居家养老环境风险评估体系的构建

目的 构建居家养老环境风险评估指标体系,为开展老年人居家环境风险评估提供测评工具.方法 采用文献研究法、焦点小组讨论法、德尔菲专家咨询法筛选评估指标,运用层次分析法确定指标权重,建立老年人居家养老环境风险评估体系.结果 2轮专家咨询问卷有效回收率分别为92.31％、86.11％,权威系数分别为0.878、0.892;Ⅰ级指标协调系数分别为0.276、0.291;最终构建的居家养老环境风险评估指标体系包括Ⅰ级指标9个和Ⅱ级指标43个,并确定各级指标权重.结论 居家养老环境风险评估体系被专家认可,评估指标体系的内容全面、权重合理,但需进一步在社区开展实证研究.     

老年人居家长期照护服务项目体系构建及风险评价

目的探讨老年人居家长期照护服务项目体系及其风险水平。方法通过文献回顾、质性访谈拟定老年人居家长期照护服务项目体系草案,采用德尔菲专家咨询法对其进行修订,并对各个项目的风险水平进行初步评价。结果 3轮专家咨询有效回收率分别为94.44%、100%、100%,专家权威系数分别为0.895、0.907、0.885,肯德尔和谐系数为0.404～0.519(P0.05)。最终确定的服务项目体系包含4项一级指标、13项二级指标、57项三级指标; 4项一级指标下的项目风险等级评分分别为1.47～3.56、1.88～3.35、2.94～3.18、1.94～4.71。结论老年人居家长期照护服务项目体系的内容和风险水平咨询可靠,可为长期照护保险制度的建设提供参考。     

社区居家卧床患者压疮管理质量评价指标的构建

目的构建社区居家卧床患者压疮管理质量评价指标,以规范性评价社区居家卧床患者压疮管理质量。方法查阅国内外文献、小组讨论,形成社区压疮管理质量评价指标问卷,采用Delphi法对15名专家进行2轮咨询。结果构建的社区居家卧床患者压疮管理质量评价指标包括一级指标3项,二级指标11项,三级指标32项;专家的权威系数为0.794;2轮三级指标的协调系数分别为0.613、0.622(均P0.01)。结论社区居家卧床患者压疮管理质量评价指标及其内容可靠,经目标人群(大样本)验证后,可用于社区压疮护理质量的评价。     

北京地区肾内科护理质量敏感指标的构建

目的 建立北京地区肾内科护理质量敏感指标,为北京地区肾内科护理质量评价与监测提供参考.方法 通过循证筛选肾内科护理质量敏感性指标,对30名专家进行2轮咨询及面对面讨论.结果 构建了 26项肾内科护理质量敏感性指标.2轮专家咨询积极系数分别为85.71％和100％,权威系数为0.80和0.81,第2轮专家咨询后变异系数为0.02～0.22,协调系数为0.26～0.52.结论 构建的肾内科护理质量敏感性指标科学性与可操作性强,可用于肾内科护理质量评价与监测.     

应用Delphi法构建护理人员灾难救护素质评价指标的研究

目的 通过Delphi法构建一套符合我国国情、较科学的护理人员灾难救护素质评价工具.方法 在文献查阅、半结构式专家访谈的基础上,初拟护理人员灾难救护素质评价指标,然后运用Delphi法对30名专家进行3轮问卷咨询,最终确立素质评价指标.结果 3轮专家咨询问卷有效回收率分别为93.3%、96.7%和100%.专家平均权威系数为0.85;专家协调系数为0.95,经检验后具有显著性(P＜0.01).最终得出5项一级指标:知识储备、应急处置、心理应激、工作质量以及个人素质;25项二级指标,专家接受度均>70%.结论 3轮专家咨询结果可靠、专家意见一致性较好,为评估护理人员参与灾难救护素质标准提供了较科学、系统的工具.     

社会参与视角下养老机构适老宜居评价体系的构建

目的 构建养老机构适老化宜居环境评价指标体系,为养老机构适老宜居环境评价提供工具。方法 基于文献检索建立指标库,运用DPSIR模型法提取并梳理初始指标体系,通过Delphi法对专家进行2轮函询并确定指标,应用优序图法、G1法、决策实验室法组合赋权确定各指标权重。结果 2轮函询的专家积极系数分别为90.91%、90.00%,专家权威系数分别为0.72、0.72,协调系数分别为0.112、0.298(均P<0.05)。构建的指标体系包含社区水平、社区设施、老年人主观属性、老年人人际关系、社区服务、社区活动、老年人心理状态、老年人老化态度、制度政策9个一级指标和36个二级指标。结论 建立的评价指标体系综合考虑了养老机构客观环境与老年人自身主观感受,可用于养老机构及其他以社区为单位的组织适老宜居环境的评价,以建立优质养老机构,促进老年人社会互动、参与社会活动。     

