氯比格雷治疗局限性缺血性脑卒中致神经功能缺损患者的循证护理干预效果分析

目的探讨循证护理干预在氯比格雷治疗局限性缺血性脑卒中致神经功能缺损患者的临床效果。方法选取2015年12月至2016年12月在该院神经内科接受氯吡格雷药物治疗的局限性缺血性脑卒中患者146例,通过随机数字表法将146例患者分为观察组(73例)和对照组(73例)。对照组采用常规护理和常规的康复训练;观察组在对照组的基础上采取循证护理干预,包括认知、心理、皮肤、饮食以及功能性的康复训练。比较两组之间给药后的不良反应、神经功能缺损评分(NIHSS评分)、日常生活能力评分(MBI评分)、生活质量评分(QOL-BREF评分)以及护理满意度。结果观察组给药后不良反应的发生率低于对照组,差异有统计学意义(P0.05);治疗后观察组患者的神经功能和日常生活能力均得到了明显改善,NIHSS评分低于对照组,MBI评分高于对照组,差异均有统计学意义(P0.05);观察组QOL-BREF评分中的生理、环境、健康状态、生存质量评分高于对照组,差异有统计学意义(P0.05);在护理满意度比较中,观察组总护理满意度为"非常满意",评分为(37.94±0.42)分,对照组为"满意",评分为(32.54±0.33)分,差异有统计学意义(P0.05)。结论对局限性缺血性脑卒中患者早期采取循证护理干预可以在一定程度上缓解药物不良反应,改善患者的神经功能和生活质量,对提高治疗效果有重要意义。     

早期整体化治疗对脑血管病预后的影响研究

展开对早期整体化治疗措施对脑血管疾病预后影响的分析。选择收治的脑血管病患者50例作为研究对象,通过数字随机表法分为对照组和观察组,对照组按照常规治疗方案使用内科药物进行治疗,观察组按照早期整体化治疗方案进行治疗。对两组接受治疗后的神经功能缺损情况及日常生活自理能力进行对比观察。两组接受治疗前,神经功能缺损评分、日常生活自理能力评分均无明显差异(P0.05);接受治疗后,观察组神经功能缺损评分明显低于对照组,生活自理能力明显高于对照组,差异显著,具有统计学意义(P0.05)。对脑血管病患者实施整体化治疗有确切效果,可减轻患者神经功能缺损症状,改善日常生活能力,值得进一步关注。     

综合护理干预对脑梗死后抑郁患者神经功能康复的作用研究

目的探讨综合护理干预对脑梗死后抑郁患者神经功能康复的作用。方法选择2014-07—2015-12在沈阳医学院附属中心医院神经内四科就诊的110例脑梗死患者,将所有患者按照随机数字表法分为观察组与对照组,每组55例,给予对照组患者以神经内科常规护理,观察组在对照组的基础上给予心理护理、环境护理、健康指导、功能康复、出院指导等综合护理,于治疗前后评价脑梗死患者抑郁症状、程度及日常生活自理能力。结果观察组治疗前汉密尔顿评分为(24.03±5.76)分,第4周为(13.62±3.48)分,第6周为(6.97±2.49)分,对照组治疗前汉密尔顿评分为(24.55±4.98)分,第4周为(19.31±5.26)分,第6周为(15.03±4.14)分;观察组治疗前生活自理能力评分为(33.26±9.28)分,第4周为(13.49±7.03)分,第6周为(7.96±2.01)分,对照组治疗前生活自理能力评分为(33.14±9.62)分,第4周为(18.37±8.53)分,第6周为(15.01±5.22)分。治疗前两组患者的抑郁症状、程度及日常生活自理能力评分接近,差异无统计学意义(P0.05)。经过4周治疗后,两组患者的抑郁症状、程度及日常生活自理能力均有所改善,观察组患者的改善较对照组明显(P0.05);治疗6周后,观察组患者抑郁症状、程度及日常生活自理能力改善明显优于对照组,差异有统计学意义(P0.05)。结论综合护理干预对脑梗死后抑郁患者神经功能康复具有积极推进作用,使患者明显改善其抑郁程度及生活自理能力,提高患者生活质量。     

