维持性血液透析98例营养状况分析及护理

目的:探讨维持性血液透析患者营养状况及发生营养不良的常见膳食危险因素,为护理干预提供依据.方法:对98例患者采用膳食分析、人体学测量及生化指标的测定,对影响患者营养状况的常见因素进行分析.结果:维持性血液透析患者营养不良发生比例高,患者处于不同程度的营养不良状态,主要由营养知识缺乏、蛋白质及能量摄入不足、透析不充分、膳食摄入不合理等因素引起.结论:重视维持性血液透析患者的营养不良状况,指导患者合理膳食,针对相关因素进行合理的护理干预,从而达到改善患者营养状况、提高患者生活质量的目的.     

胃肠癌辅助化疗患者营养状况及膳食营养素摄入情况调查分析

目的:调查胃肠癌辅助化疗患者营养状况及膳食营养素摄入情况,为护理人员对患者进行饮食营养护理提供依据。方法:对62例患者采用综合性营养评价法(SGA)调查其总体营养状况;采用询问和称重法相结合的方法,对患者化疗前任意3 d、化疗用药后1~3 d、停药后8~10 d的膳食营养素摄入情况进行调查[7]。对SGA标准下营养良好与营养不良患者传统营养评价指标(BW、BMI、Hb、TLC及ALB)、膳食营养素(能量、蛋白质、脂肪、碳水化合物、膳食纤维、维生素A、维生素C、维生素E、钙、磷、铁、锌、硒)摄入情况进行比较。结果:营养良好14例(22.6%),营养不良48例(77.4%)。营养良好者与营养不良者除BW外,BMI、Hb、TLC及ALB比较差异均有统计学意义(P<0.01),且能量、蛋白质、脂肪、碳水化合物、钙、铁的摄入量比较差异均有统计学意义(P<0.01,P<0.05)。结论:胃肠癌辅助化疗患者普遍存在营养不良状况,分析认为膳食营养的摄入情况在改善患者营养状况中起着重要的作用。肿瘤专科护士应加强营养相关知识的学习,对患者进行专业的饮食营养护理。     

维持性血液透析患者营养状况及其影响因素调查分析

目的调查维持性血液透析患者的营养状况,并分析其影响因素,以便为临床改善患者的营养状况提供参考。方法采用改良主观全面营养评价法对199例维持性血液透析患者进行营养评估。结果 50.25%的患者轻度营养不良,43.72%的患者中度营养不良,4.52%的患者重度营养不良。年龄、透析时间、主要照顾者是影响维持性血液透析患者营养状况的主要因素。结论维持性血液透析患者的营养状况令人堪忧,应更多地关注高龄、透析时间长、缺乏照顾的患者,以改善这些患者的营养状况,提高其生活质量,延长患者寿命。     

腹膜透析患者蛋白摄入与血浆前白蛋白的相关分析

目的了解我国腹膜透析患者膳食营养摄入情况与前白蛋白水平的关系,寻找改善腹膜透析患者营养状况的有效护理措施.方法对35例长期随诊的腹膜透析患者,检测反映营养状况的生化指标,包括白蛋白、血红素以及血浆前白蛋白,并进行透析充分性评价.对这些患者同时进行1周食谱调查,根据食物成份表计算每日平均蛋白摄入量.对患者膳食结构、蛋白摄入及其与患者临床指标的关系进行分析.结果患者平均每日蛋白摄入量为(0.78±0.24)g/(kg·d),低于推荐摄入量;77%的患者血白蛋白水平低于正常,所有患者均有不同程度的贫血.患者每日蛋白摄入量与血浆前白蛋白水平明显相关,相关系数为0.43,(P《0.05).患者每日蛋白摄入量,尤其是动物蛋白摄入量,与透析充分性亦相关.结论我国腹膜透析患者蛋白摄入远远低于推荐值,蛋白摄入不足是患者营养不良的原因之一.在护理中应加强腹膜透析患者营养知识的培训,指导患者合理膳食,尤其是进一步提高动物蛋白摄入,以避免营养不良的发生.     

腹膜透析患者蛋白摄入与血浆前白蛋白的相关分析

目的了解我国腹膜透析患者膳食营养摄入情况与前白蛋白水平的关系,寻找改善腹膜透析患者营养状况的有效护理措施。方法对35例长期随诊的腹膜透析患者,检测反映营养状况的生化指标,包括白蛋白、血红素以及血浆前白蛋白,并进行透析充分性评价。对这些患者同时进行1周食谱调查,根据食物成份表计算每日平均蛋白摄入量。对患者膳食结构、蛋白摄入及其与患者临床指标的关系进行分析。结果患者平均每日蛋白摄入量为(0.78±0.24)g/(kg.d),低于推荐摄入量;77%的患者血白蛋白水平低于正常,所有患者均有不同程度的贫血。患者每日蛋白摄入量与血浆前白蛋白水平明显相关,相关系数为0.43,(P<0.05)。患者每日蛋白摄入量,尤其是动物蛋白摄入量,与透析充分性亦相关。结论我国腹膜透析患者蛋白摄入远远低于推荐值,蛋白摄入不足是患者营养不良的原因之一。在护理中应加强腹膜透析患者营养知识的培训,指导患者合理膳食,尤其是进一步提高动物蛋白摄入,以避免营养不良的发生。     

