共管照护模式对老年髋部创伤性骨折患者预后的作用

目的探讨共管照护模式在老年髋部创伤性骨折患者预后的作用。方法选取2019年3月至2020年3月该院收治的髋部创伤性骨折的老年患者154例, 根据两组基础资料有配比性的原则分为对照组和观察组, 每组77例。对照组采取常规诊疗和护理模式, 观察组采取共管照护模式干预, 对比两组干预前后的疼痛程度、心理状态、睡眠质量、日常生活能力。结果入院时观察组与对照组VAS疼痛、SAS焦虑量表、SDS抑郁量表、PSQI睡眠质量量表评分差异无统计学意义;术后3 d, 观察组VAS评分低于对照组, PSQI量表7维度评分与总分低低于对照组, 差异有统计学意义(P<0.05), 出院时观察组SAS、SDS评分低于对照组, 差异有统计学意义(P<0.05);入院时两组患者Barthel巴氏指数评分差异无统计学意义;出院后8 w观察组Barthel评分明显高于对照组, 差异有统计学意义(P<0.05)。结论为髋部创伤性骨折患者提供共管照护模式能取得较好的临床效果, 有效缓解患者术后疼痛, 改善不良心理状态, 提升日常生活能力。     

基于混合方法的老年髋部骨折术后患者的居家照护需求及照护资源整合期望的研究

目的探究老年髋部骨折术后患者的居家照护需求及居家资源整合期望, 以掌握老年髋部骨折术后患者的需求, 为出院后健康照护指导提供依据。方法采用一致性平行设计的混合研究方法, 对2021年6月至2022年4月广州医科大学附属第三医院的15例老年髋部骨折术后患者进行半结构式访谈, 同时以便利抽样法选取134例老年髋部骨折术后患者用国际居民评估工具家庭护理评估量表进行健康问题调查, 综合资料结果进行分析。结果通过对访谈资料进行分析归纳提取出两大主题:居家照护需求多元化、居家照护服务资源整合度不够。髋部骨折术后老年患者共触发25个健康问题, 健康问题主要集中在日常生活活动能力受限、社会活动不足, 社会交往受限、临床健康问题(跌倒风险、营养问题、疼痛, 心血管与呼吸系统问题、健康促进不足、乏力)等方面。结论对于老年髋部骨折术后患者, 应在出院时加强康复指导, 整合居家照护资源提供过渡阶段多元化护理服务, 促进患者康复行为的形成与持续, 改善患者的临床结局。     

适时模式的全程照护在老年髋部脆性骨折患者中的应用

目的：探讨适时模式的全程照护在老年髋部脆性骨折患者中的应用效果。方法：将2021年1月1日～2022年1月31日收治的160例老年髋部脆性骨折患者随机分为观察组和对照组各80例，对照组给予常规干预，观察组在对照组基础上实施适时模式的全程照护。两组在院内均接受了医疗干预并延续至出院后6个月，最终有134例患者纳入研究，其余26例患者未能坚持完成研究，造成临床资料缺失。比较两组老年髋部脆性骨折健康知识掌握程度、依从性、髋关节功能Harris评分、二次骨折发生率。结果：干预后，两组危险因素、运动知识、钙知识掌握情况评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);观察组抗骨质疏松药物规范治疗依从率、饮食方案实施依从率、腰背肌肉平衡锻炼执行率、行为习惯改变依从率均高于对照组(P<0.01,P<0.05);两组出院前1 d、出院后3个月、出院后6个月Harris评分均升高(P<0.01),且观察组高于同期对照组(P<0.01);观察组出院后3、6个月二次骨折发生率低于对照组(P<0.05)。结论：适时模式的全程照护在老年髋部脆性骨折患...     

加速康复外科理念下多学科共管模式在急诊老年髋部骨折围手术期中的应用

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念下多学科共管模式在急诊老年髋部骨折围手术期护理中的应用效果,以期提高老年髋部骨折的治疗效果。方法采用不同病例前-后对照研究方法,将2015年5月—2017年2月在本院急诊住院手术的375例老年髋部骨折患者设为对照组,采用围手术期常规治疗护理;将2017年3月—2018年10月在本院急诊住院手术的401例老年髋部骨折患者设为试验组,采用ERAS理念下多学科共管模式治疗护理程式。比较两组患者入院至手术的时间,48h内手术的比例,术后并发症发生率,总住院时间和围手术期死亡率。结果两组患者入院至手术的时间,48h内手术的比例,术后并发症发生率,总住院时间和围手术期死亡率比较,均P0.05,差异具有统计学意义,试验组患者入院到手术的时间短于对照组,48h内手术率高于对照组,术后并发症发生率与围手术期死亡率低于对照组。结论急诊老年髋部骨折患者采用ERAS理念下多学科共管模式治疗护理,可提高48h手术率,降低术后并发症发生率,缩短住院时间及降低围手术期死亡率。     

