微信平台在妇科肿瘤患者延续护理中的应用效果研究

目的 建立妇科肿瘤延续护理微信平台,探讨微信平台在妇科肿瘤患者延续护理中的应用效果。方法 成立延续护理微信平台小组,在妇科肿瘤延续护理中试运行,评估212名使用微信平台的患者或家属的使用状况。结果 在使用微信平台1个月期间,延续护理团队向每位使用微信平台的患者均发送了延续护理服务内容,完成率为100．00％。患者本人对平台的使用较积极,182名(71.09％)患者本人关注了公众号,30名(11.72％)患者家属关注。使用平台完成延续护理服务的患者复诊依从性、综合医院焦虑亚量表、抑郁亚量表测评结果均明显优于未使用平台的患者(P相似文献   

乳腺癌化疗患者对延续护理App功能的需求调查

目的 调查分析乳腺癌化疗患者对延续护理App功能的需求状况和应用前景,以指导App的构建.方法 研究者自行设计调查问卷,对某三级甲等医院652例乳腺癌化疗患者进行问卷调查,问卷内容包括移动医疗App知晓度和对延续护理App主要功能的需求.结果 不同学历患者对移动医疗App知晓度差异无统计学意义(P>0.05);不同年龄阶段患者对移动医疗App知晓度差异有统计学意义(P<0.05,P<0.01),年龄越小,知晓度越高;患者对延续护理App主要功能的需求依次为:复诊预约(97.4%)、疾病咨询(96.3%)、预后随访(95.9%)、复诊提醒(94.6%)、康复指导(92.3%)、护理服务(91.7%)、互动交流(91.4%)、用药指导(87.9%)、健康资讯(87.3%).结论 乳腺癌化疗患者对移动医疗App知晓度较高,延续护理App市场需求较高,有较好的市场应用前景,可通过开发设计App为患者提供延续护理服务,创新延续护理模式,推进行业公益化发展.     

延续护理在乳腺癌患者中的应用

目的探讨延续护理在乳腺癌患者中的应用。方法建立延续护理小组、制定延续护理方案,采用电话回访、现场咨询和指导、利用网络和乳腺健康俱乐部平台进行服务等。结果患者的治疗依从性、患肢功能的康复、乳腺相关知识的掌握度和满意度等,都取得明显效果(P0.01)。结论延续护理能提高患者的治疗依从性,促进患肢功能的康复和患者掌握乳腺相关知识,有效促进医患沟通,提高患者的满意度。     

移动医疗App应用于鼻咽癌患者延续护理的实践

目的评价移动医疗App应用于鼻咽癌患者延续护理的效果。方法将80例鼻咽癌患者按出院时间顺序分为对照组和观察组各40例,对照组采用常规延续护理,观察组采用移动医疗App进行延续护理,包括教会患者应用APP,推送鼻咽癌相关知识,医患、患患互动,健康状况分析和复查提醒等。结果干预3个月后观察组患者鼻塞、口干的发生率和严重程度均低于对照组(P0.01或P0.05);自我护理能力和希望水平评分均高于对照组(P0.01或P0.05)。结论应用移动医疗App进行延续护理,有助于减轻鼻咽癌患者放疗毒副反应,提高患者的自我护理能力和希望水平。     

前列腺癌根治术后患者延续护理服务需求的调查

目的调查前列腺癌根治术后患者延续护理服务需求情况,为制定个性化护理措施提供理论和实践依据。方法采用自行设计的调查问卷对96例前列腺癌根治术后患者的延续护理服务需求内容和方式进行调查。结果在延续护理服务内容上,前列腺癌患者对术后切口护理(96.9%)、术后并发症预防(93.8%)、活动锻炼(96.9%)、出院后复诊及预约(91.7%)、后续治疗(96.9%)、复发及预后信息咨询(96.9%)的服务内容有较高的需求;在延续护理服务方式上,99.0%患者选择医院专科门诊随访,81.3%患者选择电话、短信、网络咨询疾病的康复知识,仅有8.3%患者选择到社区医疗服务部门复诊。结论前列腺癌根治术后患者有较多延续性护理服务需求,医护人员应根据患者疾病及需求提供针对性延续护理服务。     

