细化健康教育在小儿肠造口术的应用

目的 探讨细化健康教育在小儿肠造口护理中的应用效果.方法 选择2012年1~12月在我科行小儿肠造口术的患儿(实施细化健康教育后)为观察组,选择2011年1～12月小儿肠造口术患儿(未实施细化健康教育)为对照组,比较两组患儿肠造口并发症发生率的差异性.结果 两组患儿肠造口并发症发生率比较,观察组明显低于对照组,差异有统计学意义(P＜0.05).结论 在小儿肠造口护理中实施细化的健康教育,可减少护理并发症,促进患儿康复,值得临床推广.     

妇科恶性肿瘤并肠转移行造口术的护理

我科自2007年9月～2009年2月共实施了5例恶性肿瘤肠转移行造口术的患者，术后经过精心的护理无并发症，均治愈出院，现将护理体会报告如下。     

1例结肠穿孔行肠造口术后并发肠脱垂的护理体会

肠造口术是外科最常施行的手术之一。全球每年由于结肠癌、直肠癌、外伤、炎症及先天性畸形而行肠造口术者达数十万人之多。其中最常见的是回肠末端或结肠造口,俗称人工肛门。肠造口术虽然挽救了很多生命,但肠造口术后并发症发生率很高．国外文献报道,术后并发症发生率达21％～71％。国内报道为16．3％～53．8％。肠造口术后并发症的发生主要与施术者的技术和术后的护理质量有关。     

围术期心理干预对肠造口术后镇痛效果的临床观察

目的:观察围术期适当的心理干预对肠造口手术患者术后镇痛效果的影响。方法:选择我院2012年12月至2014年2月胃肠外科收治的直肠癌行肠造口手术患者60例,并将其随机分成对照组(C组)和干预组(T组),对照组患者给予正常术后镇痛,干预组患者给予正常术后镇痛并在围术期给予心理干预处理,观察和比较两组患者的VAS、术后镇痛效果满意度、术后不良反应的发生情况。结果:两组的性别、年龄、体重、身高、术前VAS评分比较差异无统计学意义(P0.05)。T组患者术后24 h的VAS评分明显低于C组(P0.05),72 h VAS评分虽然有所下降,但差异无统计学意义(P0.05)。与C组相比,T组对术后镇痛满意度为"非常满意"的人数百分率显著高于C组(P0.05)。T组不良反应的发生率低于C组,但两组差异无统计学意义(P0.05)。结论:围术期对直肠癌行肠造口手术患者进行恰当的心理干预可增强患者术后的镇痛效果,提高患者术后满意度,且不增加不良反应。     

国内整体护理的现状及进展

随着科学技术的发展,人民生活水平的提高和疾病谱的改变,人们对身心整体健康更加重视,多年来建立在以疾病为中心的功能制护理模式的缺陷愈来愈突出,已经不能适应２１世纪保健服务的需求。护理工作如何适应这种变化和需求是新时期护理改革的重要任务。近年来,我国护理界引进了整体护理,并将其思想应用于临床护理工作中,旨在加快护理模式转变,促进护理学科发展,现将国内整体护理的现状及进展综述如下。１　整体护理的形成和发展　　１８６０年南丁格尔开创近代护理以来,护理模式经过了个案护理、功能制护理、小组制护理和责任制护理…     