“医护一体化”照护模式应用于老年髋部骨折病人的临床效果评价

[目的]分析髋部骨折老年病人实施"医护一体化"照护模式的临床效果。[方法]将我院2016年4月—2017年3月接诊的55例髋部骨折老年病人视为对照组,予以传统护理照护;将我院2017年4月—2018年3月接诊的58例髋部骨折老年病人视为研究组,在传统护理照护基础上实施"医护一体化"照护。比较两组病人的护理工作质量、髋关节功能水平、并发症发生率。[结果]研究组诊疗信息掌握、护理操作、护理专业知识及医护措施落实评分均高于对照组,髋关节康复优良率高于对照组,术后并发症发生率低于对照组,差异有统计学意义(P0.05)。[结论]将"医护一体化"照护模式应用于髋部骨折老年病人,能提高其护理工作质量及改善髋关节功能。     

共管模式在老年髋部骨折患者围手术期静脉血栓栓塞症预防中的应用

目的探讨共管模式在老年髋部骨折患者围手术期静脉血栓栓塞症(VTE)预防中的应用效果。方法采用便利抽样法,选取2019年1—12月郑州大学第一附属医院收治的146例老年髋部骨折患者为研究对象,将2019年1—6月收治的73例患者设为对照组,接受常规静脉血栓风险评估、治疗、宣教等,将2019年7—12月收治的73例患者设为试验组,接受共管模式管理。比较两组患者的VTE发生率、首次下床活动时间、住院天数及费用、VTE相关知识知晓率、DVT健康信念水平。结果实施共管模式后,试验组患者的术后VTE发生率低于对照组(P<0.05);试验组的首次下床活动时间、住院天数短于对照组,住院费用少于对照组,DVT健康信念评分、VTE相关知识评分均高于对照组,差异有统计学意义(P<0.05);试验组DVT健康信念中疾病的易感性、疾病严重性、健康行为的益处、自我效能方面得分均高于对照组(P<0.05);两组健康行为的障碍维度得分、健康动力得分比较,差异无统计学意义(P>0.05)。结论老年髋部骨折患者在围手术期实施共管模式可提高患者DVT健康信念及改善VTE知识掌握度,缩短患者住院时间,有效预防VTE的发生,促进患者快速康复。     

“智慧养老”视域下社区老年人出院后延续性照护模式的实施及效果研究

目的：探讨“智慧养老”视域下社区老年人出院后延续性照护模式的实施效果。方法依托宁波“智慧养老”服务设施的推广,建立社区老年患者出院后的延续性照护模式,构建智慧化的延续性照护服务平台,对宁波某三甲医院50名老年患者进行调查和实施。结果社区老年人出院在延续性照护模式减轻了老年患者出院后的家庭照护负担,促进社区医生签约服务的发展。结论社区老年人出院后延续性照护模式有利于医院-社区-家庭服务连接更加紧密,提高老年患者对医院及社区医疗的满意度。     

老年髋部骨折患者围手术期静脉血栓栓塞症预防中引入共管模式的临床实践

目的:探讨在老年髋部骨折患者围手术期静脉血栓栓塞症预防中引入共管模式的效果。方法:选择2020年2月至2021年2月无锡市锡山人民医院行手术治疗的120例老年髋部骨折患者,随机分为2组,每组60例。对照组行常规围手术期干预,观察组在此基础上引入共管模式干预。对比2组静脉血栓栓塞症发生率、手术前后下肢深静脉血栓形成健康信念、静脉血栓栓塞症相关知识知晓度及初次下床活动时间、住院时间、住院花费情况。结果:观察组静脉血栓栓塞症发生率为1.67%(1/60),低于对照组的16.67%(10/60),差异有统计学意义(P<0.01);观察组术1周后除健康行为的障碍,下肢深静脉血栓形成健康信念其余各项评分均高于对照组(均P<0.001);观察组术后1周静脉血栓栓塞症相关知识知晓度高于对照组(P<0.001);观察组初次下床活动时间、住院时间短于对照组,住院花费低于对照组(均P<0.001)。结论:老年髋部骨折患者围手术期引入共管模式干预可有效预防静脉血栓栓塞症发生,提升患者下肢深静脉血栓形成健康信念及静脉血栓栓塞症相关知识知晓度,促进患者早日恢复。     

