分析國內急診護理教育現狀與發展情況，介紹自身急診護理發展情況及教育成效。提出急診護理教育必須注重急診理論教育與專科操作技能的結合，綜合運用課堂教學、讀書報告、業務查房、論文撰寫等多樣的形式組織學習，并定期考核。通過急診護理教育的拓新，必將保證急診臨床護理質量，促進專科發展。
【摘要】 目的 〖JP2〗研究質子泵抑制劑（PPI）是否為危重患者發生醫院獲得性肺炎的危險因素。 方法 收集2002年6月-2009年6月收治的198例重癥患者資料，分為使用PPI組（96例）和未使用PPI組（102例）。采用logistic回歸分析PPI使用情況和醫院獲得性肺炎的關系。 結果 使用PPI組肺炎的發生率較高（26.9%），尤其是PPI使用時間超過7 d者（37.5%）。在不同的多變量logistic回歸模型中，分別用APACHE Ⅱ評分和入住重癥監護室原因校正后，使用PPI以及使用天數均是醫院獲得性肺炎發生的危險因素（P=0.031，OR＝2.230，95%CI：1.957~2.947；P=0.002，OR＝1.824，95%CI：1.457~2.242）。 結論 長時間應用PPI可能是增加ICU患者發生醫院獲得性肺炎的一種風險因素。【Abstract】 Objective To identify whether proton pump inhibitors (PPI) is a risk factor of hospital-acquired pneumonia (HAP) in critical patients. Methods The clinical data of the critical patients admitted to ICU from June 2002 to June 2009 were retrospectively analyzed. A total of 198 patients were divided into two groups: 96 in PPI group and 102 in non-PPI group. The relationship between PPI and HAP was analyzed by logistic regression. Results The patients in PPI group had a higher risk of HAP (26.9%), especially who were treated with PPI more than 7 days (37.5%). Adjusted by APACHE Ⅱ score and reason for admission to ICU, PPI therapy and the using duration of PPI were both the risk factors of HAP in different multiple logistic models (P=0.031, OR=2.230, 95%CI: 1.957-2.947; P=0.002, OR=1.824, 95%CI: 1.457-2.242). Conclusion Long-term use of PPI is a risk factor of HAP.
目的:信息系統的改進應用是為確保急診科預檢分診處將來能使醫院對自然災害事件的傷員救治時以最便捷、最快速的方式錄入自然災害事件傷員的信息資料和快速評估傷情，優先準確的將傷員按病情和就診區域分類，以便暢通及時救治傷員；在治療中和日后便于識別、查找、統計災害事件傷員。方法:LIS（檢驗系統）+ RIS（影像系統）+ HIS（無紙化辦公系統）三合一系統和增加自然災害傷員的“錄入信息資料”眉欄。結果:進一步改進信息網絡應用系統后，能滿足一般患者信息資料錄入和自然災害事件應急狀況下的患者資料錄入，實現電子病歷和電子處方等信息網絡系統，達到院內、科內資源共享。
At present, upper limb motor rehabilitation relies on specific rehabilitation aids, ignoring the initiative of upper limb motor of patients in the middle and late stages of rehabilitation. This paper proposes a fuzzy evaluation method for active participation based on trajectory error and surface electromyography (sEMG) for patients who gradually have the ability to generate active force. First, the level of motor participation was evaluated using trajectory error signals represented by computer vision. Then, the level of physiological participation was quantified based on muscle activation (MA) characterized by sEMG. Finally, the motor performance and physiological response parameters were input into the fuzzy inference system (FIS). This system was then used to construct the fuzzy decision tree (FDT), which ultimately outputs the active participation level. A controlled experiment of upper limb flexion and extension exercise in 16 healthy subjects demonstrated that the method presented in this paper was effective in quantifying difference in the active participation level of the upper limb in different force-generating states. The calculation results of this method and the active participation assessment method based on sEMG during the task cycle showed that the active participation evaluation values of both methods peaked in the initial cycle: (82.34 ± 9.3) % for this paper’s method and (78.44 ± 7.31) % for the sEMG method. In the subsequent cycles, the values of both showed a dynamic change trend of rising first and then falling. Trend consistency verifies the effectiveness of the active participation assessment strategy in this paper, providing a new idea for quantifying the participation level of patients in middle and late stages of upper limb rehabilitation without special equipment mediation.
