近视手术前口服安定对患者术中配合的影响

目的 了解近视手术前口服安定对患术中配合情况的影响程度。方法 对160例近视患采用随机分组的方法分成观察组（术前常规口服安定5mg)和对照组（术前不口服安定），并对两组患术中配合情况进行观察。结果 两组患术中配合情况有显差异，对照组优于观察组。结论 近视术前口服安定导致部分患术中产生睡眠状态，影响术中配合。故近视术前口服安定不应作为常规执行。     

创伤性肘关节僵硬病人的围术期护理

[目的]探讨创伤性肘关节僵硬围术期综合康复护理方法。[方法]对36例经内外侧肌群-韧带复合体彻底剥离术治疗创伤性肘关节僵硬的病人行围术期综合康复护理干预,并进行1.5年~5.3年的随访。[结果]36例病人术后均能继续配合后续康复治疗。患肘关节屈伸活动度术前为32.5°±28.9°,术后1.5年为108.8°±36.0°;Mayo功能指数评分术前为33.1分±2.7分,术后1.5年为82.3分±14.4分,术前与术后1.5年患肘关节屈伸活动度及Mayo功能指数评分比较差异均有统计学意义(P0.05)。病人肘关节评分优13例,良19例,中2例,差2例,优良率为88.89%。[结论]针对内外侧肌群-韧带复合体彻底剥离治疗创伤性肘关节僵硬特点采取的围术期综合康复措施,对保证康复治疗的顺利进行、改善患肘关节功能起着重要作用。     

球囊扩张术治疗膝下动脉硬化闭塞症患者的护理

目的探讨球囊扩张术治疗膝关节以下肢动脉硬化闭塞症患者的护理。方法对80例患者术前进行有针对性的心理护理，完善各项术前准备，术后严密监测生命体征，密切观察患侧皮温及血运恢复情况，预防并发症的发生。结果80例患者中，术后70例治疗效果满意，下肢缺血显著改善，10例因为小腿动脉狭窄严重，导丝无法通过闭塞段，导致无法完成手术。术后随访，10例足趾溃疡于1～3个月痊愈。66例患者未在出现患肢缺血症状，有效率达到94．3％，4例再次出现患肢缺血症状，而入院治疗。结论合理有效地术前指导、术后护理对球囊扩张术治疗膝下动脉狭窄闭塞症患者术后恢复起到重要的作用。     

1例乳腺癌术后患者行对侧肺癌根治术的体位护理

总结1例乳腺癌术后25天的患者行胸腔镜下乳腺癌对侧肺癌根治手术的体位护理管理。术前评估患者乳腺癌术侧肢体的情况、病情、心理状态以及皮肤情况，开展多学科合作的术前讨论，医护患一体制定特殊体位管理方案。术中实施不外展乳腺癌术侧肢体的侧卧位，妥善固定和保护患者，术中通过血氧饱和度监测该侧肢体的血运及回流情况。熟悉手术医生的手术步骤以及习惯，提前完成所有用物的准备，流畅配合手术，尽量缩短手术时间，减少乳腺癌术侧上肢的受压时间。术后进行肢体的评估和随访1周，评估患者术后患侧肢体的情况。     

术前及术中超声、CT及术中触诊诊断肝肿瘤的一致性评价

目的 评价术前超声、CT及术中超声、术中触诊诊断肝肿瘤良恶性的一致性.方法 分析70例肝肿瘤患者的术前超声、术前CT检查、术中超声以及术中触诊结果,对四种检查结果与病理及随访结果诊断肝肿瘤良恶性的一致性进行评价.结果 术前超声与病理及随访结果诊断肝肿瘤良恶性的一致性为中等(Kappa值0.63),术中触诊与病理及随访结果的诊断一致性较低(Kappa值0.38),CT以及术中超声检查与病理及随访结果诊断一致性较高(Kappa值分别为0.71及0.89),而术中超声与CT检查之间诊断一致性也较高(Kappa值为0.53).而术前超声与术中超声以及术前超声与术中触诊之间诊断一致性均较低(Kappa值均为0.23).结论 在肝肿瘤诊断评价中,CT与术中超声具有较高的诊断一致性,虽然术前超声与术中触诊诊断结果一致性较低,但在临床工作中依然不可或缺,而若能将四者结合应用,将有助于肝肿瘤的诊断与治疗.     