试论适合城市社区发展的老年慢性疾病患者出院后照护模式的构建

目的探讨适合我国城市社区老年慢性疾病患者出院后照护模式的构建。方法介绍目前国内外老年人概况及我国人口老龄化带来的问题、老年人慢性疾病的流行病学概况、目前城市社区老年慢性疾病患者出院后照护模式的现状及发展趋势,在借鉴国外经验及分析我国国情的基础上,提出构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略。结果构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略包括：在医院建立老年护理专业架构及成立老年专科护理小组;在医院及社区建立及实施老年慢性疾病患者出院计划模式。结论构建适合我国城市社区老年慢性疾病患者出院后照护模式是当前拓宽、发展老年护理事业的必然途径,将能够为医疗卫生保障体系的改革和健康发展起到促进作用。     

试论适合城市社区发展的老年慢性疾病患者出院后照护模式的构建

目的 探讨适合我国城市社区老年慢性疾病患者出院后照护模式的构建.方法 介绍目前国内外老年人概况及我国人口老龄化带来的问题、老年人慢性疾病的流行病学慨况、目前城市社区老年慢性疾病患者出院后照护模式的现状及发展趋势,在借鉴国外经验及分析我国国情的基础上,提出构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略.结果 构建适合我国城市社区老年慢性疾病患者出院后照护模式的思路和策略包括:在医院建立老年护理专业架构及成立老年专科护理小组;在医院及社区建立及实施老年慢性疾病患者出院计划模式.结论 构建适合我国城市社区老年慢性疾病患者出院后照护模式是当前拓宽、发展老年护理事业的必然途径,将能够为医疗卫生保障体系的改革和健康发展起到促进作用.     

Factors associated with changes in mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture

Purpose: To examine factors associated with changes in mobility and living arrangements in a comprehensive geriatric outpatient assessment after hip fracture. Method: Population-based prospective data on 887 consecutive hip fracture patients aged 65 years and older. The domains of the geriatric assessment were the independent and changes in mobility level and living arrangements 4 months postoperatively the outcome variables. Results: Of the survivors, 499 (73%) attended the assessment. The mobility level had declined in 39% of the attendees and 38% of them had moved to more supported living arrangements 4 months after the hip fracture. In the age-adjusted univariate logistic regression analyses, almost all the domains of the comprehensive geriatric assessment were significantly associated with both outcomes. In the forward stepwise multivariate analysis, disability in activities of daily living, poor performance in Timed Up and Go and comorbidity as measured by the American Society of Anesthesiologists scores remained significantly associated with the outcomes. Conclusions: While comorbidity and disability in activities of daily living and mobility are the major indicators of poor outcomes of mobility and living arrangements after hip fracture, all the domains in the comprehensive geriatric assessment deserve attention during hip fracture care and rehabilitation.

• Implications for Rehabilitation

• In almost half of the patients the mobility level and living arrangements had deteriorated 4 months after the hip fracture, suggesting an urgent need for more effective postoperative rehabilitation.

• Almost all the domains of the comprehensive geriatric assessment were associated with poor outcomes and require equal attention during the acute and postacute phases of hip fracture care and in the course of rehabilitation.

• A geriatric outpatient assessment a few months after the hip fracture provides a check-point for the outcomes and an opportunity to target interventions at different domains of the comprehensive assessment.

     

老年髋部骨折行髋关节置换术后患者出院时延续护理需求的质性研究

目的深入了解老年髋部骨折行髋关节置换术后患者出院时的延续护理需求。方法采用目的抽样法,于2019年1—3月对15例接受全髋关节置换的老年髋部骨折患者出院时进行半结构式访谈,并用Colaizzi 7步法分析资料,了解其需求问题。结果通过分析、整理和提炼,得出患者术后关心的3个主题,分别为对健康教育的需求、对改善不良心理的需求、对卫生服务资源的需求。结论接受全髋关节置换术的髋部骨折患者在生理、心理、社会等方面存在诸多负担与需求。护理人员应加强对此类患者的关注,做好针对性的疏导干预,为出院患者提供详尽的健康教育,以提高其自我照护能力。     

国内老年康复护理研究热点与研究趋势的可视化分析

目的 通过可视化图谱挖掘国内老年康复护理的研究热点和研究趋势.方法 以中国知网数据库为检索平台,运用CiteSpace软件对建库至2019年12月15日收录的老年康复护理相关文献进行可视化分析.结果 国内老年康复护理文献量呈上升趋势.该领域研究热点包括脑卒中、吞咽障碍、患肢、髋关节、髋关节置换术、针灸、生活质量、功能锻...     

