«Cuidados perdidos» y calidad de los cuidados durante la pandemia por COVID-19: factores y estrategias influyentes

ObjectiveTo analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care.BackgroundGiven the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided.MethodExploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the ‘Care Left Undone’ Scale, and ad hoc questionnaire for demographic variables.ResultsThe mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies.ConclusionBoth personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.     

Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers

ObjectivesTo determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers.DesignWe conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers.SettingWe used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario.ParticipantsThe cohort included the admission assessment of 56,433 NH residents.MethodsPPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92 days after admission.ResultsOverall, 6.2% of residents had at least 1 PPED transfer within 92 days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy [of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer's or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED.Conclusions and ImplicationsThough many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers.     

基于预算的公立医院成本费用目标管理研究

基于预算的公立医院成本费用目标管理,兼具年度预算的资金管控与月度目标的执行进度管控,其信息系统设计的关键点是数据信息抓取、传递、回馈、监督,形成事前预算、事中分析执行、事后反馈的成本费用管控模式,实现提质、增效、降耗的管控目的,使公立医院的发展由“规模扩张”型的成长阶段平稳过渡到精细化、质量效益型的成本管理阶段。     

乳腺癌随访和药物副作用管理策略的研究进展

乳腺癌是全球女性发病率最高的恶性肿瘤,随着诊断技术及治疗手段的不断提高,乳腺癌患者接受系统治疗后生存期明显延长。乳腺癌患者需要长时间的随访以便及早监测到局部复发和远处转移。此外,激素敏感性乳腺癌患者还需要给予5~10年的内分泌治疗,针对其副作用的全程管理也需要随访,进而提高患者的生活质量,减轻患者疾病负担。本文就近年来乳腺癌随访相关方面进行简要综述。     

Method’s corner: Allergist’s guide to network meta-analysis

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.     

基于信息平台的医院POCT管理改进

以华中科技大学同济医学院附属同济医院为例，探讨医院通过健全POCT管理体系，并借助信息平台改进POCT管理的经验，为其他医院POCT规范化管理提供参考。该医院通过搭建POCT管理平台，实现了设备标准化准入、人员资质统一授权、设备自动化质控和诊疗全流程闭环管理；基于信息平台的POCT管理改进，提升了医护人员的POCT认知度和操作水平，提高了医疗工作效率；实行诊疗全程风险管控，保障了医疗安全。     

胰腺切除患者围术期血糖管理的最佳证据总结

背景血糖紊乱是胰腺切除患者围术期常见问题。然而，目前国内开展的胰腺切除患者围术期血糖管理实践多以经验为指导，缺乏循证依据。目的总结胰腺切除患者围术期血糖管理的最佳证据。方法系统检索BMJ最佳临床实践、Up to Date、国际指南协作组、国际糖尿病联盟（IDF）、世界卫生组织（WHO）、美国国立指南数据库（NGC）、美国糖尿病协会、英国国家临床优化研究所（NICE）、新西兰指南研究组、加拿大糖尿病协会、澳大利亚糖尿病协会、苏格兰校际指南网络（SIGN）、PubMed、Web of Science、EMBase、CINHAL数据库、Cochrane图书馆、乔安娜布里格斯研究所（JBI）循证卫生保健中心、医脉通、万方数据知识服务平台、中国知网（CNKI）、生物医学数据库（CBM），筛选关于胰腺切除患者围术期血糖管理的文献。检索时间为建库至2020年12月。指南的质量评价采用国际AGREE协作组织2009年更新的AGREE Ⅱ量表。专家共识的质量评价采用澳大利亚JBI循证卫生保健中心专家共识评价标准2017版。随机对照试验的评价采用Jadad评分量表。结果通过初步检索筛选出文献6 637篇，最终纳入文献13篇，其中7篇为临床实践指南，4篇为专家共识，2篇为随机对照试验。评价结果显示，7篇临床实践指南中3篇总体质量评价为A级，剩下4篇为B级；4篇专家共识的质量评价在"观点与其他文献不一致的地方是否有合理解释？"条目的评价结果为"不清楚"，其余条目的评价结果均为"是"。2篇随机对照试验均为高质量文献。共汇总了62条最佳证据，主要涉及围术期组织管理、入院评估及处理、血糖控制目标、血糖监测、术前血糖管理策略、术中血糖管理策略、术后血糖管理策略、危急状况处理以及出院指导9个方面。结论临床医务人员应根据总结的9个方面最佳证据（包括围术期组织管理、入院评估及处理、血糖控制目标、血糖监测、术前血糖管理策略、术中血糖管理策略、术后血糖管理策略、危急状况处理以及出院指导）为胰腺切除患者制定个体化、全程化的围术期血糖管理方案。     

Climate Change: Effects on the Older Adult

The effects of climate change include floods, hurricanes, heat waves, and fires; these natural disasters can result in respiratory, cardiovascular, and psychological harm in older adults, who experience the highest morbidity and mortality during heat waves. Advanced practice registered nurses (APRNs) need education on preparing, assessing, and treating older adults for climate-change disasters, especially heat waves. This article will help APRNs understand the effects of climate-change events on the vulnerable older adults and advocates for the need to integrate health effects of climate change into curricula, practicums, policy, and research agendas.     

基于正交试验的肾造瘘管固定方案研究

目的 探讨基于正交试验的肾造瘘管不同固定方案的比较效果。方法 将14Fr硅胶肾造瘘管固定在聚乙烯展板和拉力显示器上，以固定材料、固定方法、面积为3个影响因素，每个因素3个水平，每组进行3次试验再求平均值作为最后拉力值F，共进行9个固定方案共27次试验。利用L9（33）正交试验矩阵研究不同材料（医用橡皮膏、医用透气胶带、医用无纺布胶带）、固定方法（交叉固定法、“工”字固定法和改良“工”字固定法）及面积(16 cm2、24 cm2、32 cm2）对肾造瘘管固定强度的影响。结果 正交试验所选的3种影响因素中，对拉力值影响显著性排序为：材料＞方法＞面积；3种固定材料中，医用橡皮膏固定强度最大。结论 肾造瘘管固定方案中，最佳固定组合为以医用橡皮膏结合改良“工”字法固定，可为临床管道固定方案的选择提供参考。