不同的阻滞方法对75岁以上高龄老人阻滞效果及循环功能的影响

为比较硬膜外隙阻滞(硬外)、蛛网膜下隙阻滞(腰麻)和单侧蛛网膜下隙阻滞(腰麻)在75岁以上高龄股骨颈骨折手术中的阻滞效果及对循环的影响.选ASAⅢ～Ⅳ级90例,随机等分为3组,Ⅰ组为硬外阻滞组(A组),用1.5%Lidocaine 4ml试验剂量并确认无脊麻后,根据情况追加1.5%Lidocaine 4～6ml;Ⅱ组为腰麻组,Ⅲ组为单侧腰麻组,两组注药速度均为0.1ml·s-1,注药过程均不作往返吸注.Ⅱ组用0.75%布比卡因1ml(7.5mg),注药后仰卧;Ⅲ组患侧在下侧卧,用0.75%布比卡因0.6ml(4.5mg)、10%葡萄糖液0.4ml,注药20min后平卧.结果显示:①患侧痛觉阻滞起效由快到慢为Ⅱ组、Ⅲ组和Ⅰ组.②三组阻滞前后的心率比较,均无显著性差异;Ⅲ组阻滞前后的平均动脉压也无显著性差异,但Ⅰ和Ⅱ组的阻滞前后的平均动脉压均有显著性差异.③患侧痛觉阻滞达标率(无痛平面达L1的百分率)为Ⅰ组93.3%,Ⅱ和Ⅲ组均为100%.④阻滞不全者Ⅰ组3例,而Ⅱ和Ⅲ组则无.⑤发生低血压者Ⅰ和Ⅱ组各3例,且同时都伴有ECG的ST段下移;Ⅲ组则无.表明①单侧腰麻组起效较快、阻滞完善和患侧痛觉阻滞达标率高.②单侧腰麻所用剂量小,阻滞范围小,对循环干扰轻和阻滞平面似乎更易控制.因此,小剂量布比卡因单侧腰麻可能更适合高龄老人下肢手术.     

心理暗示干预在老年人牙拔除术中的应用

目的：探讨心理暗示干预在老年人牙拔除术中的应用价值。方法：将老年人拔牙患者118例随机分为心理暗示组及对照组各59例。心理暗示组在拔牙术前采用心理暗示干预的方法,对照组未给予任何暗示,按照沉稳型、张乱型及混合型三个等级统计数据,进行对比研究。结果：心理暗示组的沉稳型率显著高于对照组（P〈0.01）,张乱型率显著低于对照组（P〉0.05）。结论：心理暗示干预应用于老年人牙拔除术时,可明显降低患者的畏惧程度,缩短手术时间,确保手术的顺利进行,有一定的应用价值。     

医疗机构互联网便民惠民移动应用测评研究

通过多维度测评方法评估北京地区医疗机构互联网移动应用建设、管理情况,介绍测评范围、方法、指标体系,分析测评结果并提出建议,包括明确移动应用定位,建立业务规范和标准,加强诊中和诊后服务等.     

某乡镇高三中学生变应性鼻炎患者的心理学特点分析

目的：研究某乡镇高三中学生变应性鼻炎患者的心理学特点。方法对300例某乡镇高三中学生变应性鼻炎患者采用症状自评量表（scl-90）进行问卷调查,并统计分析与患者心理健康状况有关的某些因素。结果躯体化、强迫症状、抑郁、焦虑、精神病性5个因子得分与国内常模比较差异有统计学意义（t值分别为5.923、3.698、2.995、5.896、4.713,P〈0.05）。结论某乡高三学生变应性鼻炎患者存在躯体化、强迫症状、抑郁、焦虑、精神病性等方面的心理特点,学校、家庭及社会应予重视并针对其心理问题给予正确的心理辅导。     

