中风偏瘫患者坐-站转移过程中的生物力学分析

中风偏瘫患者由于半侧高级中枢神经系统损坏,导致其坐-站转移能力受损,在坐站转移过程中容易跌倒。从生物力学角度描述偏瘫患者在不同足位下的坐-站转移特征,讨论不同特征之间的相互联系,分析其跌倒原因,叙述坐-站转移训练在偏瘫患者的术后康复中的应用,从而为偏瘫患者的术后康复提供依据。     

脑卒中患者出院安置现状及风险因素调查分析

目的 了解脑卒中患者出院安置现状，分析影响因素，为针对性干预提供参考。方法 对神经内科371例脑卒中患者采用衰弱筛查量表、社会支持水平量表、医院焦虑抑郁量表，以及基于健康生态学自行设计的一般资料调查表进行问卷调查，以出院安置改变与否分析影响因素。结果 136例(36.7%)发生出院安置改变。logistic回归分析结果显示，卒中前衰弱、中度卒中、日常生活活动能力重度依赖、抑郁症状、独居及与配偶同住、认知障碍和中高跌倒风险是脑卒中患者出院安置改变的风险因素(均P<0.05)。结论 脑卒中患者出院安置改变发生率较高；医护人员应在患者入院早期进行评估与筛查，重点关注风险因素，早期干预，协助患者转入合适的出院住所。     

Development and Internal Validation of a Prediction Model for Falls Using Electronic Health Records in a Hospital Setting

ObjectiveFall prevention is important in many hospitals. Current fall-risk-screening tools have limited predictive accuracy specifically for older inpatients. Their administration can be time-consuming. A reliable and easy-to-administer tool is desirable to identify older inpatients at higher fall risk. We aimed to develop and internally validate a prognostic prediction model for inpatient falls for older patients.DesignRetrospective analysis of a large cohort drawn from hospital electronic health record data.Setting and ParticipantsOlder patients (≥70 years) admitted to a university medical center (2016 until 2021).MethodsThe outcome was an inpatient fall (≥24 hours of admission). Two prediction models were developed using regularized logistic regression in 5 imputed data sets: one model without predictors indicating missing values (Model-without) and one model with these additional predictors indicating missing values (Model-with). We internally validated our whole model development strategy using 10-fold stratified cross-validation. The models were evaluated using discrimination (area under the receiver operating characteristic curve) and calibration (plot assessment). We determined whether the areas under the receiver operating characteristic curves (AUCs) of the models were significantly different using DeLong test.ResultsOur data set included 21,286 admissions. In total, 470 (2.2%) had a fall after 24 hours of admission. The Model-without had 12 predictors and Model-with 13, of which 4 were indicators of missing values. The AUCs of the Model-without and Model-with were 0.676 (95% CI 0.646-0.707) and 0.695 (95% CI 0.667-0.724). The AUCs between both models were significantly different (P = .013). Calibration was good for both models.Conclusions and ImplicationsBoth the Model-with and Model-without indicators of missing values showed good calibration and fair discrimination, where the Model-with performed better. Our models showed competitive performance to well-established fall-risk-screening tools, and they have the advantage of being based on routinely collected data. This may substantially reduce the burden on nurses, compared with nonautomatic fall-risk-screening tools.     

2021年重庆市江津区城乡饮用水水质监测结果分析

摘 要：目的：了解云南省某县留守儿童跌落伤发生的流行现况及影响因素，为预防儿童跌落的发生及制定相应干预措 施提供理论支撑。方法：采用分层抽样法，在云南省某县 5所中小学中随机选取 2 909名中小学生为调查对象，采用定性和 定量相结合的方法调查其相关信息。结果：留守儿童中跌落伤发生率为23.01%；跌落发生原因排在前3位的依次是平地因推 搡碰撞摔倒、滑倒或绊倒 （35.4%），上下楼梯 （26.4%），爬树或爬山 （10.5%）；跌落伤发生地点主要在家中 （34.7%）、家 附近 （19.1%） 和学校 （16.6%）；受伤部位多见于下肢 （23.2%）、上肢和头面部 （19.7%）。留守儿童跌落伤发生的危险因素 为：性格外向 （OR=1.632，P＜0.05）、由祖辈照顾 （OR=1.908，P＜0.05），保护因素为：年级为中学 （OR=0.611，P＜ 0.05）、年龄为 18 岁 （OR=0.424，P＜0.05）。结论：云南省某县留守儿童跌落伤的发生率较高，是多因素共同作用的结果。 留守儿童跌落伤的发生与性格、监护人类型、年级、年龄、是否寄宿等多因素相关，提示应加强对留守儿童的保护，改变教 育方式，以减少儿童跌落伤的发生。     

基于扎根理论的养老机构跌倒管理现状与期望质性研究

目的 探讨养老机构跌倒管理的现状与期望，为预防跌倒干预提供参考。方法 选取长沙市4家养老机构的11名管理人员进行半结构式访谈，采用扎根理论的范式收集、整理和分析资料。结果 共总结2个主题：跌倒管理现状（跌倒评估，跌倒预防和跌倒处置）和跌倒管理期望（素质品质，理论知识和实践能力）。结论 养老机构跌倒管理处在勤观察和重经验阶段，照护人员理论知识和实践能力缺乏；希望通过培训，达到短期内提高照护者实践能力以及实现理论知识积累的长期目标。     

老年患者皮肤撕裂伤流行特征及危险因素的多中心横断面研究

目的 调查分析我国不同医疗机构老年患者皮肤撕裂伤的流行特征及危险因素,为有效预防老年皮肤撕裂伤提供参考.方法 招募16个省、2个自治区和2个直辖市52所医院或养老院,整群抽取≥60岁的住院患者,从头到脚检查纳入对象的皮肤识别是否存在皮肤撕裂伤及其严重度,并收集人口学、健康状况以及皮肤撕裂伤致伤原因等相关资料.结果 共获...