直肠癌切除术患者永久性与临时性造口术后生活质量变化及其与排便症状的相关性研究

摘要 目的：探讨直肠癌切除术患者永久性与临时性造口术后生活质量变化,并分析其生活质量与排便症状的相关性。方法：纳入我院2017年4月～2020年4月收治的直肠癌切除术患者110例,所有纳入者均行造口术。根据造口方式,分成永久性造口组（简称永久组,n=41）、临时性造口组（简称临时组,n=69）。记录两组造口并发症发生率,分别在患者术后1、3、6个月,采用简明生活质量量表（SF-36）评估其生活质量,采用排便症状量表评估患者排便症状的变化。经Pearson线性相关分析患者生活质量评分与排便症状评分的相关性。结果：临时组造口并发症发生率（8.90%）与永久组（12.20%）比较无差异（P＞0.05）。两组术后3、6个月SF-36各维度评分均高于术后1个月,术后6个月各评分高于术后3个月,且临时组术后3个月SF-36各维度评分高于永久组（P＜0.05）,但两组术后6个月各评分比较无差异（P＞0.05）。两组术后3、6个月大便症状各评分均低于术后1个月,术后6个月的排便急迫感、排便费力、里急后重评分及总分低于术后3个月,且临时组术后3个月的排便急迫感、排便费力、里急后重评分及总分低于永久组（P＜0.05）,但两组术后6个月排便症状各评分比较未见差异（P＞0.05）。Pearson线性相关分析显示,排便症状总分与机体疼痛、躯体功能、躯体角色受限、情感角色受限、心理健康、社会功能、总体健康评分呈负相关（P＜0.05）。结论：直肠癌切除术患者临时性造口能够进一步促进术后3个月生活质量、排便功能的改善,在术后6个月,永久性造口患者的生活质量、排便功能基本达到临时性造口患者的状态,且排便功能与生活质量具有相关性。     

肠造瘘术治疗单纯性肠穿孔较肠吻合术具有较好的疗效

为探讨单纯性肠穿孔患者实施肠造瘘术和肠吻合术治疗效果及预后差异,本研究选取单纯性肠穿孔患者75例作为研究对象,根据患者手术方式分为造瘘组(肠造瘘术治疗, 43例)和吻合组(肠吻合术治疗,32例),比较两组患者围手术期指标、近期疗效、术后并发症发生率及生活质量。研究发现两组患者发病到手术时间、手术时间、术中出血量比较无统计学意义(p>0.05);造瘘组患者胃肠功能恢复时间、术后禁食时间、卧床时间、住院时间均短于吻合组患者(p<0.05);造瘘组患者术后肠梗阻、二次手术、死亡发生率均低于吻合组患者(p<0.05);然而,造瘘组患者术后生活质量评分低于吻合组患者(p<0.05)。因此,本研究的初步结论为,肠造瘘术治疗单纯肠穿孔,相对肠吻合术治疗可缩短患者术后恢复时间、降低并发症发生率,但可对患者术后生活质量造成一定影响。     

糖尿病足内科治疗与护理进展

糖尿病足内科治疗的治疗存在着很多的困难,目前许多学者也对糖尿病足内科治疗做出了很多年的研究,但是该病情往往出现病情的周期长、病情的控制较为困难等情况。现在对于现在关于糖尿病足内科治疗与护理工作进行一个相关的总结。     

肠癌肠造口病人手术的护理

我院１９８９年７月至１９９７年６月,先后收治２０例结、直肠癌症病人,其中１２例做了肠造口术,取得了良好效果。现将护理体会总结如下。１临床资料１２例患者中,男性９例,女性３例,年龄最大６９岁,最小３２岁,平均５２岁,３例行暂时性肠造口,９例为永久性肠造...     

Status and progress in coral reef disease research

Recent findings on the ecology, etiology and pathology of coral pathogens, host resistance mechanisms, previously unknown disease/syndromes and the global nature of coral reef diseases have increased our concern about the health and future of coral reef communities. Much of what has been discovered in the past 4 years is presented in this special issue. Among the significant findings, the role that various Vibrio species play in coral disease and health, the composition of the 'normal microbiota' of corals, and the possible role of viruses in the disease process are important additions to our knowledge. New information concerning disease resistance and vectors, variation in pathogen composition for both fungal diseases of gorgonians and black band disease across oceans, environmental effects on disease susceptibility and resistance, and temporal and spatial disease variations among different coral species is presented in a number of papers. While the Caribbean may still be the 'disease hot spot' for coral reefs, it is now clear that diseases of coral reef organisms have become a global threat to coral reefs and a major cause of reef deterioration.     

Parental Perceptions of Quality of Life in Children on Long-Term Ventilation at Home as Compared to Enterostomy Tubes

Objective

Health related quality of life (HRQL) of children using medical technology at home is largely unknown. Our aim was to examine the HRQL in children on long-term ventilation at home (LTHV) in comparison to a cohort using an enterostomy tube.

