动机性访谈对1型糖尿病患儿自我效能及血糖的影响

目的探讨动机性访谈对1型糖尿病患儿的胰岛素笔注射技能、自我效能和血糖水平的影响。方法选取2016年7月—2017年6月在华中科技大学同济医学院附属同济医院儿童内分泌专科就诊入院的1型糖尿病患儿70例。按照随机数字表法分为观察组(n=35)、对照组(n=35)。对照组患儿接受由糖尿病专科护士主导的疾病相关知识和技能的常规健康教育(包括住院、出院2个阶段),观察组患儿在健康教育过程中接受基于行为分阶段转变理论的动机性访谈干预,在住院、出院2个阶段共接受5次干预。由护士在患儿出院时、出院1个月和3个月时使用胰岛素笔注射技能调查问卷评估患儿的胰岛素笔注射技能掌握情况;在出院时、出院3个月时测量患儿的自我效能和血糖水平。结果出院时两组患儿胰岛素笔注射技能得分、自我效能、血糖水平均无统计学差异(P0.05)。出院3个月时,两组患儿自我效能得分均较同组出院时提高(P0.05),但观察组自我效能得分高于对照组(P0.05);观察组在出院1个月、出院3个月时的胰岛素笔注射技能得分均高于对照组(P0.05),且时间与组别的交互作用有统计学意义(P0.05);观察组出院3个月时的血糖水平均较出院时下降(P0.05),且低于对照组(P0.05)。结论与常规健康教育相比,基于行为分阶段转变理论的动机性访谈干预可以提高1型糖尿病患儿的胰岛素笔注射技能和自我效能水平,有助于患儿的血糖控制,值得临床推广应用。     

动机访谈技术对2型糖尿病病人胰岛素笔注射行为改变的影响

[目的]探讨动机访谈技术对2型糖尿病病人胰岛素笔注射行为改变的影响。[方法]采取方便抽样的方法,选取江苏省省级机关医院糖尿病防治中心住院的使用胰岛素笔注射治疗的2型糖尿病病人62例,随机分为两组,对照组给予系统的糖尿病相关知识及技能的教育,研究组在教育的基础上使用动机性访谈技术进行干预。通过在干预前(基线)、1个月、3个月时使用问卷调查和现场评价的方式评价干预效果。[结果]两组的胰岛素注射知识、技能及自我效能均显著改善,且研究组除胰岛素注射知识外胰岛素注射技能及自我效能评价均显著优于对照组(P<0.05);研究组的胰岛素注射技能及自我效能改善幅度均高于对照组(P<0.05)。[结论]与现有教育模式相比,动机性访谈技术更能提高使用胰岛素笔病人的注射技能,并对认知行为转变有一定的积极作用。     

技能体验推动法对2型糖尿病老年患者胰岛素使用技能与血糖控制效果的影响

目的:探讨技能体验推动法对2型糖尿病老年患者胰岛素使用技能与血糖控制效果的影响。方法:选择2016年10~11月收治于我院的2型糖尿病老年患者90例做为研究对象,随机等分为对照组和试验组,对照组老年糖尿病病例接受常规胰岛素注射笔使用教育,试验组接受技能体验推动法护理干预,对两组患者干预后的各相关观察指标进行比较。结果:试验组干预后的自我效能评分、胰岛素笔注射技能评分和血糖控制总有效率均显著高于对照组(P0.05)。结论:采用技能体验推动法对2型糖尿病胰岛素笔老年使用者实施培训,可显著提高该类患者的自我效能、胰岛素笔注射技能和血糖控制效果。     

护理小程序在居家糖尿病患者胰岛素注射管理中的应用

目的 探讨护理小程序对规范糖尿病患者居家胰岛素注射及血糖管理的应用效果。方法 以2022年收治于上海市某三级甲等医院内分泌科初次确诊为2型糖尿病且需接受胰岛素治疗的患者为研究对象。以1-2月收治的53例患者作为对照组,给予常规宣教;以5-6月收治的47例患者作为观察组,在对照组基础上结合护理小程序干预。干预3个月后,比较两组患者胰岛素注射操作评分、糖尿病管理自我效能问卷评分及糖化血红蛋白监测值。结果 干预3个月后,观察组患者10项胰岛素注射操作技能评分及糖尿病管理自我效能4个维度评分均优于对照组,差异有统计学意义（P<0.05）;且观察组患者干预后糖化血红蛋白水平低于对照组,差异有统计学意义（P<0.05）。结论 护理小程序可有效提升居家糖尿病患者胰岛素注射技能及疾病管理自我效能、降低其糖化血红蛋白水平,有利于患者血糖控制及疾病管理,且可节约医疗资源。     

动机性访谈对2型糖尿病患者自我效能及生活质量的影响

目的观察动机性访谈对2型糖尿病患者自我效能及生活质量的影响。方法选取108例2型糖尿病患者作为研究对象,按照随机数字表分为对照组(55例)和观察组(53例)。对照组采用糖尿病常规健康教育+电话随访,观察组在对照组的基础上采用动机性访谈。在干预前及干预后2个月、6个月测量患者空腹血糖、餐后2h血糖、糖化血红蛋白,并评估患者糖尿病知识掌握情况、患者自我效能及生活质量。结果干预后观察组患者空腹血糖、餐后2h血糖、糖化血红蛋白控制水平,知识掌握情况、自我效能及生活质量均优于对照组,差异有统计学意义(P0.05)。结论动机性访谈可改善2型糖尿病患者血糖水平,提高患者自我效能及生活质量。     

