居家高龄老年人照护需求及满足情况调查

目的了解居家高龄老年人的照护需求及满足情况,为建立合理有效的居家养老服务网络提供参考。方法采用自制居家高龄老年人养老服务需求调查问卷对上海市某社区272名年龄≥80岁老年人进行入户调查。结果188人(69.1%)有照护需求,精神慰藉需求最高(46.7%),其次为生活照料(42.3%)、上门医疗护理(31.2%);陪同外出、临终关怀、志愿者陪伴分别是生活照料、上门医疗护理、精神慰藉需求中满足率最低的项目。结论居家高龄老年人的照护需求较高,但部分项目的满足率较低。为更好地满足其照护需求,应采取措施扩大社区照护资源、扩展精神慰藉途径、提高上门访视的数量及质量,建立专业化的居家养老服务团队。     

社区中老年居民养老护理服务的需求调查

目的了解社区中老年居民对养老护理需求现状,为满足其护理服务需求的干预提供参考。方法对东莞市456名社区中老年居民采用自行编制的护理服务需求调查表进行调查。结果社区中老年居民所希望的养老方式首选家庭养老(53.07%),最担心的养老问题为"失去生活自理能力"(占52.63%),护理服务需求总分(71.33±8.57)分;护理服务需求较高的条目为干重活、紧急救助和体育锻炼场地。结论我国老年人的养老方式仍然以家庭养老为主,对养老护理服务需求表现为多样性,对生活照顾、医疗保健及精神及活动需求较高。政府和养老机构应进一步完善养老政策和保险及医疗保障体系,满足老年人的养老护理服务需求。     

基于CLHLS的老年人社区养老服务需求及影响因素研究

目的分析社区现有养老服务内容以及老年人对社区养老服务的护理需求,为政府合理分配社区养老服务资源,提高老年人生活质量提供参考。方法基于2017~2018年中国老年人健康长寿影响因素追踪调查数据(CLHLS),采集有关老年人期望社区提供的养老服务需求与社区供给情况,以及老年人人口学、社会经济状况、健康状况相关数据,运用Logistic回归分析方法,探究老年人社区养老服务需求的影响因素。结果共采集到11981名老年人数据资料。75.7%的老年人希望得到保健知识教育服务,42.2%的老年人报告其社区会提供该类服务;64.3%的老年人希望得到居家护理服务,但仅10.2%的老年人报告其社区会提供此类服务;81.0%的老年人希望得到家访照顾,35.0%的老年人报告其社区会提供此类服务;67.3%老年人希望提供心理咨询服务,但仅12.1%的老年人报告其社区会提供此类服务。老年人的年龄、居住地、居住现状、经济情况及健康状况等是影响其社区养老服务需求的主要因素(P<0.05,P<0.01)。结论老年人对社区养老服务需求较大,但我国社区养老仍存在供需不平衡、城乡差距明显以及老年人生活水平差异等。社区养老应以老年人需求为导向,建立多层次、全方位、多元化的养老服务体系,提高社区养老服务质量,满足老年人社区养老服务需求。     

四川城区老年人养老方式选择及其影响因素调查

目的了解四川城区老年人养老方式选择及其影响因素。方法在四川省6个地区,采用自行设计问卷方便抽样640名城区老年人进行调查,分析老年人养老方式选择及相关影响因素。结果 640名老年人中,8.1%选择社区居家养老,10.3%选择机构养老,81.6%选择家庭养老。单因素分析中,性别、文化程度、个人月收入、与子女关系满意度、子女个数、养老费用来源个数对老年人养老方式选择有影响;多因素Logistic回归分析中,文化程度越高、与子女关系越不满意的老年人越愿意接受机构养老和社区居家养老;养老费用来源个数越多的老年人更愿意接受社区居家养老。结论家庭养老仍然是城区老年人养老方式的主要选择,合适的养老方式对满足老年人需求、合理利用养老资源,实现"健康四川2030"健康老龄化有积极作用。     

老年人社区嵌入式养老服务需求及影响因素研究

目的 了解老年人社区对嵌入式养老服务的需求意愿，分析影响因素，为满足老年人多元化的养老需求提供参考。方法 方便抽取832名老年人进行问卷调查。结果 老年人对社区嵌入式养老服务需求率为19.2%。logistic回归分析显示，文化程度、就医频率、子女数量、自理能力、对现阶段养老方式的满意度及社区嵌入式养老是否满足自身养老需求，是老年人社区嵌入式养老需求的影响因素(P<0.05,P<0.01)。结论 老年人对社区嵌入式养老服务的需求意愿较低，受多方面因素的影响。需提高老年人对社区嵌入式养老的认识。     

