天津市静海县养殖人群与非养殖人群布鲁杆菌病宣传干预效果评价

目的 比较干预前后养殖人群和非养殖人群布鲁杆菌病(布病)知识和健康行为意识得分,探讨针对不同人群的适宜的宣传方法.方法 选择天津市静海县牲畜养殖人群和非养殖人群作为调查对象.对养殖人群采取健康讲座的方式、非养殖人群采取媒体及广播宣传的方式,实施布病知识健康教育干预1个月,在干预前后分别进行问卷调查,比较干预前后的效果.结果 分别问卷调查牲畜养殖人群和非养殖人群500人和502人,其中,牲畜养殖人群干预前、后各调查250人;普通人群干预前调查257人,干预后调查245人.在干预前牲畜养殖人群的布病知晓率[18.8％(47/250)]高于非养殖人群[5.8％(15/257)],组间比较差异有统计学意义(x2=19.84,P＜ 0.05),干预后两组人群的知晓率均得到了明显提高,养殖人群为[100.0％(250/250)]仍然高于非养殖人群[68.6％(168/245)].在健康行为认知方面,干预后两组人群的正确认知率均有提升.结论 在养殖人群中开展布病知识的健康讲座可明显提高布病知识的知晓率和健康行为认知率,非养殖人群更适合依赖于媒体、广播等覆盖面广的宣传形式.     

护士对压疮危险因素预测能力调查分析

目的调查护士对压疮危险因素预测能力并提出应对对策。方法采用问卷调查法对全院308名护士进行调查和分析,并针对存在问题提出干预对策。结果干预后各层次护士对压疮相关知识考核得分明显高于干预前(P0.05)。结论通过转变护士观念、采用多种形式培训更新压疮相关知识、规范压疮管理流程等可有效提高各层次护士对压疮危险因素的预测能力。     

压疮专业小组对社区压疮护理干预的探讨

目的探讨压疮专业小组对社区压疮护理干预的有效性。方法成立医院压疮专业小组和社区压疮专业小组。压疮专业小组对社区压疮高危人群、家属和患者进行健康宣教、知识培训、制定措施、入户现场指导、定时追踪、随访、评价。全程、规范、系统护理干预。结果通过压疮专业小组对社区压疮进行有效护理干预使社区压疮发生率由原来的43％降低到8％。结论通过全程有效护理干预,减少社区压疮发生,提高患者生活质量,有效预防社区的压疮发生率。     

老年压疮高危病人卧减压床垫翻身间隔时间的循证实践

目的总结老年压疮高危病人卧减压床垫翻身间隔时间的相关证据,并验证证据的安全性与可行性。方法选取2018年3～6月于南京医科大学第一附属医院老年神经内科住院的老年病人50例,试验组和对照组各25例,试验组按照循证证据每4 h翻身1次,对照组按照护理常规每2 h翻身1次。通过比较2组的压疮发生率、压疮前期症状发生率、护理工作量及病人的满意度评价2种翻身间隔时间的压疮预防效果与可行性。结果试验组和对照组病人均未出现压疮; 2组压疮前期症状发生率差异无统计学意义(χ2=0. 272,P=0. 602);试验组的护理工作量及病人满意度均高于对照组(t=-47. 413,P0. 001;χ2=4. 504,P=0. 034)。结论对于卧减压床垫的老年压疮高危病人,相比2 h一次的翻身间隔时间,每4 h一次的翻身并不增加压疮发生风险,但却能减少护理工作量,并有利于提高病人的满意度。     

2020年定西市中小学生近视防控知识知晓调查

目的 调查甘肃省定西市中小学生近视防控知识知晓情况,为进一步加强近视防控工作提供依据.方法 采用分层整群抽样方法,2020年在定西市7个县(区)的城区和农村分别抽取小学、初中、高中各1所,每个学校每个年级抽取一个班级,利用自行设计的问卷调查每个学生.结果 共调查18 649人,近视防控知识总知晓率为62.96％,单项题目知晓率14.77％～91.83％,女性(63.60％)高于男性(62.31％);不同性别人群近视防控知识平均得分差异有统计学意义(F=30.584,P＜0.05),个人平均得分安定区最高(9.9±2.2)、岷县最低(8.5±2.6),小学一年级至高中三年级个人平均得分呈下降—上升—下降的趋势,个人平均得分城区明显高于农村(t'=23.283,P＜0.05).结论 定西市中小学生近视防控知识知晓率低,应引起学校、家长和学生的高度重视;建议加强近视防控宣传教育工作,切实减轻家庭作业负担,控制电子产品的使用频率和时间,不断提升近视防控核心知识知晓率,预防近视的发生和发展.     

