精细化管理在高龄髋关节置换患者围术期护理中的应用

目的：探讨精细化管理在80岁以上超高龄髋关节置换患者围术期护理中的应用效果。方法为36例80岁以上髋关节置换患者实施围术期的精细化护理,观察患者手术及术后恢复情况,并在患者出院时调查患者或家属的满意度。结果患者术后均能扶助行器下床行走,髋关节功能恢复良好,顺利出院,患者及家属对护理工作满意度达99％。结论对超高龄髋关节置换患者实施精细化护理管理,能使患者安全度过围术期,有效降低术后并发症的发生,提高超高龄患者的护理质量。     

老年髋关节置换患者应用个性化健康教育处方的临床效果、Harris评分及预后观察

目的探究老年髋关节置换患者应用个性化健康教育处方对临床效果、Harris评分及预后的影响。方法选取2015年2月~2016年3月合肥市第一人民医院接收的88例老年髋关节置换患者资料,将行个性化健康教育的44例患者设研究组,行常规健康教育的44例患者设对照组,对比两组Harris评分、Barthel指数评分及生存质量。结果护理后研究组Harris评分、Barthel指数评分及社会功能、精神状态等评分均显著高于对照组(P<0.05)。结论围术期予以髋关节置换患者个性化健康教育可提高生存质量与日常生活能力,改善髋关节功能。     

围手术期康复护理对髋关节置换术后恢复的影响研究

观察围手术期康复护理对髋关节置换术后恢复的影响。选择2014年9月~2016年3月期间在我院接受髋关节置换手术的患者70例作为研究对象,随机划入观察组和对照组,观察组35例,对照组35例,分别接受围手术期康复护理和常规围手术期护理,比较两组患者患者术后髋关节Harris评分。观察组术后1月患者髋关节Harris评分(73.9±3.2)分,术后3月(84.6±2.4)分,术后6月(88.9±2.4)分,术后6月(88.9±2.4)分,术后1年(95.8±2.2)分,对照组患者术后1月患者髋关节Harris评分(62.3±2.5)分,术后3月(72.1±2.3)分,术后6月(79.1±2.2)分,术后1年(86.8±1.9)分,组间差异有统计学意义(P<0.05)。围手术期康复护理在髋关节置换术术后恢复中的应用效果显著,值得临床应用和推广。     

连续护理干预在全髋关节置换术患者护理中的效果观察

目的探讨连续护理干预在全髋关节置换术患者护理中的效果。方法选取2017年1月至2019年12月本院收治的80例全髋关节置换术患者,随机分为两组。对照组给予常规手术护理,观察组给予连续护理干预。对比两组护理前后的满意度评分及Barthel指数评分。术后6个月采取Harris评分对两组患者的髋关节功能进行评估对比。结果护理前,两组的满意度评分、Barthel指数无明显差异(P>0.05),护理后,两组全髋关节置换术患者的满意度评分、Barthel指数均明显改善(P<0.05),且观察组的满意度评分(86.39±6.57分)、Barthel指数(52.36±13.89)明显优于对照组(P<0.05);观察组术后6个月的功能、疼痛、活动范围以及畸形等Harris评分均明显高于对照组(P<0.05)。结论连续护理干预在全髋关节置换术患者的临床护理中具有较佳的效果,能改善患者的日常生活能力和髋关节功能,加快康复。     

快速康复外科理念在高龄髋关节置换患者围手术期护理中的应用

目的探讨快速康复外科理念(FTS)在高龄髋关节置换患者围手术期中的应用效果。方法将2013年1月-2014年4月进行髋关节置换手术的35例高龄患者作为对照组,进行常规围术期护理;将2014年5月-2015年4月进行髋关节置换手术的35例高龄患者作为观察组,应用FTS理念进行围术期护理。比较两组患者手术前后髋关节Harris评分、并发症发生率、平均住院时间、平均住院费用、患者满意度等。结果两组患者手术前后不同时间髋关节Harris评分比较差异无统计学意义(P0.05);两组患者术后并发症发生率、平均住院时间、平均住院费用比较,观察组明显低于对照组,差异有统计学意义(P0.05);观察组患者满意度明显高于对照组(P0.05)。结论快速康复外科理念应用于高龄髋关节置换患者围术期,能缩短平均住院时间,降低平均住院费用,减少术后并发症发生率,减轻患者疼痛,促进了患者髋关节功能恢复,提高了患者对护理服务的满意度。     

