信息化平台在助产质量敏感指标中的应用

目的 建立助产质量敏感指标的信息化管理系统，并探讨其临床应用效果。方法 根据现有的助产质量指标，设计信息化管理系统，通过数据筛选-整合分析-持续改进-评价效果等环节，进行助产质量指标的监测及应用效果评价。结果 改进后质控结果汇总时长、图表生成时长、结果反馈时长均显著减少（P＜0.001），质控人员满意度提高（P＜0.01），助产质量敏感指标在进行持续改进的基础上有所改善（P <0.05或P <0.01）。 结论 助产质量指标的信息化管理系统建设和应用有效提高产房护理质量管理效率，有利于促进助产质量持续改进。     

情景模拟健康教育在晚期肺癌患者癌痛管理中的应用

目的 探讨情景模拟健康教育在晚期肺癌患者癌痛管理中的应用效果，旨在提高晚期肺癌患者提高癌痛应对和管理能力。方法 采用便利抽样法，选取2019年5月-2020年5月在同济大学附属上海市肺科医院肿瘤科住院的晚期肺癌患者60例为研究对象，按其住院时间先后顺序分为对照组（n=30）和观察组（n=30）。对照组患者给予肺癌常规护理及健康教育，观察组在其基础上给予情景模拟健康教育干预，主要围绕正确认识癌痛、癌痛自我评估、癌痛应对、躯体功能应对和负性心理情绪调试等展开。分别于患者入院第1天及第7天评估患者疼痛管理效能及情绪状况。结果 入院第1天，两组患者慢性疼痛自我效能感量表和中文版简式-简明心境问卷得分组间比较，差异无统计学意义（P＞0.05），入院第7天，组间比较有统计学差异（P＜0.05）。结论 情景模拟健康教育可有效提高晚期肺癌患者疼痛管理自我效能，改善患者负性心理情绪，进而提高其生活质量，值得临床进一步应用和推广。     

专人专职管理在卡介苗接种中的应用

【目的】探讨专人专职管理卡介苗( Bacille Calmette-Guerin vaccine,BCG)预防接种的实施效果。【方法】选取2014～2017年在上海市国际和平妇幼保健院出生的新生儿为研究组,2010～2013年出生的新生儿为对照组。通过疑似预防接种异常反应信息管理系统,收集2010～2017年报告的卡介苗预防接种异常反应( adverse events following immunization,AEFI)个案数据,比较专人专职管理前后两组新生儿在卡介苗使用情况及发生BCG AEFI之间的差异。【结果】研究组BCG的AEFI报告发生率、拒种率均低于对照组,差异有统计学意义(p<0.05)。BCG的AEFI分类中直径>1.0cm淋巴结炎最常见,研究组报告发生率为31.31/100万剂,低于对照组205.35/100万剂,差异有统计学意义(p<0.05)。【结论】通过专人专职管理可规范卡介苗的接种,降低AEFI的发生率和拒种率,利于临床推广。     

风险管理在预防PICC相关性静脉血栓中的临床观察

目的：探讨风险管理对降低PICC相关性血栓的应用效果。方法：选取2012年1月-2014年12月PICC置管患者291例作为对照组。2015年1月-2017年12月PICC置管患者568例作为干预组。对照组给予常规护理措施,干预组在此基础上给予风险管理,比较2组在深静脉血栓发生情况。结果：干预组PICC相关性静脉血栓的发生率为0.53 %,对照组血栓发生率为2.06%,差异有显著性( P=0.037),对照组中有1位肺癌患者因血栓而耽误治疗,最终死亡。干预组中3例血栓经积极治疗血栓完全溶解,无相关其他并发症的发生。结论：护理风险管理能够有效预防或降低PICC导管相关性静脉血栓的发生 ,值得临床推广应用。     

La prise en charge du sujet âgé dépressif en thérapies cognitivo-comportementales : aspects pratiques et spécificités

