术前眼位注视训练对老年白内障超声乳化摘除术患者术中眼位及术后视力恢复的影响

目的探讨术前眼位注视训练对老年白内障超声乳化摘除术患者术中眼位及术后视力恢复的影响。方法选取2018年9月-2019年9月我院收治的105例老年白内障超声乳化摘除术患者为研究对象,按随机数字表法将其分为对照组52例和试验组53例。对照组给予常规围术期管理。观察组在对照组的基础上予以术前眼位注视训练。观察两组术中眼位情况,术后视力恢复情况及术后并发症发生率。结果试验组术中调整眼位次数>3次和眼球旋转偏移率均低于对照组(P<0.05);试验组术后视力恢复至0.5以上比例为60.38%,高于对照组的40.38%(P<0.05);试验组术后并发症发生率为15.09%,低于对照组的32.69%(P<0.05)。结论老年白内障超声乳化摘除术患者术前进行眼位注视训练,通过降低术中调整眼位次数和眼球旋转偏移率,降低术后并发症发生率,促进患者术后视力恢复。     

环形电切锥切术治疗老年宫颈高度病变病人的临床疗效

目的探讨环形电切锥切术(LEEP)治疗老年宫颈高度病变病人的临床效果及对逆转率的影响。方法选择2017年6月至2019年6月老年宫颈高度病变病人143例作为对象,采用随机数表法分为对照组(n=70)和观察组(n=73)。对照组采用宫颈冷刀锥切术治疗,观察组采用LEEP治疗,术后3 d对病人手术指标进行评估,术后对病人进行6个月随访,比较2组手术指标、逆转率、并发症发生率及术后生活质量。结果观察组手术、住院及切口愈合的时间,术中出血量及手术费用均少于对照组(P<0.05)。术后6个月,2组宫颈管粘连、感染、阴道出血的发生率差异均无统计学意义(P>0.05)。2组术后1、6个月逆转率差异均无统计学意义(P>0.05)。观察组术后6个月的健康、食欲、精神症状、躯体感觉及睡眠状态评分均高于对照组(P<0.05)。结论LEEP用于老年宫颈高度病变病人中,手术创伤较小,能提高逆转率,降低术后并发症发生率,有助于提高病人生活质量,值得推广应用。     

Protocol for a pilot and feasibility study of nurse practitioner-pharmacist telehealth collaboration to simplify complex medication regimens

IntroductionNew and flexible multidisciplinary workforce models are needed to address unnecessary medication regimen complexity in residential aged care facilities (RACFs). This study will investigate the feasibility of a nurse practitioner-pharmacist telehealth-based collaborative care model to simplify complex medication regimens.MethodsThis is a pragmatic, non-randomized pilot and feasibility study of up to 30 permanent residents from 4 RACFs in Western Australia. Simplification will be conducted in accordance with a validated 5-step implicit process. Nurse practitioners will identify residents potentially interested in and who may benefit from simplification, including any regulatory or safety imperatives that might preclude simplification. Medication regimens will be assessed by an off-site clinical pharmacist to identify opportunities for simplification in terms of drug–drug, drug–food, or drug–time interactions, and the availability of alternative formulations. The pharmacist will communicate simplification opportunities to nurse practitioners via video case conferencing. Nurse practitioners will then discuss simplification opportunities with the resident, caregiver and the health and care team, including any unintended consequences for the resident or RACF. The primary outcome measure will be feasibility (stakeholder acceptability, protocol adherence, recruitment and retention rates). Secondary outcomes include change in the number of medication administration times per day, medication and behavioral incidents, falls and fractures, hospitalization and mortality at 4 months.Ethics and disseminationEthical approval has been obtained from the Monash University Human Research Ethics Committee. Research findings will be disseminated through industry report, lay summaries, conference presentations and peer-reviewed publications.     

An observational study of the maintenance of the 30° side‐lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose‐designed positioning device

The aim of the study was to evaluate the maintenance of the 30° side‐lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose‐designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated‐measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.     

老年癌症患者恐惧疾病进展与希望水平的相关性研究

目的了解老年癌症患者恐惧疾病进展及希望水平现状,并探讨两者相关性。方法采用一般资料调查表、中文版恐惧疾病进展简化量表和Herth希望量表对226例老年癌症患者进行调查。结果老年癌症患者恐惧疾病进展总分为(35. 04±6. 49)分,希望总分为(34. 93±5. 07)分。老年癌症患者恐惧疾病进展总分及各维度得分与希望总分及各维度得分呈负相关(均P 0. 01)。结论老年癌症患者恐惧疾病进展水平较高,且与希望水平有显著相关性,提高患者希望水平可改善其恐惧疾病进展水平。