从“道法自然”探眩晕临床证治

中医对眩晕病证的认识,从病因病机、辨证论治到处方用药,无不彰显着“道法自然”“取象比类”思维的妙处.“象”思维是中国古人认知世界的主要思维方式,是一种对客体形态的再认识与内在实质的理解相统一的认识活动.中医运用“取象比类”方法来阐释阴阳、五行、藏象等中医经典理论,更用之来指导临床.“培土生金”“增水行舟”“提壶揭盖”“釜底抽薪”等治法,皆体现了道法自然的思想.眩晕的病位在脑窍,病变脏腑主要在肝、脾、肾,尤与肝关系最为密切.其治疗应祛避外风,镇熄肝风,清疏上窍,培土养正.     

风险管理在老年病房护理安全管理中的应用

目的有效地规避和化解护理风险,为老年病人提供安全、优质的护理服务。方法以风险管理知识为指导,通过识别老年病房护理安全工作中存在或潜在的护理风险,进行风险衡量与评价,制订风险管理策略,指导临床规避和化解护理风险,确保护理安全。结果住院病人对护理工作综合满意度和静脉穿刺成功率提高。结论在老年病房护理安全管理工作中,识别老年病房存在或潜在风险是前提,培训护理人员风险意识和能力是关键,完善管理制度和工作流程是保障。     

尿核基质蛋白22在膀胱移行细胞癌诊断中的临床应用

目的评价尿核基质蛋白22(NMP22)对诊断膀胱移行细胞癌的价值。方法选取膀胱占位的患者48例,健康志愿者20例作对照,留取患者术前及对照组人群的晨尿1次,应用免疫酶标记法检测尿中NMP22的数值,并进行分析比较。结果48例膀胱占位患者均经手术治疗,术后病理检查42例为移行细胞癌。42例移行细胞癌患者术前尿NMP22水平为(37.30±7.36)U/ml;而其他6例非膀胱移行细胞癌患者术前尿NMP22水平为(3.85±0.94)U/ml。对照组尿NMP22水平为(1.35±0.59)U/ml,明显低于膀胱移行细胞癌组(P<0.05)。原发性膀胱移行细胞癌患者尿NMP22水平随肿瘤分级、分期的递增而升高。结论尿NMP22对膀胱移行细胞癌具有高灵敏度、高特异度、无创伤性,是检测膀胱移行细胞癌的有效标志物。     

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face-to-face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers' needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.     

精神科护士职业价值观与社会支持的调查分析

目的了解精神科护士职业价值观及社会支持状况。方法 2014年10月,采用护士职业价值观量表(nursing professional values scale-revised,NPVS-R)及社会支持评定量表(social spuport rate scale,SSRS)对广西某精神病专科医院的78名专科护士进行调查。结果 78名精神科护士获得的社会支持偏低,SSRS得分为(36.95±6.30)分;职业价值观为中等水平,得分为(3.30±0.62)分;其社会支持与职业价值观水平呈正相关(P0.05)。结论护理管理者应通过提升精神科护士的社会支持以促进专科护士职业价值水平的提高。     

腹腔镜腹股沟疝修补术患者实施日间病房护理模式的效果

目的探讨腹腔镜腹股沟疝修补术患者实施日间病房护理模式的可行性。方法便利抽样选择2013年1-12月入住湖州市中心医院外科及日间病房行腹腔镜腹股沟疝修补术的患者共56例,其中日间手术组(日间病房护理模式)和住院手术组(常规住院护理模式)各28例,比较两组患者的医疗费用、住院时间、患者满意度及医疗安全情况。结果日间手术组患者的医疗费用及住院时间均少于住院手术组,患者满意度优于对照组,差异均有统计学意义(均P0.05)。两组患者术后均恢复良好,无医疗安全问题发生。结论腹腔镜腹股沟疝修补术的日间病房护理模式是一种方便、快捷、安全的医疗模式,是对住院模式的完善补充,有助于提高患者的满意度、提高床位使用率、降低总体医疗费用。     

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

PURPOSE

We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration.

RESULTS

We identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87–0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51–0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious.

CONCLUSIONS

Clinicians and managers who implement TCIs in primary care can incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option.     

重症监护远程教学查房系统的构建

目的:创新重症患者管理、查房和教学的模式,构建重症监护远程教学查房系统.方法:针对重症监护病房的特殊性及其要求,通过信息化手段,借助现代音视频传输技术和数字处理技术来构建系统.结果:由重症监护病房(intensive care unit,ICU)重症示教系统、ICU视频示教移动手推车、数字化示教室、网络视频传输等组成的教学查房系统满足了ICU临床实践教学的要求.结论:该系统的使用,改善了教学效果,提高了教学效率,减少了ICU污染的机会,高水平发挥了重症医学临床实践教学的作用.