早期康复护理对偏瘫患者康复治疗的临床价值分析

目的探讨早期康复护理对偏瘫患者康复治疗的临床价值。方法选取我院收治的98例脑卒中偏瘫患者,随机将其分为观察组和对照组,各49例,对照组行常规护理,观察组行针对性的护理干预,对两组患者治疗总有效率及护理前后的神经功能缺损程度评分及日常生活能力评分进行对比。结果观察组患者的治疗总有效率明显高于对照组(P0.05)。两组患者治疗前神经功能缺损程度评分及日常生活能力评分差异无统计学意义(P0.05),治疗后两组患者均有所改善,但观察组明显优于对照组(P0.05)。结论在常规治疗的基础上给予偏瘫患者针对性的康复护理干预可有效地提高治疗效果,改善患者日常生活能力及神经功能缺损现象,临床效果显著,值得推广和应用。     

亚低温联合治疗脑溢血的疗效观察

选取200例脑溢血患者为研究对象,随机分作观察组和对照组各100例,观察组接受亚低温联合治疗,对照组接受常规治疗,比较两组的临床疗效、治疗前后神经功能缺损程度评分、治疗前后日常生活活动能力。观察组总有效率(87%)优于对照组(64%),差异明显有统计学意义(χ2=4.39,P<0.05);治疗后观察组神经功能缺损程度评分(9.33±1.23)分优于对照组的(11.21±1.44)分,差异明显,有统计学意义(t=3.58,P<0.05);治疗后观察组日常生活活动能力评分(71.18±1.95)分优于对照组(66.73±1.89)分,差异明显,有统计学意义(t=4.62,P<0.05)。在脑溢血的临床治疗中,亚低温联合疗法具有较为理想的临床疗效,同时在改善神经功能缺损及日常生活活动能力方面也表现出了良好的效果,值得临床步推广应用。     

分期康复护理模式对急性脑卒中患者生活质量的影响

目的探讨分期康复护理模式对脑卒中患者神经功能恢复及日常生活能力的影响。方法选取神经内科收治的脑卒中患者30例随机分为对照组和试验组各15例,2组患者均接受神经内科的脑卒中常规治疗和护理,试验组患者除接受常规护理外,还接受三期十步法的早期康复护理干预。分别在入院时、干预1周和干预2周后进行资料收集,并运用日常生活活动能力量表(Barthel指数)、美国国立卫生院神经功能缺损评分(NIHSS)对患者的神经功能缺损情况和日常生活能力进行分析。结果 2组患者NIHSS、Barthel指数评分在入院时比较差异无统计学意义(P0.05)。干预1周、2周后2组的NIHSS评分相比,差异均具有统计学意义(P0.05或P0.01)。2组的Barthel指数在干预1周、2周后比较差异均具有统计学意义(P0.01)。结论分期康复护理模式能够显著促进脑卒中患者的神经功能恢复和日常生活能力的提高。     

PDCA循环管理对偏瘫卒中患者抑郁及功能恢复的影响

目的探究PDCA循环管理对偏瘫卒中患者抑郁及功能恢复的影响。方法选择2015年1月~2016年11月本院收治的74例偏瘫卒中患者,根据随机数字表法分为两组,每组各37例。对照组实施健康教育,在此基础上观察组予以PDCA循环管理。护理8周后,比较两组日常生活能力、神经功能缺损程度、抑郁程度、幸福度及护理满意度。结果观察组NIHSS为(6.15±3.68)分低于对照组的(10.08±4.12)分,差异有统计学意义(P0.05);观察组ADL为(72.34±8.71)分较对照组的(51.28±6.95)分明显提高,差异有统计学意义(P0.05);观察组与对照组相比,总幸福度评分显著提高,差异有统计学意义(P0.05);对照组SDS评分为(39.54±7.31)分显著高于观察组的(32.85±5.56)分,差异有统计学意义(P0.05);观察组护理总满意度为97.30%,对照组护理总满意度为78.38%,差异有统计学意义(P0.05)。结论对偏瘫卒中患者实施PDCA循环管理能有效改善患者的抑郁程度、神经功能缺损程度,提高其预后幸福度、日常生活能力及护理满意度。     