人工全髋关节置换术后早期康复训练对肢体功能恢复的观察

目的:分析早期康复训练对全髋关节置换手术后肢体功能恢复的影响探讨提高康复质量、缩短康复时间、减少相关并发症的方法。方法:全髋关节置换术患者45例,常规治疗对照组22例和康复组2例。通过比较两组患者治疗前后简式Harris积分、Barthel指数评价肢体功能恢复质量。结果:两组治疗后Harris积分、Barthel指数,康复组分别为(91.58±9.20)分,79.32±18.25,对照组(72.19±11.24)分,68.08±12.25,康复组优于对照组。结论:在常规药物治疗的同时,早期进行患肢康复训练,可明显提高全髋关节置换手术的近期和远期效果,从而提高患者生活质量,缩短康复时间,减少相关并发症的发生。     

高龄患者行人工髋关节置换术围手术期并发症相关因素分析

目的分析髋关节假体置换术围手术期内并发症发生的相关因素,探讨高龄患者行人工髋关节置换术的安全性和有效性.方法对63例高龄患者进行人工髋关节置换手术,平均年龄82.3岁.对患者术前进行全面评估并对围手术期内并发症发生状况进行分析.结果患者术后髋关节评分平均提高20.5分(Harris评分),38例患者围手术期内存在并发症,不同分级患者术后并发症发生率不同.结论高龄患者行人工髋关节置换术后并发症发生率高,高龄患者行人工髋关节置换术在缓解疼痛、改善髋关节功能方面具有较高安全性和可靠性.     

高龄患者行人工髋关节置换术围手术期并发症相关因素分析

目的：分析髋关节假体置换术围手术期内并发症发生的相关因素，探讨高龄患者行人工髋关节置换术的安全性和有效性。方法：对63例高龄患者进行人工髋关节置换手术，平均年龄82．3岁。对患者术前进行全面评估并对围手术期内并发症发生状况进行分析。结果：患者术后髋关节评分平均提高20．5分(Harris评分)，38例患者围手术期内存在并发症，不同分级患者术后并发症发生率不同。结论：高龄患者行人工髋关节置换术后并发症发生率高，高龄患者行人工髋关节置换术在缓解疼痛、改善髋关节功能方面具有较高安全性和可靠性。     

高龄股骨颈骨折全髋与半髋方式的选择

背景：近年来高龄股骨颈骨折患者大量增加,而75岁以上患者选择全髋或半髋关节置换的手术方式仍有较大争议,合理选择手术方式,对增加手术安全性、改善患者髋关节功能、提高生活质量、降低置换后并发症、减少翻修率具有重要意义。 目的：对75岁以上患者行髋关节置换的相关资料进行回顾分析,比较二者间优劣,试图寻找更加准确的手术适应证。 方法：纳入171例全髋（观察组）和半髋（对照组）关节置换患者的病例资料,其中观察组51例、对照组120例。通过对两组患者基础疾病、手术时间、出血量、置换后并发症、置换后住院日、置换后1周、3个月髋关节Harris评分等方面来比较二者差异。 结果与结论：两组患者经过3-39个月（平均23个月）随访,二者在置换前基础疾病、平均年龄、置换后住院日、置换后并发症及置换后1周Harris评分方面进行比较,差异无显著性意义（P〉0.05）;而在假体置入后3个月Harris评分及优良率方面,观察组效果优于与对照组（P〈0.05）。结果说明严格选择手术适应证,两种手术方式均能达到较好的短期疗效,使高龄患者髋关节功能较早恢复,显著提高了患者的生活质量。而高龄患者行全髋关节置换后3个月关节功能恢复相对较好,并发症发生率并未明显增加,提示即使高龄患者,只要做好充分置换前准备工作,仍建议优先选择全髋关节置换。     

全程持续与阶段强化结合式健康教育在髋关节置换术患者中的应用

目的:探讨全程持续与阶段强化结合式健康教育在全髋关节置换术患者中的应用效果。方法:将2014年10~12月59例髋关节置换术患者作为对照组,实施常规髋关节置换围术期健康教育和延续健康教育;将2015年1~3月59例髋关节置换术患者作为实验组,实施全程持续与阶段强化结合式健康教育;比较两组干预后疾病知识知晓率、自我护理技能考核合格率、Barthel指数评分和Harris评分情况。结果:实验组髋关节置换术患者干预后疾病相关知识知晓率、自我护理技能考核合格率、Barthel指数评分和Harris评分均显著高于对照组(P0.05)。结论:对髋关节置换术患者实施全程持续与阶段强化结合式健康教育,能够提高患者疾病相关知识知晓率、自我护理能力及髋关节功能恢复效果。     

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.     

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.     

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.     

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.