Study Design

Participants were divided into three groups: 1) LTHV without an enterostomy tube (LTHV cohort); 2) Enterostomy tube (GT cohort); 3) LTHV with an enterostomy tube (LTHV+GT cohort). Caregivers of children ≥ 5 years and followed at SickKids, Toronto, Canada, completed three questionnaires: Health Utilities Index 2/3 (HUI2/3), Caregiver Priorities Caregiver Health Index (CPCHILD), and the Paediatric Quality of Life Inventory (PedsQL). The primary outcome was the difference in utility (HUI2/3) scores between the cohorts.

Results

One hundred and nineteen children were enrolled; 47 in the LTHV cohort, 44 in the GT cohort, and 28 in the LTHV+GT cohort. In univariate analysis, HUI2 mean (SE) scores were lowest for the GT cohort, 0.4 (0.04) followed by the LTHV+GT, 0.42 (0.05) and then the LTHV cohort, 0.7 (0.04), p = 0.001. A similar trend was seen for the HUI3 mean (SE) scores: GT cohort, 0.1 (0.06), followed by the LTHV +GT cohort, 0.2 (0.08) and then the LTHV cohort, 0.5 (0.06), p = 0.0001. Technology cohort, nursing hours and the severity of health care needs predicted HRQL as measured by the HUI2/3.

Conclusion

The HRQL of these children is low. Children on LTHV had higher HRQL than children using enterostomy tubes. Further work is needed to identify modifiable factors that can improve HRQL.     

Evolution and progress

The concept of progress is one which makes evolutionists feel very uneasy, yet it is also a concept to which they are forever returning. It is useful to make a distinction between 'comparative progress' which involves competition between groups, and 'absolute progress' which involves the climb up some objective scale. Both kinds of progress have been the subject of much debate in recent years, leading one to turn from expectations that the controversy will ever be resolved to queries about why it continues to obsess so many people.     

Status and the Brain

Social hierarchy is a fact of life for many animals. Navigating social hierarchy requires understanding one''s own status relative to others and behaving accordingly, while achieving higher status may call upon cunning and strategic thinking. The neural mechanisms mediating social status have become increasingly well understood in invertebrates and model organisms like fish and mice but until recently have remained more opaque in humans and other primates. In a new study in this issue, Noonan and colleagues explore the neural correlates of social rank in macaques. Using both structural and functional brain imaging, they found neural changes associated with individual monkeys'' social status, including alterations in the amygdala, hypothalamus, and brainstem—areas previously implicated in dominance-related behavior in other vertebrates. A separate but related network in the temporal and prefrontal cortex appears to mediate more cognitive aspects of strategic social behavior. These findings begin to delineate the neural circuits that enable us to navigate our own social worlds. A major remaining challenge is identifying how these networks contribute functionally to our social lives, which may open new avenues for developing innovative treatments for social disorders.

“Observing the habitual and almost sacred ‘pecking order’ which prevails among the hens in his poultry yard—hen A pecking hen B, but not being pecked by it, hen B pecking hen C and so forth—the politician will meditate on the Catholic hierarchy and Fascism.” —Aldous Huxley, Point Counter Point (1929)

