埃博拉出血热患儿二例的护理

目的总结埃博拉出血热(Ebola hemorrhagic fever,EHF)患儿的临床特点和护理措施。方法回顾性分析2014年12月在利比里亚首都蒙罗维亚中国埃博拉治疗中心(Ebola Treatment Center,ETC)留观病区收治的2例EHF患儿的临床资料,分析并总结护理措施。结果 EHF患儿的临床症状主要以发热、精神差、食欲减退、恶心、呕吐、腹泻,葚至不能进食,意识不清或昏迷等为主,心理问题主要表现为焦虑、恐惧、孤独、无助、自卑和绝望。2例患儿确诊为EHF后转至治疗区,1例治愈出院,1例死亡。结论护士应在确保自身安全的前提下采取有针对性的护理干预方法,以促进EHF患儿早日康复出院。     

重症监护病房患者合并的心理问题分析及护理预防

目的探讨重症监护病房(ICU)患者疾病治疗中合并存在的心理问题及应采取的科学护理措施。方法选取本院2014年5月~2014年11月收治的ICU患者262例,对其合并存在的心理问题进行分析探究。结果在262例患者中,出现心理问题病患的总例数为160(61.07%),其中焦虑、忧郁、偏见患者例数分别为67例(41.88%)、51例(31.87%)及42例(26.25%)。由疾病、环境、睡眠因素导致出现心理问题的患者例数分别为71例(44.38%)、63例(39.37%)及26例(16.25%)。在采取了相应的护理防治措施后,存在心理问题的患者明显减少,差异有统计学意义(P0.05)。结论 ICU患者主要存在的心理问题为焦虑、忧郁、偏见等,多为疾病、环境、睡眠等因素影响,针对性的护理措施一定程度上可以改善患者的心理状态。     

呼吸机相关肺炎的临床分析及护理体会

目的 通过分析我院呼吸科重症监护病房(RICU)患者的临床资料,研究呼吸机相关肺炎的发生原因,总结护理经验,以降低VAP的发生率,进而减少病死率.方法 对2006年8月～2007年5月在呼吸科重症监护病房(RICU)行机械通气(MV)的80例病人的一般情况、VAP发生的原因、护理措施、VAP发生率等临床资料进行分析研究.结果 VAP发生率为40%,发生的常见原因有:患者年龄偏高、分泌物排出不畅、咽部定殖菌误吸、呼吸道屏障破坏、无菌操作不严、呼吸机环路污染等.结论 加强机械通气患者的临床系统护理措施可明显减少VAP的发生,从而降低病死率.     

重症监护病房患者常见心理问题及护理对策

目的 探讨重症监护病房(ICU)患者的心理问题.方法 对100例ICU患者进行入科心理评估,并针对性采取安全承诺、加强沟通、人为关怀等消除紧张心理的护理措施.结果 心理评估显示,ICU患者入科时精神紧张100%,重度焦虑82%,恐惧死亡67%,孤独63%.经心理护理后,全部患者精神紧张、孤独等心理问题消除,中度焦虑15%,恐惧死亡16%.结论 与入科时相比效果显著,说明对ICU患者进行入科心理评估及采取相应护理措施很有必要.     

重症颅脑损伤36例临床护理

目的:探讨重症颅脑损伤患者的临床护理方法及效果。方法:对36例重症颅脑损伤患者实施精心护理,不断对护理措施分析、总结、改进,观察临床效果。结果:本组36例重症颅脑损伤患者无一例发生气道感染、误吸、窒息,无一例发生压疮及并发症,治愈11例,好转25例。结论:有效护理措施可改善重症颅脑损伤患者的预后,降低病死率。     

重症监护病房患儿家长的心理问题及护理干预

目的了解危重症患儿家长的心理问题,为制定有效的护理措施提供依据。方法采用症状自评量表(SCL-90),对本院重症监护病房110例患儿家长进行心理评估及分析,针对其心理问题给予个体化的护理干预措施,比较干预前后心理症状结果。结果危重症患儿家长存在焦虑、抑郁、敌对等诸多心理问题,护理干预后心理症状明显改善(p<0.05)。结论对危重症患儿家长的心理问题进行护理干预,有利于患儿康复。     

高容量血液滤过治疗重症创伤后多器官功能障碍的疗效及护理体会

目的总结高容量血液滤过(high volume hemofiltration,HVHF)治疗重症创伤后多器官功能障碍综合征(multipleorgan dysfunction syndrome,MODS)的疗效和护理方法。方法回顾性分析成都军区总医院2004-2011年行HVHF治疗的82例重症创伤后MODS患者,总结其临床资料及护理经验。结果 82例患者中好转43例,死亡39例,病死率为47.5%;HVHF治疗后患者的血肌酐、氧合指数、平均动脉压均明显改善。结论 HVHF可有效治疗重症创伤后MODS;高质量的护理可保证HVHF的安全、顺利进行。     

流行性出血热并发肺部急症的观察及护理

目的:对流行性出血热(EHF)并发肺部急症的发生期、病因、死因进行分析并总结护理体会。方法:总结流行性出血热并发肺部急症的40例患者的临床资料,并在无呼吸机监护的情况下,采取氧疗、心理护理、饮食指导等护理措施。结果:EHF并发肺部急症少尿期占40.00%,移行期占35.00%;发生肺部急症病因:尿毒症肺占50.00%,肺水肿占40.50%,呼吸窘迫占30.00%;发生肺部急症死因:呼吸窘迫占36.36%,肺水肿占18.18%,尿毒症、心衰等均占9.09%。通过精心的护理无1例护理并发症的发生。结论:临床的观察为治疗提供了依据,精心的护理对EHF并发肺部急症起着重要的作用。     

高容量血液滤过治疗重症创伤后多器官功能障碍的护理体会

目的总结高容量血液滤过(high volume hemofiltration,HVHF)治疗重症创伤后多器官功能障碍综合征(multipleorgan dysfunction syndrome,MODS)的疗效和护理方法。方法回顾性分析成都军区总医院自2004-2011年行HVHF治疗的82例重症创伤后MODS患者,总结其临床资料及护理经验。结果 82例患者中好转43例,死亡39例,病死率为47.5%;HVHF治疗后Cr、氧合指数、MAP均明显改善。结论 HVHF可有效治疗重症创伤后MODS;高质量的护理可保证HVHF的安全、顺利进行。     

老年慢性病患者的心理状态及护理应对措施

目的探讨老年慢性病患者的心理问题,总结此类患者的护理策略,以提高护理效果。方法选取100例慢性病老年患者作为观察对象,采用访谈法和问卷调查法对其心理状况(包括焦虑型、孤独型、恐惧型、悲观型、情绪不稳定型5个方面)进行调查与统计,分析其产生原因并实施相应的护理措施,比较护理干预前后老年慢性病患者心理状况。结果护理干预前,观察对象存在焦虑型、孤独型、恐惧型、悲观型、情绪不稳定型心理问题的比例分别为21.00%、16.00%、12.00%、17.00%、14.00%,护理干预后,这一比例分别降至8.00%、6.00%、5.00%、6.00%、5.00%,前后差异有统计学意义(P<0.05)。干预后,患者人际关系、生理状况与心理状态评分均较干预前显著上升(P<0.01),且干预后患者总满意度较干预前显著上升(P<0.01)。结论对老年慢性病患者存在的心理问题进行针对性护理干预,可有效提高护理效果,改善患者心理状态。     

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.     

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.     

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.     

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.