Patient involvement and language barriers: Problems of agreement or understanding?

ObjectiveThis study aims to explicate efforts for realizing patient-centeredness (PCC) and involvement (SDM) in a difficult decision-making situation. It investigates what communicative strategies a physician used and the immediate, observable consequences for patient participation.MethodsFrom a corpus of videotaped hospital encounters, one case in which the physician and patient used Norwegian as lingua franca was selected for analysis using conversation analysis (CA). Secondary data were measures of PCC and SDM.ResultsThough the physician did extensive interactional work to secure the patient’s understanding and acceptance of a treatment recommendation, his persistent attempts did not succeed in generating the patient’s participation. In ratings of PCC and SDM, this case scored well above average.ConclusionDespite the fact that this encounter displays some of the ‘best actual practice’ of PCC and SDM within the corpus, our analysis of the interaction shows why the strategies were insufficient in the context of a language barrier and possible disagreement.Practice implicationsWhen facing problems of understanding, agreement and participation in treatment decision-making, relatively good patient centered skills may not suffice. Knowledge about the interactional realization of key activities is needed for developing training targeted at overcoming such challenges.     

医院工会对职工主观幸福感的现状调查分析

目的 调查北京天坛医院职工的主观幸福感情况,并分析影响因素,为改善医院职工心理健康提供循证参考。方法 采用分层抽样法随机选取北京天坛医院医生500人,护士800人,医技200人和其他岗位职工300人,资料收集时间为2019年11月1—8日,内容包括职工的一般人口学特征及主观幸福感评分,分析不同人口学特征对职工主观幸福感评分的影响。结果 调查共回收有效问卷1785份,问卷的信度和效度良好(克朗巴赫α系数为0.834; KM0值为0.978),被调查职工的主观幸福感评分为(77.00±5.25)分。不同年龄、婚姻状况、学历、岗位、职称和编制的职工主观幸福感评分比较,差异有统计学意义(P0.001),35岁以上年龄组职工的主观幸福感评分均显著低于35岁以下职工,差异有统计学意义(P0.001);相较于医技和护理岗位,医生的主观幸福感评分较低,差异有统计学意义(P0.001)。结论 医院应持续开展体验式心理服务项目,提高职工心理健康保健能力,积极改善工作-生活不平衡,提升职工共情能力,重视医生群体的主观幸福感,搭建跨学科交流平台,从而提升职工的主观幸福感。     

Temporomandibular disorder in a patient with pseudoxanthoma elasticum: a case report and review

Pseudoxanthoma elasticum (PXE) is a disorder characterized by progressive degeneration of elastic fibers and ectopic mineralization. Cutaneous manifestations are a hallmark of this disease and organs that may be affected by the disease process include cardiovascular, central nervous system, ocular and gastrointestinal systems. Oral manifestations of PXE have been previously reported as intramucosal nodules observed on various intraoral surfaces. We present a case of a 46‐year‐old female with PXE diagnosed with temporomandibular disorder (TMD). To our knowledge, this is the first report of a patient with TMD coexisting with PXE in the scientific literature.     

肝动脉化疗栓塞术患者的多模式疼痛管理

目的评价多模式疼痛管理方案应用于肝动脉化疗栓塞术患者的效果。方法将166例肝动脉化疗栓塞术患者随机分为对照组80例和干预组86例,对照组采用传统疼痛管理策略,干预组采用多模式疼痛管理策略,包括建立医生、护士、药师及疼痛治疗师多学科团队,实施多模式镇痛知识宣教、超前非甾体抗炎药镇痛、局部浸润渗透、静脉自控镇痛泵、疼痛分级护理等措施。结果干预组术后24h内疼痛严重程度、不良反应(恶心呕吐、便秘腹胀)发生率及睡眠质量显著优于对照组(P0.05,P0.01)。结论多模式疼痛管理方案可有效控制肝动脉化疗栓塞术患者术后疼痛,有利于促进术后恢复。     

