内脏利什曼病合并HIV感染患者诊断和治疗研究进展

内脏利什曼病是全球被忽视的传染病之一,危害严重。而利什曼原虫-人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并感染对流行地区造成的威胁更甚。利什曼原虫与HIV存在相互作用,合并感染者在临床表现、诊断及治疗方面具有一定特殊性,其病死率及复发率均高于HIV阴性的内脏利什曼病患者。本文对利什曼原虫-HIV合并感染患者的临床表现、诊断和治疗进展进行综述。     

脊柱后路内固定术后硬膜外血肿的预防与护理体会

目的 探讨脊柱后路内固定术后硬膜外血肿的预防与护理体会。方法 遵照回顾性分析法选择我院2013年2 月～2018 年2 月纳入的60 例脊柱后路内固定术患者，依照不同理疗方式进行分组。其中30 例给予常规药物治疗作为对照组，另30 例除了常规治疗之外实施综合护理作为研究组，记录两组硬膜外血肿、腰椎术后血肿及颈椎术后血肿发生率，分别在干预前后进行生活质量评分（QOL）调查，出院时发放满意度调查问卷表，对比两组干预结果。结果 研究组血肿发生率为6.67%，明显低于对照组的20.00%（P＜0.05）。干预前两组的食欲、精神、睡眠、疼痛及日常生活评分相比差异无统计学意义（P＞0.05），干预后研究组的各项评分均高于对照组（P＜0.05）。研究组对干预效果的满意度为90.00%，明显高于对照组的76.67%（P＜0.05）。结论 护理干预运用于脊柱后路内固定中效果显著，能够有效减少硬膜外血肿的发生率，提升生活质量，促进病情稳定，患者满意度较高，可维持良好医患关系。     

Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran

Background and objective

Pressure ulcer (PU) is one of the important and frequent complications of hospitalization, associated with high treatment costs. The present study was conducted to determine the incidence of PU and its direct treatment costs for patients in intensive care unit (ICU) in Iran.

奥扎格雷联合低分子肝素钙治疗脑血栓的临床研究

目的：对应用低分子肝素钙与奥扎格雷联合对患有脑血栓疾病的患者实施治疗的临床效果进行研究。方法整群选择在该院2012年12月—2014年12月就诊的患有脑血栓疾病的患者86例，随机分为对照组和治疗组，每组43例。采用奥扎格雷对对照组患者实施治疗；采用低分子肝素钙与奥扎格雷联合对治疗组患者实施治疗。对比神经功能缺损评分在药物治疗前后的变化幅度、脑神经功能恢复正常时间和脑血栓药物治疗计划实施总时间、脑血栓疾病药物治疗效果、用药期间的不良反应人数。结果治疗组患者神经功能缺损评分在药物治疗前后的变化幅度明显大于对照组；脑神经功能恢复正常时间（9.66±2.41）d和脑血栓药物治疗计划实施总时间（13.28±2.14）d明显短于对照组（13.62±3.47）、（17.39±3.20）d；脑血栓疾病药物治疗效果（总有效率90.6%）明显优于对照组（总有效率69.8%）；用药期间的不良反应人数（1例）明显少于对照组（8例）。结论应用低分子肝素钙与奥扎格雷联合对患有脑血栓疾病的患者实施治疗的临床效果非常明显。     

A Tool to Assess Patient and Surrogate Knowledge About the POLST (Physician Orders for Life-Sustaining Treatment) Program

ContextIt is especially important that patients are well informed when making high-stakes, preference-sensitive decisions like those on the Physician Orders for Life-Sustaining Treatment (POLST) form. However, there is currently no way to easily evaluate whether patients understand key concepts when making these important decisions.ObjectivesTo develop a POLST knowledge survey.MethodsExpert (n = 62) ratings of key POLST facts were used to select items for a POLST knowledge survey. The survey was administered to nursing facility residents (n = 97) and surrogate decision-makers (n = 112). A subset (n = 135) were re-administered the survey after a standardized advance care planning discussion to assess the scale's responsiveness to change.ResultsThe 19-item survey demonstrated adequate reliability (α = 0.72.). Residents' scores (x = 11.4, standard deviation 3.3) were significantly lower than surrogate scores (x = 14.7, standard deviation 2.5) (P < 0.001). Scores for both groups increased significantly after administration of a standardized advance care planning discussion (P < 0.001). Although being a surrogate, age, race, education, cognitive functioning, and health literacy were significantly associated with higher POLST Knowledge Survey scores in univariate analyses, only being a surrogate (P < 0.001) and being white (P = 0.028) remained significantly associated with higher scores in multivariate analyses.ConclusionThe 19-item POLST Knowledge Survey demonstrated adequate reliability and responsiveness to change. Findings suggest the survey could be used to identify knowledge deficits and provide targeted education to ensure adequate understanding of key clinical decisions when completing POLST.