糖尿病足高危患者及其足部护理状况调查

目的了解住院糖尿病患者中糖尿病足高危人群的比例及其足部护理状况。方法方便取样,选择101例住院糖尿病患者,采用Semmes Weistein 5.07/10g单尼龙丝检查患者压力觉,128兆音叉测定患者震动觉,两者相结合筛查糖尿病足的高危人群,同时应用糖尿病控制状况评价量表(CSSD70)以及病历回顾等方法了解患者发生糖尿病足的危险因素、血糖控制情况(空腹血糖、糖化血红蛋白)以及患者目前足部自我护理状况。结果101例患者中86例(85.1%)为高危,正常者仅为15例(14.9%)。高危患者中压力觉异常者为61例(60.4%),振动觉异常者为85例(84.2%)。压力觉和振动觉得分均与糖化血红蛋白呈正相关(r=0.25,r=0.27,P<0.01),与年龄呈负相关(r=-0.28,r=-0.40,P<0.01)。高危组和正常组患者糖尿病控制状况评价量表总分和各模块得分无显著差异。患者每天检查双脚,穿鞋前检查鞋内异物及不应赤脚行走,不穿有破洞、打补丁的袜子等方面的知识较欠缺,行为不健康。结论住院糖尿病患者中糖尿病足的高危人群比例相当高,存在生活习惯、治疗情况、生存技能、治疗目标和疾病知识等方面问题较多,足部护理状况令人担忧,提示应加强住院患者的筛查、教育与管理。     

药学干预对农村慢、性病患者用药依从性的影响

目的：探讨药学干预对提高农村慢性病患者用药依从性的效果,提高其治疗效果,降低严重并发症的发生。方法：随机抽取4个行政村的慢性病患者分为试验组和对照组,对对照组患者仅根据慢性病管理要求进行监控;对试验组患者及家属进行强化教育、针对性的用药指导等药学干预措施,在首次干预后1个季度及1年进行用药依从性调查。结果：通过药学干预,试验组患者的用药依从性显著提高,疾病控制效果也明显提高。结论：药学干预能明显提高农村慢性病患者的用药依从性、疾病控制效果,能显著提高慢性病管理的效果,药学干预与慢性病管理相结合是提高公共卫生工作质量的新思路。     

心理护理对肛肠科围术期患者的护理效果评价

目的探讨肛肠科患者围手术期心理护理的护理效果。方法对我院2012年1月至2012年12月期间收治的80例行肛肠手术患者进行分组护理,分别为40例观察组(采用常规护理+心理护理)与40例对照组(采用常规护理),并对两组的护理效果进行对比。结果对照组手术前后SAS(焦虑自评量表)评分分别为(54.95±3.86)分、(56.92±3.65)分,观察组手术前后SAS评分分别为(55.32±3.09)分、(62.34±3.13)分,相比之下,两组患者术前SAS评分无明显差异,(P>0.05)无统计学意义,两组人术后SAS评分对比有明显差异,(P<0.05)具有统计学意义。结论肛肠科患者在围手术期给予心理护理能有效缓解患者的不良情绪,促进治疗工作的进行,值得在临床护理上推广应用。     

强化干预代谢综合征改变心脑血管事件发病率的临床探讨

目的探讨改变代谢综合征患者心脑血管事件发病率的强化干预措施,并比较分析干预效果。方法以2011年5月至8月在我院体检中心进行健康体检的三水区事业单位职工3480例作为研究对象,强化干预组共1740例,其中MS组286例,非MS组1454例;对照组共1740例,其中MS组305例,非MS组1435例。对照组接受自主常规的临床治疗;强化干预组接受常规治疗的同时,根据患者是否患有代谢综合征及其相关疾病、疾病前状态(包括高血压、肥胖、超重、糖尿病、糖耐量减退、血脂异常)等分别采取不同的强化治疗方案进行干预。分别统计两组患者在治疗前后体质量指数、血压、血脂、空腹血糖等指标变化和心脑血管事件发生情况。结果强化干预组MS亚组患者治疗后血压下降(9.53±2.43)mm Hg(1 mm Hg=0.133 kPa),空腹血糖为(6.26±1.17)mmol/L,对照组MS亚组患者分别为(5.61±2.65)mm Hg和(6.89±1.19)mmol/L,强化干预组改善效果明显优于对照组,具有统计学意义(P<0.05)。强化干预组中,MS亚组患者的冠心病事件和脑卒中事件的发生数分别为28例和26例,而非MS亚组患者的冠心病事件和脑卒中事件的发生数分别为99例和91例;对照组中,MS亚组患者的冠心病事件和脑卒中事件的发生率分别为40例和41例,而非MS亚组患者的冠心病事件和脑卒中事件的发生率分别为172例和174例。强化干预组MS亚组心脑血管事件的发生例数,明显低于对照组MS亚组患者的发生例数,强化干预组非MS亚组的患者例数明显低于对照组非MS亚组的患者例数,组间对比均具有统计学意义(P<0.05)。结论强化干预手段联合治疗代谢综合征患者,可以有效降低心脑血管事件的发病率,值得临床积极推广。     

Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis

BackgroundSleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely.ObjectiveTo estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation.MethodsElectronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included.ResultsWe found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards–Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation.ConclusionSleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.     

Factors Associated With Severe Uncontrolled Asthma and the Perception of Control by Physicians and Patients

IntroductionDespite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.MethodsMulticenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.ResultsAccording to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥1 day/week), frequent use of rescue medication (≥5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1≤80% and a poorer understanding of the disease by the patient (physicians only).ConclusionsOnly 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.     

论患者权利冲突的法学思考

在我国,虽然许多专家对患者的权利内容做了具体的论述,然而,医患之间权利的冲突和矛盾却并没有因此而减少,甚至愈演愈烈,从而使医患关系变得敏感和脆弱,影响了医学事业正常和健康的发展。本文通过对医患权利冲突进行分析,来揭示患者权利的现状及其存在的主要焦点矛盾冲突,进而探讨患者权利保护的法律解决机制。     

心内科老年患者跌倒的原因分析与预防对策

目的：通过对患者跌倒事件进行分析,探讨老年患者跌倒预防对策,降低其跌倒的发生率。方法回顾性调查研究,对本院心内科住院患者发生的15例跌倒事件进行分析。结果住院患者的跌倒发生与年龄、时间、人力因素、药物因素密切相关。结论对住院患者进行跌倒危险评估,进行预见性护理干预,并对高危患者加强宣教及监控,可降低心内科老年患者跌倒的发生率。     

社区健康教育在慢性阻塞性肺疾病患者实施长期家庭氧疗中的作用

目的：研究社区健康教育对慢性阻塞性肺疾病患者实施长期氧疗的方法及优势。方法选择2012年6月-2013年12月本社区收治的慢性阻塞性肺疾病患者90例,根据就诊的先后顺序随机分为两组。对照组患者使用一般社区干预方法,试验组患者在对照组干预的基础上给予社区健康教育,观察两组患者的干预效果。结果在健康教育后,试验组患者治疗依从性高于对照组患者,差异有统计学意义（ P ＜0.05）;家庭氧疗3个月后,试验组患者的 PaO2、血氧饱和度（SaO2）、用力肺活量（FVC）、1秒末用力呼气容积（FEV1）均高于对照组,差异有统计学意义（P ＜0.05）。结论加强社区健康教育可以有效地提高慢性阻塞性肺疾病患者家庭氧疗的依从性,改善患者肺部功能。