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ObjectiveTo investigate whether a tailored intersectoral discharge program (TIDP) impacts on multidimensional frailty, rehospitalization days, and patient-related outcome measures in older in-patients undergoing acute care and usual rehabilitative care.DesignRandomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019–2020, and historical control with a 6-month follow-up, 2016–2019.Setting and ParticipantsGeriatric co-managed internal medicine ward of a metropolitan university hospital. One hundred-twelve multimorbid patients older than age 60 years were consecutively assessed for eligibility and inclusion (age ≥60 years, multimorbidity, admitted for treatment of acute disease, at least 2 geriatric syndromes requiring usual rehabilitative care, and able to consent) and signed informed consent, with 110 recruited and randomized to either TIDP or usual rehabilitative care. At discharge, 104 patients were alive in the intention-to-treat group, the 6-month follow-up was completed for 91 patients. A historical control group of 468 patients was included for comparison.InterventionTIDP as intervention included contact with treating general practitioner to discuss the further treatment plan, a structured medical and lifestyle counseling to patients and caregivers at admission as well as a discharge program with internist, geriatrician, and general practitioner in shared decision making with patients.MethodsFifty-four patients underwent TIDP, 53 patients underwent usual rehabilitative care only. Rehospitalization days at follow-up as primary endpoint; multidimensional frailty and prognosis (Multidimensional Prognostic Index, Geriatric Depression Scale, Rosenberg Self-Esteem Scale, quality of life, falls, mortality, home care service need, and need of long-term care at 1-, 3- and 6-month follow-up as secondary endpoints.ResultsTIDP (median age 76.0 years, 56% female) showed significantly improved Multidimensional Prognostic Index scores at discharge compared with usual rehabilitative care (median age 78.5 years, 58% female) (0.43 vs 0.49, P = .011). Compared with usual rehabilitative care, TIDP improved self-confidence (Rosenberg Self-Esteem Scale 13.9 vs 12.4, P = .009) and mood (Geriatric Depression Scale 4 vs 5, P = .027) at follow-up. Compared with historical control (median age 77.0 years, 39 % female), usual rehabilitative care patients showed significantly lower rehospitalization rates (53% vs 70%, P = .002) and lower mortality rates (13% vs 32%, P < .001).Conclusions and ImplicationsA feasible TIDP improves frailty and mood in advanced age. In older patients undergoing potentially disabling acute treatments, usual rehabilitative care significantly reduces rehospitalization rates. Therefore, implementing geriatric treatment in general is useful to improve outcomes in older in-patients and a tailored discharge program can further increase the benefit for this frail population.  相似文献   
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周潇潇   《妇幼护理》2022,2(15):3418-3420
目的 研究将妊高症护理在产科护理中对提升母婴生活质量的影响。方法 2021 年 9 月至 2022 年 7 月在本院实施分娩的 110 例产妇,按照护理模式的不同将其分为对照组和观察组。对照组实施常规护理,观察组在实施常规护理工作的基础上应用 妊高症护理。比较两组的母婴分娩结局,新生儿状态和护理满意度。结果 观察组产妇难产发生率、子痫发生率、产后出血发 生率优于对照组(P<0.05)。观察组护理满意度高于对照组(P<0.05)。结论 将妊高症护理措施应用在产科护理,能够改善母婴 结局,提高护理满意度。  相似文献   
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BackgroundValue-based contracts that tie payments for pharmaceuticals to predefined outcomes aim to promote value through shared risk and aligned incentives between manufacturers and payers.MethodsWe conducted a Delphi study among diverse stakeholders (patients, providers, payers, pharmacy benefits managers, pharmaceutical company representatives) to identify top meaningful outcomes for inclusion in value-based contracts for atrial fibrillation medications. The final panel (n = 55) rated the importance of each outcome on a 5-point Likert scale and selected their top 3 most meaningful outcomes. Non-patient participants rated the feasibility of collecting each outcome on a 5-point Likert scale. Consensus was defined as ≥75% agreement (Likert scores ≥4/5 or selection of an outcome as most