脑卒中院前延迟综合健康教育方案的构建

在健康信念模式、社会认知理论和缺血性脑卒中院前应对模式等理论指引的基础上,结合适宜的健康教育方法和内容,以脑卒中高危者和其家属为健康教育对象,构建了可行性较强的脑卒中院前延迟综合性健康教育方案,以达到提高社区高危人群和其家属对脑卒中疾病认知,减少院前延迟的发生,推动社区健康教育活动发展的目的。     

脑卒中高危人群院前延迟行为意向的潜在剖面分析

目的 探索脑卒中高危人群院前延迟行为意向的潜在剖面分型,并分析其影响因素,为制定针对性干预措施提供参考。 方法 采用一般资料调查表、脑卒中院前延迟行为意向量表、慢性病病人健康素养量表对213例脑卒中高危人群进行调查。对脑卒中高危人群院前延迟行为意向进行潜在剖面分析，并通过单因素分析和logistic回归分析识别其潜在剖面的影响因素。结果 脑卒中高危人群院前延迟行为意向分为3个类别：高延迟-高合理化组（12.7%）、中等延迟组（66.7%）和低延迟-低警觉组（20.6%）。logistic回归分析结果显示,常居地、吸烟情况、性格分型、健康素养是脑卒中高危人群院前延迟行为意向潜在剖面的影响因素（均P<0.05）。结论 脑卒中高危人群院前延迟行为意向存在异质性，医护人员可依据院前延迟行为意向特征及影响因素开展针对性干预，改善其院前延迟现状。     

脑卒中高危人群院前延迟行为意向的潜在剖面分析

目的 探索脑卒中高危人群院前延迟行为意向的潜在剖面分型,并分析其影响因素,为制定针对性干预措施提供参考。方法 采用一般资料调查表、脑卒中院前延迟行为意向量表、慢性病病人健康素养量表对213例脑卒中高危人群进行调查。对脑卒中高危人群院前延迟行为意向进行潜在剖面分析,并通过单因素分析和logistic回归分析识别其潜在剖面的影响因素。结果 脑卒中高危人群院前延迟行为意向分为3个类别：高延迟-高合理化组(12.7%)、中等延迟组(66.7%)和低延迟-低警觉组(20.6%)。logistic回归分析结果显示,常居地、吸烟情况、性格分型、健康素养是脑卒中高危人群院前延迟行为意向潜在剖面的影响因素(均P<0.05)。结论 脑卒中高危人群院前延迟行为意向存在异质性,医护人员可依据院前延迟行为意向特征及影响因素开展针对性干预,改善其院前延迟现状。     

社区主要不良心脏事件高危者院前延迟行为意向调查

目的 了解社区主要不良心脏事件高危者院前延迟行为意向现状,并探讨其影响因素.方法 采用主要不良心脏事件高危者院前延迟行为意向测评量表、主要不良心脏事件知识问卷对社区325名主要不良心脏事件高危者进行调查分析.结果 社区主要不良心脏事件高危者院前延迟行为意向总分为(55.07±8.87)分,知识得分为8.99(4.00,...     

基于扎根理论的急性脑卒中患者延迟就诊应对模型的构建

目的探讨急性脑卒中患者延迟就诊的应对过程,构建应对模型。方法运用格拉泽传统扎根理论研究方法,对12例延迟就诊的急性脑卒中患者进行半结构式深度访谈,提取主题。结果析出核心主题"急性脑卒中患者就诊应对方式",基于Lazarus压力应对模式构建急性脑卒中患者延迟就诊应对模型,包括感知阶段、犹豫阶段、决策阶段3个应对阶段,认知因素、经济因素、社会支持、促进因素和阻碍因素5个原因要素。结论急性脑卒中患者延迟就诊受多种因素影响,应对模型的初步构建可为进一步探索急性脑卒中患者院前延迟就诊的干预策略提供依据。     

急性脑卒中患者就医延迟影响因素研究进展

对急性脑卒中患者就医延迟(包括院前及院内延迟)的影响因素进行阐述,院前延迟影响因素包括人口学特征,症状识别及严重性感知,转运方式和环境因素。院内延迟影响因素有医院管理因素和基础设施,医务人员、患者及家属因素。提出针对性的建议,以缩短院前及院内延迟时间,同时为患者接受超早期的静脉溶栓治疗奠定基础。     

急性主动脉夹层患者首发症状与院前延迟的关系研究

目的 探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考.方法 选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系.结果 患者院前时间为135.5(48.3,1735.5) min,其中院前时间≤150 min...     

