个性化康复护理在老年股骨转子间骨折中的应用

目的探讨个性化康复护理在老年股骨转子间骨折中的应用效果。方法选择2012年12月—2014年6月收治的老年股骨转子间骨折患者80例,随机分为对照组38例和观察组42例。对照组采用骨科常规护理,观察组在常规护理的基础上,进行个性化康复护理。两组均于术后15 d、3、6个月进行Harris评分,比较两组压力性溃疡、下肢深层静脉血栓、肺部感染的发生情况,对患者或家属进行满意度测评。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果术后3、6个月,对照组Harris评分分别为(69.35±6.56)、(85.68±3.66)分,观察组分别为(80.29±5.81)、(93.17±2.49)分,两组比较差异均有统计学意义(均P0.05)。术后15 d,对照组下肢深静脉血栓及肺部感染发生率分别为26.32%、18.42%,观察组分别为4.76%、2.38%,两组比较差异均有统计学意义(均P0.05)。对照组总满意率为71.05%,观察组为95.24%,两组比较差异有统计学意义(P0.05)。结论个性化康复护理促进了患者髋关节功能的恢复,减少了并发症的发生,提高了患者满意度。     

早期活动护理预防脑出血患者术后下肢深静脉血栓的效果

目的:探讨早期活动护理预防脑出血患者术后下肢深静脉血栓的效果.方法:选择2016年1月-2017年1月于本院进行手术的脑出血患者92例作为研究对象,并随机分为对照组45例与观察组47例,对照组接受常规护理,观察组在常规护理基础上进行早期活动护理,观察两组患者术后下肢深静脉血栓发生情况.结果:观察组下肢深静脉血栓发生率(6.38%)明显低于对照组(26.67%)(P<0.05).结论:早期活动护理应用于脑出血术后患者,可有效避免下肢深静脉血栓形成,对稳定患者病情,促进术后康复具有一定应用价值.     

正念训练对食管癌患者术后负性心理与睡眠及生活质量影响

目的食管癌术后多数患者存在抑郁和焦虑等负性心理,影响患者睡眠、术后康复和生活质量,为改善这种情况,本研究探讨正念训练即将情绪和压力的管理,以及疾病的临床适应方法应用于食管癌术后护理,为食管癌术后护理提供指导。方法选取2017-02-01-2018-08-10南阳医学高等专科学校第一附属医院胸外科收治的83例手术治疗食管癌患者,根据入院顺序编号,单号为对照组42例,双号为观察组41例,两组患者均接受8d术后护理,观察组采用正念训练,对照组采用常规护理。采用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)评估患者的负性心理情况,采用匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)量表评估患者睡眠质量,入院时及干预后比较两组患者的负性心理和睡眠质量得分。对两组患者院外随访3个月后,采用QLQ-C30生活质量量表评估患者的生活质量。结果术后护理8d后,观察组与对照组SAS评分分别为(50.50±6.72)和(57.30±7.15)分,差异有统计学意义,t=-4.463,P=0.012;SDS评分分别为(41.40±7.01)和(50.70±6.89)分,差异有统计学意义,t=-6.947,P=0.001;PSQI评分分别为(6.52±2.40)和(8.77±3.61)分,差异有统计学意义,t=-3.335,P=0.008。随访3个月,观察组生活质量评分中躯体功能(t=6.508,P=0.001)、角色功能(t=2.897,P=0.028)、认知功能(t=4.317,P=0.005)、情绪功能(t=6.868,P=0.001)和社会功能(t=4.773,P=0.005)评分差异均有统计学意义。结论情绪和压力的管理方法正念训练可减轻食管癌患者术后焦虑、抑郁状况,改善负性心理,提高睡眠质量,对改善术后长期生活质量有一定的帮助。     

