循证护理的优效性及影响因素分析--来自终末期糖尿病肾病患者血液透析的证据

目的：探讨循证护理对终末期糖尿病肾病患者血液透析时低血糖的优效性，以及医护人员循证护理效果的影响因素。方法：分析2008年2月至2013年7月收治的106例接受血液透析的终末期糖尿病肾病患者的临床资料和意见反馈，将接受常规护理的55例患者作为对照组，51例接受常规护理联合循证护理的患者作为实验组，使用GBD 2010分析技术和stata13.0分析数据。结果：实验组发生低血糖的人数要明显少于对照组（2%vs14.5%，χ2=6.450，P=0.026）；将接受循证护理的患者反馈的意见信息汇总，并结合值班护理人员的个人特征，建立logistic回归，发现护理人员的工龄、职称会显著影响循证护理的工作质量，而学历、性别并不存在显著影响。结论：循证护理应用于终末期糖尿病肾病患者的血液透析中能够有效减少患者低血糖的发生，我国目前阶段应从经验和专业素养等方面提高循证护理人员的执业水平。     

Dissociating the effects of semantic grouping and rehearsal strategies on event-related brain potentials

The application of elaborative encoding strategies during learning, such as grouping items on similar semantic categories, increases the likelihood of later recall. Previous studies have suggested that stimuli that encourage semantic grouping strategies had modulating effects on specific ERP components. However, these studies did not differentiate between ERP activation patterns evoked by elaborative working memory strategies like semantic grouping and more simple strategies like rote rehearsal. Identification of neurocognitive correlates underlying successful use of elaborative strategies is important to understand better why certain populations, like children or elderly people, have problems applying such strategies. To compare ERP activation during the application of elaborative versus more simple strategies subjects had to encode either four semantically related or unrelated pictures by respectively applying a semantic category grouping or a simple rehearsal strategy. Another goal was to investigate if maintenance of semantically grouped vs. ungrouped pictures modulated ERP-slow waves differently. At the behavioral level there was only a semantic grouping benefit in terms of faster responding on correct rejections (i.e. when the memory probe stimulus was not part of the memory set). At the neural level, during encoding semantic grouping only had a modest specific modulatory effect on a fronto-central Late Positive Component (LPC), emerging around 650 ms. Other ERP components (i.e. P200, N400 and a second Late Positive Component) that had been earlier related to semantic grouping encoding processes now showed stronger modulation by rehearsal than by semantic grouping. During maintenance semantic grouping had specific modulatory effects on left and right frontal slow wave activity. These results stress the importance of careful control of strategy use when investigating the neural correlates of elaborative encoding.     

The Medical Director in Integrated Clinical Care Models

Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care. Six broad areas are proposed where dialysis unit medical directors can have the greatest effect on shifting the quality-care paradigm where integrated care models are used. The medical director will need to develop an awareness of the regional medical care delivery system, collect and analyze actionable data, determine patient outcomes to be targeted that are mutually agreed on by participating physicians and institutions, develop processes of care that result in improved patient outcomes, and lead and inform the medical staff. Three practical examples of patient-centered, quality-focused programs developed and implemented by dialysis unit medical directors and their practice partners that targeted dialysis access, modality choice, and fluid volume management are presented. Medical directors are encouraged to move beyond traditional roles and embrace responsibilities associated with integrated care.     

基于依从性曲线变化规律的分阶段健康指导在维持性血液透析病人中的应用

目的:探讨基于依从性曲线变化规律的分阶段健康指导在维持性血液透析病人中的应用效果。方法:将168例行维持性血液透析治疗的慢性肾病病人根据透析时间将病人分为对照组和观察组,每组84例,对照组行常规健康指导,观察组基于依从性曲线变化规律对病人实施健康指导,比较两组病人干预前后遵医行为、自我护理能力及血液透析并发症发生率。结果:干预后观察组病人遵医行为总分及各维度评分(合理饮食、控制液体摄入、血管通路维护、日常生活管理、规律运动、定期门诊随访)较对照组明显提高(P<0.05);干预后观察组病人自我护理能力总分及相关维度评分较对照组明显提高(P<0.05);观察组病人并发症发生率低于对照组(P<0.05)。结论:基于依从性曲线变化规律的分阶段健康指导能有效提高维持性血液透析病人遵医行为及自我护理能力,从而降低病人血液透析并发症发生率。     

Incidence,Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study

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