循证护理对心血管内科长期卧床老年患者压疮的预防效果

目的分析循证护理对心血管内科长期卧床老年患者压疮的预防效果。方法选择我院2011年1月—2013年1月心血管内科收治的长期卧床老年患者120例,将其随机分为观察组和对照组,各60例。两组患者均积极治疗原发病并行相应护理,观察组在此基础上增加循证护理干预项目预防压疮的发生。比较两组患者压疮发生率、Braden评分、治疗依从度、护理满意度和生活质量。结果观察组患者压疮发生率低于对照组,干预后患者感知能力、活动能力、移动能力、潮湿度及摩擦力5个维度得分高于对照组,治疗依从度、护理满意度和生活质量得分高于对照组(P0.05)。结论循证护理可以有效降低心血管内科长期卧床老年患者压疮发生率,降低其发生压疮的风险,提高患者治疗依从度、护理满意度及生活质量。     

农村老年糖尿病前期人群糖尿病预防相关知识水平及影响因素分析北大核心CSCD

目的了解农村老年糖尿病前期人群的糖尿病预防相关知识的水平及影响因素。方法采用中国健康教育中心编制的《中国公众糖尿病防治素养调查问卷》进行调查。结果农村老年糖尿病前期人群的糖尿病相关知识得分为（2．5±4．9）分,糖尿病相关观点得分（0．7±1．6）分,典型症状得分（0．7±1．3）分,并发症得分（0．3±1．1）分,高危人群得分（0．3±1．1）分,预防措施得分（0．5±1.3）分。不同年龄（F=4．42,P=0．01）、文化程度（t=-2．34,P=0．02）、婚姻状况（t=1．99,P=0．04）、高血糖史（F=7．29,P=0．00）、糖尿病家族史（t=9．04,P=0．00）的人群糖尿相关知识得分差异有统计学意义,不同性别（t=0．53,P=0．53）和糖尿病症状情况（t=0．09,P=0．93）的人群糖尿相关知识得分差异无统计学意义。结论农村老年糖尿病前期人群的糖尿病预防相关知识严重不足,年龄、文化程度、高血糖史是其独立影响因素。     

老年脑卒中患者子女照顾者照顾行为现状及影响因素

目的评估老年脑卒中患者子女照顾者的照顾行为及相关影响因素。方法采用便利抽样法抽取134例老年脑卒中患者及其子女家庭照顾者进行问卷调查。结果子女照顾者相关照顾行为得分总分为(40.75±7.518)分,处于中等水平。子女的年龄、照顾年限是影响其照顾行为的主要因素(P<0.05)。结论医院医护人员及社会保健相关部门需给予子女照顾者关于老年脑卒中患者照顾知识及行为相关的教育和指导,改善其照顾行为,提高其照顾水平,进而改善脑卒中患者的康复效果和生活质量。     

城市社区健康状态较差老年人的状况评估及分析

目的了解社区健康状态较差的老年人的需求,为合理干预提供依据。方法 2013年2月至2013年5月对北京市部分社区≥65(79.2±8.3)岁、健康状态较差的209位老年人进行老年综合评估。结果巴氏日常生活活动能力(Barthel-ADL)正常者50例(23.9%),功能受损者159例(76.1%);所有老年人均有≥2个多种慢性状况(MCC),受调查者有老年综合征3.9[4(3,5)]个,高于平均慢性疾病数3.5[3(2,4)]个,功能受损组老人慢性疾病及老年综合征数均高于功能正常组(P=0.007,P=0.05)。需要他人照顾者占79.9%,其中照顾者为配偶者占50.3%。每年规律接种流感疫苗者仅占8.1%,规律体检者占14.8%。结论老年综合征对该人群影响更大,应予以重视;社区针对失能老年人的医学照护模式、照顾者负担等问题仍需关注。     

针对性压疮护理对老年糖尿病合并股骨骨折患者术后压疮的影响研究

目的研究针对性压疮护理用于老年糖尿病合并股骨粗隆间骨折患者术后的临床效果及对压疮影响。方法选取该院2018年1—12月期间收治的60例老年糖尿病合并股骨粗隆间骨折术后患者为研究对象,采用随机数字表法将其分为观察组30例和对照组30例。对照组给予术后常规护理,观察组在对照组基础上采取针对性压疮护理,比较两组患者的护理质量满意度、压疮发生率及临床分期。结果观察组患者术后压疮的总发生率及Ⅱ期患者总数显著低于对照组,差异有统计学意义(P0.05),观察组患者整体满意度显著高于对照组,差异有统计学意义(P0.05)。结论实施针对性压疮护理可显著降低压疮发生率,提高患者满意度,具有重要的临床推广价值。     

MDS+ items not contained in the pressure ulcer RAP associated with pressure ulcer prevalence in newly institutionalized elderly

All federally funded facilities are required to use the Minimum Data Set Plus (MDS+) for functional assessment of their residents. Within the MDS+ there are 18 specific conditions addressed through Resident Assessment Protocols (RAPs). The purpose of this study was to determine if MDS+ items not included in the pressure ulcer RAP correlated with pressure ulcer prevalence in newly institutionalized elderly. Additionally, this study examined whether the addition of nutritional status information to the correlated items increased association with pressure ulcer prevalence. Data were collected through a retrospective chart review of 990 residents over age 65 at eight nursing homes. Pressure ulcer prevalence was 33.2%. Nineteen of 59 non-RAP MDS+ items were correlated with pressure ulcer prevalence. Logistic regression determined that 10 MDS+ items predicted pressure ulcer prevalence in 28.88% of the subjects. Including serum albumin in the logistic model increased the predictability for pressure ulcer prevalence to 36.3%. Results of this study demonstrate the strong association between nutrition and pressure ulcer prevalence and the need to revise the pressure ulcer RAP.     

