舒适护理模式在手术室护理中的应用效果

目的：探讨舒适护理模式在手术室护理中的应用效果。方法选取2013年3月至2014年4月我院手术室患者80例,随机分为观察组和对照组,各40例,对照组采取常规的手术护理,观察组在此基础上采取舒适护理模式。分析比较两组患者舒适度以及满意度情况。结果观察组患者舒适度明显优于对照组（97．5％＞72．5％）,两组相比较差别具有统计学意义（ P＜0．05）;两组患者在术前及术后的血压、心率和呼吸无显著差别,术中观察组患者血压、心率和呼吸明显低于对照组,两组相比较差别具有统计学意义（ P＜0．05）;观察组患者满意度显著高于对照组（95．0％＞67．5％）,两组相比较差别具有统计学意义（ P＜0．05）。结论通过研究可知,在手术室护理中应用舒适护理模式效果显著,明显提高患者舒适度和满意度,促进手术的顺利进行,值得临床推广应用。     

自配营养液在重型颅脑损伤患者胃肠内营养中的应用与护理

目的：探讨舒适护理模式对腹部术后患者疼痛的影响。方法：将90例腹部术后患者随机分为观察组与对照组各45例。对照组采用常规护理方法，观察组采用常规护理加舒适护理模式护理。结果：两组术后72h内疼痛发生率比较有极显著性差异（P〈0．01），两组患者舒适度和满意度比较均有显著性差异（P〈0．05）。结论：舒适护理模式护理可以减轻腹部术后患者疼痛程度，增加患者舒适度和满意度，从而有利于保持良好护患关系和提高护理质量，促进患者术后顺利康复。     

舒适护理应用于剖宫产术后下肢静脉栓塞患者临床观察

目的：探讨舒适护理对剖宫产后下肢静脉栓塞患者的影响。方法选取2010年8月至2013年8月无锡市人民医院收治的剖宫产术后下肢静脉栓塞患者80例,随机分为两组;观察组患者接受舒适护理,对照组患者接受常规护理;观察两组患者舒适度以及对护理的满意度。结果观察组评价中度舒适及高度舒适的患者比例明显高于对照组,差异具有统计学意义（P＜0．05）;观察组患者护理满意度明显高于对照组,差异具有统计学意义（P＜0．05）。结论舒适护理可以使患者获得生理、心理方面的满足感和安全感,以最佳状态接受药物治疗,为顺利治愈疾病、保护母婴健康创造良好的条件,值得临床进一步推广应用。     

舒适护理在腹腔镜直肠癌根治术患者中的应用效果

目的：探讨舒适护理在腹腔镜直肠癌根治术患者中的应用效果。方法选取我院收治的48例直肠癌患者作为研究对象,将其随机分为观察组和对照组各24例,对照组采用常规护理,观察组采用舒适护理,比较两组治疗前后患者心理状态、生命体征变化及患者满意度。结果护理后SAS、SDS评分及生命体征较同组护理前比较,差异均有统计学意义（ P＜0．05）;观察组护理后SAS、SDS评分和收缩压、舒张压及心率较对照组显著降低,差异均有统计学意义（ P＜0．05）;观察组患者满意度为95．8％,高于对照组的75．0％,差异有统计学意义（ P＜0．05）。结论舒适护理能改善腹腔镜直肠癌根治术患者心理状态及生命体征,提高患者满意度,值得在临床上进一步推广应用。     

疼痛护理干预对妇科腹腔镜手术患者术后肩痛及护理满意度的影响

目的：探讨疼痛护理干预在妇科腹腔镜患者术后护理中的应用效果。方法将本院2013年8月至2014年3月收治的80例妇科腹腔镜患者随机分为观察组和对照组,每组40例,对照组术后采用常规护理,观察组在对照组的基础上术后加强疼痛护理干预,比较两组术后肩痛情况、护理满意度及住院时间。结果两组患者术后6 h的肩痛评分差异无统计学意义（P＞0．05）。观察组术后24、48、72小时的肩痛评分均低于对照组,镇痛剂使用剂量少于对照组,出院前在生理、心理、社会环境、文化方面的舒适度评分均高于对照组,差异有统计学意义（ P＜0．05）。观察组的住院时间短于对照组,在服务态度、护理过程、护理结果等方面的护理满意度均高于对照组,差异有统计学意义（ P＜0．05）。结论疼痛护理干预有利于减少妇科腹腔镜患者术后肩痛程度,提高患者的舒适度和护理满意度,促进患者术后康复。     

