the International Classification of Functioning, Disability and Health (ICF) in adults with burn injury: a systematic review

Purpose

To identify and quantify the health related concepts contained in the most common outcome instruments used in adult burn care, and to compare the content of these instruments based on their linkage to the International Classification of Functioning, Disability and Health (ICF). The ICF has been validated as a reference tool by the World Health Organization and is a framework that incorporates physical, emotional, environmental and social aspects of daily functioning.

Methods

Electronic searches of MEDLINE, EMBASE CINAHL, PsychINFO and the Cochrane Library from 2003 onwards were carried out using a predetermined search strategy. Specific characteristics of the included studies and data pertaining to the outcome instruments were extracted. Two reviewers independently categorised the underlying concepts contained in the most commonly used outcome measures and linked them to ICF categories using standardised linkage rules.

Results

Out of a total 132 included studies, 151 outcome instruments were identified. Of these, 14 frequently used generic and burn-specific instruments were selected for linkage to the ICF. From the 381 items contained in the 14 instruments, 356 concepts were extracted and subsequently linked to 99 ICF categories. Nearly 46% of the concepts were linked to body function and 20% to activities and participation, whereas only a few concepts were formally linked to health condition, body structures and personal or environmental factors.

Conclusion

The ICF proved highly useful for the content comparison of frequently used generic and burn-specific instruments. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in those with burn injury.