声乐干预联合有氧健肢康复操对脑出血病人神经功能恢复及生活质量的影响

[目的]探讨声乐干预联合有氧健肢康复操对脑出血病人神经缺损功能恢复及生活质量的影响。[方法]于2015年1月—2016年8月选取神经外科收治的128例脑出血病人,根据随机数字表将病人分为观察组(n=64)及对照组(n=64),对照组接受常规康复护理,观察组在对照组基础上应用声乐干预联合有氧健肢康复操进行护理,干预时间为2个月,干预前后应用Fugl-Meyer运动功能积分法(FMA)、日常生活活动功能量表(ADL)及美国国立卫生院神经功能缺损评分(NIHSS)对两组病人肢体功能恢复、日常生活活动及神经功能进行评价。[结果]观察组干预后肢体感觉功能(22.98分±3.15分)、上肢运动功能(24.56分±2.78分)、下肢运动功能(17.45分±3.25分)、关节活动度(10.96分±2.02分)评分高于对照组肢体感觉功能(16.93分±4.52分)、上肢运动功能(16.23分±2.36分)、下肢运动功能(13.96分±1.89分)、关节活动度(6.39分±1.45分),两组比较差异均有统计学意义(P0.05);观察组干预后ADL评分(57.98分±3.96分)高于对照组(46.22分±4.52分),两组比较差异有统计学意义(P0.05);观察组干预后NIHSS评分(12.59分±3.45分)低于对照组(16.85分±4.02分),两组比较差异有统计学意义(P0.05);观察组干预后总生活质量评分(175.22分±32.02分)高于对照组(135.45分±25.78分),两组比较差异有统计学意义(P0.05)。[结论]声乐干预联合有氧健肢康复操有助于改善脑出血病人神经功能,提高其生活质量。     

小牛血清去蛋白注射液联合依达拉奉治疗缺血性脑卒中的临床效果分析

目的 探讨小牛血清去蛋白注射液联合依达拉奉治疗缺血性脑卒中的临床效果。方法 选取2019年3月～2020年12月在我院接受治疗的缺血性脑卒中患者120例,随机平均分为对照组和观察组各60例。比较两组患者治疗前后神经功能缺损情况与日常生活活动能力;比较两组患者治疗后的临床疗效。结果 治疗前,两组患者的神经功能缺损评分比较,差异无统计学意义(P0.05);治疗后,观察组神经功能缺损评分明显低于对照组,差异有统计学意义(P0.05)。治疗前,两组患者的ADL评分比较,差异无统计学意义(P0.05);治疗后,观察组ADL评分显著高于对照组,差异有统计学意义(P0.05)。观察组治疗总有效率为91.67,显著高于对照组的75.00%,差异有统计学意义(P0.05)。结论 小牛血清去蛋白注射液联合依达拉奉能有效改善缺血性脑卒中患者神经功能缺损和提高患者日常生活活动能力,临床疗效更佳。     

阶段性康复护理干预对促进颅脑外伤患者康复的影响

目的探讨阶段性康复护理干预对颅脑外伤患者康复效果的影响。方法选取本科室2018年1月—12月60例颅脑外伤患者为研究对象,采用随机数字表法将其分为研究组及对照组。对照组实施常规护理,研究组实施阶段性康复护理。护理后对比两组的神经功能缺损情况及康复情况。结果干预前,两组的神经功能缺损情况评分比较,差异无统计学意义(P0.05);研究组护理10 d、20 d、30 d的神经功能缺损评分依次为(19.0±1.8)分、(14.6±1.5)分、(9.0±0.6)分,对照组护理10 d、20 d、30 d的神经功能缺损评分依次为(25.1±2.2)分、(19.5±1.8)分、(15.1±1.5)分,两组比较差异有统计学意义(P0.05);研究组的预后情况优于对照组(P0.05);研究组的住院时间为(22.0±2.4)d,短于对照组(32.2±4.0)d(P0.05)。结论对颅脑外伤患者在临床治疗期间实施阶段性康复护理,可有效改善神经功能缺损情况,促进康复,改善预后,缩短住院时间,具有较高的临床应用价值。     

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.