Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus

ObjectiveTo better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines.MethodsThese cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines.ResultsAmong 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations.ConclusionsThe most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers.     

一起尿源性脓毒血症死亡案例的解析与改进*

对一起尿源性脓毒血症患者死亡案例进行解析，从明确诊断标准、制定规范举措、畅通绿色通道、促进患方参与等方面进行改进。改进后，尿源性脓毒血症患者诊断率提高，就诊至处理时间（DTN）从88.9min缩短至55.6min（P＜0.001），患者住院时间由7.9天缩短至4.9天，人均住院总费用减少8 105元，差异均有统计学意义（P＜0.05）。运用精益管理方法，优化专科急危重症诊治流程，能够缩短治疗时间，促进患者康复，节约住院费用，改善患者愈后     

Nurse’ prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care

BackgroundA high prevalence for the development of delirium after hip fracture was found in the group of geriatric patients. The National Institute for Health and Clinical Excellence has introduced a guideline for the management delirium (NICE, 2010). Protocols composed of detection, prevention and management of post-operative delirium required some adaptation to meet the needs of local nurses.AimA protocol with a nursing care plan referenced from an international guideline and other literature was developed to predict, prevent and manage post-operative delirium for geriatric patients with hip fracture.MethodsThe literature suggests numerous risk factors are associated with post-operative delirium and its preventive interventions were adopted to develop the protocol and nursing care plan.FindingsSix major risk categories included mental and behavioural influence, sensory impairment, physiological influence, immobility influence, electrolyte disturbance and infection influence. These were used for screening patients, accompanied by various preventive interventions. A protocol was developed to strive for the best management of geriatric patients receiving hip fracture surgery from admission to discharge.ConclusionsThe protocol incorporated with the Risk Assessment for Management of Postoperative delirium (RAMP) care plan was adapted for staff to implement in their local clinical area. Further study is required to determine its effectiveness on the prevention of the development of post operative delirium (POD) in the future.     

老年股骨近端骨折患者并发症的预见性护理

目的总结老年股骨近端骨折患者并发症的预防和护理对策。方法将192例患者分成对照组96例与观察组96例。对照组使用常规护理方法,观察组在常规护理基础上强化并发症的预防护理。观察、记录两组患者并发症的发生率和满意度。结果观察组患者住院期间并发症的发生率均低于对照组,满意度高于对照组,差异均有统计学意义(P0.05)。结论实施预见性护理对降低老年股骨近端骨折患者的并发症、提高满意度有较好的临床效果,预见性护理策略和精细的护理工作模式是今后护理工作方向。     

偏头痛预防性药物治疗降低血清谷氨酸水平研究

目的探讨谷氨酸在偏头痛中发病机制的作用及水平变化。方法抽选珠海市平沙医院门诊或者住院诊断为偏头痛患者60例,随机分组分为预防性药物治疗组(应用西比灵治疗)和常规药物治疗组,各30例。同时选择60例健康人员作为对照组,不进行任何药物治疗。测量所选对象体内血清谷氨酸水平,比较偏头痛及对照正常组患者用药前及用药后8 w血浆中谷氨酸水平及用药前后头痛发作时间。同时对比治疗组两种方法治疗后患者头痛发作频率。结果药物使用前,治疗组患者谷氨酸水平为(235.6±25.6)μmol/L,明显高于对照组,P<0.01;治疗后8 w,治疗组谷氨酸水平明显下降,与对照组比较,P>0.05;治疗后,预防性药物治疗组患者谷氨酸水平明显降低,发作频率明显减少,与对照组相比,P<0.05。结论偏头痛患者血清内谷氨酸水平明显提高,预防性药物明显能够降低谷氨酸水平,降低头痛发作频率。     

Issues with implementing a high‐quality lung cancer screening program

Answer questions and earn CME/CNE After a comprehensive review of the evidence, the United States Preventive Services Task Force recently endorsed screening with low‐dose computed tomography as an early detection approach that has the potential to significantly reduce deaths due to lung cancer. Prudent implementation of lung cancer screening as a high‐quality preventive health service is a complex challenge. The clinical evaluation and management of high‐risk cohorts in the absence of symptoms mandates an approach that differs significantly from that of symptom‐detected lung cancer. As with other cancer screenings, it is essential to provide to informed at‐risk individuals a safe, high‐quality, cost‐effective, and accessible service. In this review, the components of a successful screening program are discussed as we begin to disseminate lung cancer screening as a national resource to improve outcomes with this lethal cancer. This information about lung cancer screening will assist clinicians with communications about the potential benefits and harms of this service for high‐risk individuals considering participation in the screening process. CA Cancer J Clin 2014;64:351–363. © 2014 American Cancer Society.     

医院医学工程科科室建设探究

目的：医院医学工程科是为医院开展医疗、科研、教学工作提供物质保障的重要科室之一,研究医学工程科科室建设对医院的科学发展有重要的意义。方法：分析医学工程科的现状,并研究出现阻碍医学工程科发展问题的原因所在。结果：结合医院的实际情况以及工作经验,得出改善医学工程科现状的对策,并对其进行进一步的分析和探讨。结论：提高医学工程科的工作质量是促进医疗卫生事业发展的一项重要工作,同时也是医院全面建设、科学发展的可靠保证。     

门诊输液护理差错原因分析与防范对策

目的 分析门诊输液护理差错发生的原因,并提出防范对策.方法 回顾性分析2011年5月～2014年5月本院门诊输液室发生26例护理差错的资料.结果 护理差错类型包括医嘱转抄错误、注射错误及液体外渗等,护理差错主要发生在白班,工作年限5年内护士护理差错的发生率高于其他工作年限的护士（P＜0.05）.结论 未严格执行“三查七对”是发生差错的重要原因.科学管理、完善各项规章制度是预防门诊输液护理差错的主要对策.