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American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20–49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.  相似文献   
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背景国内外用于评估癌症患者支持性照护需求的量表较多,但有关此类量表质量的标准化评价研究及不同量表间的横向比较研究较为缺乏,也少有研究者对此类量表的测量特性进行系统的整合与评价。目的评价中文版癌症患者支持性照护需求量表的测量学性能及研究的方法学质量。方法2021年4月检索中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、EmBase、Web of Science、CINAHL Complete数据库,获取有关中文版癌症患者支持性照护需求量表测量学性能评价的研究,检索时限均为建库至2021年3月30日。由两位研究者独立筛选文献、提取资料后,采用健康测量工具遴选标准(COSMIN)系统综述指南,在对量表的测量特性及研究的方法学质量进行评价的基础上,综合评定中文版癌症患者支持性照护需求评估量表各测量特性的证据等级,并形成对于量表的最终推荐意见。采用描述分析法对评价结果进行汇总、分析。结果共纳入15项研究,涉及8个中文版癌症患者支持性照护需求评估量表〔癌症患者支持性照护需求简明问卷中文版(SCNS-SF34)、中文版支持性照护需求筛查工具(SCNS-ST9-C)、癌症患者综合需求评估量表(CNAT)、癌症需求简明问卷(CNQ-SF)、中文版癌症患者未满足需求量表(CaSUN-C)、癌症患者未满足需求简明量表(SF-SUNS)、晚期癌症患者需求评估问卷(ACNQ-41)、晚期癌症患者需求评估表简表(ACNQ-29)〕。就量表的测量特性质量而言,除ACNQ-29的内容效度为"未提及"外,其余7个量表的内容效度均为"不确定";除CaSUN-C、SF-SUNS的结构效度为"充分"外,其余6个量表的结构效度均为"不确定";SCNS-SF34、CNQ-SF、CaSUN-C、SF-SUNS的内部一致性为"充分",ACNQ-41的内部一致性为"不充分",其余3个量表的内部一致性为"不确定";CNAT、CNQ-SF、ACNQ-29的假设检验为"未提及",CaSUN-C、SF-SUNS、ACNQ-41的假设检验为"不确定",SCNS-SF34、SCNS-ST9-C的假设检验为"充分";除ACNQ-41的稳定性为"不充分",SCNS-ST9-C、ACNQ-29的稳定性为"未提及"外,其余5个量表的稳定性均为"充分";仅SCNS-SF34的跨文化效度为"充分",其余7个量表的跨文化效度均为"未提及"。8个量表的推荐等级均为B级。结论SCNS-SF34的测量特性得到了最为全面的评价,其具有较好的信效度,且临床应用可行性高,可暂时被推荐使用,但上述结论仍有待更多高质量证据加以支撑。  相似文献   
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BackgroundPolypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge.ObjectiveThis Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective.MethodsSystematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data.Results3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up).ConclusionsConsidering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation.  相似文献   
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徐素琴  向邱 《全科护理》2022,20(1):73-76
目的:探讨项目管理在降低呼吸重症监护室(RICU)环境物品表面多重耐药菌检出率中的应用效果。方法:采用目的抽样方法,选取医院呼吸与危重症医学科RICU 17张编制床位、32处高频接触环境物品表面及42名工作人员为观察对象。2019年1月—2019年3月实施RICU常规管理,2019年4月—2019年6月实施项目管理。比较项目管理前后RICU各类别工作人员手卫生依从率、RICU环境物品表面清洁合格率及多重耐药菌检出率。结果:在项目管理后RICU各类别工作人员手卫生依从率均高于项目管理前(P<0.05);项目管理后RICU环境物品表面清洁合格率较项目管理前升高(P<0.05);项目管理后多重耐药菌(MDRO)病人床单位及病区办公区域环境物体表面的耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯鲍曼不动杆菌(CRAB)检出率均较项目管理前降低(P<0.05)。结论:项目管理可有效提高RICU各类别工作人员手卫生依从性及环境物品表面清洁合格率,降低RICU环境物品表面多重耐药菌检出率。  相似文献   
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目的观察医护一体化管理模式对沙库巴曲缬沙坦治疗老年心力衰竭患者用药依从性及并发症的影响。 方法纳入2020年1月至12月江苏省人民医院心血管内科收治的老年心力衰竭患者106例,入院后给予强心、利尿等常规治疗,并在常规治疗的基础上加用沙库巴曲缬沙坦治疗。将106例患者按入院后管理方式的不同分为2组,对照组55例采用常规管理,医护一体化组51例采用医护一体化模式管理,患者出院后随访6个月。观察2组患者出院后总有效率、满意度、依从性和并发症发生率的差异。 结果出院后6个月随访可见,与对照组相比,医护一体化组患者并发症发生率显著降低(P<0.05),而总有效率、用药依从性和满意度均显著提高(P<0.05)。 结论对沙库巴曲缬沙坦治疗的老年心力衰竭患者而言,采用医护一体化管理模式可有效提高患者出院后的用药依从性,在提高总体疗效的同时还降低了并发症发生率。  相似文献   
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《Australian critical care》2022,35(4):362-368
BackgroundThere are limited published data on physical activity of survivors of critical illness engaged in rehabilitation in hospital, despite it plausibly influencing outcome.ObjectiveThe aims of this study were to measure physical activity of patients with critical illness engaged in rehabilitation in the intensive care unit (ICU) and on the acute ward and report discharge destination, muscle strength, and functional outcomes.MethodsThis was a single-centre, prospective observational study. Adults with critical illness, who received ≥48 h of invasive mechanical ventilation, and who were awake and able to participate in rehabilitation were eligible. To record physical activity, participants wore BodyMedia SenseWear Armbands (BodyMedia Incorporated, USA), during daylight hours, from enrolment until hospital discharge or day 14 of ward stay (whichever occurred first). The primary outcome was time (minutes) spent performing physical activity at an intensity of greater than 1.5 Metabolic Equivalent Tasks. Secondary outcomes included discharge destination, muscle strength, and physical function.ResultsWe collected 807 days of physical activity data (363 days ICU, 424 days ward) from 59 participants. Mean (standard deviation) duration of daily physical activity increased from the ICU, 17.8 (22.8) minutes, to the ward, 52.8 (51.2) minutes (mean difference [95% confidence interval] = 35 [23.8–46.1] minutes, P < .001). High levels of activity in the ICU were associated with higher levels of activity on the ward (r = .728), n = 48, P < .001.ConclusionsPatients recovering from critical illness spend less than 5% of the day being physically active throughout hospital admission, even when receiving rehabilitation. Physical activity increased after discharge from intensive care, but had no relationship with discharge destination. Only the absence of ICU-acquired weakness on awakening was associated with discharge directly home from the acute hospital. Future studies could target early identification of ICU-acquired weakness and the preservation of muscle strength to improve discharge outcomes.  相似文献   
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The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.  相似文献   
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