口腔正畸患者复诊情况调查及其影响因素分析

目的了解正畸患者的复诊现状并分析其影响因素,以提高患者复诊依从性。方法采用便利抽样法,选取2017年9—11月在上海交通大学医学院附属第九人民医院口腔科进行正畸治疗的复诊患者作为研究对象。采用自行编制的问卷调查患者的复诊情况并分析影响因素。结果共调查正畸复诊患者366例,其中定期复诊者287例(78%),未定期复诊者79例(22%)。Logistic回归分析显示,患者的性别及婚姻状况是影响患者定期复诊的主要因素(P0.05)。患者未按时复诊的原因有:症状因素、个人时间安排冲突、忘记复诊、医生停诊等。结论影响正畸患者复诊的因素较多,建议通过加强正畸后健康宣教提高患者对相关症状的识别及处理能力,并通过完善预约医嘱、加强信息化建设等措施来提高患者的定期复诊率。     

正畸患者复诊依从性调查及影响因素分析

目的 探讨正畸患者复诊的依从性及影响因素。方法 采用便利抽样法,选取 2017年8~11月在上海市某三级甲等医院口腔科进行正畸治疗复诊的患者。采用自设问卷对366例正畸患者进行复诊现状调查,问卷主要包括患者一般资料及复诊原因等内容,并分析影响因素。结果 共调查366例患者,其中定期复诊的患者287例（78%）,未定期复诊者79例（22%）,Logistic回归分析显示,患者的性别、婚姻状况、居住地是复诊依从性的影响因素(P < 0 . 0 5),复诊主要原因包括遵医嘱复诊、症状复诊。结论 影响正畸患者复诊的因素较多,建议通过加强正畸后健康宣教及书面医嘱撰写等措施来提高患者的复诊依从性。     

口腔正畸病人复诊现状分析及影响因素研究

目的:探讨口腔正畸病人复诊现状及影响因素。方法:采取整群便利抽样法选取2018年1月—2019年12月医院收治的202例口腔正畸病人为研究对象,采用自行设计调查问卷对入选对象一般资料和复诊率进行收集,并对影响口腔正畸病人复诊因素进行单因素分析和多因素Logistic回归分析。结果:在202例口腔正畸病人中定期复诊的有114例(56.44%),未定期复诊的有88例(43.56%);单因素分析显示,性别、年龄、职业、文化程度、有无并发症、复诊次数、复诊时间、付费方式及心理状况均为口腔正畸病人复诊的相关影响因素(P<0.05);多因素分析显示,性别、有无并发症及心理状况均为影响口腔正畸病人复诊的独立影响因素(P<0.05)。结论:女性、合并有并发症及负性心理均为影响口腔正畸病人复诊的独立影响因素,临床应加强对病人心理疏导和全程健康指导,提供便捷的复诊和健康咨询渠道,全面提升口腔正畸病人的身心健康,确保临床疗效的质量。     

喉癌术后患者复诊依从性的研究及护理干预

目的：对60例喉裂开喉癌术后患者,包括全喉及半喉切除术后患者复诊依从性进行调查,研究影响复查的因素,进行护理干预,提高复诊的依从性,尽早发现是否有瘢痕挛缩,能否堵管、拔管以及是否有复发或转移,提高患者生活质量及生存率。方法采用《人口学变量问卷》、《复诊依从性问卷》,对60例喉裂开全喉或半喉切除术后的患者,建立复诊资料,进行电话随访问卷,或来院复诊时进行问卷调查。采用随机数字表法分为2组,观察组30例（采用电话随访,定期通知患者复诊,并告知复诊所需的项目及大概费用）,对照组30例（出院时给予健康指导,并发放健康教育手册）,比较两组复诊的依从性及影响因素。结果观察组和对照组复诊的依从性有统计学意义（χ2＝13．18,P＝0．04）。结论对喉癌术后的患者加强健康宣教,告知复诊的重要性,并定期提醒患者复诊,使患者尽可能地排除一切影响因素,遵从医嘱复诊,发现是否有瘢痕挛缩,能否堵管、拔管以及是否有复发或转移,可提高生活质量及5年生存率。     

影响正畸患者更改预定复诊时间的原因调查及对策

1 临床资料 我院口腔中心2009年上半年共接诊正畸患者675例,大多数为在校学生,占92%。考虑到学生课程紧、请假困难、每次复诊所需时间长等因素,医生有意根据正畸计划规程将患者安排在周末复诊,并进行时间段管理,但有的患者未告知医生单方面随意提前或延迟预定复诊时间现象严重,给正畸就诊管理带来很大困难。对2009年5～8月未按预定时间复诊的正畸患者随机发放调查表,共发放100份,回收有效调查表98份,回收率98％,其中男性患者62份,女性患者36份,更改预定复诊时间的原因调查结果（表1）。     

