延续护理对永久性肠造口患者并发症及生活质量的影响

目的探讨永久性肠造口患者采用延续护理对其并发症及生活质量的影响。方法选取本院收治的直肠癌患者62例,均行永久性肠造口,依据护理模式的不同分组,其中对照组(n=31)采用常规护理,观察组(n=31)采用延续护理,比较2组生活质量及并发症发生率。结果观察组干预后生活质量明显优于干预前与对照组(P0.05);观察组并发症发生率明显低于对照组(P0.05)。结论对永久性肠造口患者行延续护理可有效改善其生活质量且减少并发症,值得临床推广。     

永久性肠造口患者术后生活质量影响因素及干预措施

目的探讨永久性肠造口患者生活质量影响因素及制定有效的造口专科护理干预措施。方法采取非随机方便取样方法选择2016年3月至2019年2月在湘南学院附属医院行肠造口手术患者150例, 应用肠造口患者基本信息量表、造口患者社会心理适应性量表(OAI-20)、造口自我效能量表(SSES)、造口自我护理能力量表(SSCS-CV)及欧洲癌症研究与治疗组织生活质量核心问卷(EORTC-QLQ-C30)对患者进行问卷调查, 应用多元回归分析影响永久性肠造口患者生活质量的相关因素。结果永久性肠造口患者OAI-20评分为(52.12±3.45)分, SSES评分为(75.26±4.58)分、SSCS-CV评分为(31.23±3.78)分、QLQ-C30评分为(62.12±4.23)分。永久性肠造口患者OAI-20总评分及其社会适应性、SSES评分及造口照护自我效能、社交自我效能、SSCS-CV评分及自我护理技能与QLQ-C30评分呈正相关, 差异均有统计学意义(均P<0.05), 而负性情绪与QLQ-C30评分呈负相关, 差异有统计学意义(P<0.05)。永久性肠造口患者术后并发症、造口时间&...     

全程无缝对接护理在肠造口患者中的应用

目的:探讨全程无缝对接护理在肠造口患者中的应用效果。方法:将84例永久性肠造口患者随机分为对照组和观察组各42例,对照组实施肠造口常规护理模式,观察组在此基础上实施全程无缝对接护理,比较两组护理效果。结果:观察组干预后肠造口自我管理能力评分及肠造口生活质量评分高于对照组(P 0. 05)。结论:全程无缝对接护理可提升肠造口患者的自我管理能力和生活质量。     

居家造口护理平台联合家庭随访在永久性肠造口患者延续护理中的效果

目的探讨居家造口护理平台联合家庭随访在永久性肠造口患者延续性护理过程中的应用效果。方法选取80例永久性肠造口手术患者作为研究对象,随机分为2组。对照组采用常规造口护理,实验组在常规护理基础上通过居家造口护理平台联合家庭随访实施延续性护理。比较2组患者出院后1周、1个月、3个月的造口自我管理依从性、自我效能评价结果、生活质量指数、造口护理整体满意度。结果出院后3个月,实验组患者的造口管理依从性、自我效能、生活质量指数、造口护理整体满意度均优于对照组,差异有统计学意义(P 0. 05)。结论居家造口护理平台联合家庭随访的延续护理管理方式可显著提高肠造口患者造口管理的依从性,提升患者自我护理能力,改善患者生活质量,提升造口护理满意度,从而提高科室的护理质量。     

永久性肠造口患者心理韧性现状及影响因素分析

目的调查永久性肠造口患者心理韧性现状及影响因素,为提高患者心理社会适应能力及心理韧性水平提供参考。方法采用一般资料调查表和中文版心理韧性量表对242例永久性肠造口患者进行问卷调查。结果永久性肠造口患者心理韧性得分为(64.51±12.43)分,处于中等水平;性别、职业、家庭人均月收入及自我护理能力是永久性肠造口患者心理韧性的影响因素(P0.01或P0.05)。结论永久性肠造口患者心理韧性水平有待提高,应针对其影响因素制订相应的心理韧性策略,从而提高其生活质量。     