五位一体对预防老年髋部骨折术后便秘的临床研究

目的：探讨五位一体(医生、护士、康复师、患者、家属)模式对预防老年髋部骨折术后患者便秘的效果,为五位一体的模式深入推广到治疗护理老年髋关节专科疾病提供依据。方法实验组,2014年10月~2015年4月住院患者共39例,其中男11例,女28例,平均年龄75.6岁,髋关节置换术有12例,粗隆间骨折内固定术有27例,合并糖尿病8例、高血压13例、冠心病5例、胃炎4例、肺气肿2例,运用五位一体的模式对患者进行预防便秘。对照组,2013年1月~8月住院患者共40例,其中男12例,女28例,平均年龄76.1岁,髋关节置换术有15例,粗隆间骨折内固定术有25例,合并糖尿病9例、高血压20例、冠心病3例、肺气肿1例,采用常规护理的方法,护士每天观察患者排便情况,便秘者报告医生处理。通过总体疗效、首次排便时间、辅助通便率、患者满意度、并发症发生率,比较两组的临床疗效。结果实验组的总体疗效、满意度均高于对照组,实验组平均排便时间、辅助通便率、并发症发生率均低于对照组,两组在显效、有效、无效率方面对比有显著差异(P<0.01),总有效率对比有显著差异(χ2=19.32,P<0.01)。结论在五位一体模式下,医生、护士、康复师、患者、家属共同评估、制定、实施预防便秘方案,护士在团队中发挥着主导作用,取得较好的临床效果,值得推广。     

Combined fascia iliaca compartment block and monitored anesthesia care for geriatric patients with hip fracture: Two case reports

BACKGROUNDMajor hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARYThis report established that hip surgical procedures can be performed with a fascia iliaca compartment block (FICB) and monitored anesthesia care (MAC) while avoiding neuraxial or general anesthesia. This was a preliminary experience with two geriatric patients with hip fracture, American Society of Anesthesiologists status III, and with many comorbidities. Neither patient could be operated on within 48 h after admission. Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications. Hence, we chose nerve block combined with a small amount of sedation. Intraoperative analgesia was provided by single-injection ultrasound-guided FICB. Light intravenous sedation was added. Surgical exposure was satisfactory, and neither patient complained of any symptoms during the procedure.CONCLUSIONThis report showed that hip surgery for geriatric patients can be performed with FICB and MAC, although complications and contraindications are common. The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.     

The Delirium Observation Screening Scale: a screening instrument for delirium

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses' observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, alpha = 0.93 and alpha = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p < or = 0.001) in the hip fracture patients and Rs -0.66 (p < or = 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse's ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p < or = 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p < or = 0.001) in the study with the hip fracture patients and 0.33 (p < or = 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p < or = 0.05) in the geriatric medicine patients and -0.55 (p < or = 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses' observation.     

Hip fractures in primary health care. Evaluation of a rehabilitation programme

The routine follow-up of hip fracture patients was transferred from the Orthopaedic Department, Lund University Hospital, to the primary health care districts in 1985. The medical state and social functions of all 298 patients during the first 12 months of the follow-up rehabilitation programme were registered. Before fracture, 61% lived in their own homes, 22% in old people's homes, and 14% in geriatric hospitals or nursing homes. Four months after fracture, 13% were dead, 47% were living in their own homes, 14% were in old people's homes, 25% in geriatric hospitals or nursing homes, while the rest were in other types of institutional residence. Of patients coming from their own homes, 75% were back at home four months after fracture and their social and functional status were as good as before fracture. The study has shown that routine check-ups at the orthopaedic department can be omitted. Follow-up in primary health care without radiography and orthopaedic expertise gives equally good functional results as in previous studies, provided that patients with pain and walking problems from the hip are guaranteed rapid specialist treatment.