社区护理干预对高血压患者遵医行为的影响

目的:探讨社区护理干预对高血压患者遵医行为的影响.方法:选择2008年7月～2009年7月社区内的108例原发性高血压患者,并随机分为干预组和对照组,对照组给予常规治疗和护理,干预组进行综合社区护理干预.观察两组患者的遵医行为及干预后患者的血压情况.结果:干预组与对照组相比,其中合理饮食、按时按量服药、进行适量运动、戒烟禁酒、血压监测、精神舒缓相比均存在统计学差异(P＜0.05).干预组患者干预后的血压状况也有显著好转(P＜0.05).结论:对高血压患者进行护理社区干预可提高患者的遵医行为,有效控制血压状况,可以在社区慢性病管理中发挥了其重要作用.     

高血压患者社区综合护理效果观察

目的制订高血压患者护理干预措施,探讨社区护理对高血压患者康复的影响。方法选择社区内确诊的高血压患者61例,建立个人健康档案,给予健康教育,包括饮食、运动、心理指导、药物治疗及定期血压监测等干预措施,比较干预措施前后患者遵医行为、血压控制情况。结果社区护理行为干预后,高血压患者规律服药、饮食控制、定期血压监测和运动疗法等遵医行为人数较干预前明显增多,差异有统计学意义（P〈0．005或P〈0．01）。结论对高血压患者采用社区护理行为干预,效果良好。     

社区护理干预对老年原发性高血压病病人的影响

[目的]探讨社区护理干预对社区老年原发性高血压病病人生活不良行为、服药遵医情况及血压控制的影响.[方法]将社区内122例老年原发性高血压病病人随机分成两组,干预组62例,对照组60例.干预组按照系统性的社区慢性病护理程序进行护理,对照组采用常规护理.[结果]干预组病人生活不良行为、遵医服药情况、降血压等方面明显优于对照组,差异具有统计学意义.[结论]系统性的社区护理干预使社区老年高血压病病人血压得到良好控制,提高了病人的生活质量.     

社区护理干预对高血压患者遵医行为的影响

目的通过社区护理干预，提高高血压患者的遵医行为，有效控制高血压，减少并发症的发生。方法对60名高血压患者厦家属进行健康教育、心理、行为、服药等方面的护理干预并与对照组60例进行比较。结果护理干预组在坚持规律服药、低盐低脂饮食、戒烟戒酒、控制体重等方面与对照组存在差异显著（p〈0．01）；实验组干预前、后血压比较差异有高度显著性意义（p〈0．01）。结论社区护理干预能提高患者的遵医行为，有效控制高血压，减少并发症的发生。     

“以家庭为中心”的护理干预模式在社区高血压病人中的应用效果评价

[目的]评价“以家庭为中心”的护理干预模式在社区高血压病病人中的应用效果。[方法]将管辖社区内的174例高血压病病人采用随机数字表法分为对照组和观察组各87例,对照组采取常规护理模式,观察组采用“以家庭为中心”的护理模式,干预12个月后对照分析两组对高血压的认知水平、遵医行为及血压控制情况。[结果]护理干预后观察组对高血压的认知水平和遵医行为明显高于对照组(P<0.05),观察组的血压控制达标率明显高于对照组(P<0.05)。[结论]对社区高血压病病人实施“以家庭为中心”的护理干预模式,能显著提高病人对高血压的认知水平、遵医行为及血压控制达标率。     

护理干预对特需病房高血压患者遵医行为的影响

目的 探讨护理干预对特需病房高血压患者遵医行为的影响.方法 对110例高血压Ⅱ期患者进行遵医行为调查后,采取护理干预措施;6个月后再次调查患者遵医行为,并比较干预前后的遵医率.结果 干预后患者在合理运动、按时服药、血压监测、饮食控制等方面的遵医率明显高于干预前.结论 护理干预可以提高特需病房高血压患者的遵医率和治疗效果,提高患者的自我管理能力,同时对高血压患者进行长期监测、随访,可有效控制并发症的发生率.     

护理干预对高血压病患者遵医行为的影响分析

目的 研究遵医行为对高血压病患的影响。方法 将120例患随机分为实验组和对照组，对实验组进行护理干预，对照组未施加任何影响，半年后比较两组患的遵医率(包括定期复查，按时服药，血压监测，合理运动，饮食控制)。结果 实验组在定期检查、按时服药、血压检测、饮食控制等方面的遵医率明显高于对照组。结论 护理干预可以提高患遵医率和治疗效果。     

护理干预对老年高血压患者遵医行为的影响

目的 探讨护理干预对老年高血压患者遵医行为的影响.方法 选择2009年6～12月我院收治的老年高血压患者84例,随机将患者分为干预组和对照组各42例.2组患者经明确诊断后均给予常规治疗及护理,而干预组则在此基础上给予全面系统的护理干预措施,并对2组患者的遵医行为等指标进行对比分析.结果 干预组按时服药、血压监测、合理饮食、适当运动、情绪稳定的情况 明显优于对照组.与此同时,干预组血压稳定的情况明显优于对照组.结论 护理干预措施不仅可以保障老年高血压患者的遵医行为,还能有效的控制血压,为老年高血压患者的早日康复奠定了坚实的基础.     

社区护理干预对高血压病病人遵医行为影响的研究

[目的]探讨社区护理干预对高血压病人遵医行为的影响.[方法]将100例高血压病人分为两组,干预组50例进行社区护理干预,对照组50例行常规护理,护理干预后比较两组病人遵医行为的改善情况.[结果]干预组的遵医行为较对照组要好很多,两组比较有统计学意义(P<0.05).[结论]社区护理干预可提高高血压病病人的遵医行为.     

家庭干预对老年高血压患者遵医行为的影响

目的：探讨提高老年高血压患者遵医行为的方法,提高高血压患者的生活质量。方法：103例出院的高血压患者随机分为家庭干预组和对照组,对照组进行常规健康教育,家庭干预组在常规健康宣教的基础上实施家庭干预,观察两组患者的遵医行为的改变,包括是否按时复查、自我监测血压、定时服药、饮食控制、心理调整、运动疗法等6个方面的情况并严密监测血压。结果：家庭干预组的遵医行为和血压控制情况明显好于对照组。结论：实施家庭干预对老年高血压病患者的遵医行为有着正面的影响。     

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.