精神分裂症缓解期患者社会支持水平及其相关影响因素分析

目的 分析精神分裂症缓解期患者社会支持水平及其相关影响因素。方法 选取2021年1月至2022年3月于医院就诊的精神分裂症缓解期患者87例，采用社会支持评定量表（SSRS）评估患者社会支持水平，采用自制基线资料调查问卷记录一般资料，并比较不同特征的精神分裂症患者SSRS评分，找出影响精神分裂症缓解期患者社会支持水平的危险因素。结果 87例精神分裂症患者社会支持（SSRS）评分（31.24±8.37）分；不同婚姻状况、工作情况、家庭人均月收入、复诊情况的精神分裂症患者SSRS评分比较，差异有统计学意义（P<0.05）；经多元线性回归分析结果显示，未婚、无工作、家庭经济收入低及未规范复诊是影响精神分裂症患者社会支持水平的危险因素（P<0.05）。结论精神分裂症缓解期患者社会支持水平一般，受到患者婚姻状况、工作状况、家庭经济收入、复诊等危险因素影响。     

影响痛风患者尿酸达标的独立危险因素分析与护理干预对策

目的探讨影响痛风患者尿酸达标的因素与护理对策。方法选取2017年6月至2018年6月我院收治的76例痛风患者为研究对象,其中25例尿酸达标的作为达标组,51例未达标的作为未达标组,采用多因素logistic回归分析确定痛风患者尿酸达标的影响因素。结果单因素分析显示,合并症、血肌酐异常、吸烟史、饮酒史、体质量指数(BMI≥24 kg/m~2)、未定期复诊及医嘱执行不理想是影响痛风患者尿酸达标的因素(P 0. 05);多因素logistic回归分析显示,血肌酐异常、体质指数≥24 kg/m~2、未定期复诊、饮酒史为影响尿酸达标的独立危险因素。结论血肌酐异常、BMI≥24 kg/m~2、未定期复诊、饮酒史以及医嘱执行不理想均为影响尿酸达标的独立危险因素,临床护理可以根据以上因素给予患者针对性的护理。     

心肌梗死并发心力衰竭患者再入院率影响因素分析与护理

目的探讨心肌梗死并发心力衰竭患者再入院率的影响因素。方法选取2016年4月至2017年4月在本院治疗的心肌梗死并发心力衰竭患者168例作为研究对象,采用医院自拟问卷调查表对影响患者再入院率相关因素进行比较,并行多因素logistic回归分析。结果年龄、定期复诊、遵循医嘱服药、吸烟及是否停用β受体阻滞剂方面患者再入院率比较差异有统计学意义(P 0. 05)。多因素logistic回归分析结果显示,年龄 60岁、未定期复诊、未遵循医嘱服药、吸烟、停用β受体阻滞剂是心肌梗死并心力衰竭患者再入院率的独立危险因素。结论影响心肌梗死并发心力衰竭患者再入院率的危险因素较多,通过采取有效护理,减少危险因素的发生,降低患者再入院率。     

基于新媒体平台的延续性护理对中青年固定正畸患者口腔健康的影响

目的 探讨基于微信、抖音等新媒体平台的延续性护理对中青年固定正畸患者口腔健康的影响。方法 选取 2021 年 1 月 1 日至2021 年 12 月31 日期间来我院接受固定正畸的70 例中青年患者作为研究对象。按照随机数字表法,将患者分为观察组（n=35） 和对照组（n=35）。观察组患者给予常规护理,对照组患者给予基于新媒体平台的延续性护理。对比两组患者护理前和护理后 （正畸治疗后 3 个月时）牙周炎的发生情况、牙龈指数与菌斑指数、复诊情况及护理后的满意度情况。结果 正畸治疗后 3 个 月时,观察组牙周炎发生率显著低于对照组（P<0.05）（P<0.05）。观察组牙龈指数与菌斑指数均显著低于对照组（P<0.05）。 观察组患者按时复诊率（85.71%）显著高于对照组（62.86%）（P<0.05）。观察组随机复诊率（5.71%）显著低于对照组（22.86%） （P<0.05）。观察组患者非常满意的比例和总满意率显著高于对照组（P<0.05）。观察组不满意比例（5.71%）显著低于对照组 （25.71%）（P<0.05）。结论 基于新媒体平台的延续性护理干预对于中青年固定正畸患者的口腔健康状况具有明显的促进作 用,即显著降低牙周炎的发生率、减轻牙龈炎症并减少菌斑形成,同时优化患者复诊率,提高护理满意度,值得进一步推广。     

农村高血压患者治疗依从性及影响因素调查

目的：了解农村高血压患者治疗的依从性及影响因素。方法采用自行编制的调查问卷,选择已办理门诊高血压定期复诊194例患者进行现场调查。结果农村高血压患者的治疗依从性为24.7%,单因素分析结果显示服用降压药次数少、有高血压病住院经历、了解高血压病知识、得到个体化健康教育者、定期监测血压和体育锻炼者治疗依从性好( P<0.01)。结论农村高血压患者治疗依从性低,做好高血压患者健康教育,从而提高高血压病的知晓率、治疗率、控制率。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.