Prospective validation of the Parkland Grading Scale for Cholecystitis

Background

The Parkland Grading Scale for Cholecystitis (PGS) was developed as an intraoperative grading scale to stratify gallbladder (GB) disease severity during laparoscopic cholecystectomy (LC). We aimed to prospectively validate this scale as a measure of LC outcomes.

基于整合医学理念的护理路径应用于脑梗死后鼻饲患者的临床成效

目的 剖析基于整合医学理念的护理路径应用于脑梗死后鼻饲患者的临床成效,以增加医疗实践经验。方法 利用电脑对我院在2015年10月至2017年10月收治的88例脑梗死后鼻饲患者行随机化分组,各自命名为研究组(n=44)和对照组(n=44)。对照组实施传统护理,研究组采取整合式医疗模式护理路径。待干预后第4周末,比较两组患者的吞咽功能、情感状况、生活质量及营养状况。结果 干预后,研究组患者的SAS、SDS评分低于对照组,营养状况优于对照组,生活质量评分高于对照组,洼田试验评分高于对照组,均有统计学差异(P<0.05)。结论 基于整合医学理念的护理路径应用于脑梗死后鼻饲患者,对其吞咽功能的改善以及情感状况的稳定大有助益,且能增进机体对营养物质的吸收及提升生活质量。     

品管圈提高脑室引流患者引流瓶高度设置准确率的作用

目的 探讨品管圈在脑室引流患者引流瓶高度设置准确率的应用效果。方法 2016年9月至2017年3月，宿迁市第一人民医院重症医学科按照品管圈十大步骤进行操作，调查脑室引流患者引流瓶高度设置不准确的原因，制定对策并实施。结果 脑室引流患者引流瓶高度设置准确率由品管圈活动实施前的45%提高至实施后的76%（P﹤0.001）。圈员能力也得到提高。结论 品管圈活动能够提高脑室引流患者引流瓶高度设置的准确率，同时在活动过程中增强了护士的综合能力。     

Re-evaluation of websites from burn centers in Austria,Germany and Switzerland

Introduction

Websites serve as information and communication platforms; hence, they are important tools for the self-promotion of hospitals. In 2010, Selig et al. evaluated the online presence of burn centers in Germany, Austria, and Switzerland based on 37 quality criteria. This study aimed to re-evaluate these websites to assess their development over the past 6.5 years.

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

Comment vieillit-on en institution avec une scoliose ? Impact de l’arthrodèse vertébrale sur la qualité de vie des paralysés cérébraux adultes

IntroductionQuality of life is now part of the discussion, when considering spinal arthrodesis in children and teenagers with severe cerebral palsy and scoliosis. From the subjective point of view of close caregivers, quality of life is significantly improved two to five years after surgery. Nevertheless information relevant to the long-term evolution of those patients, most of them institutionalized, is lacking. In this study the quality of life of 45 adult cerebral palsy subjects with scoliosis (20 with arthrodesis and 25 without), classified IV or V on the Gross Motor Classification System and living in institutions was questioned.Material and methodFour items: daily care, pain/comfort, sitting position and communication, were proposed to evaluation by professional caregivers, blind to the final goal of the study and asked to answer along a Lickert scale (−2 to +2).ResultsResults show that professional caregivers dont make any difference between operated and non operated patients when considering easiness of daily care, pain/comfort of the resident or ability to communicate, but judge sitting position to be slightly better for those with spinal arthrodesis. Satisfaction with sitting posture depends for one part on the degree of scoliotic curve but other factors (hip and knee rigidity, quality of the sitting orthosis) also seem to be relevant.ConclusionSpinal arthrodesis is beneficial for sitting posture, even in aging subjects with severe cerebral palsy and scoliosis living in institutions. But the study also points to the numerous other health challenges which negatively affect the quality of life of such patients.     

Quality of life in caregivers of a family member with serious mental illness: Evidence from China

Purpose

To evaluate the quality of life (QoL) and social support among family caregivers of a family member with a mental illness and to identify factors associated with the QoL.

Quality of life after hemifacial spasm surgery: French versions of the HFS-8 and HFS-30 questionnaires

ObjectivesThe aim of the present study was to assess quality of life before and after surgery for hemifacial spasm, in order to validate two specific quality of life scales translated in French. Surgical results and complications were reported.Material and methodsTwenty-three patients with hemifacial spasm treated by microvascular decompression were retrospectively included. The HFS-8 and HFS-30 quality of life scales were translated from English into French using a forward-backward method and implemented on patients at least one year after surgery.ResultsMedian HFS-8 and HFS-30 values were respectively 16 ± 12.5 (range: 8–20.5) and 38 ± 38.5 (range: 23–61.5) before surgery and 0.5 ± 4.5 (range: 0–4.5) and 5 ± 17.5 (range: 1–18.5) after surgery, showing significant improvement in quality of life (P < 0.001). The internal consistency of both scales was excellent (Cronbach's alpha > 0.9), and they were significantly correlated (Pearson coefficient = 0.95; 95% CI [0.91; 0.98]; P < 0.0001). Success rates were 83% and 91%, respectively, after primary and revision surgeries. Complications were transient with minor consequences in 80% of cases, but could impact quality of life when lasting.ConclusionsThese results support the validity of the French versions of HFS-8 and HFS-30. Microvascular decompression is a safe and effective treatment for hemifacial spasm, and these scales are reliable tools to assess postoperative quality of life.