Multidisciplinary approaches to the pressure ulcer problem

Multiple factors affect the specific condition and overall clinical profile of individuals at risk for chronic wounds. The complexity of the pressure ulcer problem lends itself to the application of the National Institute of Health Roadmap Initiative that encourages interdisciplinary research and new organizational models. An overview of research studies relevant to telemedicine and neuromuscular electrical stimulation in the care and prevention of pressure ulcers as well as preliminary results of an innovative multidisciplinary skin care team approach to the primary and tertiary prevention of pressure ulcers are encouraging. The team's pilot study results indicate that patients are satisfied with telehealth provision of care; however, literature and experience also suggest that discrepancies in the inter-rater assessment of wounds using digital photography remain, particularly with regard to wound dimension variables assessed (P<0.01). In another endeavor, the skin care team developed a Longitudinal Analysis with Self-Registration statistical algorithm to assess the effects of electrical stimulation; in a preliminary study, this tool documented improvement in gluteus maximus health and resultant ability to withstand pressure. As the number of groups pursuing multidisciplinary research and care increases, so, too, will the evidence base required to address these common, and complex, chronic wounds.     

Neutrophil elastase in pressure ulcer fluid degrades fibronectin in the exudates

Background:   Pressure ulcers are classified as chronic wounds, which do not heal in a timely fashion. Fibronectin is condensed in granulation tissue, and essential glycoprotein of wound healing. It has been proposed that fibronectin degradation may be involved in delaying wound healing. We have investigated whether pressure ulcer fluid (PUF) contains degraded fibronectin. In addition, we tried to identify the proteinase which contributes to fibronectin degradation in PUF.
Methods:   Fibronectin degradation and the presence of neutrophil elastase (NE) in PUF were determined by immunoblot analysis. Fibronectin degradation activity in PUF was determined in the presence of various proteinase inhibitors. NE activity was assessed using NE specific substrate.
Results:   Immunoblot analysis revealed that degraded fibronectin was observed in PUF samples but not in acute wound fluid (AWF). The PUF contained a proteinase capable of degrading freshly added fibronectin and its activity in PUF was blocked by a broad-spectrum serine proteinase inhibitor or sivelestat, a specific neutrophil elastase inhibitor, but not by metalloproteinase and cysteine proteinase inhibitors. Immunoblot analysis of PUF using an antineutrophil elastase antibody revealed that neutrophil elastase was detected as three bands at molecular weights of ∼30 kDa, ∼38 kDa, and ∼54 kDa, indicating that neutrophil elastase in the exudates existed not only as free monomers, but also in polymers or complexes with other molecules.
Conclusion:   These results suggest that PUF contains a high level of neutrophil elastase which may be involved in the delay of the healing of pressure ulcer through the fibronectin degradation.     

Stage 2 pressure ulcer healing in nursing homes

OBJECTIVES: To identify resident and wound characteristics associated with Stage 2 pressure ulcer (PrU) healing time in nursing home residents. DESIGN: Retrospective cohort study with convenience sampling. SETTING: One hundred two nursing homes participating in the National Pressure Ulcer Long‐Term Care Study (NPULS) in the United States. PARTICIPANTS: Seven hundred seventy‐four residents aged 21 and older with length of stay of 14 days or longer who had at least one initial Stage 2 (hereafter Stage 2) PrU. MEASUREMENTS: Data collected for each resident over a 12‐week period included resident characteristics and PrU characteristics, including area when first reached Stage 2. Data were obtained from medical records and logbooks. RESULTS: There were 1,241 initial Stage 2 PrUs on 774 residents; 563 (45.4%) healed. Median time to heal was 46 days. Initial area was significantly associated with days to heal. Using Kaplan‐Meier survival analyses, median days to heal was 33 for small (≤1 cm²), 53 days for medium (>1 to ≤4 cm²), and 73 days for large (>4 cm²) ulcers. Using Cox proportional hazard regression models to examine effects of multiple variables simultaneously, small and medium ulcers and ulcers on residents with agitation and those who had oral eating problem healed more quickly, whereas ulcers on residents who required extensive assistance with seven to eight activities of daily living (ADLs), who temporarily left the facility for the emergency department (ED) or hospital, or whose PrU was on an extremity healed more slowly. CONCLUSION: PrUs on residents with agitation or with oral eating problems were associated with faster healing time. PrUs located on extremities, on residents who went temporarily to the ED or hospital, and on residents with high ADL disabilities were associated with slower healing time. Interaction between PrU size and place of onset was also associated with healing time. For PrU onset before or after admission to the facility, smaller size was associated with faster healing time.