社区老年人居家护理服务需求及影响因素分析

目的探讨社区老年人居家护理服务需求情况及其影响因素。方法采用一般资料调查表、日常生活活动能力量表(ADL)、自行设计的社区老年人居家护理服务需求问卷对咸宁市社区523名老年人进行调查分析。结果血压监测、血糖监测、疾病知识健康教育、生活方式健康指导、服药健康指导及心理支持分别占老年人居家护理服务需求的前6位,Logistic回归分析显示,影响老年人居家护理服务需求的因素主要有年龄、平均月收入、文化程度、患病种数及日常生活活动能力。结论社区老年人对居家护理服务需求较大,高龄、患慢性病数目多、ADL能力低、文化程度及收入高的社区老年人居家护理服务需求更高。     

西安市医养融合社区居家养老服务现状调查

目的通过调查西安市"医养融合"社区居家养老服务现状,分析其存在问题,探索借助"互联网+"视角的解决策略。方法方便抽取西安市438名接受"医养融合"社区居家养老服务的60岁以上的老人,采用自制西安市"医养融合"社区居家养老服务现状调查表进行调查。结果老年人对"医养融合"社区居家养老服务满意度仅为11.0%,医保付费、创建健康档案、转诊机制完善是提高"医养融合"社区居家养老服务满意度的影响因素(P0.05,P0.01)。结论 "医养融合"社区居家养老服务中心普遍存在"医养融合"深度不够,严重影响老年人对其服务的满意度,可借助"互联网+"优势加速"医养融合",提高服务满意度,进而提升老年人生活质量。     

青岛市社区老年人居家不出现状及影响因素研究

目的了解社区老年人居家不出现状及影响因素,为针对性干预提供参考。方法对587名老年人采用一般资料调查问卷、居家不出状态量表、日常生活能力量表、老年抑郁量表和社会支持评定量表进行问卷调查。结果 587人中居家不出107人(占18.2%),不同性别、年龄、婚姻状况、经济来源、患病种数、吸烟饮酒情况、活动爱好、锻炼身体、助行器使用、日常生活能力、抑郁及社会支持度的老年人居家不出发生率差异有统计学意义(均P0.01),其中高龄、缺乏活动爱好、疏于锻炼身体、抑郁状态、日常生活能力及收入低下是居家不出的危险因素(OR=3.062～33.199)。结论社区老年人居家不出发生率较高,应针对主要影响因素制订切实可行的干预措施,帮助老年人尽可能多地外出,以丰富老年人生活,实现积极养老。     

失能老年人照护需求及照护模式的研究进展

伴随人口老龄化进程的加快,快速增长的失能老年人口已成为目前日益严峻的问题,如何解决失能老年人的照护问题是当今养老的重中之重。对失能老年人的长期照护需求内容、需求现状以及需求未满足的不良结局、照护模式进行综述,照护模式包括延续性护理服务模式、社区居家护理服务、“互联网+”养老服务平台及医养护一体化管理模式,为今后有效对接失能老年人护理服务需求,拓展适合失能老年人养老的长期照护体系提供参考依据,早日实现健康老龄化。     

盐城市不同养老模式高龄老年人的护理需求分析

目的了解盐城市不同养老模式高龄老年人的护理需求,从而提出改进对策,以提高高龄老年人的生活质量。方法采用自行编制的调查表对盐城市家庭养老(282人)、机构养老(234人)和社区居家养老(139人)的≥80岁老年人的疾病护理、疾病预防和健康促进三方面需求进行调查。结果3种养老模式下高龄老年人的护理需求比较,差异有统计学意义(均P<0.01),其中社区居家养老高龄老年人健康促进的需求最高,家庭养老对疾病护理的需求最高,机构养老对疾病预防需求最高;影响高龄老年人护理需求的主要因素有对护理服务的认识和患病数目(均P<0.01)。结论不同养老模式高龄老年人的护理需求不同,在我国多种养老模式并存的情况下,护理人员需针对性满足高龄老年人的护理需求,提高其生活质量。     

Characteristics of patients who are acutely admitted to hospital under surgical care and do not have a surgical procedure – Is there an alternative to admission?

Introduction

Previous work has shown that 56% of all acute surgical admissions in Ireland in 2012 did not have a formal surgical procedure. In light of the pressures on health systems internationally and the lack of relevant data on this topic in the literature, we examined the characteristics of this cohort of patients in Ireland.

