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1.
目的调查上海市2022年3月以来新一波新型冠状病毒肺炎(COVID-19)疫情期间方舱医院新冠肺炎患者心理健康状况,并分析影响因素,为开展针对性的心理干预和治疗提供科学依据。方法于2022年4月6日—5月11日,采用横断面研究、方便抽样法,应用微信小程序“同心守沪”对上海市3所方舱医院新冠肺炎患者采用突发性公共卫生事件心理问卷,调查心理健康状况,并初步分析影响因素。结果共268例患者完成问卷调查,心理症状检出者261例(97.4%),其中抑郁、神经衰弱、恐惧、强迫-焦虑、疑病症状检出率分别为80.6%、69.8%、89.6%、75.4%、41%。心理健康总评分影响因素有年龄(P=0.008)、躯体疾病(P=0.03)、既往是否有精神心理问题(P<0.001)、疫情对心身的影响程度(P<0.001);抑郁评分(P=0.019)和神经衰弱评分(P=0.021)还受教育程度影响;神经衰弱评分还受性别影响(P=0.024);疑病评分还受新冠肺炎认知程度影响(P=0.007)。结论上海市方舱医院集中隔离治疗点内患者恐惧、抑郁、强迫-焦虑症状多见,心理异常症状严重程度以轻、中度为主。随年龄越小、受教育程度越高、女性患者、有躯体疾病、既往存在精神心理问题、对新冠肺炎认知程度低、疫情对心身影响程度越大,心理症状总分越高,症状越严重。  相似文献   
2.
Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.  相似文献   
3.
ObjectivesGeriatric inpatient rehabilitation aims to restore function, marked by physical performance, to enable patients to return and remain home after hospitalization. However, after discharge some patients are soon readmitted, institutionalized, or may die. Whether changes in physical performance during geriatric rehabilitation are associated with these short-term adverse outcomes is unknown. This study aimed to determine the association of changes in physical performance during geriatric inpatient rehabilitation with short-term adverse outcomes.DesignObservational longitudinal study.Setting and ParticipantsGeriatric rehabilitation inpatients of the REStORing health of acutely unwell adulTs (RESORT) cohort study of the Royal Melbourne Hospital (Melbourne, Australia) were included.MethodsThe change from admission to discharge in the Short Physical Performance Battery (SPPB) score, balance, gait speed (GS), chair stand test (CST), and hand grip strength (HGS) were calculated and analyzed using logistic regression analysis with readmission, incidence of institutionalization, and mortality, and ≥1 adverse outcome within 3 months postdischarge.ResultsOf 693 inpatients, 11 died during hospitalization and 572 patients (mean age 82.6 ± 7.6 years, 57.9% female) had available physical performance data. Within 3 months postdischarge, 47.3% of patients had ≥1 adverse outcome: readmission was 20.8%, institutionalization was 26.6%, and mortality was 7.9%. Improved SPPB score, balance, GS, CST, and HGS were associated with lower odds of institutionalization and mortality. Improved GS was additionally associated with lower odds of readmission [odds ratio (OR) 0.35, 95% CI 0.16-0.79]. CST score had the largest effect, with a 1-point increase associating with 40% lower odds of being institutionalized (OR 0.60, 95% CI 0.42-0.86), 52% lower odds of mortality (OR 0.48, 95% CI 0.29-0.81), and a 24% lower odds of ≥1 adverse outcome (OR 0.76, 95% CI 0.59-0.97).Conclusions and ImplicationsImprovement in physical performance was associated with lower odds of short-term institutionalization and mortality indicating the prognostic value of physical performance improvement during geriatric inpatient rehabilitation.  相似文献   
4.
PurposeThis study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes.MethodsA before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence postadmission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed.ResultsRegarding nurse outcomes, handover quality (p < .001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between preintervention and postintervention.ConclusionDespite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.  相似文献   
5.
[目的]分析地市级公立医院住院患者在医疗技术、医德医风、服务态度、流程管理、医疗费用、就医环境等方面的就医体验,对地市级公立医疗服务质量进行科学评估,为进一步提高地市级公立医院服务质量提供依据。[方法]从某市域内选取4家公立医院的518名患者进行面对面问卷调查。采用描述性分析方法、Friedman M秩和检验、Pearson相关分析方法了解样本基本情况和住院患者对服务质量的体验评价情况,采用t检验、方差分析、Kruskal-Wallis检验和多元线性回归分析方法探讨影响住院患者总体体验的主要因素。[结果]地市级公立医院住院患者服务质量总体体验得分为(3.36±1.75)分,6个维度体验感得分依次为:医德医风>服务态度>医疗技术>流程管理>医疗费用>就医环境;年龄、职业类别、医生技术水平、杜绝索礼受贿、护士态度和善、合法权益保护、住院费用明白合理、等待入院天数、住院环境安静和住院费用可承受是影响住院患者体验的主要影响因素(P<0.05)。[结论]地市级公立城市住院患者服务质量体验评价处于一般水平,对医德医风的体验感较高,对住院环境和住院费用可承受的体验感较差。总体来说,年龄越大,住院患者体验越低;职业类别、医生技术水平、杜绝索礼受贿、护士态度和善、合法权益保护、住院费用明白合理、等待入院天数、住院环境安静和住院费用可承受是影响住院患者总体体验的正性因素。  相似文献   
6.
