行为干预对慢性阻塞性肺疾病缓解期患者生活质量的影响

目的:探讨行为干预对慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)缓解期患者生活质量的影响。方法:将54例COPD患者按随机抽签法分为行为干预组与对照组。两组临床治疗相同,行为干预组在此基础上增加行为干预:心理情绪干预、躯体功能干预、生活行为干预。参考方宗君等人的COPD患者生活质量问卷及评分方法分别在治疗前、出院前、出院后3个月、1年评估两组患者生活质量。结果:随访1年,行为干预组日常生活能力F1,社会活动状况F2,抑郁心理症状F3,焦虑心理症状F4评分(2.03±0.32,2.29±0.77,2.36±0.34,2.07±0.25)较对照组(2.29±0.30,2.39±0.41,2.41±0.28,2.16±0.51)降低明显,差异具有显著性意义(t=2.801,2.914,P<0.01,t=2.250,2.340,P<0.05)。结论:行为干预可有效改善COPD缓解期患者生活质量。     

综合疼痛管理在腰椎间盘突出症保守治疗中的应用效果

目的：探讨综合疼痛管理在腰椎间盘突出症(LDH)保守治疗中的应用效果。 方法：2018年1月~12月选取宜宾市第一人民医院中医骨伤科门诊LDH患者100例，随机分为对照组和管理组，在常规非手术治疗基础上，对照组不予特殊疼痛管理，管理组给予疼痛教育、疼痛评估和多模式镇痛等综合疼痛管理措施，干预3个月后比较其疼痛评分、对疼痛控制方法和疼痛教育的满意度及疗效。 结果：干预前两组患者疼痛视觉模拟(VAS)评分和简化McGill疼痛量表(SF-MPQ)评分差异无统计学意义(P>0.05)，干预后管理组显著低于对照组(P<0.05)。干预后患者对疼痛控制方法和疼痛教育的满意度管理组优于对照组[疼痛控制方法满意度：(37.3±7.7)vs(31.2±7.2)，对疼痛教育的满意度：(31.8±5.9)vs(22.9±6.1)，P<0.05]。管理组总有效率和疗效等级高于对照组(92.0%vs74.0%，P<0.05)。 结论：综合疼痛管理有利于缓解患者疼痛，维持患者身心健康和改善生活质量。     

住院病人陪护人员对陪探视需求的调查

[目的]了解住院病人陪护人员对陪探视的需求,旨在探讨有效的陪护管理对策。[方法]采用自行设计问卷对498名陪护人员进行调查。[结果]大多数调查者认为病人在住院期间需要陪护,对陪护人员的需求主要为直系亲属占84.6%;69.9%陪护人员认为应该限制探视时间,54.0%的陪护人员认为在任何时间均可探视。[结论]在现有条件下最大限度地支持家人陪护,满足病人的陪护需求,适当限制探视时间,才能保障病人的身心需求。     

吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响

目的 观察吞咽训练结合营养干预对喉癌患者术后放疗后营养状态和生活质量的影响。 方法 采用随机数字表法将56例喉癌术后放疗后患者分为实验组和对照组,每组28例。2组患者均接受常规健康咨询和吞咽训练,实验组在此基础上给予营养干预。在干预前、干预后3个月,采用安德森吞咽困难量表(MDADI)、患者主观整体营养状况评分量表（PG-SGA)、生活质量调查表30(QLQ-C30)评价2组患者的吞咽功能、营养状态、生活质量。 结果 干预前,2组患者MDADI评分、PG-SGA评分、QLQ-C30评分比较,差异无统计学意义（P>0.05）。实验组干预后3个月MDADI评分［（63.96±11.37）分］、PG-SGA评分［（3.07±1.75）分］、QLQ-C30评分［（55.93±7.07）分］较组内治疗前显著改善（P<0.05）,对照组干预后3个月仅MDADI评分［（58.72±10.57）分］较组内治疗前改善（P<0.05）。与对照组干预后3个月比较,实验组MDADI评分、PG-SGA评分、QLQ-C30评分显著改善（P<0.05）。实验组与对照组干预前、后3个月MDADI评分、PG-SGA评分、QLQ-C30评分差值［（13.43±10.23）分、（1.81±1.63）分、（7.47±6.32）分］比较,差异有统计学意义（P<0.05）。 结论 吞咽训练结合营养干预可以更有效改善喉癌患者术后放疗后的吞咽功能和营养状态,提高患者的生活质量。     

舌头操在慢性心衰患者康复护理中的作用

[目的]探讨舌头操对慢性心衰(CHF)患者的临床效果及对患者生活质量的影响,并评估护理满意度,为临床护理提供依据.[目的]选择本院2013年1月至2014年12月收治的CHF患者120例,随机分为对照组和观察组,每组各60例.对照组患者采用常规护理干预,观察组在常规护理干预基础上,指导患者应用舌头操进行功能锻炼.比较两组干预后6 min步行试验、左室射血分数(LVEF)、心功能NYHA分级,急性缺血及心功能恶化等心血管事件发生情况、再次住院次数;并进行生活质量评估和护理满意度评价.[结果]两组干预后6 min步行距离、左室射血分数(LVEF)、心功能纽约心脏病协会(NYHA)分级和生活质量评分均优于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05);观察组住院天数、再次住院率和心血管事件发生率少于对照组,差异有统计学意义(P<0.05);观察组护理满意度为(94.78±3.61)分,高于对照组(90.23±2.96)分,差异有统计学意义(P<0.05).[结论]应用舌头操对CHF患者进行护理干预,能够显著改善患者心功能及生活质量,并提高护理满意度,减少患者再次住院率,对心衰患者的康复具有一定价值.     

