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1.
IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.  相似文献   
2.
背景 音乐治疗作为新兴的治疗方法,在慢性疾病康复中的应用逐渐兴起,且日益得到重视。但音乐治疗对糖尿病康复的效果研究尚少见报道。 目的 观察音乐辅助阿格列汀对2型糖尿病患者糖脂代谢的影响。 方法 选取2019年10月至2021年2月在中国康复研究中心北京博爱医院内分泌科门诊就诊的口服药物血糖控制不佳的2型糖尿病患者65例。采用随机数字表法将患者分为A组(n=35)和B组(n=30),两组患者均保持原有饮食、运动习惯。A组在原治疗(药物种类、剂量不变)基础上联用阿格列汀片治疗,B组在A组基础上给予音乐辅助治疗。两组患者均连续治疗12周。比较治疗前及治疗12周后两组患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、餐后2 h血糖(2 hPG)、超敏C反应蛋白(hs-CRP)、游离脂肪酸(FFA)、胰岛素抵抗指数(HOMA-IR)、β细胞功能分泌指数(HOMA-β);观察患者治疗过程中不良反应发生情况。 结果 两组试验过程中因药物不良反应均剔除1例患者,A组、B组最终分别有34、29例患者完成试验。B组患者治疗12周后2 hPG低于A组(P<0.05)。治疗12周后两组患者FPG、HbA1c、2 hPG均低于组内治疗前,HOMA-β高于组内治疗前(P<0.05);治疗12周后B组患者LDL-C、TC均低于组内治疗前(P<0.05)。两组均未发生低血糖事件。 结论 音乐辅助阿格列汀较无音乐辅助更能降低2型糖尿病患者的餐后血糖,改善血脂情况。需要强调的是,音乐治疗的效果一定是在饮食控制、适当运动、合理用药的基础上。  相似文献   
3.
BackgroundGastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.MethodsFrom August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).ResultsThe mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.ConclusionsHigher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.  相似文献   
4.
BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.  相似文献   
5.
目的 从医疗机构康复医疗服务结构、环节、结局质量等方面,对2020年全国综合医院康复医学科、康复医院的医疗服务与质量安全进行分析。  相似文献   
6.
目的 探讨医院信息系统中增加住院陪护管理功能的应用效果。方法 基于互联网医院、智慧医院等信息系统,开发信息化住院陪护管理功能,包括流行病学史调查、免费核酸申请、电子陪护证办理、体温监测登记及上报和统计查询。该功能与医院智慧护理链接后全院应用。比较功能应用前和应用后的遵医嘱一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率,评价护士和管理者疫情防控管理的人均耗时以及对该管理功能的满意度。结果 应用信息化陪护管理功能后,一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率显著高于应用前(均P<0.05);护士陪护管理人均耗时从(554.13±30.77)s降至(311.67±21.54)s(P<0.05);护士和管理者对该信息化陪护管理功能的满意度显著提高(均P<0.05)。结论 信息化住院陪护管理功能的应用有效提升了疫情期间陪护的管理质量和管理效率,提高了一线护士和管理者的满意度。  相似文献   
7.
ObjectiveThis study aimed to analyze national influenza infection control policy documents within aged care settings by identifying the consistencies, inconsistencies, and gaps with the current evidence and by evaluating methodological quality. Aged care providers can use these findings to identify their policy documents' strengths and weaknesses.DesignA quality and content analysis of national level policy documents.Setting and ParticipantsAged care settings rely on national agencies' policy recommendations to control and prevent outbreaks. There is limited research on the effectiveness of control measures to prevent and treat influenza within aged care settings. Because of the complexities around aged care governance, the primary responsibility in developing a comprehensive facility-level, infection-prevention policy, falls to the providers.MethodsThe analysis was conducted using the (1) International Appraisal of Guidelines, Research and Evaluation assessment tool, containing 23 items across 6 domains; and the (2) Influenza Related Control Measures in Aged Care settings checklist, developed by the authors, with 82 recommendations covering: medical interventions, nonmedical interventions, and physical layout.ResultsThere were 19 documents from 9 different high-income countries, with a moderately high methodological quality in general. The quality assessment's average score was 40.2% (95% CI 31.9%–44.7%). “Stakeholder involvement” ranked third, and “Editorial independence” and “Rigor of development” had the lowest average scores across all domains. The content analysis' average score was 37.2% (95% CI 10.5%–21.5%). The highest scoring document (59.1%) included term definitions, cited evidence for recommendations, and clear measurable instructions. “Physical Layout” had the least coverage and averaged 21.9% (95% CI 4.2%–37.5%), which shows a substantial gap in built environment recommendations.Conclusions and ImplicationsExisting policy documents vary in their comprehensiveness. The higher scoring documents provide an ideal model for providers. The checklist tools can be used to assess and enhance documents. Further research on document end-user evaluation would be useful, as there is room for improvement in methodological quality and coverage of recommendation coverage, especially related to physical layout.  相似文献   
8.
提出一种面向医院患者的视觉监控跌倒检测算法,解决患者由于意外跌倒不能被及时发现的问题,为医护人员快速处理患者跌倒等异常行为提供必要的技术保障。方法:首先,基于深度神经网络模型检测监控图像中人体关节点(如肩部、肘部、腕部、胯部、膝关节等)在图像中的位置,再根据亲和度向量场模型提取人体骨架,最后计算患者躯干、腿部与地面的夹角作为判别性特征,判断监控区域内是否有患者出现意外跌倒。结果:实验结果表明,本文所提算法在实际的医院监护环境中的处理速度高达25帧/s,检测准确率高达96%。结论:该方法能够实时、准确地提取医院环境下患者的行为特征,并针对意外跌倒情况发出警报,为医护人员监测患者跌倒等异常行为提供更准确、方便的计算机辅助医疗护理方法。  相似文献   
9.
10.
目的 了解粤西某市城区寄宿的中学生饮食行为现状与影响因素,为探索干预方法提供依据。方法 自编调查问卷,2021年10月对某城区全部有食宿条件的10所中学,用分层抽样法现场调查547名初一至高二学生,对5种饮食行为与相关因素进行描述分析和logistic回归分析。结果 饮食的5种行为不良率从高到低依次为:吃外卖(49.0%)、不吃早餐(31.7%)、喝奶茶(24.3%)、吃夜宵(11.8%)、零食代餐(1.3%);“学生可支配费用少于100元/星期”“学校饭堂饮食口味评价——不满意”两个因素均能促成5种不良饮食行为发生(P<0.05),“饮食重要性感知意识——不重要”因素对“喝奶茶”“吃夜宵”行为影响强度最大(OR=4.386,P=0.019;OR=5.780,P=0.006);女生能促成“吃外卖”(OR=1.586,P=0.015)和“喝奶茶”(OR=1.770,P=0.010),“每星期可支配消费超过200元以上”能促成“吃外卖”和“吃夜宵”(OR=2.346,P=0.001;OR=2.585,P=0.009)。结论 城区寄宿学校中学生不良饮食行为问题突出,不满学校饭堂饮食口味对促发不良饮食行为影响最广,“认为饮食不重要”是促发不良行为产生的最强因素,亟须加强寄宿中学饮食支持条件的管理,加强学生饮食健康教育,控制当前城市寄宿学校中学的学生不健康饮食行为。  相似文献   
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