90例维持性血液透析病人营养状况分析及其护理

目的对维持性血液透析患者的营养状况及其影响因素进行科学分析,探讨合理有效的护理措施。方法对90例患者进行营养学评估,采用膳食分析、人体学测量及生化指标的测定对可能影响患者营养状况的常见因素进行分析。结果患者均处于营养不良状态,主要由于蛋白质及能量摄入不足、透析不充分、未使用促红细胞生成素(EPO)等。结论重视维持性血液透析患者的营养不良情况,指导患者合理膳食,针对各相关因素全面落实护理措施,可改善患者的营养状况,提高患者的生活质量。     

维持性血液透析患者39例营养状况分析及护理

目的对维持性血液透析患者的营养状况及其影响因素进行科学分析,探讨合理有效的护理措施。方法对39例患者进行营养学评估,采用膳食分析、人体学测量及生化指标的测定对可能影响患者营养状况的常见因素进行分析。结果患者均处于营养不良状态,主要由于蛋白质及能量摄入不足、透析不充分、未使用促红细胞生成素(EPO)等。结论重视维持性血液透析患者的营养不良情况,指导患者合理膳食,针对各相关因素全面落实护理措施,可改善患者的营养状况,提高患者的生活质量。     

老年肺结核患者营养状况及其影响因素研究

目的 了解老年肺结核患者营养状况并分析其影响因素,为临床医护人员实施个体化营养干预方案提供依据。方法 采用一般资料调查问卷、微型营养评定法（MNA）、24小时膳食回顾（连续三天）、食物频率调查（三个月内）、心理状况评估表、社会支持量表、家庭功能评定量表对上海市肺科医院结核科共134例老年肺结核患者进行调查。结果 老年肺结核患者MNA营养评估得分为（19.79±4.89）分,其中存在营养不良的风险及营养不良得分分别为（21.10±0.96）分和（13.42±2.75）分。不同年龄、文化程度、婚姻状况、月收入、经济来源、月医药费用、医疗付费方式、结核确诊时长的患者MNA营养评估单因素分析中,差异无统计学意义(P>0.05)。患者的性别、居住情况、患病情况、服药情况、耐药状况的不同,其MNA营养评估单因素分析中,差异有统计学意义 (P<0.05)。多元线性回归分析显示,耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构是老年肺结核患者营养状况的重要影响因素。结论 老年肺结核患者的营养状况不容乐观,影响老年肺结核患者营养状况的因素可能与其耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构有关。建议临床医生及营养师针对老年肺结核患者营养不良的特点及膳食营养素的摄入状况,尽早采取临床营养管理工作,制定个体化、精准的营养干预方案,给予合理的膳食结构建议,纠正其营养不良,改善营养状况。     

维持性血液透析105例营养状况分析及对策

目的:探讨维持性血液透析(MHD)患者的营养状况及其影响因素,并提出相应的护理对策。方法:对105例MHD患者进行营养学评估,采用膳食分析、人体学及测量生化指标对可能影响患者营养状况的因素进行评估,评估患者干预前后营养状况及生化指标情况。结果:本组MHD患者营养不良发生率为69.5%,其中蛋白质及能量摄入、透析时间、透析充分性、使用促红细胞生成素是发生营养不良的主要原因;患者干预前后生化指标及营养不良发生率比较差异有统计学意义(P<0.05)。结论:重视MHD患者的营养不良情况,指导患者合理膳食,针对相关因素进行相应的护理措施,改善其营养状况,从而提高生存率。     

8 例不随意运动型脑瘫儿童感染后严重扭转痉挛护理

目的探讨持续非卧床腹膜透析（CAPD）患者的营养状况与护理要点。方法选取我院2010年5月-2013年5月收治的30例CAPD患者作为研究对象,对患者进行营养状况评价、人体测量、生化指标检测及半定量SGA评分四项评定,统计分析患者的营养状况,并基于评估结果进行护理干预,观察护理效果。结果半定量SGA评分23例,占76.7%患者存在不同程度的营养不良;营养生化指标检测10例,占33.3%患者营养不良;人体测量16例,占53.3%患者营养不良。护理后23例患者营养状况明显改善,护理满意度达92.4%。结论 CAPD患者营养不良发生率较高,应结合膳食营养与CAPD患者营养状况之间的关系对其进行科学的营养指导与护理。     

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.