糖尿病合并冠心病PCI术后患者微信平台和移动APP延续性护理效果观察

目的糖尿病是常见的慢性终身代谢性疾病,心血管疾病是其常见的并发症,经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗糖尿病合并冠心病效果显著,但术后康复护理仍是重要一环,有效的延续护理是患者生命安全和生活质量的保证。本研究探讨基于微信平台和移动应用程序(application,APP)的延续性护理在糖尿病合并冠心病患者行PCI术后的应用效果,为提高患者自我护理能力和生活质量提供参考。方法选择2015-01-01-2016-10-01平顶山市第一人民医院收治的104例2型糖尿病合并冠心病PCI术后患者作为研究对象,按照护理方法的不同分为对照组与观察组各52例。对照组进行常规出院宣教和电话回访等,观察组进行基于微信平台和移动APP的延续性护理。比较两组血糖控制、疾病认知、自我护理能力和生活质量等。结果护理后,观察组FBG水平为(5.58±1.26)mmol/L,低于对照组(7.17±1.58)mmol/L,t=5.674,P0.001;观察组2hPBG水平为(7.75±2.25)mmol/L,低于对照组(9.08±2.51)mmol/L,t=2.845,P=0.005。护理后观察组疾病认知评分为(22.45±1.87)分,高于对照组(19.56±1.75)分,t=8.137,P0.001;护理后观察组药物使用评分为(22.71±1.25)分,高于对照组(20.21±1.38)分,t=9.682,P0.001;护理后观察组服药依从性评分为(23.68±1.22)分,高于对照组(20.24±1.59)分,t=12.378,P0.001;护理后观察组症状管理评分为(20.36±1.85)分,高于对照组(17.39±2.59)分,t=6.729,P0.001;护理后观察组情绪管理评分为(20.29±1.50)分,高于对照组(18.26±1.43)分,t=6.869,P0.001。随访1年后,观察组躯体疼痛评分为(84.5±7.3)分,高于对照组(81.2±7.6)分,t=2.258,P=0.026;观察组生理功能评分为(86.5±8.1)分,高于对照组(83.1±7.9)分,t=2.167,P=0.033;观察组生理职能评分为(87.4±7.1)分,高于对照组(82.8±8.4)分,t=3.016,P=0.003;观察组总体健康评分为(86.8±6.9)分,高于对照组(82.5±7.2)分,t=3.109,P=0.002;观察组精神健康评分为(85.9±7.5)分,高于对照组(82.1±8.6)分,t=2.401,P=0.018;观察组情感职能评分为(86.9±6.4)分,高于对照组(81.7±7.9)分,t=3.688,P0.001;观察组社会功能评分为(88.4±7.8)分,高于对照组(83.1±7.4)分,t=3.555,P0.001;观察组活动评分为(86.7±6.5)分,高于对照组(83.6±6.3)分,t=2.470,P=0.015。结论基于微信平台和移动APP的延续性护理能够显著提高糖尿病合并冠心病PCI术后患者的护理效果,患者血糖控制良好,自我护理能力提升,生活质量明显提高。     

妇科术后静脉血栓预警机制联合多元护理效果观察

目的妇产科术后患者多属于深静脉血栓形成(deep venous thrombosis,DVT)的高危人群,针对可能存在的妇产科术后DVT风险开展预警研判和风险处理,是妇产科术后护理的管理重点。本研究探讨预警机制联合多元护理改善妇科术后DVT的防治效果,为有效降低静脉血栓栓塞症发生率提供依据。方法选取2017-05-01-2019-05-01在本院接受妇科手术治疗的160例患者纳入研究,分为观察组和对照组各80例。两组均接受常规围手术期护理,观察组依据现有循证医学证据,参考DVT预防指南和专家意见,制定针对性"静脉血栓预警机制联合多元护理"的干预流程。观察两组患者术后DVT相关症状,记录血小板、血浆D-二聚体等主要血液指标的变化情况,对两组患者DVT发生率进行比较。结果观察组术后7d,膝下10cm腿围为(2.44±1.02)cm,低于对照组的(3.26±1.04)cm,t=6.629,P0.001;膝上10cm腿围为(3.13±0.91)cm,低于对照组的(3.55±1.15)cm,t=2.729,P=0.006。观察组术后24h的D-D水平为(6.42±0.52)ng/L,低于对照组的(7.35±0.55)ng/L,t=2.427,P=0.019;观察组术后24h的血小板计数为(141.57±23.27)×109 L-1,高于对照组的(112.21±24.31)×109 L-1,t=4.530,P0.001。观察组术后症状积分为(3.95±2.12)分,低于对照组的(4.67±2.40)分,t=5.051,P0.001。观察组术后DVT发生率为3.75%,低于对照组的8.75%,χ~2=6.275,P=0.027。结论妇科病房构建静脉血栓预警机制联合多元护理的干预策略,有助于医护人员对DVT风险进行准确评估和合理治疗决策,对于妇产科术后深静脉血栓的防治具有重要价值。     