From the schoolyard to the boardroom, we are all, sometimes painfully, familiar with the pecking order. First documented by the Norwegian zoologist Thorleif Schjelderup-Ebbe in his PhD thesis on social status in chickens in the 1920s, a pecking order is a hierarchical social system in which each individual is ranked in order of dominance [1]. In chickens, the top hen can peck all lower birds, the second-ranking bird can peck all birds ranked below her, and so on. Since it was first coined, the term has become widely applied to any such hierarchical system, from business, to government, to the playground, to the military.Social hierarchy is a fact of life not only for humans and chickens but also for most highly social, group-living animals. Navigating social hierarchies and achieving dominance often appear to require cunning, intelligence, and strategic social planning. Indeed, the Renaissance Italian politician and writer Niccolo Machiavelli argued in his best-known book “The Prince” that the traits most useful for attaining and holding on to power include manipulation and deception [2]. Since then, the term “Machiavellian” has come to signify a person who deceives and manipulates others for personal advantage and power. 350 years later, Frans de Waal applied the term Machiavellian to social maneuvering by chimpanzees in his book Chimpanzee Politics [3]. De Waal argued that chimpanzees, like Renaissance Italian politicians, apply guile, manipulation, strategic alliance formation, and deception to enhance their social status—in this case, not to win fortune and influence but to increase their reproductive success (which is presumably the evolutionary origin of status-seeking in Renaissance Italian politicians as well).The observation that navigating large, complex social groups in chimpanzees and many other primates seems to require sophisticated cognitive abilities spurred the development of the social brain hypothesis, originally proposed to explain why primates have larger brains for their body size than do other animals [4],[5]. Since its first proposal, the social brain hypothesis has accrued ample evidence endorsing the connections between increased social network complexity, enhanced social cognition, and larger brains. For example, among primates, neorcortex size, adjusted for the size of the brain or body, varies with group size [6],[7], frequency of social play [8], and social learning [9].Of course, all neuroscientists know that when it comes to brains, size isn''t everything [10]. Presumably social cognitive functions required for strategic social behavior are mediated by specific neural circuits. Here, we summarize and discuss several recent discoveries, focusing on an article by Noonan and colleagues in the current issue, which together begin to delineate the specific neural circuits that mediate our ability to navigate our social worlds.Using structural magnetic resonance imaging (MRI), Bickart and colleagues showed that the size of the amygdala—a brain nucleus important for emotion, vigilance, and rapid behavioral responses—is correlated with social network size in humans [11]. Subsequent studies showed similar relationships for other brain regions implicated in social function, including the orbitofrontal cortex [12] and ventromedial prefrontal cortex [13]. Indeed, one study even found an association between grey matter density in the superior temporal sulcus (STS) and temporal gyrus and an individual''s number of Facebook friends [14]. Collectively, these studies suggest that the number and possibly the complexity of relationships one maintains varies with the structural organization of a specific network of brain regions, which are recruited when people perform tests of social cognition such as recognizing faces or inferring others'' mental states [15],[16]. These studies, however, do not reveal whether social complexity actively changes these brain areas through plasticity or whether individual differences in the structure of these networks ultimately determines social abilities.To address this question, Sallet and colleagues experimentally assigned rhesus macaques to social groups of different sizes and then scanned their brains with MRI [17]. The authors found significant positive associations between social network size and morphology in mid-STS, rostral STS, inferior temporal (IT) gyrus, rostral prefrontal cortex (rPFC), temporal pole, and amygdala. The authors also found a different region in rPFC that scaled positively with social rank; as grey matter in this region increased, so did the monkey''s rank in the hierarchy. As in the human studies described previously, many of these regions are implicated in various aspects of social cognition and perception [18]. These findings endorse the idea that neural plasticity is engaged in specifically social brain areas in response to the demands of the social environment, changing these areas structurally according to an individual''s experiences with others.Sallet and colleagues also examined spontaneous coactivation among these regions using functional MRI (fMRI). Measures of coactivation are thought to reflect coupling between regions [19],[20]; these measures are observable in many species [21],[22] and vary according to behavior [23],[24], genetics [25], and sex [26], suggesting that coactivation may underlie basic neural function and interaction between brain regions. The authors found that coactivation between the STS and rPFC increased with social network size and that coactivation between IT and rPFC increased with social rank. These findings show that not only do structural changes occur in these regions to meet the demands of the social environment but these structural changes mediate changes in function as well.One important question raised by the study by Sallet and colleagues is whether changes in the structure and function of social brain areas are specific outcomes of social network size or of dealing with social hierarchy. After all, larger groups offer more opportunity for a larger, more