集束化护理在心内科危重患者压力性损伤管理中的应用效果

目的 探讨集束化护理在心内科危重患者压力性损伤管理中的应用效果。方法 选取2019年7～12月在心内科住院并病情危重的患者70例作为研究对象,分为对照组与观察组,每组各35例,其中对照组给予常规护理,观察组给予集束化护理,并比较分析两组患者压力性损伤的发生率、压力性损伤发生程度、压力性损伤发生时间以及压力性损伤护理满意度的情况。结果 集束化护理管理的观察组压疮发生率要低于常规护理的对照组的压力性损伤发生率(P0.05),观察组患者压力性损伤程度好于对照组(P0.05),观察组患者压力性损伤的发生时间长于对照组患者的压力性损伤发生时间(P0.05),观察组患者经过集束化护理后满意度要高于对照组,差异有统计学意义(P=0.039)。结论 对心内科危重患者进行集束化护理管理措施,能够有效降低心内科患者压力性损伤的发生率及严重程度,同时还延缓了压力性损伤的发生时间,并提升了患者的护理满意度,具有较好的应用效果。     

Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia

BackgroundFor couples coping with provoked vestibulodynia (PVD), interpersonal sexual goals are associated with sexual and psychological functioning as well as women’s pain during intercourse, however, self-focused sexual goals (eg, having sex for personal pleasure, having sex to avoid feeling bad about oneself) have not been studied in this clinical population.AimThe purpose of this study was to examine the associations between self-focused approach and avoidance sexual goals and women's pain during intercourse and sexual satisfaction and depressive symptoms for both women and their partners.MethodsWomen diagnosed with PVD (N = 69) and their partners completed measures of self-focused sexual goals, sexual satisfaction, and depressive symptoms. Women also reported on pain experienced during sexual intercourse.OutcomesOutcomes included the Global Measure of Sexual Satisfaction, the Beck Depression Inventory-II, and a Numerical Rating Scale of pain during sexual intercourse.ResultsWhen women reported higher self-focused approach sexual goals, they also reported lower pain intensity. Women's higher self-focused avoidance sexual goals were associated with their own higher depressive symptoms, whereas men's higher self-focused approach goals were associated with their own higher depressive symptoms. When controlling for frequency of sexual intercourse, there were no significant associations between women or partners' sexual goals and sexual satisfaction.Clinical ImplicationsWithin a clinical context where many interpersonal pressures for sex exist, interventions should target self-focused sexual goals alongside interpersonal sexual goals to improve pain and psychological adjustment.Strengths & LimitationsThis is the first study to examine self-focused sexual goals among women with PVD and their partners. This study is cross-sectional, and the direction of associations cannot be inferred. Couples were in mixed-sex relationships, and results may not generalize to same-sex couples.ConclusionFindings suggest that self-focused goals are relevant to the psychological adjustment of women with PVD and their male partners and for women's pain.Corsini-Munt S, Bergeron S, Rosen NO. Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia. J Sex Med 2020;17:975–984.     

基于“317护”健教平台的慢性肝病患者健康教育效果评价

目的探讨"317护"健教平台在住院的慢性肝病患者健康教育应用中的临床效果。方法选择2018年1～6月我院170例15～65周岁的住院患者为研究对象,采用随机数字表法等分为观察组和对照组,对照组由责任护士进行常规面对面的健康教育指导,观察组采用"317护"微信平台开展健康教育,比较两组患者对入院须知、疾病知识、治疗方法、检查须知、药物知识、饮食指导、出院指导等知识的掌握程度,两组患者对所获健康知识方式的满意度。结果观察组患者对入院须知、疾病知识、药物知识、饮食指导等的知晓率达93.95%,知识掌握程度明显高于对照组的81.18%,差异有统计学意义(P0.05),观察组患者对健康教育的满意度高于对照组,差异有统计学意义(P0.05)。结论结合"317护"健教平台的管理模式,能提高患者对健康教育知识的知晓率,促进患者对疾病的自我管理,提高其对护理工作的满意度。     

全程质控管理对提高消毒供应室护理管理质量、预防医院感染的作用

目的探讨消毒供应室采用全程质控管理模式进行干预对护理管理质量以及预防医院感染的影响作用。方法于该院2017年1-12月期间内接收的患者中选取117例作为对照组,此期间消毒供应室未实施全程质控管理。另于该院2018年1-12月期间内接收的患者中选取105例作为观察组,此期间消毒供应室实施全程质控管理。对比两组患者医院感染发生率以及消毒供应室满意率,并观察手术科室对消毒供应室工作人员工作质量评价情况。结果观察组医院感染发生率较对照组更低,且消毒供应室满意率较对照组更高;观察组清洗质量、器械处理、物品包装、环境监测评分较对照组均更高;差异有统计学意义(P<0.05)。结论全程质控管理可有效提高消毒供应室护理管理质量,降低医院感染事件发生率,临床实用价值较高。     

Impulsive and compulsive behaviors in Parkinson's disease: Impact on quality of and satisfaction with life,and caregiver burden