动机性访谈在特诊科糖尿病患者健康教育中的应用

目的探讨动机性访谈在特诊科糖尿病患者健康教育中的应用效果。方法将50例糖尿病患者按数字表法随机分为对照组和干预组,每组各25例,对照组患者采用常规健康教育,干预组患者采用动机性访谈进行健康教育。6个月后比较两组患者自我效能及空腹血糖和糖化血红蛋(glycosylated hemoglobinAlc,HbAlc)状况。结果干预6个月后,干预组患者自我效能量表(diabetes self-efficacy scale,DSES)得分及空腹血糖和AbA1c各项指标明显优于对照组,两组比较,差异具有统计学意义(均P0.01)。结论动机性访谈式健康教育优于常规健康教育,可有效提高患者自我效能,更好地控制血糖水平,提高了健康教育质量。     

体验式学习在2型糖尿病病人胰岛素注射技能教育中的应用研究

[目的]探讨体验式学习在2型糖尿病病人胰岛素注射技能教育中的应用效果。[方法]便利抽取既往未注射过胰岛素的2型糖尿病病人400例,按入院时间分为对照组和干预组各200例,对照组采用常规教育方式进行住院期间及出院后糖尿病及胰岛素注射技能教育,干预组在此基础上进行体验式学习。比较两组出院时及出院6个月后糖化血红蛋白值(HbA1c)、胰岛素笔注射技能得分、病人胰岛素注射部位的疼痛评分。[结果]两组病人出院后6个月HbA1c、胰岛素注射技能得分、胰岛素注射部位疼痛评分比较差异均有统计学意义(P=0.000)。[结论]体验式学习能提高2型糖尿病病人胰岛素注射技能、降低胰岛素注射的疼痛感,有效降低HbA1c水平。     

动机访谈在糖尿病心理性胰岛素抵抗患者中的效果研究

目的:探讨动机访谈在糖尿病心理性胰岛素抵抗患者中的应用效果。方法:选择2015年9月~2016年2月入住我院内分泌科因病情需要注射胰岛素而存在心理性胰岛素抵抗的2型糖尿病患者111例,随机分为对照组55例和试验组56例,对照组住院期间采用常规健康教育,出院后常规电话随访,试验组住院期间采用动机访谈健康教育,出院后电话随访采用动机访谈技术,比较两组患者出院时和出院后6个月心理性胰岛素抵抗诊断量表"我对胰岛素看法"主表得分情况和血糖控制状况、出院后6个月复查次数、胰岛素停用情况。结果:出院后6个月,试验组心理性胰岛素抵抗减轻程度、血糖及糖化血红蛋白控制情况、复查次数及胰岛素停用情况均优于对照组(P0.05),两组比较差异均有统计学意义。结论:动机访谈可有效减轻糖尿病患者心理性胰岛素抵抗,提高出院后治疗效果和遵医行为。     

胰岛素使用访谈工具在2型糖尿病患者健康教育中的应用效果研究

目的观察胰岛素使用访谈工具在2型糖尿病胰岛素治疗患者健康教育中的应用效果。方法将90例2型糖尿病患者按随机数字表分为观察组44例和对照组46例。观察组采用胰岛素使用访谈工具进行健康教育,对照组采用传统健康教育方法。入院当天及出院前1 d对患者进行我对胰岛素的看法自评量表调查,出院前1 d对患者进行护理服务满意度调查,出院3个月后门诊检查患者空腹血糖、餐后2 h血糖、糖化血红蛋白。结果我对胰岛素看法评分,干预前观察组和对照组比较差异无统计学意义(P0.05),出院时观察组评分明显优于对照组,两组比较差异有统计学意义(P0.01);观察组患者的满意度明显高于对照组(P0.05);患者出院3个月后,观察组血糖及糖化血红蛋白的指标控制优于对照组。结论胰岛素使用访谈工具的应用既可以提高患者对注射胰岛素治疗的认知,增强患者对使用胰岛素的依从性,提高患者的满意度,也良好的控制了血糖及糖化血红蛋白。     

2型糖尿病患者胰岛素笔注射技能的影响因素分析

目的:探讨影响2型糖尿病患者胰岛素笔注射技能的因素。方法:选取60例2型糖尿病患者,采用问卷调查法收集患者一般资料、糖化血红蛋白值、出院时及出院3个月后的胰岛素笔注射技能得分、患者胰岛素注射意愿及疼痛评分,行单因素分析后使用多元线性回归对相关影响因素进行分析。结果:患者出院3个月后胰岛素笔注射技能得分较出院当日提高(P0.01);2型糖尿病患者的胰岛素使用意愿、出院时胰岛素笔注射技能是影响2型糖尿病患者出院3个月后的注射技能。结论:2型糖尿病患者的胰岛素笔注射意愿及出院时胰岛素笔注射技能是影响患者出院后胰岛素笔注射技能的因素。糖尿病专科护士在为患者制定并实施技能教育时应充分考虑这些因素。     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.