高龄产妇妊娠期糖尿病发病的危险因素与干预措施

目的分析高龄产妇妊娠期糖尿病(GDM)发病的危险因素与干预措施。方法回顾性纳入我院妇产科2018年1月至2019年2月收治的365例高龄产妇为研究对象,收集产妇一般人口学资料、临床指标以及其他相关因素,对可能影响高龄产妇GDM的发病因素进行单因素和多因素logistic回归分析。结果365例高龄产妇GDM发病69例,发生率为18.90%。经多因素logistic回归分析显示,孕前BMI值、孕期增重、糖尿病家族史、血红蛋白水平、早孕期空腹血糖(FPG)水平、日常运动量、睡眠时间均为影响高龄产妇GDM发病的独立因素(P<0.05)。结论针对高龄产妇GDM发病的危险因素应加强关注,实施早期筛查、早期干预,指导产妇妊娠期适当运动锻炼、注意饮食健康、控制体质量。     

住院患儿不安全因素的分析及对策

目的 减少住院患儿的非医疗意外非医疗技术意外伤害事件的发生。方法 回顾性分析1998年11月至2000年10月住院期间患儿发生非医疗技术意外伤害的原因,针对分析结果自2000年11月起逐步完善各项安全管理措施,比较实施安全管理前后(分别为对照组和观察组)住院患儿非医疗技术意外伤害事件的发生率。结果 对照组患儿非医疗技术意外伤害事件的发生率为0.37％(8/2166),观察组为0.04％(1/2250),两组有显著差异(P<0.05)。结论 由于患儿缺乏自卫意识,在儿科护理工作中应加强安全管理,以降低住院患儿非医疗技术意外伤害事件的发生率。     

临床医生肿瘤诊断编码填写准确性影响因素分析:基于上海市某三级甲等综合性医院的实证研究

目的:基于上海市某三级甲等综合性医院的临床数据,分析临床医生肿瘤诊断编码填写准确性的影响因素,探讨有效的应对策略及实证效果。方法:结合我院《病案首页检索系统》与《病理报告系统》,筛查出2019年1月至2019年7月医院住院病案首页中主要诊断ICD-10编码为C00-D48的病例,并对应核查病理报告结果,根据对应发现的肿瘤诊断编码错漏病例,分析问题产生的原因,用同样的筛查方式,检索医院制定并实施质量改进措施后2020年1月至2020年7月住院病案首页中肿瘤诊断编码错漏例数。结果:2019年1月至7月,共采集12 382份病例,其中存在病理诊断编码错漏的病例有2 712份,错漏率在21.92%。2020年1月至7月11 872份病例中,错漏病例为1 272份,错漏率在10.70%,两组间差异有统计学意义(P0.05),肿瘤诊断编码错漏率低于改进前,改善幅度11%。2019年病例数中,临床编码原则错误、病理结果不确定以及病理报告时间滞后产生的错漏合计为2 712份,分别占病例统计总量的12%、6%、4%。2020年因临床编码原则错误、病理结果不确定及病理报告时间滞后产生错误的情况都出现较明显的改善(P0.05)。其中,临床编码原则错误率减少了7%,因病理结果不确定、病理报告时间滞后产生错误率分别减少了3%、2%。结论:基于上海市某三级甲等综合性医院的实证研究数据表明,通过对临床医生肿瘤诊断编码质量的一系列改进措施实施,能明显提高肿瘤诊断编码的质量。     

The development of a clinical practice stroke guideline for physiotherapists in The Netherlands: a systematic review of available evidence

Purpose. To develop a clinical practice guideline for the physiotherapy management of patients with stroke as support for the clinical decision-making process, especially with respect to the selection of appropriate interventions, prognostic factors and outcome measures.

Introduction. Physiotherapists have a high caseload of patients with stroke, so there is a need to identify effective evidence-based physiotherapy procedures. The availability of a guideline that includes information about prognostic factors, interventions, and outcome measures would facilitate clinical decision-making.

Method. A systematic computerized literature search was performed to identify evidence concerning the use of: (i) prognostic factors related to functional recovery; (ii) physiotherapy interventions in patients with stroke; and (iii) outcome measures to assess patients' progress in functional health. Experts, physiotherapists working in the field of stroke rehabilitation, and a multidisciplinary group of health professionals reviewed the clinical applicability and feasibility of the recommendations for clinical practice and their comments were used to compose the definitive guideline.

Results. Of 9482 relevant articles, 322 were selected. These were screened for methodological quality. Seventy-two recommendations for clinical practice were retrieved from these articles and included in the guideline: Six recommendations concerned the prediction of functional recovery of activities of daily living (ADL), including walking ability and hand/arm use; 65 recommendations concerned the choice of physiotherapy interventions; and 1 recommendation concerned the choice of outcome instrument to use. A core set of seven reliable, responsive, and valid outcome measures was established, to determine impairments and activity limitations in patients with stroke.

Conclusions. The guideline provides physiotherapists with an evidence-based instrument to assist them in their clinical decision making regarding patients with stroke. As most of the recommendations included in the guideline came from studies of patients in the post acute and chronic phase of stroke, and in general involved patients with less severe and uncomplicated stroke, more needs to be learned about the more complex cases.     