IntroductionTo disentangle the association between impulsive and compulsive behaviors (ICBs), health-related quality of life (HRQOL), satisfaction with life (SwL), and caregiver distress in dyads of people with Parkinson's disease (PwP) and caregivers.MethodsData used in this study were obtained from the ongoing Norwegian ParkWest study, a population-based longitudinal cohort study of the incidence, neurobiology and prognosis of PD in Western Norway. One hundred and one dyads of PwP free of dementia and their caregivers were included 5 years after PD diagnosis and inclusion in the ParkWest study. Standardized clinical rating scales were used to evaluate ICBs, HRQOL, SwL and caregiver distress.ResultsOf 101 PwP-caregiver dyads, self-reported ICBs were seen in 33% of PwP and only caregiver-reported ICBs in 12% of PwP. PwP-reported ICBs were associated with poorer HRQOL and SwL, whereas ICBs reported by caregivers only were associated with increased caregiver distress, but not poorer HRQOL or SwL in PwP.ConclusionsICBs have adverse effects on HRQOL, SwL and caregiver distress. These findings underpin the need for proper identification and management of ICBs in PwP.     

Breast reconstruction after therapeutic or prophylactic mastectomy for breast cancer: A comparison of guideline recommendations

BackgroundThe purpose of this article is to illuminate differences in published clinical practice guideline recommendations for breast reconstruction after prophylactic and therapeutic mastectomy.MethodsTen guidelines were identified through a systematic search of websites and databases of reputable oncology guideline developers, and key differences and gaps in recommendations were noted. Quality assessment of the guidelines was conducted by three reviewers using the AGREE II tool, focusing on breast reconstruction specific documents rather than the general breast cancer guidelines.ResultsThe most comprehensive guidelines were published by Alberta Health Services, Cancer Care Ontario, the American Society of Plastic Surgeons, and the Association of Breast Surgery/British Association of Plastic Reconstructive and Aesthetic Surgeons. AGREE II scores in the domains of “Scope and Purpose” and “Clarity and Presentation” were ranked relatively high for all four guidelines while “Applicability” and “Editorial Independence” were ranked relatively low. The Alberta and Ontario guidelines were the overall highest ranked guidelines across all domains.ConclusionOverall, these guidelines provide consistent recommendations on who should receive breast reconstruction education, who is a candidate for postmastectomy breast reconstruction, and the appropriate timing of reconstruction and extent of mastectomy. Future updates from all should focus on expanding to include alloplastic and autologous forms of reconstruction and should include a broad scope of relevant questions.     

自制气管套管固定装置对气管切开患者颈部皮肤保护作用观察

目的 观察自制气管套管固定装置对气管切开患者颈部皮肤的保护作用，探讨用于固定气管套管的可行性。方法60例气管切开患者采用随机数字法分为两组，每组30例。研究组使用自制气管套管固定装置固定气管套管；对照组使用传统棉布带固定。分别于固定后1、2、3周评价两组患者颈部皮损、切口皮损情况，并于第3周评价患者舒适度和家属满意度。结果研究组患者颈部皮损程度明显低于对照组，且皮损出现时间晚于对照组，差异均有统计学意义（Z=-5.183、-8.214，均P＜0.01）；切口皮损程度研究组比对照组明显减轻，差异有统计学意义（P＜0.01）；研究组患者舒适度及家属满意度分别为（7.57±1.01）、（7.77±0.86）分，对照组分别为（5.90±1.16）、（6.03±1.10）分，两组比较差异均有统计学意义（均P＜0.01）。结论使用自制的气管套管固定装置，可有效减轻患者颈部及切口皮肤损害，同时提高患者舒适度及家属满意度。     

A comparison of termination of pregnancy procedures: Patient choice,emotional impact and satisfaction with care

ObjectivesTo investigate: (1) whether women self-report an ability to choose their preferred termination of pregnancy (TOP) procedure, (2) what factors influence this choice, and (3) what effect this choice has on emotional responses and satisfaction with care.Study designA mixed-method prospective comparative study in which women requesting a TOP between five and eighteen weeks gestation for social reasons (as opposed to medical indications), were invited to complete a semi-structured pre-TOP interview and questionnaire, and a post-TOP questionnaire four weeks after the procedure.Main outcome measuresQuantitative data was collected using the Patient Health Questionnaire, Generalised Anxiety Disorder Scale, Positive and Negative Affect Scale, Impact of Event Scale – Revised, and Client Satisfaction Questionnaire.ResultsPre-TOP emotion-based factors did not differ between groups. Most women felt that they were able to choose their preferred method of TOP. Their decisions were based on factors categorised as procedure-related, lifestyle or social circumstance-related, emotional, or other factors. When no choice was perceived, common reasons reported were that: (1) gestation was too far along for there to be another option, or (2) an appointment was not available within the required timeframe. When women felt that the method of TOP performed was not their choice they found the procedure more stressful. All women reported high satisfaction with care.ConclusionA better understanding of the patient experience can inform service development, enabling staff to ensure that the services provided meet women’s needs. The perception that one is able to choose their preferred TOP procedure is important for reducing procedure-related stress and ensuring high satisfaction with care.