我国部分三级综合医院护理质量管理组织架构调查与分析

目的调查我国三级综合医院护理质量管理组织架构。方法对全国85所医院相关护理人员进行问卷调查,并采用半结构式访谈法对其中11所医院护理质量管理专家进行访谈。结果90.6%的医院护理质量管理采用三级管理;85所医院均设有护理质量管理委员会,其中9.4%的委员会中缺少护士长参与,54.1%的护理质量管理委员会由护理队伍独立组成;访谈资料归纳出3个主题为;护理质量管理组织架构和运行方式较成熟,但仍需改进;希望多部门共同参与护理质量管理以及对目前护理质量管理组织架构的建议。结论建议优化护理质量管理三级模式和运行方式,建立多部门合作机制.鼓励护士长参与质量控制,并根据医院自身实际调整护理质量管理架构,以促进护理质量持续改进。     

Limitación auditiva y fragilidad social en hombres y mujeres mayores

ObjectiveTo explore the association between hearing loss and social frailty in a sample of Spanish older adults recruited from primary health care network.MethodCross-sectional study on a sample of 445 non-institutionalized adults aged 65 or more years (190 men and 255 women), recruited from primary care centers in Spain. Three self-reported hearing impairment questions were used to assess hearing loss. Social frailty was deemed to exist when the person presented two or more of the following conditions: living alone, absence of a person to provide help, infrequent contact with family, infrequent contact with friends, lack of confident and lack of help for daily activities in the last 3 months. To study the association between hearing loss and social frailty we used logistic regression models adjusted for potential confounders, including physical frailty.ResultsThe mean age of participants was 76.2 years (77.5 years for women). More than half of the participants (54.4%) reported hearing loss and the frequency of social frailty was 23.2%. Hearing loss was associated with social frailty (adjusted odds ratio [aOR] = 1.78; 95% confidence interval [95%CI]: 1.04-3.06). However, the association was sex-dependent (p for interaction = 0.041). In stratified analysis, the association was only found in women (aOR = 3.21; 95%CI: 1.44-7.17).ConclusionsHearing loss was associated with social frailty in women, but not in men. Longitudinal studies are needed to confirm this association and to understand the differential effect of gender.     

Effects of exogenous factors on spatial accuracy in neurosurgery

The study aimed to assess the effect of exogenous factors such as surgeon posture, surgical instrument length, fatigue after a night shift, exercise and caffeine consumption on the spatial accuracy of neurosurgical manipulations. For the evaluation and simulation of neurosurgical manipulations, a testing device developed by the authors was used. The experimental results were compared using nonparametric analysis (Wilcoxon test) and multivariate analysis, which was performed using mixed models. The results were considered statistically significant at p < 0.05. The study included 11 first-year neurosurgery residents who met the inclusion criteria. Hand support in the sitting position (Wilcoxon test p value = 0.0033), caffeine consumption (p = 0.0058) and the length of the microsurgical instrument (p = 0.0032) had statistically significant influences on the spatial accuracy of surgical manipulations (univariate analysis). The spatial accuracy did not significantly depend on the type of standing position (Wilcoxon test p value = 0.2860), whether the surgeon was standing/sitting (p = 0.1029), fatigue following a night shift (p = 0.3281), or physical exertion prior to surgery (p = 0.2845).When conducting the multivariate analysis, the spatial accuracy significantly depended on the test subject (p < 0.0001), the use of support during the test (p = 0.0001), and the length of the microsurgical instrument (p = 0.0397). To increase the spatial accuracy of microsurgical manipulations, hand support and shorter tools should be used. Caffeine consumption in high doses should also be avoided prior to surgery.     

大小便失禁病人尊严丧失感与社会支持和应对方式的相关性研究

目的:探讨大小便失禁病人尊严丧失感现状及其与社会支持和应对方式的相关性。方法:采用一般资料调查表、病人尊严量表(PDI)、社会支持评定量表(SSRS)、应对方式量表(MCMQ)对山东省3所三级甲等医院119例大小便失禁病人进行调查。结果:病人尊严丧失感程度不一,不同大小便失禁时间病人尊严丧失感得分比较差异有统计学意义(P<0.05)。多元回归分析显示,大小便失禁后不同时间、主观支持、对社会支持的利用度以及屈服的应对方式是导致大小便失禁病人尊严丧失的重要因素。结论:大小便失禁病人尊严丧失感与社会支持和应对方式密切相关,加强社会支持以及积极有效的应对方式能减轻病人的尊严丧失感。     

Improving HIV medical care engagement by attending to status disclosure and social support

ABSTRACT

Expeditious linkage and consistent engagement in medical care is important for people with HIV’s (PWH) health. One theory on fostering linkage and engagement involves HIV status disclosure to mobilize social support. To assess disclosure and social support’s association with linkage and engagement, we conducted a qualitative study sampling black and Latino men who have sex with men (MSM of color) in the U.S. Participants' narratives presented mixed results. For instance, several participants who reported delaying, inconsistent access, or detachment from care also reported disclosing for support purposes, yet sporadic engagement suggests that their disclosure or any subsequent social support have not assisted. The findings contribute to the literature that questions disclosure and social support’s influence on care engagement, especially when decontextualized from circumstances and intentions. Our findings suggest the mechanics of disclosure and social support require planned implementation if intending to affect outcomes, especially among MSM of color. From the findings, we explore steps that may bolster interventions seeking to anchor medical care engagement.