meaningful). Differences between stakeholder groups were examined using Fisher's Exact Test.ResultsConsensus was achieved for importance of 10 outcomes (Likert scale), where “preventing stroke or mini-stroke” reached 100% agreement (55/55). Eighty-one percent (44/54) of participants selected “preventing stroke or mini-stroke” as the most meaningful outcome (rank order question). The measures rated as most feasibly collected were “reducing hospitalizations” (97%, 36/37) followed by “preventing stroke or mini-stroke” and “reducing emergency department visits” (both 92%, 34/37). There were statistically significant differences between patients and non-patients [0% (0/17) vs 22% (8/37), P = 0.047] and patients and providers [0% (0/17) vs 39% (7/18), P = 0.008] in selection of “improving health-related quality of life” as a most meaningful outcome.ConclusionsThese findings will inform the design of atrial fibrillation value-based pharmaceutical contracts and provide additional insight into preferences for outcomes which could be used to improve the quality of atrial fibrillation care.  相似文献   
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《Value in health》2022,25(4):482-491
ObjectivesExisting measures for estimating quality-adjusted life-years are mostly limited to health-related quality of life. This article presents an overview of the development the EQ-HWB (EQ Health and Wellbeing), which is a measure that encompasses health and wellbeing.MethodsStages: (1) Establishing domains through reviews of the qualitative literature informed by a conceptual framework. (2) Generation and selection of items to cover the domains. (3) Face validation of these items through qualitative interviews with 168 patients, social care users, general population, and carers across 6 countries (Argentina, Australia, China, Germany, United Kingdom, United States). (4) Extensive psychometric testing of candidate items (using classical, factor analysis, and item response theory methods) on > 4000 respondents in the 6 countries. Stakeholders were consulted throughout.ResultsA total of 32 subdomains grouped into 7 high-level domains were identified from the qualitative literature and 97 items generated to cover them. Face validation eliminated 36 items, modified 14, and added 3. Psychometric testing of 64 items found little difference in missing data or problems with response distribution, the conceptual model was confirmed except in China, and most items performed well in the item response theory in all countries. Evidence was presented to stakeholders in 2 rounds of consultation to inform the final selection of items for the EQ-HWB (25-item) and the short version of EQ-HWB (9-items).ConclusionsEQ-HWB measures have been developed internationally for evaluating interventions in health, public health, and social care including the impact on patients, social care users, and carers.  相似文献   
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急性呼吸窘迫综合征发展至今五十余年,从最初的机械通气治疗到呼吸机相关肺损伤的识别,肺保护通气策略已成临床诊疗共识,但这一策略限制了呼吸机或患者自身呼吸努力对肺部施加的机械压力,脱机困难发生率日趋增加,膈肌功能障碍作用日趋明显,膈肌保护性通气策略应运而出,优化机械通气参数和膈肌负荷,减少人机不同步,可减轻或避免膈肌损伤。但肺保护仍然是机械通气首要考虑的因素,通过最佳方式来降低机械通气的并发症,优化患者呼吸努力,从而达到同时保护肺和膈肌的作用。本文就膈肌保护性通气的概念和进展进行综述。  相似文献   
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五味子乙素是五味子中主要活性成分之一,具有多种药理作用。长期研究表明五味子乙素具有保护肝脏、肾脏、肺和心脑血管等作用。五味子乙素的多器官保护作用通过不同的途径起效,作用机制包括抗氧化、抗炎、抗纤维化、促进热休克反应、调节脂质代谢、抑制细胞凋亡。就五味子乙素对各器官的保护作用的分子机制进行了总结,为推进其药理研究和分子机制的阐明以及临床应用提供参考。  相似文献   
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目的探讨多部门合作在多重耐药菌(MDRO)医院感染防控中的作用。方法回顾性分析多部门合作管理实施前(2019年1~12月)期间所有住院患者1478例进行检测统计,从2020年1月开始实施多部门合作管理,具体包括:(1)建立多部门合作管理组织体系;(2)建立MDRO三级管理网络;(3)多学科联合培训;(4)临床科室配备临床药师;(5)采用医院感染监控系统对微生物标本的送检、MDRO的检出率、耐药菌普的变迁、抗菌药物的使用等进行实时监控;(6)由院感科、医务处牵头,定期对MDRO检出率高的科室和重点科室进行联合查房检查;(7)采用PDCA循环模式对医院感染防控措施的各个环节质控;对多部门合作管理实施后(2020年1~12月)所有住院患者1849例进行检测统计,对比实施前后医院感染发生率和MDRO检出率、手卫生依从率和接触隔离执行率及治疗性使用抗菌药物标本送检率和抗菌药物合理使用率。结果多部门合作管理实施后医院感染发生率和MDRO检出率明显低于实施前(χ2=46.611,χ2=16.814,P<0.05);手卫生依从率和接触隔离执行率明显高于实施前(χ2=25.357,χ2=29.227,P<0.05);治疗性使用抗菌药物标本送检率抗菌药物合理使用率明显高于实施前(χ2=25.576,χ2=33.624,P<0.05)。结论多部门合作管理的实践发挥学科间优势互补,提高医务人员对MDRO防控措施落实的执行力,可有效降低MDRO医院感染发生率。  相似文献   
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