Effect of full-time health education nurses in the tuberculosis ward

目的 分析专职健康教育护士对结核病患者的干预效果,探寻一种低投入、高效益的健康教育模式。方法 按时间顺序依次纳入2018年6—12月和2019年1—6月在北京胸科医院结核科住院治疗的所有结核病患者340例和300例,分别排除12例和4例的聋哑、外籍和问卷无效患者,最终纳入328例(对照组,由责任护士提供健康教育)和296例(试验组,由专职健康教育护士提供健康教育)作为研究对象。采用调查问卷[包括健康教育知识测评表(20道结核病防治核心信息及知识要点选择题,选择正确计5分、错误计0分,满分100分)、健康教育满意度调查表(包含入院宣传教育、疾病知识、出院指导、服务态度等15条题目,选择很满意、一般、不满意分别赋值3分、2分、1分,总分45分)]和出院随访(复诊情况)的方式收集相关数据,比较两组患者健康教育知识知晓情况(包括知晓率和测评平均得分)、患者满意度及复诊依从性(包括按时复诊、未按时复诊及从未复诊3种情况,以按时复诊率为复诊依从性好)。结果 试验组患者健康教育知识测评平均得分[(92.42±5.64)分]、总知晓率[92.41%(5471/5920)]均明显高于对照组[分别为(67.52±9.14)分、67.74%(4444/6560)](t=-41.004,P<0.001;χ²=2520.110,P<0.001)。试验组患者健康教育满意度在入院宣传教育[(7.70±0.86)分]、疾病知识[(17.53±1.25)分]、出院指导[(7.70±0.84)分]及服务态度[(5.07±0.73)分]等方面的得分均高于对照组[分别为(7.02±0.80)、(16.14±1.25)、(7.06±0.85)、(4.30±0.55)分](t值分别为-9.700、-13.364、-9.531、-15.387,P值均<0.001)。试验组患者严格按时复诊依从性[86.82%(257/296)]明显高于对照组[55.79%(183/328)],差异有统计学意义(χ²=73.760,P<0.001)。结论 配置专职健康教育护士可提高患者健康教育知晓率、健康教育质量及护理满意度及患者治疗依从性,值得在结核科病房推广。     

Patient safety with orthognathic surgery in an outpatient setting

Orthognathic surgery is traditionally performed in inpatient care. The question is whether patient safety is maintained when orthognathic surgery is performed in outpatient care. This retrospective cohort study was conducted to investigate patient safety in selected single-jaw orthognathic surgeries performed in outpatient care compared to inpatient care. Postoperative infection, postoperative bleeding, postoperative pain, plate removal, and re-operation, as well as emergency visits/phone calls and postoperative admission during the first 12 months after surgery were recorded. Predictor variables were sex, age, smoking, general disease, antibiotics, operation type, and operation time. Of the 165 patients included, 58 were treated in inpatient care and 107 in outpatient care. No significant difference was found between the groups regarding postoperative bleeding, pain, plate removal, re-operation, or emergency visits/phone calls. Ninety-four percent of outpatients (n = 101) were able to leave the hospital on the day of surgery as planned. There was an increased risk of postoperative infection in the outpatient care group (odds ratio 2.46, P = 0.049). Selected single-jaw orthognathic surgery can be performed in the outpatient setting, with maintained patient safety. The reason for the increased risk of postoperative infection among patients operated in outpatient care should be investigated in further studies.     

Comparison of Characteristics,Inpatient Outcomes,and Trends in Percutaneous Versus Open Placement of Spinal Cord Stimulators

ObjectivesSpinal cord stimulation (SCS) is an effective treatment modality for chronic pain conditions for which other treatment modalities have failed to provide relief. Ample prospective studies exist supporting its indications for use and overall efficacy. However, less is known about how SCS is used at the population level. Our objective is to understand the demographics, clinical characteristics, and utilization patterns of open and percutaneous SCS procedures.Materials and MethodsThe Nationwide Inpatient Sample data base of 2016–2019 was queried for cases of percutaneous or open placement (through laminotomy/laminectomy) of SCS (excluding SCS trials) using International Classification of Disease (ICD), 10th revision, procedure coding system. Baseline demographic characteristics, complications, ICD-Clinical Modification, Diagnosis Related Group, length of stay (LOS), and yearly implementation data were collected. Complications and outcomes were evaluated in total and between the open and percutaneous SCS groups.ResultsA total of 2455 inpatients had an SCS placed, of whom 1970 (80.2%) received SCS through open placement. Placement of open SCS was associated with Caucasian race (odds ratio [OR] = 1.671, p < 0.001), private insurance (OR = 1.332, p = 0.02), and age more than 65 years (OR = 1.25, p = 0.034). The most common diagnosis was failed back surgery syndrome (23.8%). Patients with percutaneous SCS were more likely to have a hospital stay of < 1 day (OR = 2.318; 95% CI, 1.586–3.387; p < 0.001). Implant complications during the inpatient stay were positively associated with open SCS placement and reported in 9.4% of these cases (OR = 3.247, p < 0.001).ConclusionsPatients who underwent open SCS placement were more likely to be older, Caucasian, and privately insured. Open SCS placement showed greater LOS and implant-related complications during their hospital stay. These findings highlight both potential socioeconomic disparities in health care access for chronic pain relief and the importance of increasing age and medical comorbidities as important factors that can influence SCS implants in the inpatient setting.     

住院重性抑郁发作患者自杀未遂保护性因素的研究

目的：探讨住院重性抑郁发作（MDE）患者自杀未遂的保护性因素。方法收集当前符合DSM －IV MDE标准的住院患者，进行人口学调查问卷、自杀意念及自杀未遂调查表、汉密尔顿抑郁量表（HAMD）、贝克绝望量表（BHS）、生存理由量表中文版（RFL －C）评定。根据RFL －C来确定在抑郁发作期间可以用来预防或抑制自杀未遂的因素。结果筛查的214例住院情感障碍患者中，101例符合MDE标准。96例纳入最终分析，63例（65．6％）无自杀未遂史。和有自杀未遂史者比，无自杀未遂的患者更多为男性、BHS得分低，而RFL －C总分、生存和应对信念、家庭责任、对自杀的恐惧、对社会排斥的恐惧因子分均高。RFL －C总分及各因子分均与BHS得分呈负相关。结论生存和应对信念、家庭责任、对自杀的恐惧、对社会排斥的恐惧可能是重性抑郁发作患者自杀未遂的保护性因素，较高的RFL －C得分可能抑制绝望观念。