despotic pecking order. In the current volume, Noonan and colleagues address this question directly by examining the structural and functional correlates of social status in macaques independently of social group size [27]. The authors collected MRI scans from rhesus macaques and measured changes in grey matter associated with social dominance. By scanning monkeys of different ranks living in groups of different sizes, the authors were able to cleave the effects of social rank from those of social network size (Figure 1).Open in a separate windowFigure 1Brain regions in rhesus macaques related to social environment.Primary colors indicate brain regions in which morphometry tracks social network size. Pastel colors indicate brain regions in which morphometry tracks social status in the hierarchy. Regions of interest adapted from [48], overlaid on Montreal Neurological Institute (MNI) macaque template [49].The authors found a network of regions in which grey matter measures varied with social rank; these regions included the bilateral central amygdala, bilateral brainstem (between the medulla and midbrain, including parts of the raphe nuclei), and hypothalamus, which varied positively with dominance, and regions in the basal ganglia, which varied negatively with social rank. These regions have been implicated in social rank functions across a number of species [28]–[32]. Importantly, these relationships were unique to social status. There was no relationship between grey matter in these subcortical areas and social network size, endorsing a specific role in social dominance-related behavior. Nevertheless, grey matter in bilateral mid-STS and rPFC varied with both social rank and social network size, as reported previously. These findings demonstrate that specific brain areas uniquely mediate functions related to social hierarchy, whereas others may subserve more general social cognitive processes.Noonan and colleagues next probed spontaneous coactivation using fMRI to examine whether functional coupling between any of these regions varied with social status. They found that the more subordinate an animal, the stronger the functional coupling between multiple regions related to dominance. These results suggest that individual differences in social status are functionally observable in the brain even while the animal is at rest and not engaged in social behavior. These findings suggest that structural changes associated with individual differences in social status alter baseline brain function, consistent with the idea that the default mode of the brain is social [33] and that the sense of self and perhaps even awareness emerge from inwardly directed social reasoning [34].These findings resonate with previous work on the neural basis of social dominance in other vertebrates. In humans, for example, activity in the amygdala tracks knowledge of social hierarchy [28],[35] and, further, shows activity patterns that uniquely encode social rank and predict relevant behaviors [28]. Moreover, recent research has identified a specific region in the mouse hypothalamus, aptly named the “hypothalamic attack area” [36],[37]. Stimulating neurons in this area immediately triggers attacks on other mice and even an inflated rubber glove, while inactivating these neurons suppresses aggression [38]. In the African cichlid fish Haplochromis burtoni, a change in the social status of an individual male induces a reversible change in the abundance of specialized neurons in the hypothalamus that communicate hormonally with the pituitary and gonads [39]. Injections of this hormone in male birds after an aggressive territorial encounter amplifies the normal subsequent rise in testosterone [40]. Serotonin neurons in the raphe area of the brainstem also contribute to dominance-related behaviors in fish [29],[31] and aggression in monkeys [41].Despite these advances, there are still gaps in our understanding of how these circuits mediate status-related behaviors. Though regions in the amygdala, brainstem, and hypothalamus vary structurally and functionally with social rank, it remains unknown precisely how they contribute to or respond to social status. For example, though amygdala function and structure correlates with social status in both humans and nonhuman primates [27],[28],[35],[42], it remains unknown which aspects of dominance this region contributes to or underlies. One model suggests that the amygdala contributes to learning or representing one''s own status within a social hierarchy [28],[35]. Alternatively, the amygdala could contribute to behaviors that support social hierarchy, including gaze following [43] and theory of mind [44]. Lastly, the amygdala could contribute to social rank via interpersonal behaviors or personality traits, such as aggression [45], grooming [45], or fear responses [46],[47]. Future work will be critical to determine how signals in these regions relate to social status; direct manipulation of these regions, possibly via microstimulation, larger-scale brain stimulation (e.g., transcranial magnetic stimulation and transcranial direct current stimulation), or temporary lesions, will be critical to better understand these relationships.The work by Noonan and colleagues suggests new avenues for exploring how the brain both responds to and makes possible social hierarchy in nonhuman primates and humans. The fact that the neural circuits mediating dominance and social networking behavior can be identified and measured from structural and functional brain scans even at rest suggests the possibility that similar measures can be made in humans. Although social status is much more complex in people than it is in monkeys or fish, it is just as critical for us and most likely depends on shared neural circuits. Understanding how these circuits work, how they develop, and how they respond to the local social environment may help us to understand and ultimately treat disorders, like autism, social anxiety, or psychopathy, that are characterized by impaired social behavior and cognition.