社区脑卒中照顾者获益感干预方案应用效果评价

目的评价社区脑卒中照顾者获益感干预方案的应用效果。方法基于修订版压力应对理论和认知适应理论构建社区脑卒中照顾者获益感干预方案。将郑州市6个社区的68名脑卒中照顾者以社区为单位使用抽签法随机分为对照组和干预组各34名。对照组接受9周有关脑卒中的一般健康教育,干预组在对照组的基础上接受每周1次,共9次的一对一的获益感干预。结果干预后,干预组获益感及生活质量评分显著高于对照组(P0.05,P0.01)。结论对社区脑卒中照顾者实施获益感干预方案有利于提高其获益感及生活质量。     

社区糖尿病高危人群预防性健康教育的实施

目的 提高社区糖尿病高危人群对糖尿病的认知能力,降低糖尿病的发病率.方法 对社区糖尿病高危人群采用多种方式实施预防性健康教育活动.结果 预防性健康教育6个月后社区糖尿病高危人群对糖尿病基本知识的知晓率及自我管理状况显著优于教育前(均P＜0.05、P＜0.01);无1例新增糖尿病患者.结论 对社区糖尿病高危人群开展预防性健康教育,能有效提高社区糖尿病高危人群对糖尿病的认知能力,有效降低糖尿病的发病率.     

网络互动式一级预防教育用于社区脑卒中高危人群效果观察

目的探讨网络互动式一级预防教育在社区脑卒中高危人群的实施效果。方法选取脑卒中高危患者110例随机分为对照组和观察组各55例。对照组进行常规健康教育,观察组在此基础上实施网络互动式一级预防健康教育6个月。结果干预后观察组健康知识知晓程度及遵医行为显著高于对照组(均P0.01)。结论网络互动式一级预防教育有助于患者积极参与,增加对脑卒中相关知识的了解,能有效提高脑卒中高危人群的遵医行为。     

Zeitbasiertes Management des akuten Schlaganfalls

Summary Progression in medical research and economic needs require new planning and organization of treatment strategies. This does also apply for stroke treatment: New pathophysiological knowledge, positive results of thrombolytic therapy and the demostrated importance of early treatment at Stroke Units justify that stroke must be regarded as an emergency. Timing is of utmost importance. Time-based management serves as a planning model for a new stroke treatment strategy. The treatment process is divided into three phases: alarming, pre-hospital and in-hospital phase. The effectiveness of each of these phases is influenced by several variables (personnel, technical equipment, course of the disease, etc.). Knowledge of each separate phase helps to discover weaknesses, which allows an aimed improvement, e.g. public education, training of paramedics and medical personnel. Modern communication systems allow new information transfer, which can help to avoid unnecessary transport of patients.      

Experience of implementing a National pre-hospital Code Red bleeding protocol in Scotland

IntroductionThe Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) have introduced a unified National pre-hospital Code Red protocol. This paper reports the results of a study aiming to establish whether current pre-hospital Code Red activation criteria for trauma patients successfully predict need for in hospital transfusion or haemorrhagic death, the current admission coagulation profile and Concentrated Red Cell (CRC): Fresh Frozen Plasma (FFP) ratio being used, and whether use of the protocol leads to increased blood component discards?MethodsProspective cohort study. Clinical and transfusion leads for each of Scotland’s pre-hospital services and their receiving hospitals agreed to enter data into the study for all trauma patients for whom a pre-hospital Code Red was activated. Outcome data collected included survival 24 h after Code Red activation, survival to hospital discharge, death in the Emergency Department and death in hospital.ResultsBetween June 1 st 2013 and October 31 st 2015 there were 53 pre-hospital Code Red activations. Median Injury Severity Score (ISS) was 24 (IQR 14–37) and mortality 38%. 16 patients received pre-hospital blood. The pre-hospital Code Red protocol was sensitive for predicting transfusion or haemorrhagic death (89%). Sensitivity, specificity, positive and negative predictive values of the pre-hospital SBP <90 mmHg component were 63%, 33%, 86% and 12%. 19% had an admission prothrombin time >14 s and 27% had a fibrinogen <1.5 g/L. CRC: FFP ratios did not drop to below 2:1 until 150 min after arrival in the ED. 16 red cell units, 33 FFP and 6 platelets were discarded. This was not significantly increased compared to historical data.ConclusionsA National pre-hospital Code Red protocol is sensitive for predicting transfusion requirement in bleeding trauma patients and does not lead to increased blood component discards. A significant number of patients are coagulopathic and there is a need to improve CRC: FFP ratios and time to transfusion support especially FFP provision. Training clinicians to activate pre-hospital Code Red earlier during the pre-hospital phase may give blood bank more time to thaw and prepare FFP and may improve FFP administration times and ratios so long as components are used upon their availability.     

Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: Based on 46 cases

To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre-hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre-hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.     

Portable ultrasound in pre-hospital emergencies: a feasibility study

BACKGROUND: Ultrasound plays a central role in the evaluation of both trauma and medical emergencies. The development of portable sonography devices could extent its application into the pre-hospital arena. The aim of our study was to evaluate feasibility of pre-hospital ultrasound in the Norwegian Air Rescue setting. MATERIAL AND METHODS: During a 3-month period, we conducted a prospective study using sonography in pre-hospital patient management. All examinations were carried out by the same ultrasound-certified physician using a Primedic Handyscan in a standardized focused protocol for abdominal and lung sonography and a subcostal 2-chamber long axis view. Inclusion criteria were abdominal/thoracic and obstetric trauma, circulatory/respiratory compromise, pulseless electric activity (PEA) in cardiac arrest, acute abdomen and monitoring during transport. Allowed examination time was restricted to 3 min on the scene. The patient's gender, age, symptoms, trauma mechanism, quality of visualization and diagnose made were recorded. Pre-hospital results were compared with in-hospital findings. RESULTS: Thirty-eight patients were entered into the study. Three patients had to be excluded due to technical difficulties. Nineteen medical, 15 traumas and 1 obstetric patient were included. Good visualization was obtained in 74% (n= 26), moderate in 26% (n = 9). Median examination time was 2.5 min (range 1-3 min). Nine patients (26%) showed positive sonography findings. Sensitivity was 90%, specificity 96%. Diagnostic usefulness was high in undetermined cardiac arrest and hypotension and massive hematoperitoneum. CONCLUSION: Pre-hospital ultrasound when applied by an proficient examiner using a goal-directed, time sensitive protocol is feasible, does not delay patient management and provides diagnostic and therapeutic benefit. Further studies are warranted to identify the exact indications and role of pre-hospital sonography.     

Pre-hospital burn mission as a unique experience: A qualitative study

IntroductionA thorough understanding of experiences related to pre-hospital emergency care of burns is a prerequisite of skill promotion for medical personnel. The aim of the present study was to evaluate the experiences of pre-hospital emergency personnel during burn accidents.MethodsThe present qualitative study was performed using a content analysis method. In total, 18 Iranian emergency care personnel participated in the study. A purposeful sampling method was applied until reaching data saturation. Data were collected using semi-structured interviews and field observations. Afterwards, the gathered data were analyzed through face content analysis.ResultsBy analyzing 498 primary codes, four main categories; the nature of burn care, tension at the accident scene, gradual job ‘burnout’, and insufficient information, were extracted from the experiences of pre-hospital emergency personnel during burn care. These categories each included several sub-categories, which were classified according to their significant characteristics.ConclusionThis study showed that different factors affect the quality of pre-hospital clinical services for burns. Authorities and health system administrators should consider the physical and psychological health of their staff, and assign policies to improve the quality of pre-hospital medical care. According to the present results, it is recommended that the process of pre-hospital emergency care for burns be investigated further.     