快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用

目的 探讨快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用效果.方法 选取该院2014年10月~2015年10月入院的行腹腔镜胆囊切除术患者88例,随机分为两组,对照组患者采用常规护理,实验组患者则加施快速康复护理联合中药治疗,比较两组患者总体治疗效果评价、并发症、干预前后健康知识评分与术后疼痛、相关临床指标与护理满意度.结果 两组患者治疗总有效率比较差异无统计学意义(P>0.05);实验组患者并发症发生率(9.09%)显著低于对照组(36.36%)(P<0.05);干预后健康知识评分(92.50±4.22)分显著高于对照组(75.49±17.38)分(P<0.05),术后VAS评分(0.57±0.29)分显著性低于对照组(1.26±0.82)分(P<0.05);肛门排气时间(27.14±8.07)h、首次排便时间(34.71±9.34)h与住院时间(3.24±1.33)h显著低于对照组(38.22±8.94,45.96±9.62,4.49±1.50)(P<0.05);总体护理满意度显著优于对照组(P<0.05).结论 快速康复护理联合中药治疗在腹腔镜胆囊切除术中的应用效果显著,可提高满意度,具有借鉴性.     

陪护人员职业态度现状调查分析及干预对策

目的:调查陪护人员职业态度现状,探索有针对性的干预措施,做好陪护的管理工作,为患者提供优质的身心护理。方法:自行设计陪护人员职业态度现状调查表(内容包括:陪护人员职业态度的3个组成方面,即认知成分、情感成分、行为成分)。对129名陪护人员进行调查。结果:在认知方面,60.8%陪护人员过去未接触过陪护工作,82.2%的人是因为生活来应聘,12%的人认为陪护工作意义不大;在情感方面,15%陪护人员工作心情不愉快,28.2%陪护人员觉得,做一名陪护人员不好意思告诉别人,低人一等;在行为方面,陪护人员对工作的热情程度占69.5%,对工作责任心自我评价强的占80%,一般强占20%。结论:加强陪护人员管理,促进护理质量的提高。     

肺康复干预治疗稳定期慢性阻塞性肺疾病患者的疗效观察

目的 观察肺康复干预治疗稳定期慢性阻塞性肺疾病（COPD）患者的疗效。 方法 采用随机数字表法将110例稳定期COPD患者分为观察组及对照组，每组55例。2组患者均给予常规治疗，观察组患者在此基础上辅以肺康复干预（包括肢体运动训练、呼吸肌训练及社会心理支持干预等）。于治疗前、治疗6个月后分别评价2组患者肺功能、病情严重程度、焦虑/抑郁情绪及生活质量改善情况。 结果 治疗后观察组第1秒钟用力呼气量占预计值百分比［(70.71±4.96)%］和第1秒钟用力呼气量占用力肺活量比值［(73.55±9.21)%］均较治疗前及对照组显著提高(P<0.05)；治疗后观察组患者BODE指数评分［(2.01±0.68)分］、焦虑量表(SAS)评分［(38.75±8.22)分］、抑郁量表(SDS)评分［(44.59±7.80)分］及圣·乔治COPD生活质量调查问卷(SGRQ)评分［(43.55±7.31)分］均较治疗前及对照组显著降低(P<0.05)。 结论 在常规治疗基础上辅以肺康复干预可明显改善稳定期COPD患者肺功能及心理状况，减轻病情程度，提高生活质量，该疗法值得在COPD患者人群中推广、应用。     

强化管理在糖尿病足高危患者保肢治疗中的意义

目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。     

护士主导的协同一体化护理模式在尿道下裂手术患儿中的应用

目的探讨护士主导的协同一体化护理模式在尿道下裂手术患儿中的应用效果, 为协同医护患一体化, 提高护士护理水平和患儿护理质量提供借鉴。方法采用类实验研究方法, 2020年1月至2021年12月, 选取南京医科大学附属儿童医院泌尿外科行尿道下裂手术84例男性患儿的临床资料进行回顾性分析, 并将对应的84位陪护人员纳入研究对象。其中2020年1—12月入院的患儿42例及陪护人员42人作为对照组, 2021年1—12月入院的患儿42例及陪护人员42人作为干预组。对照组采用常规围手术期护理模式, 干预组采用护士主导的协同一体化护理模式。比较2组陪护人员的焦虑情绪评分及满意度, 2组患儿的医疗恐惧、医疗依从性及术后疼痛, 2组患儿的术后并发症发生率。结果干预后干预组陪护人员满意度评分为(96.46 ± 3.27)分, 患儿医疗依从性评分为(2.93 ± 0.89)分;对照组分别为(85.24 ± 5.71)、(1.75 ± 0.63)分, 2组比较差异均有统计学意义(t=9.52、-8.40, 均P<0.05)。干预后干预组陪护人员焦虑情绪评分为(44.33 ± 2.43)分, 患儿医疗恐惧...     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."