延续性服务对老年脑梗塞后遗症合并高血压患者遵医行为效果观察

目的 通过延续服务电话随访对脑梗塞合并高血压老年患者进行的遵医行为宣教和干预,观察患者用药依从性。 方法 将出院后,符合标准的脑梗塞合并高血压患者,在出院前进行宣教,出院后二周、三周、一个月、三个月进行延续性电话随访,第四周门诊复诊,随访内容分用药依从性、社会支持系统、自理能力情况,并评估用药依从性、社会支持度执行力。 结果 延续服务电话随访105例中,第二周,遵守用药依从性105例(100%);第三周,遵守用药依从性100例(95.2%),未遵守用药依从性5例(4.7%),一个月遵守用药依从性95例(90.4%),未遵守用药依从性10例(9.52%),三月遵守用药依从性98例(93.3%),未遵守用药依从性7例(6.6%)。 结论 延续电话随访服务对脑梗塞合并高血压老年患遵医行为起到重要作用,提高用药依从性,提高生存质量。     

“共情共呼吸”延续护理服务模式在呼吸专科护理门诊中的应用

[目的]探讨“共情共呼吸”延续护理服务模式在呼吸专科护理门诊中的应用。[方法]。将2018年1月—2018年6月门诊400例呼吸道慢性疾病病人以就诊顺序分为单双数,单数为对照组,双数为观察组,对照组采用常规“共呼吸”延续护理服务模式,观察组采用“共情共呼吸”延续护理服务模式。比较两组病人自我管理质量(吸入制剂规范使用率、家庭氧疗率、肺康复计划执行率、正规复诊率)以及病人及家属对专科护士满意率。[结果]观察组病人吸入制剂规范使用率、家庭氧疗率、肺康复计划执行率、正规复诊率以及病人及家属对专科护士满意率均高于对照组。[结论]在呼吸专科护理门诊中应用“共情共呼吸”延续护理服务模式可提高病人自我管理质量以及病人及家属对专科护士的满意度。     

延续护理在区域分级医疗体系构建中的作用研究

目的研究参与延续护理的护理人员服务意愿及行为,讨论延续护理实践促进区域分级医疗体系构建的作用。方法通过文献梳理总结我国在医院、社区和科室三个层面开展延续护理的探索实践及其成效,采用调查问卷法,研究279名患者的延续护理需求及175名护士参与延续护理的行为差异。结果现阶段患者对于延续护理的需求主要集中在出院后的携管护理方面,而其他延续护理项目需求更倾向于继续留在医院或返院复诊,与护士更愿意进行的延续护理时间相比,更多的患者希望一年及三年(P0.05);而希望半年及十年的医患双方差异无统计学意义(P0.05)。护士参与延续护理的现状和态度在不同年龄段、职称级别和聘用类型上差异有统计学意义(P0.05),而在学历和护龄上异无统计学意义(P0.05)。结论从改善社区医院硬件设施条件、提高社区医务人员业务能力水平、构建区域分级医疗体系、促进双向转诊制度建设等方面提出了对策建议,论证了延续护理作为区域分级医疗体系构建推动力的重要因素在体系构建中的作用。     

护患沟通在儿科护理中的作用

医患关系是医疗过程中人们之间最基本的关系。近年来,医患关系较为紧张,尤其是儿科病房,孩子是家中的宝贝,医患矛盾较成人更为突出。为此,在护理工作中通过对住院患儿及家属实施护患沟通,使医患关系融洽,患儿及家属对治疗的依从性增加,从而提高护理质量。     

家属教育对老年类风湿关节炎患者复诊依从性的影响

目的探讨家属教育对老年类风湿关节炎患者复诊依从性的影响。方法选择88例老年类风湿关节炎住院患者,将其随机分为2组,每组各44例,2组患者均给予常规治疗护理,观察组在此基础上同步实施家属健康教育,比较患者出院3个月内的复诊情况。结果观察组复诊率明显高于对照组,差异有统计学意义(P0.05)。结论对老年类风湿关节炎患者家属同步实施健康教育,可提高患者复诊依从性,值得推广。     

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.