实习护生护理关怀行为及影响因素的调查

目的了解实习护生护理关怀行为实施现状及相关影响因素。方法采用方便抽样方法,使用美国学者Wolf关怀行为量表修改版,对在江苏省某三甲医院实习的150名护生进行调查。结果实习护生护理关怀行为得分为(80.98±8.92)分。护生的护理关怀行为主要体现在对患者信息保密(3.76±0.49)、懂得注射和滴注(3.69±0.54)、倾听主诉(3.71±0.50)、对患者表示关心(3.63±0.52)、按时治疗和给药(3.61±0.64)方面;但帮助患者成长(2.91±0.77)、让患者参与护理计划制定(2.88±0.91)得分最低。影响实习护生实施护理关怀行为的因素为护理关怀课程的学习及学历(P<0.05,P<0.01)。结论实习护生护理关怀行为得分呈中等偏上水平,并主要侧重于治疗性关怀,对患者的人文关怀尚欠缺。护理教育者应探讨合适的教学方法,开设护理关怀课程并付诸实践,不断提高护生护理关怀意识和行动力。     

Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

With a history of steadily rising healthcare costs, the United States faces an unprecedented set of health and financial challenges. The COVID-19 pandemic will only exacerbate these challenges, and it is of paramount importance to reform and refine health systems to maximize the value of care delivered to the patient. Recent developments related to value improvement in total joint arthroplasty suggest that episode-based payment is likely to become standard practice given the current healthcare environment. Consequently, developing episode-based care models for total joint arthroplasty is in the best interests of surgeons, health systems, and patients. In this article, we review important developments related to value-based care in total joint arthroplasty and present an episode-based framework for delivering high-value, patient-centric care. We examine each phase of a total joint arthroplasty episode—preoperative, acute, post-acute, and follow up—and present several ideas with developing bodies of evidence that can improve the value of care delivered to the patient.     

嗜铬细胞瘤的围手术期处理

报告８１例嗜铬细胞瘤，完善的围手术期处理使手术成功率达９７．４％（７９／８１）。结合文献讨论了围手术期处理的经验：（１）控制血压；（２）纠正心律失常；（３）解决扩容问题；（４）改善一般情况及心理准备工作；（５）密切观察各项生命指标的变化。并提出术前术中处理较术后处理更重要。     

Using the intensive care unit to teach end-of-life skills to rotating junior residents

Background

This study tested the effectiveness and perceived value of a palliative/end-of-life (P/EOL) curriculum for junior residents implemented during an intensive care unit (ICU) rotation.

Methods

Residents rotating through the ICU over a 6-month period completed pre- and post-curriculum surveys evaluating their self-assessed efficacy in providing P/EOL care and attitudes towards P/EOL care. Scores were analyzed using a paired Student t test.

Results

Seventeen of 19 (90%) residents completed both the pre- and post-curriculum evaluations. The P/EOL curriculum increased self-assessed efficacy ratings in the domains of pain management (P = .04), psychosocial knowledge (P = .001), communicator knowledge (P = .001), professional knowledge (P = .002), and manager knowledge (P < .001). The rotation was rated as being valuable in preparing residents to care for patients near the end-of-life (P < .05), with surgery residents indicating it to be the most valuable rotation in their training program for learning about P/EOL care.

Conclusions

An ICU P/EOL curriculum improves self-assessed efficacy scores across multiple domains in P/EOL care and is seen as a valuable educational experience.     

A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs

Integration of pharmacists into multidisciplinary transplant patient care has advanced in recent years, with limited data available to evaluate the current status of the profession. This was a national survey developed as an AST Pharmacy COP initiative. Responses were solicited from pharmacists practicing at U.S. transplant programs based on UNOS listing; 176 participants from 113 centers (41%) responded, with 79% practicing ≤10 years. There is a median of 1.4 pharmacist full‐time equivalents (FTEs) (range 0.1–7.1) for every 100 transplants. The predominant activities performed by pharmacists during the transplant phase include medication review (95%), lab review (92%), allergy review (88%), medication therapy management (92%), bedside rounds (87%), medication education (79%), documentation (71%), and coordinating discharge medications (58%). Similar activities were reported during the other phases, but participation was less common. The involvement of dedicated transplant pharmacists within multidisciplinary care has become standard at a large number of centers, although expansion is still needed to ensure core pharmaceutical care components are provided to all transplant recipients across all centers. These results inform on the typical responsibilities of pharmacists practicing within the field of transplantation and illustrate that the level of pharmacist involvement significantly varies across transplant centers and the phases of transplantation.     

Edgar J. Poth Memorial Lecture: Lessons learned inside the Beltway: one surgeon's encounters with health care policy

Our health care system continues to undergo transformation in a context of extreme financial pressures. New models of care delivery and financing challenge us to rethink our practices as individual surgeons and as system participants. Understanding the fiscal realities of health care and how we are perceived by health care policy makers can help us to be meaningful participants in channeling reform to create better delivery systems for our patients. This article presents some background information about health care in America with a focus on government programs, and shares insights from my health care policy colleagues.