舒适护理对妇产科门诊手术患者舒适度的影响

目的探讨舒适护理在妇产科门诊手术中的应用效果。方法将200例妇产科门诊手术患者按照护理方法的不同分为观察组和对照组各100例,对照组采用常规护理,观察组采用舒适护理,比较两组患者的护理效果。结果观察组术前1h的心率、收缩压、皮质醇、血糖及SAS评分均显著低于对照组（P〈0．05）;观察组术后在生理、心理、社会环境、文化方面的舒适度均显著高于对照组（P〈0．05）;观察组术后的护理满意度显著高于对照组（P〈0．05）。结论舒适护理是一种比较人性化的护理方式,能够降低妇产科门诊患者术前手术应激,提高舒适度和满意度。     

舒适护理在自体骨髓单个核细胞移植治疗急性心肌梗死患者中的应用

目的探讨舒适护理在自体骨髓单个核细胞移植治疗急性心肌梗死患者中的应用效果。方法将62例接受自体骨髓单个核细胞冠状动脉内移植术患者随机分为对照组28例和实验组34例,对照组接受常规护理,实验组接受舒适护理。在出院前分别对两组患者进行术后舒适度、健康教育达标率、患者对护士服务态度及护理效果满意度调查。结果实验组术后舒适度、健康教育达标率、患者对护士服务态度及护理效果满意度均明显优于对照组（均P〈0．01或P〈0．05）,且实验组术后并发症明显低于对照组（均P〈0．01或P〈0．05）。结论对自体骨髓单个核细胞冠状动脉内移植术患者实施舒适护理,可使患者在心理、生理上以最佳的状态配合手术治疗与护理,同时也可提高患者对护理工作的满意度。     

重点护理指导对前列腺增生手术患者术后膀胱痉挛和舒适度的影响

目的：采用重点护理指导预防前列腺增生术后患者膀胱痉挛的发生,提高患者的舒适度。方法将我院2012年1月至2014年1月收治的120例前列腺增生手术的患者采用DOLL′S临床病例随机表的办法分为观察组和对照组,对照组采用常规护理,观察组为减少术后膀胱痉挛,提高患者舒适度进行重点护理指导,比较两组自我护理能力、膀胱痉挛情况、疼痛评分、舒适度及护理满意度。结果观察组的健康知识水平、自我概念、自我责任感等自护能力高于对照组,膀胱痉挛程度小于对照组,痉挛评分低于对照组,痉挛时间少于对照组,差异有统计学意义（P＜0．05）。观察组术后的疼痛评分少于对照组,在生理、心理、社会环境、文化方面的舒适度评分均高于对照组,护理满意度高于对照组,差异有统计学意义（ P＜0．05）。结论重点护理指导有利于减少前列腺增生患者术后膀胱痉挛的程度,降低疼痛,提高术后舒适度。     

舒适护理措施对慢性化脓性中耳炎乳突根治术患者的影响

目的：观察和讨论舒适护理措施对慢性化脓性中耳炎乳突根治术患者舒适和满意程度的临床效果及影响。方法收集我院2012年1月至2014年6月慢性化脓性中耳炎患者中实施乳突根治术患者100例,随机分为对照组与观察组各50例,对照组实施常规护理,观察组在常规护理的基础上实施舒适护理,比较两组患者的舒适度以及对护理工作的满意度。结果观察组患者舒适度为94％,明显高于对照组76％（ P＜0．05）;观察组患者对护理工作的满意度为92％,明显高于对照组80％（ P＜0．05） 。结论采取舒适护理措施对于慢性化脓性中耳炎乳突根治术患者来说,可以帮助患者平稳度过围术期产生的各种不适,有利于患者身体康复和提高患者对护理工作的满意度,值得临床推广。     

舒适护理在复杂性视网膜脱离术后的应用

目的探讨舒适护理在复杂性视网膜脱离术后的应用效果。方法将60例复杂性视网膜脱离术后患者随机分为对照组和观察组各30例,对照组采用常规护理,观察组实施舒适护理,包括心理舒适护理、疼痛、体位、饮食等舒适护理。比较两组患者舒适程度及对护士服务满意度,两组患者均于术后8d使用舒适度评价表及满意度调查表。结果观察组术后不适程度显著小于对照组（P〈0．01）,对护理工作满意度也显著高于对照组（P〈0．01）。结论对复杂性视网膜脱离术后患者实施舒适护理,可减轻患者术后不适程度,提高护理工作满意度,是有效的护理措施。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.