Cognitive behavioral therapy (CBT) has been shown to be an effective approach for a wide range of psychological problems affecting older adults. A variety of empirical and clinical papers have examined modifications to the content and delivery of CBT to enhance its efficacy with older adults. But when mental health problems do occur in the elderly, these problems are often overlooked. Thus, only a fraction of elderly persons with psychological distress receive effective treatment despite evidence that interventions can be effective for the elderly. It is important to be aware of mental health symptoms, particularly depression, and to be knowledgeable about the various treatment options available and effective for adults in later stages of life. Depression is significant problem among the elderly. Due to complexities in the medical management of elderly patients, researchers and clinicians have sought psychosocial alternatives to pharmacotherapy in order to treat depression in the elderly. Cognitive-behavioral therapy in particular has been investigated as a promising treatment. Research conducted to date has established that cognitive-behavioral therapy produces significant improvement in depression symptoms among the elderly. Issues around optimizing the structure of CBT with older adults are presented, along with suggestions for realizing these changes within a clinical context.     

Nebulized Ketamine Used for Pain Management of Orthopedic Trauma

BackgroundKetamine is a noncompetitive N-methyl-D-aspartate/glutamate receptor complex antagonist that decreases pain by diminishing central sensitization and hyperalgesia. When administered via i.v. (push-dose, short infusion, or continuous infusion) or intranasal routes, ketamine has shown to be effective in patients with acute traumatic pain. However, when i.v. access is not attainable or readily available, the inhalation route of ketamine administration via breath-actuated nebulizer (BAN) provides a noninvasive and titratable method of analgesic delivery. The use of nebulized ketamine has been studied in areas of postoperative management of sore throat and acute traumatic musculoskeletal and abdominal pain. To our knowledge, this is the first case series describing the use of nebulized ketamine for analgesia and orthopedic reduction.Case SeriesWe describe 4 patients who presented to the emergency department with acute traumatic painful conditions (one patellar dislocation, one shoulder dislocation, and two forearm fractures) and received nebulized ketamine for management of their pain.Why Should an Emergency Physician Be Aware of This?Administration of nebulized ketamine via BAN can be used as analgesic control for musculoskeletal trauma, as it can be administrated to patients with difficult i.v. access, has a rapid onset of analgesic effects with minimal side effects, and remains opioid-sparing.     

医院-社区-家庭闭环式模式在老年糖尿病周围神经病变患者中的应用价值

【摘要】目的 探讨“医院-社区-家庭”闭环式管理模式在老年糖尿病周围神经病变（DPN）患者中的应用价值。方法 选取2017年6月～2019年6月我院收治的老年DPN患者96例，随机分为观察组与对照组，每组各48例。对照组采用常规护理，观察组采用医院-社区-家庭闭环式管理模式。比较两组患者治疗依从性、血糖控制、心理健康状况、周围神经病变情况以及神经传导速率。结果 干预后，观察组患者用药、饮食、血糖测量、健康行为等方面依从率均高于对照组（P＜0.05）；观察组空腹血糖、饭后2 h血糖、糖化血红蛋白均低于对照组（P＜0.05）；观察组SCL-90症状自评量表躯体化、人际关系敏感、抑郁、焦虑、敌对以及睡眠饮食情况得分均低于对照组（P＜0.05）；观察组密西根糖尿病周围神经病变量表（MDNS）和多伦多临床神经病变评分量表（TCSS）评分均低于对照组（P＜0.05）；观察组正中神经、腓总神经神经传导速度（SNCV）和运动神经传导速度（MNCV）均高于对照组（P＜0.05）。结论 对老年DPN患者应用医院-社区-家庭闭环式管理模式能有效提高患者自我管理效能，维持血糖平稳，缓解不良情绪以改善DPN病情。     

The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

ObjectivesTo assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation.Design and settingThis is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited.Main outcome measuresSymptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life.ResultsSymptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function.ConclusionPatients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.     

Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort?

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.