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Objective:To explore the effect of repetitive transcranial magnetic stimulation(rTMS) combined with cognitive behavioral therapy for insomnia(CBT-I)for menopausal women with insomnia.Methods:A total of 76 menopausal women with insomnia who were hospitalized from April 2020 to October 2021 were enrolled.Then they were randomly divided into observation group and control group, with 38 cases in each group.Both observation group and control group were treated with CBT-I. Meanwhile, the patients in observation group were treated with low-frequency repetitive rTMS, on the contrary, the patients in control group were treated with sham rTMS.The intervention lasted for 4 weeks.Insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were all recorded at baseline and 4 weeks after intervention, as well as adverse events. Data was analyzed by SPSS 22.0 software. Data which was normally distributed, was compared by independent t-test and paired t-test. Results:(1)The scores of ISI (16.39±4.03, 15.66±4.89) and the PSQI(14.97±2.70, 14.11±3.60) in observation group and control group at baseline were not significantly different( t=-0.716, -1.190, both P>0.05). After treatment, the ISI and PSQI scores of the observation group (10.08±3.65, 9.58±1.73)were lower than those of the control group (12.82±4.47, 12.13±2.32), and the differences were statistically significant ( t=2.926, 5.440, both P<0.05). (2) After treatment, all sleep parameters were significantly improved from baseline in observation group (all P<0.05). Sleep efficiency, wake time during sleep, and number of awakenings were significantly improved from baseline in control group(all P<0.05). Compared with control group((70.38±12.99)%, (17.39±11.75)%, (13.98±6.35)%), the observation group reported a greater statistically improvement in sleep efficiency, N3% and REM%((79.52±9.31)%, (22.80±6.05)%, (18.78±6.68)%, respectively)( t=-3.526, -2.524, -3.212, all P<0.05). Neither group had serious adverse effects. Conclusion:The rTMS combined with CBT-I can significantly improve the sleep quality in menopausal women with insomnia. With its high safety rTMS combined with CBT-I may be a recommended non-drug therapy among menopausal women with insomnia.
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Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic.Methods During January,2010 to February,2015,a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx.The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm.In addition,palmar soft tissue defect (n =15) of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries,and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm.Full-thickness skin graft urethroplasty was used in the donor sites.Flap shape,texture,sensory recovery and texture of the skin region,function recovery of the wounded fingers were followed up at 1,3,and 6 months after operation.Results Thirty-five patients were followed up from 6 to 13 months (average of 7 months).All flaps survived completely in the incorporated 35 cases postoperatively.Flaps had satisfactory appearance,fine texture,and soft texture in the skin transplantation area.The postoperative improvement of sensory function was between S2 and S3,and the two-point discrimination was 10-15 mm.Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent,10 cases as good,and 2 cases as fair.Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection,reliable blood supply,and no major blood vessels needed to be sacrificed,which is an effective procedure for finger soft issue defect repairing.
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Objective To analyze the prevention and nursing measures of adverse drug reaction in patients with rheumatoid arthritis treated with Tolicizumab.Method The clinical data and nursing measures in 30 patients with rheumatoid arthritis treated with Tolicizumab were reviewed and analyzed.Result All the patients completed the treatment and no infusion reaction was observed in the first 24 hours.Conclusions Comprehensive and intensive assessment is necessary before application of Tocilizumab. Executing standard drug dispensing and injection process,mastering the infusion reaction emergency processing measures and establishing injection related systems are of great significance to observe and treat various adverse reactions in time,ensuring drug effects and safety of the patients.
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Objective To investigate the nursing of traumatic carotid-cavernous fistula(TCCF)by intervention.Methods 18 patients with TCCF by intervention were given nursing measures including psychological preparation,eye care,disease observation and complications care.Results All patients gained successful embolization,and the symptoms of proptosis and vascular murmur in patients were alleviated.One case received spring embolism because of balloon rupture.The symptoms of vascular spasm in two patients were alleviated with timely treatment.Hyperperfusion syndrome was relieved after lowering blood pressure in two patients.Conclusions The intervention embolization is an effective treatment of TCCF.Good nursing could improve the efficacy and reduce the incidence of complications.
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Objective To summarize the nursing experience of combination therapy of highly agglutinative staphylococcin (HASL) with cisplatin for patients with malignant pleural effusions. Methods After fully draining of pleural fluid in 62 cases with malignant pleural effusion through pleural puncture through central venous catheters and simply suction bottles, we injected HASL and cisplatin into the patients' pleural cavities. During the therapeutic process, firstly, we drained the pleural fluid fully before injection, secondly, we directed the patients to cooperate well and alter the positions properly, and thirdly, we closely observed the patients' condition and adverse reactions. Results 54 of 62 cases were effective after the therapies. The effective rate was 87.1%.Conclusions In order to achieve a satisfled curative effect and reduce the adverse reactions, we need the cooperation of the patients, fully draining of the pleural fluid before injection and proper alternation of the patients' positions during the treatment process.
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Objective To investigate the surgical outcome of lumbar spinal canal stenosis. Methods Forward analysis of 160 cases of the patients with lumbar spinal canal stenosis getting operative treament was performed. 87 cases were male and 73 case were female. The average age was 51 years old (18 ～ 78years old). The average course of deseases was 5 years (1 month ～ 36years). All of the cases used lumbar spinal canal decompression combined with pedicle screws fixation and posterolateral bone graft. All cases had a follow - up of 3 months to 5 years (mean 34 months). Results The (COA) recovery rate among the tolal patients was cassified as exellent in 120 ca-ses , good in 31 cases , fair in 7 cases. The excellent and good rate was 94.4%. Conclusion The operative intervention was an effective method for patients with severe or progressive clinical lumbar spinal canal stenosis. The procedure in decompressed compretely through pos-terior approach and the instability of cerrical apinein had the satisfactory clinical outcome.
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Objective To study the effect of different family nursing methods on major catheter-re-lated complications in cancer patients with peripherally inserted central catheter (PICC) during chemother-apy intermission so as to reduce the incidence of complications and prolong the indwelling time and service life of the catheter. Methods We randomly divided 213 cancer patients who were discharged from hos-pital with PICC into two groups. One group(108 cases) routinely came back to our outpatient clinic and the other (105 cases) went to the community for nursing of the catheter. Results The total incidence rate of complications of the group who came back to our outpatient clinic for nursing of the catheter was 13.8%(15/ 108) and the other group was 51.4%(54/105). There existed statistical significance between the two groups (P<0.01). Conclusions There exists correlation between different family nursing methods and catheter complication rate. We suggest patients come back to our outpatient clinic for nursing of the catheter as pos-sible as they can.
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OBJECTIVE To study the correlation between nosocomial infection rate and hand hygiene compliance rate in health care workers.METHODS We analyzed the data about hand hygiene compliance rate in health care workers,nosocomial infection rate and meticillin-resistant Staphylococcus aureus(MRSA) infection rate from 2004 to 2007.RESULTS A total of 6350 hand hygiene times in health care workers in 4 years were observed.The hand hygiene compliance rate increased significantly from 34.58% to 74.52%(P