社会参与视角下养老机构适老宜居评价体系的构建

目的 构建养老机构适老化宜居环境评价指标体系,为养老机构适老宜居环境评价提供工具。 方法 基于文献检索建立指标库,运用DPSIR模型法提取并梳理初始指标体系,通过Delphi法对专家进行2轮函询并确定指标,应用优序图法、G1法、决策实验室法组合赋权确定各指标权重。 结果 2轮函询的专家积极系数分别为90.91%、90.00%,专家权威系数分别为0.72、0.72,协调系数分别为0.112、0.298（均P＜0.05）。构建的指标体系包含社区水平、社区设施、老年人主观属性、老年人人际关系、社区服务、社区活动、老年人心理状态、老年人老化态度、制度政策9个一级指标和36个二级指标。 结论 建立的评价指标体系综合考虑了养老机构客观环境与老年人自身主观感受,可用于养老机构及其他以社区为单位的组织适老宜居环境的评价,以建立优质养老机构,促进老年人社会互动、参与社会活动。     

Development of an index system for evaluating caring capacity of nurses based on Confucianism

目的 构建基于儒家思想的护理人文关怀能力评价指标体系(下称评价指标体系),用于评价中国护理人员的人文关怀能力.方法 拟定3项一级指标、8项二级指标及75项三级指标的“评价指标体系”咨询表,采用Delphi法对分布于临床护理、护理管理、护理教育及医学人文教育领域的30名国内外专家进行3轮咨询,采用层次分析法确定权重.结果 获得包含4项一级指标、8项二级指标和59项三级指标的评价指标体系;专家积极系数为93.3％～100％,权威系数为0.86,第2、3轮调查肯德尔协调系数为0.358、0.335,集中度好.结论 评价指标体系与中国文化紧密结合,具有客观、系统、可操作的特点,可用于护理人员人文关怀能力的自我定性评价.     

前列腺增生手术患者膀胱功能康复训练方案的构建

目的 构建前列腺增生手术患者膀胱功能训练方案,为开展针对性膀胱功能训练指导提供参考.方法 在文献回顾、病例分析基础上初步拟定膀胱功能训练方案的草案,采用德尔菲专家咨询法对22名专家进行2轮咨询.结果 2轮咨询的专家积极系数均为100％,专家权威系数均为0.90.第2轮专家咨询中一、二、三级指标专家协调系数分别为0.406、0.691、0.389(均P＜0.05).最终围绕训练目标、评估、训练及护理方法、记录及随访形成的前列腺增生手术患者膀胱功能训练方案包含一级指标2项(住院期排尿功能训练、恢复期及稳定期排尿功能训练),二级指标13项,三级指标68项.结论 构建的前列腺增生手术患者膀胱功能训练方案科学、合理,能为临床护理人员指导前列腺增生手术患者膀胱功能训练提供指导.     

基于全球媒介与信息素养框架构建老年人新媒介素养评估指标

目的 构建老年人新媒介素养评估指标,为开展针对性素养教育、制订有效的智慧养老护理方案提供参考。方法 以《全球媒介与信息素养框架》为理论框架,通过文献检索和半结构式访谈,制订老年人新媒介素养评估指标专家咨询问卷,选取19名专家开展2轮函询。结果 2轮函询问卷的有效回收率均为100%,专家意见协调系数为0.134和0.199(均P<0.05)。最终构建的指标包括3个一级指标、9个二级指标、36个三级指标。结论 构建的老年人新媒介素养评估指标具有科学性、可靠性和实用性,可以为当前开展我国老年人新媒介素养测评提供工具。     

上下颌第二恒磨牙拔除后第三磨牙自行迁移情况的比较观察

目的：对上下颌第二恒磨牙拔除后第三磨牙自行迁移的情况进行观察、比较。方法：将27例病例分为上颌组和下颌组,上颌组15例拔除上颌第二恒磨牙,下颌组12例拔除第二恒磨牙。两组在治疗前和治疗1年后分别拍摄术前及术中x线侧位头影测量片,测量第三磨牙在水平方向、垂直方向移动距离,同时记录所有病例第三磨牙临床萌出情况,并对两实验结果进行统计学分析、比较。结果：上颌组上颌第三磨牙在水平方向和垂直方向分别移动7．83mm、7．73mm,下颌组下颌第三磨牙在水平方向和垂直方向分别移动6．12mm、4．97mm,上下颌间无统计学意义,除下颌组一名患者之外,其余患者第三磨牙均已萌出,两组间无显著统计学差异。结论：无论上颌、下颌,拔除第二恒磨牙都是一种良好的拔牙模式。     

Pretransplant Osteoporosis and Osteopenia are Risk Factors for Fractures After Kidney Transplantation

BackgroundThere is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT.MethodsA total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures.ResultsTwenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT.ConclusionsPretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.     

Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients

Background

Primary ventral hernia is a common condition. Surgical repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society classification offers a structured framework to describe hernias and to analyze postoperative complications. Given this structured nature, the European Hernia Society classification might prove useful for preoperative patient or treatment classification. The objective of this study was to investigate the European Hernia Society classification as a predictor for complications within 30 days after primary ventral hernia surgery.

Selection of Candidates for Lung Transplantation: The First Italian Consensus Statement

Lung transplantation is a well-established treatment for selected patients with advanced chronic respiratory insufficiency. Recognizing those patients with end-stage lung disease who might benefit from lung transplantation is a crucial task. Considering the presence of inadequate evidence-based practice, international and national scientific societies provided consensus opinions regarding the appropriate timing of listing. The Study Group for Thoracic Organs Transplantation (branch of the Italian Society for Organs Transplantation) promoted and realized a Delphi conference among the Italian lung transplantation centers to provide guidance to clinical practice based on international recommendations. The experts from the nine Italian centers completed two rounds of standardized questionnaires (answer rate, 100%): 42 statements received a consensus ≥80%. The selected statements presented in this article are intended to assist Italian clinicians in selecting patients for lung transplantation.     

Sex-based differences in transfusion need after severe injury: Findings of the PROPPR study

BackgroundWomen are underrepresented in trauma research, and aggregated results of clinical trials may mask effects that differ by sex. It is unclear whether women respond differently to severe hemorrhage compared with men. We sought to evaluate sex-based differences in outcomes after severe trauma with hemorrhage.MethodsWe performed a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial. Trauma patients predicted to require massive transfusion were randomized to a 1:1:1 vs 1:1:2 plasma to platelet to red blood cell transfusion ratio. Analysis was performed according to sex, controlling for clinical characteristics and transfusion arm.ResultsA total of 134 women and 546 men were analyzed. In multivariable analysis, there was no difference in mortality at 24 hours (hazard ratio for women 0.64, 95% confidence interval 0.34–1.23, P = .18) or in time to hemostasis (hazard ratio 1.10, 95% confidence interval 0.84–1.42, P = .49) by sex. We observed no difference between sexes in volume of blood products transfused during active hemorrhage. However, after anatomic hemostasis, women received lower volumes of all products, with a 38% reduction in fresh frozen plasma (mean ratio 0.62 (95% confidence interval 0.43–0.89, P = .01), 49% reduction in platelets (mean ratio 0.51, 95% confidence interval 0.33–0.79, P < .01) and 49% reduction in volume of red blood cells (mean ratio 0.51, 95% confidence interval 0.33–0.79, P < .01).ConclusionMortality and time to hemostasis of trauma patients with hemorrhage did not differ by sex. Although there was no difference in transfusion requirement during active hemorrhage, once hemostasis was achieved, women received fewer units of all blood products than men. Further research is required to determine whether women exhibit differences in coagulation during and after severe traumatic hemorrhage.     

前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折

目的总结前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折的疗效。方法采用前侧入路直视关节面复位内固定手术治疗31例粉碎性髌骨骨折患者。结果31例均获得随访,时间6~26个月。均未发生骨折再移位、内固定松动及断裂、感染等并发症。骨折愈合时间8~12周。结论前侧入路直视关节面复位内固定治疗粉碎性髌骨骨折恢复快、并发症少。     

颈部放射性溃疡的治疗

目的:探讨颈部放射性溃疡的手术方法。方法:彻底或姑息性切除颈部放射性溃疡组织后,根据颈部组织损伤程度的不同,分别用同侧胸三角皮瓣或胸大肌肌皮瓣进行颈部缺损的修复,供区使用全厚皮片修复。结果:11例胸三角皮瓣、3例胸大肌肌皮瓣全部成活,愈合良好,术后患者生活质量明显改善。结论:胸三角皮瓣与胸大肌肌皮瓣血运可靠,是修复颈部放射性溃疡的有效、简单和安全的方法。