基于证候要素概念构建护理措施要素施护体系的思考

证候是疾病发生、发展过程中的病理概括,任一证候都是由若干"证候要素"组合而成。本研究系统地阐述了中医"证候要素"理论形成的背景、基本内涵、意义及其目前应用研究的现状,强调了该理论对中医辨证论治过程所产生的重要影响。本研究依据中医"证候要素"辨证理论体系的指导思想,将"证候要素"的概念引入中医护理学,定义了"护理措施要素"的概念,将其作为针对病机单元的护理单元,反映了针对证候病机单元的护法护则,并进一步明确了证-护之间的对应关系,尝试探讨基于"护理措施要素"的施护体系,从而提高护理人员的辨证施护能力,促进中医护理的规范化。     

Mobility assessment: sensitivity and specificity of measurement sets in older adults

Panzer VP, Wakefield DB, Hall CB, Wolfson LI. Mobility assessment: sensitivity and specificity of measurement sets in older adults.

Objective

To identify quantitative measurement variables that characterize mobility in older adults, meet reliability and validity criteria, distinguish fall risk, and predict future falls.

Design

Observational study with 1-year weekly falls follow-up.

Setting

Mobility laboratory.

Participants

Community-dwelling volunteers (N=74; age, 65–94y) categorized at entry as 27 nonfallers or 47 fallers by using Medicare criteria (1 injury fall or >1 noninjury fall in the previous year).

Interventions

None.

Main Outcome Measures

Test-retest and within-subject reliability, criterion and concurrent validity; predictive ability indicated by observed sensitivity and specificity to entry fall-risk group (falls status), Tinetti Performance Oriented Mobility Assessment (POMA), computerized dynamic posturography Sensory Organization Test (SOT), and subsequent falls reported weekly.

Results

Measurement variables were selected that met reliability (intraclass coefficient of correlation >.6) and/or discrimination (P<.01) criteria (clinical variables: turn steps and time, gait velocity, step-in-tub time, downstairs time; forceplate variables: quiet standing Romberg ratio sway area, maximal lean anterior-posterior excursion, sit-to-stand medial-lateral excursion, sway area). Sets were created (3 clinical, 2 forceplate) using combinations of variables appropriate for older adults with different functional activity levels, and composite scores were calculated. Scores identified entry falls status and concurred with POMA and SOT scores. The full clinical set (5 measurement variables) produced sensitivity of 80% and specificity of 74% to falls status. Composite scores were more sensitive and specific overall in predicting subsequent injury falls and multiple falls compared with falls status and POMA or SOT score.

Conclusions

Sets of quantitative measurement variables obtained with this mobility battery provided sensitive prediction of future injury falls and screening for multiple subsequent falls by using tasks that should be appropriate to diverse participants.     

Is quality of life being compromised in people with dementia in long-term care?

Moyle W. (2010) Is quality of life being compromised in people with dementia in long-term care? International Journal of Older People Nursing 5 , 245–252
doi: 10.1111/j.1748-3743.2010.00230.x Aim. To outline the importance of understanding quality of life (QOL) in people with dementia living in long-term care. To consider several key research questions and some of the challenges and impact of neglecting knowledge transfer. Background. There is a gap between the knowledge in the broad dementia research literature and transfer of knowledge into practice. Quality of life research and transfer of research into practice is one means by which health professionals can inform health and social care policy and improve care practice. Discussion. There are a number of unanswered research questions in relation to QOL in people with dementia living in long term care. A selection of questions discussed in this paper relate to the impact of staff knowledge of mental health assessment and the importance of therapeutic communication, cognitive training programs and social biography, individual needs, weight and behavioural and psychological symptoms of dementia (BPSD), resident choice and the impact of the environment on QOL. Conclusion. Research methods used to assess QOL must not be too restrictive and mixed methods and data from multiple perspectives should be encouraged so that an extensive understanding is uncovered. Potential strategies to assist knowledge transfer in long-term care settings are needed.     

Mid-term results of arthroscopic subacromial decompression in patients with or without partial thickness rotator cuff tears

Aim:

To evaluate mid-term outcome in patients who underwent arthroscopic subacromial decompression (ASD) for shoulder impingement syndrome with intact and partially torn rotator cuffs.

Materials and Methods:

A total of 80 consecutive patients (83 shoulders) who underwent ASD for impingement syndrome between 2003 and 2006 were analyzed. Mean age was 57.1 years. Patients’ self-reported Oxford Shoulder Score (OSS) for pain was collected prospectively and was used as an instrument to measure surgical outcome.

Results:

The mean initial and final OSS for patients with an intact rotator cuff was 26.1 and 40.3, respectively, at a mean follow up of 71.9 months (nearly 7 years). The mean initial and final OSS for patients with a partially torn articular sided tear was 22.6 and 41.9, respectively, at mean follow up of 70.7 months. Both groups showed significant sustained improvement (P < 0.0001). The mean improvement of OSS following ASD was statistically greater (P < 0.03) for partially torn rotator cuff group (19.3 points) as compared to those with normal rotator cuff (14.2 points).

Conclusion:

Patients with dual pathology (partial rotator cuff tear and impingement) appreciated a significantly greater improvement following ASD compared to those with impingement alone. Both groups of patients had a similar final outcome at a mid-term follow up.

Level of Evidence:

IV, retrospective study on consecutive series of patients.     

The knowledge level and precautionary measures taken by older adults during the SARS outbreak in Hong Kong

The study aims to examine the knowledge and the practice of the precautionary measures taken by older adults in Hong Kong against the outbreak of severe acute respiratory syndrome (SARS). Overall, more than half the participants responded correctly that droplet transmission is one of the main transmission routes of SARS. Those who received formal education demonstrated that they acquired greater knowledge of the sources and precautionary measures for SARS. The types of precautionary measures used and the factors affecting their behaviours were discussed. The results of the study could help the health-care professionals develop appropriate health promotion and disease prevention programmes for older adults.