目的 分析不同特征的结直肠癌患者就医行为选择在中医院(含中西医结合医院)、西医院及肿瘤专科医院间的差异,为合理引导结直肠癌患者适宜就医及制订相关政策提供依据。方法 收集北京地区2018年1月-2019年12月17家三级甲等医院21894例首诊结直肠癌成年住院患者的病案首页数据,采用EmpowerStats 2.0对数据进行描述性分析。结果 21894例结直肠癌患者中就诊于中医院的有862例(3.93%),西医院的有8723例(39.85%),肿瘤专科医院的有12309例(56.22%)。对于不同医疗机构,男性占比均大于女性,58-68岁患者占比最大。且结直肠癌患者年龄、医疗付款方式及肿瘤分期在不同医疗机构间的分布存在差异(P<0.001)。西医院及肿瘤专科医院结直肠癌Ⅲ期患者占比最大,而就诊于中医院患者中结直肠癌Ⅳ期最多。从地域分布来看,异地就诊比例(57.32%)大于本地,且就诊于肿瘤专科医院的患者中73.66%来自外地。患者来源前三名分别是北京市、河北省及内蒙古自治区。而在北京市内,西医院患者主要来源于朝阳区、海淀区及西城区,中医院患者主要来源于海淀区、朝阳区及丰台区,肿瘤专科医院则主要来源于朝阳区、海淀区及丰台区。结论 应大力倡导年轻以及早期结直肠癌患者向中医院分流,充分施展中医药在结直肠癌患者中的治疗优势;发挥三级医院带动作用,建立对口帮扶医院,减少不必要的跨省流动及提倡结直肠癌的早筛早治,以降低结直肠癌死亡率。  相似文献   
7.
紧扣公立医院内控精细化管理要求,提出智慧财务体系的设计思路、总体框架及实施路径,以期实现业务层面动态定位和全流程管理。同时,结合新兴技术,以COSO内控框架为指引,搭建"一枢纽三平台"智慧财务体系,促进公立医院运营管理提质增效。  相似文献   
8.
新型冠状病毒肺炎疫情引起全球关注,病毒的高度传染性致使疫情迅速蔓延和大规模暴发。在应对突发的迅速蔓延的疫情过程中,快速建设一个安全性能高的应急传染病专科医院,对于患者治疗、医护人员防护和疫情的控制十分重要。笔者结合“三山医院”建设的经验和温州医科大学附属第一医院应急传染病治疗中心改造的实际经验,系统地对医院选址、医院规划和设计、暖通系统、给排水系统、医用气体要求及医疗废物处置进行阐述,并对关键环节进行探讨。  相似文献   
9.
Researchers continue to lament the lack of organisational focus in the sociology of health and illness. Although studies have increasingly focused on boundaries between organizations, little such research has focused on the formal boundaries within the hospital itself. Given its dramatic compartmentalisation, and continuing prevalence in health systems, the lack of organisational perspective in hospital research limits insights into the effects (as well as the construction) of the order of health work and care. With a greater emphasis on ‘ordering’ in the concept of negotiated order, the aim of this study is to examine the manifestation and consequences of the formal boundaries of hospital departments. Fieldwork featured 12 months of ethnography, including formal and informal observations, 80 audio‐recorded, semi‐structured interviews, and 56 field interviews, in the Emergency Departments (EDs) of two tertiary referral hospitals. Compared with in‐patient hospital departments, the ED has limited legitimacy claims of organ‐specific knowledge to transfer patients out of the ED. The manifestation of specialised knowledge hierarchies in organisational structures disadvantages patients who are older and who have chronic conditions, underpinning the argument that effects as well as the negotiation of stable organisational orders deserve increased attention in the sociology of health and illness.  相似文献   
10.
One of the international objectives in psychiatric care is reducing the use of coercion. Containment methods are meant to keep patients safe, yet usually include coercion. Nurses play a key role in deciding whether or not containment should be used and, as such, their attitudes towards containment can significantly impact the extent to which these methods are applied. The aim of this integrative review was to identify, analyse, and synthesize the available research on psychiatric nursing staffs’ attitudes towards containment methods in inpatient psychiatric care. An electronic search was conducted using the CINAHL, Scopus, and PsycINFO databases. In addition, the citations of identified studies were screened for relevant research. A total of 24 relevant papers published between 2002 and 2017 were selected for further analysis. These studies revealed variation in nursing staffs’ attitudes towards the use of containment methods. The use of containment methods seems to be widely accepted and nurses reported rarely considering alternative measures. It appears that attitudes towards containment have continuously become more negative, although the change has not been very pronounced. The concept of attitude was only defined in two studies. Thus, future research should strive to clarify this concept, as a generally accepted definition for attitude within nursing research and the utilization of all dimensions of this concept are both essential to the nursing field. Currently, it would be important to focus on changing attitudes among psychiatric nursing staff to reduce the use of containment methods; this calls for more research on nursing staffs’ attitudes.  相似文献   
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