从老人院听力调查情况看老人听力康复的重要性

目的通过对南宁市社会福利院的老人进行听力调查，了解老年人听力残疾发生率及残疾程度。方法在本底噪声≤40dB（A）的安静房间内，用Pc—RB便携式听力计，对老人双耳进行纯音测听，取0．5、1、2、4kHz4个频率的平均值作为评定听功能的指标。结果按第二次全国残疾人抽样调查所定听力残疾等级标准进行评定，52例老人中有听力残疾的人数为42例，占80．77％，其中一级听力残疾3例，占5．77％；二级听力残疾3例，占5．77％；三级听力残疾19例，占36．54％；四级听力残疾17例，占32．69％。在听力残疾的42例中，男26例，女16例；听力相对较好者10例，男3例，女7例。结论社会福利院60岁以上的老人相对集中，听力残疾发生率较高，这是老年性聋发生的一个缩影，应引起全社会对老年人的听力保护和康复的重视；老年听力残疾人中男性比女性多，而未定等级的10例中，女性又较男性多，这又为研究老年性聋发生机理，特别是易感基因或长寿基因的研究提供了流行病学调查的依据。     

循证护理在2型老年糖尿病患者护理中的应用及思考

目的:探讨循证护理在护理中的应用方法。方法:根据循证护理的指导思想及实施原则,指导2型老年糖尿病患者的护理工作并观察其效果。结果:本组病例在观察期间维持了良好的健康状态,未出现严重的合并症,患者具有良好的依从性。结论:循证护理应与整体护理相结合,在我国,循证护理尚需进一步的发展和完善。     

An ethnobotanical study of medicinal plants used by the Nandi people in Kenya

ETHNOPHARMACOLOGICAL RELEVANCE: The study of local knowledge about natural resources is becoming increasingly important in defining strategies and actions for conservation or recuperation of residual forests. AIMS OF THE STUDY: This study therefore sought to collect information from local populations concerning the use of Nandi Forest medicinal plants; verify the sources of medicinal plants used and determine the relative importance of the species surveyed. MATERIALS AND METHODS: Data was obtained using semi-structured forms to record the interviewee's personal information and topics related to the medicinal use of specific plants. A total of 40 medicinal plants used locally for the treatment and/or control of human ailments were collected through interviews conducted with selected traditional doctors and professional healers. RESULTS: This study demonstrated that local people tend to agree with each other in terms of the plants use and that leaf material form the major component of plant parts exploited. The other harvested materials consist of stem bark, the roots and the whole plant, though at a lower intensity for making liquid concoctions from different plants. Majority of the remedies were prepared from a single species. In most cases, the mode of administration was oral. In the forest, some of the plants collected were scarce. This scarcity was attributed to indiscriminate logging, overexploitation, poor harvesting methods and current agricultural trends. CONCLUSION: Conservation procedures and creation of awareness were identified as the main remedies to the current situation.     

医疗纠纷人民调解受理范围评析

列举并分析了各地“医调委”对受理范围的规定,认为现有规定既不统一,也比较模糊。为了推进医疗纠纷人调解在全国的应用,建议应对受理范围进行统一规定。     

广东省与河南省HIV感染者调查结果的比较分析

目的　比较分析广东省与河南省两地HIV感染者的感染特点。方法　采用调查表对广东省 81例和河南省 130例HIV感染者进行问卷调查并分析。结果　两地患者在性别、年龄、文化程度、婚姻状况、传播途径分布等方面均存在明显差异。(1)广东省男女感染比率约为 2. 1: 1,男性明显多于女性;河南省男女感染比率约为 0. 9: 1。(2)广东地区感染者中 69%年龄分布在 21-40岁间;河南地区 76%的感染者年龄分布在 31-50岁间。(3)广东省感染者总体文化程度较河南地区高。(4)广东省感染者中近一半(43. 2% )未婚或不在婚,河南省 91. 5%感染者已婚。 ( 5 )在广东以性传播 ( 54. 3% )、静脉吸毒 ( 23.4% )为主,同时存在血液传播。在河南血液传播是最主要的传播途径,性传播途径仅见于夫妻间性传播。(6)广东省感染者CD+4 计数相对较低, 57. 2%低于 200个,病情较重;河南省 70. 6%的感染者CD4+计数高于 200个,病情相对较轻。结论　经过分析,发现两地社会、经济因素对两地HIV感染特点有一定影响。根据感染特点实施干预措施,对进一步预防疾病传播及提高HIV感染者的生存质量有重要意义。     

Point-of-care hepatitis C screening with direct access referral to improve linkage to care among halfway house residents: a pilot randomised study

INTRODUCTIONLinkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group.METHODSAll participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment.RESULTS351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis.CONCLUSIONPoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.