The NORwegian study on DIstrict treatment of ST-elevation myocardial infarction (NORDISTEMI)

OBJECTIVES: Thrombolysis is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI) living in rural areas with long transfer delays to percutaneous coronary intervention (PCI). This trial compares two different strategies following thrombolysis: to transfer all patients for immediate coronary angiography and intervention, or to manage the patients more conservatively. DESIGN: The NORwegian study on DIstrict treatment of STEMI (NORDISTEMI) is an open, prospective, randomized controlled trial in patients with STEMI of less than 6 hours of duration and more than 90 minutes expected time delay to PCI. A total of 266 patients will receive full-dose thrombolysis, preferably pre-hospital, and then be randomized to either strategy. Our primary endpoint is the one year combined incidence of death, reinfarction, stroke or new myocardial ischaemia. The study is registered with ClinicalTrials.gov, number NCT00161005. RESULTS: By April 2006, 109 patients have been randomized. Thrombolysis has been given pre-hospital to 52% of patients. The median transport distance from first medical contact to catheterization laboratory was 155 km (range 90-396 km). Results of the study are expected in 2008.     

中青年人群对脑卒中先兆症状识别及反应的潜在类别分析

目的 探讨中青年人群对卒中先兆症状识别与反应的潜在分类及其特征,为构建公众卒中教育方案提供参考.方法 采用自制的中青年人卒中先兆症状识别及反应调查问卷对广东省564名中青年人进行调查,以其对卒中先兆症状做出的识别与反应进行潜在类别分析,通过多分类Logistic回归分析探索人口社会学信息、亲友卒中经历、"中风120"口...     

老年脑卒中患者基于IKAP理论的口腔管理健康教育

目的 探讨基于IKAP理论的口腔管理健康教育对老年脑卒中患者的影响。方法 将108例老年脑卒中患者按照住院时间分为对照组和干预组各54例。对照组实施常规健康教育,干预组在此基础上实施基于IKAP理论的口腔管理健康教育。比较干预前、干预完成时及干预后3个月两组患者口腔健康状况、口腔健康素养及口腔相关生活质量。结果 对照组50例、干预组51例完成研究。干预完成时及干预后3个月,两组口腔健康状况、口腔相关生活质量及口腔健康素养得分比较,组间效应、时间效应及交互效应差异有统计学意义（均P＜0.05）。结论 基于IKAP理论的口腔管理健康教育能够提高老年脑卒中患者口腔健康状况、口腔健康素养水平及口腔相关生活质量。     

脑卒中患者疾病不确定感与社会支持的纵向研究

目的 了解脑卒中患者疾病不确定感和社会支持状况,分析其纵向变化趋势及两者间的相关性.方法 采用疾病不确定感量表(MUIS)和领悟社会支持量表(PSSS)对86例脑卒中患者于出院前,出院后1个月、3个月、6个月进行调查.结果 患者疾病不确定感在出院前及出院后1个月最高,出院后3个月、6个月有所下降(P＜0.01);领悟社会支持在出院前最低,出院后随时间的推移呈上升趋势(P＜0.01);在这4个时期,患者的疾病不确定感与社会支持均呈显著负相关(均P＜0.01).结论 护理人员应加强对脑卒中患者的健康教育和心理支持,以提高其社会支持水平,降低疾病不确定感,促进身心健康.     

Success Rate of Airway Management by Residents in a Pre-hospital Emergency Setting: a Retrospective Study

Abstract Objective: The objective of this retrospective study over a 5-year period was to assess the success rate of airway management by residents. Criteria of successful airway management were both the adherence to a standardized protocol of pre-hospital airway management and successful endotracheal intubation (ETI) in rescue missions. Methods: The minimal level of training time required for residents rotating in the pre-hospital emergency team was either 1 year in our university department of anesthesiology, or 3 years of internal medicine including 20 ETIs under supervision in the operating room. According to a strict protocol detailing indications and drugs to be administered, residents performed rapidsequence intubation (RSI) except in cases of cardiopulmonary arrests where ETI was performed without drugs. Adherence to the protocol of airway management was evaluated according to data provided by the residents. Successful endotracheal tube placement was confirmed only in transported patients with a combination of clinical signs, infrared capnography, and a chest X-ray on hospital admission. Results: A total of 13,537 rescue missions were reviewed. The protocol adherence was 96.1%. ETI was attempted in 753 patients, and successful placement was confirmed in 98.2%. Conclusion: Pre-hospital airway management (protocol adherence and proper endotracheal tube placement) was successful overall in 94.3% of rescue missions. Our results support the efficacy of a pre-hospital emergency rescue system reinforced by residents.