针对性护理干预对肾下型腹主动脉瘤术后病人下肢DVT发生率的影响

目的:探讨针对性护理干预对肾下型腹主动脉瘤术后患者下肢DVT发生率的影响。方法:取我院2017-05～2019-08期间70例接受肾下型腹主动脉瘤术治疗的患者,随机分为观察组(n=35)与对照组(n=35)。观察组患者术后采用目标策略的针对性护理,对照组患者术后采用常规护理。对比两组患者术后下肢深静脉血栓(DVT)发生情况与生活质量。结果:与对照组相比,观察组下肢DVT发生率较低,差异有统计学意义(P0.05);与对照组相比,观察组生活质量评分均较高,差异有统计学意义(P0.05)。结论:目标策略的针对性护理干预可有效降低肾下型腹主动脉瘤术后下肢DVT发生率,提高患者生活质量。     

骨科老年患者术后下肢深静脉血栓预防中应用集束化护理的效果

目的:研究骨科老年患者术后下肢深静脉血栓预防中应用集束化护理的效果。方法:将2016年4月至2018年3月期间我院行骨科手术的122例老年患者随机分组,分别为实施常规护理的对照组和进行集束化护理的观察组,每组各61例,比较分析两组患者的护理效果。结果:护理干预后,观察组患者住院时间明显短于对照组(P0.05);观察组患者术后下肢深静脉血栓发生率明显低于对照组(P0.05);观察组患者护理满意度显著高于对照组(P0.05)。结论:老年骨科患者在术后给予集束化护理能够促进患者的康复,减少下肢深静脉血栓的发生,提高患者满意度,改善预后效果,值得临床应用。     

常染色体显性遗传性多囊肾病并发高血压患者特色降压护理效果

目的常染色体显性遗传性多囊肾病(autosomal dominant polycustic kidney disease,ADPKD)并发高血压对患者身体健康危害极大,为提高治疗效果,促进患者恢复,有效的护理非常关键。本研究探讨ADPKD并发高血压特色降压护理方法及效果。方法选取2016-02-01-2017-12-31沈阳市红十字会医院收治的120例ADPKD合并高血压患者进行分组护理,根据护理方式的不同分为观察组和对照组各60例。对照组实施常规血压控制及生命体征监测,观察组在对照组基础上实施特色降压护理,观察对比两组护理前后各项生化指标、血压水平及患者护理满意度。结果护理后,观察组舒张压为(90.5±6.1)mm Hg,低于对照组的(94.0±8.6)mm Hg,t=2.571,P=0.011;观察组收缩压为(140.2±12.5)mm Hg,低于对照组的(145.6±12.1)mm Hg,t=2.404,P=0.025;观察组患者护理满意度为91.67%,高于对照组的66.67%,χ~2=9.903,P=0.002。护理后,观察组左心室质量指数(left ventricular mass index,LVMI)为(129.4±10.9)g/m~2,低于对照组的(134.1±12.1)g/m~2,t=2.235,P=0.027;观察组肌酐清除率(creatinine clearance rate,CCR)为(64.1±5.9)mL/min,低于对照组的(68.4±5.3)mL/min,t=4.200,P0.001;观察组尿蛋白/肌酐为(72.8±10.4)μmol/L,低于对照组的(77.5±12.1)μmol/L,t=2.282,P=0.024。结论 ADPKD并发高血压患者给予特色降压护理具有显著疗效,有效降低患者血压水平,提高患者护理满意度,并改善患者生活质量。     

