Interventions to increase the uptake of seasonal influenza vaccination among pregnant women: A systematic review

BackgroundPregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population.MethodsWe systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies.ResultsEleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD = 0.26; RD = 0.39). The other reviewed RCTs showed discordant results, with RDs ranging from −0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied.ConclusionsThere is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.     

Follow-up in newborn hearing screening – A systematic review

IntroductionThe quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF.MethodsUsing a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF.Results53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system.ConclusionThis review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.     

Strategies to improve quality of life in patients with head and neck cancer: microvascular surgery to nanotechnology

Educational Objectives: 1. Learn selection of microvascular free flaps to improve functional outcome.     

急性脑血管病出院患者331例复诊情况的调查分析

目的了解急性脑血管病患者出院后复诊情况。方法对331例急性脑血管病患者出院后复诊情况进行调查,分析不规范复诊和未复诊的原因。结果患者出院后规范复诊为17.52%;在不规范复诊或未复诊患者中,认为没有必要复诊占39.93%、医务人员未告知需要复诊占23.81%。结论急性脑血管病患者出院后规范复诊率低,必须重视出院指导,以提高患者复诊率。     

国外基本卫生服务实施背景、策略及其影响研究

目的了解国外基本卫生服务实施的背景、策略及效果。方法由主题专家和检索人员讨论并试验后确定检索词,共检索22个电子数据库,50个非政府组织及政府机构网站和搜索引擎Google。纳入所有描述及评价已经实施的基本卫生服务内涵、服务包和遴选原则、实施背景、策略及效果的文献。用自行设计的数据提取表收集文献内容和有关研究质量的信息,对提取信息进行分析和描述。结果共纳入166篇文献,大多数研究来自中低收入国家,主要是关于各国基本卫生服务包内容、遴选原则、实施背景与策略的描述（160篇）,涉及效果评价方面的文献极少（6篇）。评价策略的研究大部分为横断面研究,只有1篇是有干预的时间序列研究。结论由于各国政治、历史文化、经济背景以及政策目标的差异,其基本卫生服务政策的实施策略也各不相同,但采取全民覆盖的医疗保险制度和政府提供的基本卫生服务,基本实现卫生服务的全民覆盖,现已成为全世界大多数国家的共识,其中转型国家的经验尤其值得借鉴。     

人—感染猪链球菌病患者心理状态分析及护理对策

目的：探讨人—感染猪链球病患者发生心理问题的原因及对策。方法：对33例人—感染猪链球菌病患者存在的心理问题进行回顾性分析。结果：患者存在紧张恐惧、焦虑多疑、悲观失望及过分依赖的问题,通过针对性的心理护理,33例患者身心康复,痊愈出院。结论：对人感染猪链球茵病患者在实施准确及时的治疗和护理措施的同时。全面准确评估患者情况,加强心理护理,进行心理疏导,给予有针对性心理干预措施,可有效的促进患者身心健康的恢复,促进疾病治愈。     

北京市1992—1998年新生儿主要死因的变化趋势及对策

【目的】　掌握北京市新生儿死亡变化趋势 ,及时调整降低新生儿死亡率的对策。　【方法】　对 1992～ 1998年北京市新生儿死亡的资料进行分析。　【结果】　 7年来北京市新生儿死亡率下降显著 ,1992年为 10 .0‰ ,1998年为 6.1‰ ( χ2 =5 8.92 ,P <0 .0 0 1)。每年的出生窒息均为新生儿死亡第一位死因 ,构成比为 17.7‰～ 2 5 .3‰。　【结论】　降低新生儿死亡率 ,关键要降低出生窒息的死亡率 ,同时也要提高对早产儿、低出生体重儿的预防、监护和治疗水平 ,提高先天性心脏病早期诊治水平     

Exploring the perspectives on medication self-management among persons with spinal cord injury/dysfunction and providers

RationaleSpinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management.ObjectiveTo explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants’ experiences with medication self-management.MethodsIn-depth, semi-structured interviews were conducted by telephone until data saturation was reached. Interviews were transcribed verbatim and analyzed using constant comparative approaches. The TEDSS framework was adapted and applied deductively.ResultsFifty-one individuals participated in this study, 32 providers and 19 persons with SCI/D. Disease controlling strategies was the domain discussed in most detail by all participants. In this domain, participants discussed managing medications and treatments, monitoring/managing side effects, and controlling complications. Process strategies (problem-solving, decision-making) and resource strategies (seeking support) were the next most frequently discussed domains. Among all participant groups, there was a lack of detailed discussion of social interactions, health behaviour, and internal strategies. Medication self-management support was not extensively discussed by any group.ConclusionThis study highlighted the complex nature of medication self-management. While persons with SCI/D and providers discussed similar components of the TEDSS framework, providers had minimal reflections on the impact of medication self-management on everyday life. This study identified the need for explicit discussions between providers and persons with SCI/D, involving all components of self-management and self-management support in order to improve medication self-management.     

核技术利用项目环保验收中的问题思考与策略

核技术利用项目是伴有辐射建设项目的组成部分,且是核与辐射安全监督管理部门日常监督管理的重点,其环保设施、辐射安全防护设施与措施环保验收又是核技术利用项目全程管理的最后一个环节,做好验收工作对后续的辐射安全管理具有事半功倍的效果。依据国家有关法律法规及行业行政主管部门的有关规定和要求,梳理日常辐射环境安全监管以及验收实践中发现的问题,分析其可能的原因,提出相应的应对策略。     

腹部手术后并发肺部感染的危险因素分析及防治策略

目的分析腹部术后并发肺部感染的危险因素,探讨防治策略。方法将2015年12月~2016年12月的80例腹部术后肺部感染患者作为观察组,选择同期未发生腹部术后感染的80例患者作为对照组,使用SPSS17.0统计软件对数据进行统计分析,探讨腹部术后感染的危险因素。结果观察组肥胖37例,占46.25%;气管插管全身麻醉38例,占47.50%;留置引流管55例,占68.75%;呼吸道疾病43例,占53.75%;吸烟史46例,占57.50%;年龄≥60岁48例,占60.00%。上述结果与对照组比较,差异有统计学意义(P0.01)。结论腹部术后肺部感染与肥胖、年龄、全身麻醉、留置引流管、吸烟、慢性呼吸道疾病等因素相关。因此应积极预防,降低感染率,减轻患者经济负担。