永久性肠造口患者伤残接受度、心理一致感对生活质量的影响

目的 了解永久性肠造口患者伤残接受度、心理一致感及生活质量现状,探讨伤残接受度、心理一致感对生活质量的影响.方法 采用自制的一般资料调查表、伤残接受度量表(Acceptance of Disabiliy Scale,AODS)、心理一致感量表(Sense of Coherence SOC)和中文版造口患者生活质量问卷(City of Hope-Quality of life-Ostomy Questionnaire-Chinese Version COH-QOL-OQ)对青岛市某三级甲等医院90例永久性肠造口患者进行问卷调查.结果 永久性结肠造口患者伤残接受度总分为(79.01±4.21)分,心理一致感总分为(53.42±4.19)分,生活质量总分为(4.47±1.31)分;生活质量总分与伤残接受度总分、心理一致感总分均呈正相关,r值分别为0.520和0.552(P<0.05);伤残接受度、心理一致感、年龄、家庭平均月收入、造口时间进入生活质量的回归模型(P<0.05),R2=0.649.结论 永久性肠造口患者伤残接受度及生活质量均处于中等水平,心理一致感处于低度水平,生活质量与伤残接受度、心理一致感密切相关.医务人员应重视提高肠造口患者的伤残接受度和心理一致感水平,并根据患者的年龄、经济情况、造口时间给予个体化护理干预,从而改善患者的生活质量.     

对140例直肠癌结肠造口患者生活质量的调查与分析

目的 了解直肠癌永久性腹壁造口患者术后生活质量的现状,分析及探讨影响生活质量因素,寻求相应的护理对策,旨在提高术后患者的生活质量.方法 具采用SF-36量表问卷凋查法对140例直肠癌永久性腹壁造口患者的生活质量情况进行涮查.结果 直肠癌永久性腹壁造口患者生活质量各维度得分均低于一般人群(P<0.05),生理职能得分为(24.3±36.1)分,下降最为明显.手术后携带造口时间与生活质量各维度(一般健康状况和躯体疼痛除外)呈现负相关(P<0.05).结论 种直肠癌永久性腹壁造口患者生活质量各方面均明显下降,护理过程中更加需要加强术前宣教、术后教育护理以及社会支持来改善护理效果,提高患者的生活质量.     

永久性肠造口患者自我形象和生活适应状况的调查与护理

目的:探讨永久性肠造口患者自我形象和生活适应状况与护理方法。方法:采用自设《永久性肠造口患者生活适应量表》和《永久性肠造口患者自我形象评分表》对106例肠造口患者的适应状况和自我形象进行调查。结果:在生活适应方面,日常功能中社会功能适应程度得分最低,中低度99例,占94.40%;患者在生活护理技能上,皮肤护理得分偏低,为(1.80±0.41)分;生活适应总分(2.03±0.55)分,中低度为79.24%。肠造口术1年患者生活适应中的日常功能、护理技能及自我形象中的预后期望较1年患者明显提高(P0.05)。结论:肠造口初期患者(1年)绝大多数处于中低度适应水平,自我形象评价较低,应加强对患者心理、角色及社会方面的调整,从而提高患者对自我的接受程度,早日回归社会。     

基于微信平台的延续护理对永久性结肠造口患者的影响

目的:探讨基于微信平台的延续护理对永久性结肠造口患者自我护理能力的影响。方法:将36例直肠癌根治术患者随机分为对照组和实验组各18例,对照组给予胃肠外科制定的肠造口常规护理,实验组给予胃肠外科制定的肠造口常规护理及基于微信平台的延续护理,以造口自我护理量表-早期版(SSCS)评价两组患者出院当天、出院后1个月、出院后3个月的造口自我护理总分。结果:对照组造口患者造口自我护理的得分均低于实验组(P0.05)。结论:基于微信平台的延续护理服务能有效提高永久性肠造口患者自我护理能力,提高造口患者的生活质量。     

永久性肠造口患者延续护理模式的研究进展

直肠癌术后行永久性肠造口患者数量逐年上升,而患者接受的专业护理往往随着出院而终止。因此,肠造口患者的自护能力较差,造口及周围皮肤并发症发病率较高,增加了造口护理的困难及经济负担,甚至影响患者的身心健康和生活质量。本文对永久性肠造口患者延续护理模式进行综述,重点阐述延续护理模式的内容,旨在为后续开展永久性肠造口患者延续护理相关干预研究,降低并发症的发生,提高患者自护能力和生命质量等提供参考。     

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.     

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.     

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.     

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."