冠心病患者责任制护理效果观察

目的冠心病治疗应在控制病情发展的同时,预防心力衰竭及心肌梗死等并发症的发生,因此实施有效的护理干预措施具有重要的意义。本研究探讨责任制护理对冠心病患者护理质量及病情康复的影响。方法选取2017-03-01-2018-03-31抚顺市第二医院收治的冠心病患者86例,按照配比的方法分为对照组和观察组,各43例。给予对照组患者常规护理干预,观察组在对照组基础上实行责任制护理,对比两组护理效果。结果观察组和对照组沟通能力评分分别为(96.23±3.12)分和(86.55±5.23)分,差异有统计学意义,t=10.423,P0.001;工作态度评分分别为(95.98±3.67)分和(85.34±5.24)分,差异有统计学意义,t=10.906,P0.001;护理技巧评分分别为(95.76±3.45)分和(85.13±6.02)分,差异有统计学意义,t=10.046,P0.001;书写规范评分分别为(96.53±3.14)分和(86.32±5.95)分,差异有统计学意义,t=9.952,P0.001。观察组和对照组心绞痛发作评分分别为(92.34±4.25)分和(80.33±6.12)分,差异有统计学意义,t=10.570,P0.001;心绞痛稳定性评分分别为(91.56±4.67)分和(80.67±5.78)分,差异有统计学意义,t=9.610,P0.001;疾病认知程度评分为(90.33±5.08)分和(81.23±5.56)分,差异有统计学意义,t=7.923,P0.001;治疗满意度评分为(91.67±5.35)分和(80.54±5.78)分,差异有统计学意义,t=9.267,P0.001。结论给予冠心病患者责任护理可提升护理质量,改善患者临床症状,促进患者恢复。     

常规切开挂线术与微创手术对复杂肛瘘患者疼痛程度及并发症影响

目的复杂肛瘘临床常以手术方式治疗,切开挂线术为常用术式,但以该术式治疗术后并发症较多。微创技术近年来在临床运用日益成熟,本研究探讨复杂肛瘘患者使用常规切开挂线术与微创手术治疗对其疼痛程度和并发症的影响,旨在为手术治疗复杂肛瘘提供参考依据。方法选取2017-01-01-2019-02-15南阳市第二人民医院肛肠外科收治的复杂肛瘘患者为研究对象,根据组间性别、年龄、病程、病灶部位均衡的原则选择对照组与观察组,每组37例。对照组实施常规切开挂线术,观察组予以微创手术治疗。比较两组手术临床指标和疼痛程度并发症情况。结果观察组和对照组术中出血量分别为(25.03±8.97)和(36.24±9.14)mL,t=5.325,P0.001;手术时间分别为(44.58±8.71)和(57.39±9.35)min,t=6.098,P0.001;住院时间分别为(4.08±1.42)和(7.39±2.14)d,t=7.840,P0.001;观察组和对照组术后3dVAS评分分别为(4.91±1.97)和(8.07±1.11)分,t=8.501,P0.001;术后7dVAS评分分别为(3.29±1.25)和(6.31±2.88)分,t=5.851,P0.001;术后14dVAS评分分别为(1.39±0.85)和(2.31±1.24)分,t=3.722,P0.001;差异均有统计学意义。观察组并发症发生率为8.11%,低于对照组的29.73%,χ2=5.638,P=0.018。结论复杂性肛瘘患者采用微创手术治疗,可有效提升手术效果,缩短手术时间与住院时间,缓解术后疼痛,降低并发症的发生率。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.