Reduced version of the Activity Measure for Post-Acute Care (AM-PAC) for inpatients, “6-clicks”: Brazilian-Portuguese cross-cultural adaptation and measurement properties

BackgroundThe “6-clicks” is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly.ObjectiveCross-culturally adapt the “6-clicks” into Brazilian-Portuguese and verify its measurement properties.MethodsCross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients’ of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included.ResultsMinor changes implemented to the original version. The three domains showed adequate internal consistency (α > 0.65). Inter-rater reliability (n = 50) and test–retest reliability, when administer to patients (n = 51) and to companions (n = 30), showed good for basic mobility domain (ICC_2.1 = 0.81, 0.83 and 0.82, respectively), good to moderate for daily activity (ICC_2.1 = 0.78 and ICC_3.1 = 0.71 and 0.82, respectively) and moderate to poor for applied cognitive (ICC_2.1 = 0.64, 0.36 and ICC_3.1 = 0.63), respectively. The highest agreements among patients/companions were also in basic mobility. Standard error of measurement ranged from 2.03 to 2.64 while the minimum detectable difference ranged from 5.63 to 7.32.ConclusionTranslated and adapted Brazilian version of the “6-clicks” showed acceptable measurement properties. The functional data provided by the instrument could be used to enhance care and help treatment follow-up.     

800例老年科住院患者医院感染的因素及防御控制措施分析

目的：分析老年科住院患者医院医院感染的因素,探讨预防与控制策略。方法回顾性分析该院2014年1—12月老年科收治的住院患者临床资料,将其分为无医院感染、合并医院感染两组,针对影响感染的相关因素进行单因素分析和多元回归分析。结果与无医院感染相比,62例合并医院感染患者在住院时间时间、病情康复状况、血红蛋白等统计指标,差异有统计学意义;通过实施单因素分析,得到糖尿病、肿瘤、营养不良、预防应用抗菌药物、住院时间、侵入性操作、使用糖皮质激素是引起医院感染的危险因素;实施多元回归分析显示导致医院感染的危险因素包括5个,分别是住院时间＞30 d、侵入性操作、营养不良、糖尿病、使用预防应用抗菌药物等。结论诱发老年科住院患者产生医院感染的因素较多,需要严格制定预防措施,降低医院感染率。     

河南省5所公立医院住院患者就医体验调查

目的 了解河南省公立医院住院患者就医体验状况及其影响因素.方法 使用自行设计的住院患者体验量表(IPEQ),采用随机抽样的方法,对河南省5所公立三级甲等医院的500名住院患者进行现场调查.结果 患者就医体验的总体满意度为8.48分,其中技术水平满意度最高(4.19分)、情感支持的满意度最低(3.31分).相关性分析显示,医生技术水平与患者体验相关程度最高(0.652).结论 河南省公立医院住院患者总体体验满意度较高,但医院在人文关怀和服务流程等方面需进一步改善.     

医院感染控制小组在内科住院患者感染中的作用研究

目的探讨医院感染控制小组在内科住院患者感染中的作用,为医院感染控制质量的提高提供参考方案。方法调查医院于2011年3月-2013年3月收治的100例内科感染患者临床资料,按照随机数字表法,随机分为对照组与研究组,各50例,对照组患者采用常规治疗,研究组患者在常规治疗与控制的基础上,由医院感染控制小组进行全方位控制,比较两组患者控制感染的效果;比较医院感染控制小组控制前后,医院内科患者的感染发生率。结果研究组患者的感染控制总有效率达94.0%,高于对照组的76.0%,对比差异有统计学意义(P<0.05);研究组患者的感染率为6.0%,显著低于对照组的24.0%,差异有统计学意义(P<0.05),此外,两组患者在医务人员管理、环境管理、医疗器械与用品管理以及总质量评分等对比,差异均有统计学意义(P<0.05)。结论医院感染控制小组可以提升医院的感染控制质量,并可有效降低内科住院患者的感染率,在内科住院患者中具有较高的应用价值,值得进一步推广。     

Is there an association between the level of grandiose narcissism severity of psychopathology?