衛生部下發《臨床路徑管理指導原則(試行)》(衛醫管發〔2009〕99號)的通知, 希望建立一套既能貫徹醫院質量管理標準, 又能節約資源的醫療標準化模式。為適應現代醫學和康復醫學發展的需要, 采用康復臨床路徑對康復治療進行規范, 是非常重要的。四川大學華西醫院康復醫學科根據臨床路徑要求, 于2011年制定了康復醫學科膝骨關節病康復臨床路徑, 希望通過臨床試用, 對路徑的臨床實用性、可行性進行探討, 并逐漸完善。
目前，國內尚未制定出較為完整的康復醫學專業常見骨關節疾病的康復臨床路徑，為適應現代康復醫學發展的需要，四川大學華西醫院康復醫學科根據衛生部《臨床路徑管理指導原則》要求，結合康復醫學科住院患者的疾病、康復評定、康復治療、康復護理、康復教育等，于2011年制定了康復醫學科常見疾病的康復臨床路徑，希望通過臨床試用，對路徑的臨床實用性、可行性進行探討，并逐漸完善。
目前，國內尚未制定出較為完整的康復醫學專業常見骨關節疾病的康復臨床路徑，為適應現代康復醫學發展的需要，四川大學華西醫院康復醫學科根據衛生部《臨床路徑管理指導原則》要求，結合康復醫學科住院患者的疾病、康復評定、康復治療、康復護理、康復教育等，于2011年制定了康復醫學科常見疾病的康復臨床路徑，希望通過臨床試用，對路徑的臨床實用性、可行性進行探討，并逐漸完善。
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1—3N0 gastric cancer. Methods One hundred and twenty patients with stage pT1—3N0 gastric tumors were included, and 2 106 lymph nodes were harvested and examined in all the specimens. There were 9－28 lymph nodes with average 18 lymph nodes from each patient. All the lymph nodes were negative by HE staining. The CK20 expression of lymph nodes was tested by immunohistochemistry. The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed. Results The positive expression rate of CK20 was 9.07% (191/2 106) in lymph nodes and 26.67% (32/120) in patients with pT1—3N0 gastric cancer by immunohistochemistry. Eleven cases were with micriometastasis, 21 cases were isolated tumor cells (ITC). The average postoperative follow-up was 66.35 (range 24—121) months. Five-year disease free survival rates were 87.4%, 78.3%, and 40.9% for the lymph node negative, ITC, and micrometastasis groups, respectively. Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group (P=0.000) and ITC group (P=0.046). However, there was no significant difference between the lymph node negative group and ITC group （P=0.253）. Multivariate analysis identified tumor diameter (P=0.011), depth of tumor invasion (P=0.043), and lymphatic vessel invasion (P=0.002) were related with CK20 positive expression. There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates. Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi), the restage rate was 9.17%. While the lymph node negative (88 patients) and ITC (21 patients) were recorded pN0(i-) and pN0(i+), respectively, and were not recommended restage (stage pN0). Conclusion Patients with stage pT1—3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate, for whom adjuvant therapies may be justified and effective.
Objective To summarize the progress of biological indexes which could predict the efficiency of neoadjuvant chemotherapy for breast cancer. Methods Various related researches were collected to make a review. Results Many indexes linked to the efficiency of neoadjuvant chemotherapy for breast cancer according to several studies. According to many studies, indexes such as human epidermal growth factor receptor-2 (HER-2) gene, estrogen receptor (ER), progesterone receptor (PR), Ki-67, P53 gene, neutrophil to lymphocyte ratio (NLR), platelet level, and mean platelet volume (MPV) may have association with the outcome of neoadjuvant chemotherapy in treatment of breast cancer, and these factors maybe individual biomarkers to predict the efficiency of the treatment, but no coincident conclusion has been reached for these indexes. Conclusion The value of these indexes that predict the efficiency of neoadjuvant chemotherapy is not sure, further study need to be done to solve this topic.
Objective To summarize types of post-mastectomy breast reconstruction and present situation. Method The relevant literatures about post-mastectomy breast reconstruction in recent years were reviewed. Results With the increasing incidence of the breast cancer and the progressing of the treatment methods, it has become a trend for the post-mastectomy breast reconstruction. If the patient’s condition is allowed, the post-mastectomy breast reconstruction can be performed. At present, the post-mastectomy breast reconstruction mainly include the implant based reconstruction, autologous tissue reconstruction, autologous fat transplantation, etc.. There are different options for the breast reconstruction according the indicators and it had the corresponding complications. So the selection of reconstruction technique depend on the individual requirements, determining by the patient choice, advice of the reconstructive surgeon, and anticipated post-mastectomy therapy, particularly the needs for the radiotherapy and chemotherapy, etc.. Conclusions Post-mastectomy breast reconstruction is common abroad, corresponding research has been carried out in our country, experiences in learning are shairing. With deepening of domestic and foreign exchanges and progressing of technology, it is believed that post-mastectomy breast reconstruction might become one of conventional reconstruction options in future.