Infiltration of Bupivacaine Local Anesthetic to Trocar Insertion Sites After Laparoscopy: A Randomized,Double-blind,Stratified, and Controlled Trial

Study ObjectiveTo determine if injection of local anesthetic into trocar insertion sites after laparoscopy improves postoperative pain.DesignA prospective, 2-arm, randomized, double-blind, stratified, and controlled trial (Canadian Task Force classification I).SettingA university-based teaching hospital.PatientsThis study was performed on women who had a laparoscopic gynecologic procedure for benign indications from March 2013 to June 2013. One hundred thirty-five subjects were stratified by chronic pelvic pain or no chronic pelvic pain. Chronic pelvic pain was defined as pelvic pain occurring for 6 months or more in duration. Randomization was performed for this trial, with 68 receiving a bupivacaine block and 67 receiving no bupivacaine block. Of the 71 patients with chronic pelvic pain, 35 patients were in group 1 (i.e., bupivacaine block) and 36 patients were in group 2 (i.e., no bupivacaine block).InterventionsAfter the laparoscopic surgery was completed, the trocar incision sites were closed. For subjects randomized to receive a local anesthesia block, bupivacaine (0.25%) was injected. Incisions 8 mm or greater were injected with 10 mL 0.25% bupivacaine. Incisions 5 mm or less were infiltrated with 5 mL. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Group 2 did not receive a local injection.Measurements and Main ResultsAt the preoperative suite, the nurses gauged the patient's pain using the Numeric Rating Scale. This score was used as the baseline pain level with which the postoperative pain scores were compared. The primary objective was to measure changes in pain scores, from preoperative to postoperative time frames of 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days postoperatively. These score changes were measured as the main objective. Secondary objectives include estimated blood loss, operating time, length of hospital stay, and histopathologic diagnosis. The hospital personnel caring for the patient during the preoperative and postoperative course were given standard pain evaluation protocols. All study pain evaluators and patients were blinded to treatment assignments throughout the pain assessment process. There were no statistically significant differences in patient characteristics between the 2 treatment groups. No significant difference was found in secondary outcomes including estimated blood loss, length of hospital stay, and histopathologic diagnosis. In general, Numeric Rating Scale pain scores were lower (i.e., less pain) in the “bupivacaine block” group compared with the “no bupivacaine” block group at the following postsurgery time assessments: 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days after surgery. However, the effect was not large enough (<1 point) to show a statistical difference between the treatment groups at any of these postsurgery assessments.ConclusionThe postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery.     

风险管理在静脉药物配置中心护理质量管理中的实践

目的探讨在静脉药物配置中心（PIVAS）实施风险管理的做法及成效。方法对PIVAS进行风险识别，包括客观因素制约、各项制度、规范、流程的落实不够，工作人员业务水平欠缺，过程质量管理力度不够等；针对识别出的风险制订防范措施，多种举措杜绝不良事件发生客观原因，建立健全制度、规范、流程以达到标准化管理，培训先行，持续提高配置中心工作人员业务水平，全员参与静脉药物配置质量管理。结果实施风险管理后，临床科室未发生因药物配置引起的输液反应；临床科室对静脉药物配置中心工作满意度由90．11％上升至98．05％；静脉药物配置相关缺陷发生率显著降低（P〈0．05）。结论风险管理在静脉药物配置中心护理质量管理中具有积极重要的作用，值得在临床推广。     

Osseous metastases: drugs that enhance bone integrity and prevent adverse skeletal events

More than 400,000 cancer patients in the USA contend with bone metastases on an annual basis. These patients often suffer pain, a decline in quality of life, and a shortened survival. As a result, over the past several years, efforts to enhance bone integrity in patients with osseus metastases have become a major research priority. This review discusses the evolving role of bisphosphonates and their side effects, highlights other pharmacological interventions aimed at enhancing bone integrity, and reviews other pragmatic approaches to prevent worsening pain and fractures, as derived from a single institution case series of patients with problematic rib metastases.