Background: Narcissism is a personality trait associated with both psychological health and resilience as well as with aggression and interpersonal problems. Aim: This study compares levels of total narcissism and subscale scores in inpatients, outpatients and a community sample. Methods: Inpatients (N = 186) were recruited from consecutively admitted patients to two closed units, and the outpatient group (N = 144) consisted of patients attending a psychiatric outpatient clinic. The patients and a normative community sample (N = 437) all filled in the Narcissistic Personality Inventory questionnaire (NPI-29). Results: The NPI total and subscales scores showed considerable gender differences. Among men only the Uniqueness/Entitlement subscale showed significant group differences, with inpatients showing higher mean score than the two other groups. Among women three factors, Leadership/Power, Superiority/Arrogance, and Uniqueness/ Entitlement, showed significant differences between the different levels of psychopathology. The outpatient female group regularly had the lowest group mean scores. The NPI-29 scores of the normative group showed weak internal consistencies. Conclusion: Our hypothesis of a significant association between mean levels of total narcissism and subscale scores and severity of psychopathology was not supported.     

脊髓损伤住院患者家庭照顾者负性情绪调查及其影响因素研究

目的调查脊髓损伤患者主要家庭照顾者的负性情绪及其相关的影响因素。方法采用焦虑、抑郁量表以及自编一般情况调查表对脊髓损伤患者主要照顾直系亲属进行问卷调查,并对其影响因素进行统计学分析。结果对我康复医学中心半年间106例入院的脊髓损伤患者主要照顾者进行调查,结果显示主要照顾者焦虑以及抑郁得分均显著高于国内常模,并且其发生与照顾者性别、家庭收入情况、患者病程时间长短、疾病的损伤程度以及是否伴有其他慢性疾病相关。结论脊髓损伤主要照顾者群体存在显著增高的焦虑以及抑郁评分,应重视对这个群体心理情绪的关注和干预。     

住院患者作息时间合理性的调查分析

目的分析现行住院患者作息时间的适宜性,找出合理的住院患者作息时间,以便既符合住院患者作息习惯,又利于患者的治疗及护理。方法采取方便抽样法,对武汉市3所综合性医院符合纳入条件的1200例住院患者,进行有关医院作息时间的问卷调查。结果 620例(51.7%)习惯7:00起床,610例(51.0%)认为8:00吃早餐较合理,560例(46.7%)认为午餐应在11:30开始,630例(52.5%)认为午休时段应为12:00～14:30,560例(46.7%)认为晚餐应在17:30开始,650例(54.2%)认为22:00熄灯休息最合适。结论合理的住院患者作息时间可以为,护士早晨7:00开始护理治疗,患者早晨7:00～7:30起床,8:00吃早餐,中午12:00吃午餐,12:30～14:30午休,17:30吃晚餐,22:00熄灯休息;可根据季节对患者的起床时间和睡觉时间进行30min的弹性调整;除了调整患者的作息时间外,还要合理配备护理人力资源、科学排班,提供个体化的适时护理,重视患者的睡眠时间及质量。     

Development and validation of a prediction model for functional decline in older medical inpatients

ObjectiveTo prevent functional decline in older inpatients, identification of high-risk patients is crucial. The aim of this study was to develop and validate a prediction model to assess the risk of functional decline in older medical inpatients.MethodsIn this retrospective cohort study, patients ≥65 years admitted acutely to medical wards were included. The healthcare database of 246 acute care hospitals (n = 229,913) was used for derivation, and two acute care hospitals (n = 1767 and 5443, respectively) were used for validation. Data were collected using a national administrative claims and discharge database. Functional decline was defined as a decline of the Katz score at discharge compared with on admission.ResultsAbout 6% of patients in the derivation cohort and 9% and 2% in each validation cohort developed functional decline. A model with 7 items, age, body mass index, living in a nursing home, ambulance use, need for assistance in walking, dementia, and bedsore, was developed. On internal validation, it demonstrated a c-statistic of 0.77 (95% confidence interval (CI) = 0.767–0.771) and good fit on the calibration plot. On external validation, the c-statistics were 0.79 (95% CI = 0.77–0.81) and 0.75 (95% CI = 0.73–0.77) for each cohort, respectively. Calibration plots showed good fit in one cohort and overestimation in the other one.ConclusionsA prediction model for functional decline in older medical inpatients was derived and validated. It is expected that use of the model would lead to early identification of high-risk patients and introducing early intervention.