鼻内窥镜下微波治疗鼻后部出血的护理

目的：总结鼻内窥镜下采用微波治疗鼻后部出血的护理经验。方法：经鼻内窥镜应用微波对50例鼻后部出血的患进行治疗。结果：50例患均一次治愈，随访3个月无复发。结论：在治疗中应针对患不同情况做好心理护理，掌握适应证及治疗方法，做好术前及术后护理是确保成功的关键。     

肩关节关节镜手术的围术期护理

[目的]探讨肩关节关节镜手术围术期的护理康复方法。[方法]回顾性分析31例肩关节关节镜手术病人的临床资料,采用术前宣教、指导肌力锻炼及术后关节短期制动、早期关节被动动度锻炼、后期主动渐进动度锻炼的方案。采用日本骨科协会(JOA)肩关节疾患评定标准对患肩进行术前、术后评分。[结果]31例病人均得到随访,随访时间6个月~26个月。患肩术前JOA功能评分49分~67分(平均58分),术后患肩JOA评分87分~100分(平均93.5分),无感染、无关节粘连、无肩关节不稳。病人平均住院时间9d,术后平均康复时间3周。[结论]科学合理的围术期护理康复方案是肩关节关节镜手术治疗过程中取得满意疗效的关键。     

大面积深度烧伤患者术中知晓的情况分析及护理干预

目的：通过护理干预减少大面积深度烧伤患者术中知晓的发生及减轻其危害。方法通过术前访视，术中密切配合，术后运用专人随访及问卷调查，了解术中知晓的发生原因，根据引发术中知晓的高危因素采取相应的干预措施。结果对大面积深度烧伤患者进行术前、术中、术后的护理干预，减少了术中知晓的发生及其危害。结论手术室护士通过加强对麻醉知识的掌握，具备较强的护患沟通与心理护理技巧，可以预防及减少术中知晓的发生及造成的不良后果。     

高龄患者的术前评估与术后护理

阐述了高龄患的特点及术前评估与术后护理的方法，指出随着年龄的增加，机体的老化，人体主要脏器的代谢能力，机能储备能力及营养状态也逐渐低下，针对高龄患的特点进行正确的术前评估和术后护理，是确保手术后顺利康复，维持和改善患日常生活活动能力的关键。     

术前股四头肌负重肌力练习对膝关节术后患肢功能恢复的影响

目的探讨术前股四头肌负重肌力练习对膝关节术后患肢功能恢复的影响.方法将32例患者随机分为实验组和对照组,实验组在术前给予股四头肌负重肌力练习指导;对照组给予常规护理.结果术后3d两组患肢功能恢复情况比较有统计学差异,实验组明显优于对照组.结论术前有计划的进行股四头肌负重肌力练习对膝关节术后患肢功能恢复有促进作用.     

电话回访对心脏瓣膜置换术患者遵医行为的影响

目的探讨电话回访对心脏瓣膜置换术患者遵医行为的影响。方法对我院160例心脏瓣膜置换术患者分为两组,实验组出院后进行电话回访式健康教育,比较两组患者遵医行为。结果实验组在正确服药率、遵循饮食原则率和功能锻炼率、主动咨询率、按时复诊率方面都优于对照组。结论电话回访方便、经济、快捷,是患者易于接受的一种健康教育方式,它满足了患者的健康需求,帮助患者提高遵医行为的自觉性,增进了护患关系,是提高随访率的有力保证,并使整体护理质量得到了进一步提高。     

Patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery

The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. We present results of an audit of patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Our results indicate that patient satisfaction with nurse-led telephone follow-up is significantly higher than conventional follow-up (p=0.001, two-tailed). More patients in the conventional follow-up group felt that a follow-up appointment with an ENT doctor was essential compared with the patients in the nurse-led telephone follow-up group (p<0.001, two-tailed). We conclude that nurse-led telephone follow-up avoids unnecessary outpatient appointments, while identifying patients who require further care. It makes more appointment slots available for patients with pressing clinical problems and has the potential to reduce outpatient access times in the NHS.     

Evaluation of a new strategy for detection of thyroid dysfunction in the routine laboratory

We assessed the use of a new strategy for detecting thyroid disorders, utilizing a sensitive assay for concentrations of thyrotropin (TSH) and free thyroid hormone in serum as follow-up tests. Of 1279 patients who were not on thyroxin (T4) replacement treatment, 82% could be classified as euthyroid and would require no further tests. In patients who were on T4 replacement, 41% fell into the euthyroid category and would require no further tests. Using this strategy to replace our existing strategy of free thyroxin as a "first-line" test would reduce the proportion of patients who would require one or more follow-up tests from 49% to 24%.     

腹膜透析患者门诊随访依从性及其对腹膜透析质量的影响

[目的]探讨腹膜透析患者门诊随访依从性状况和相关因素以及门诊随诊依从性对患者预后的影响。[方法]回顾性分析本院162例规律腹膜透析患者的门诊随访依从性,根据随访率将患者分为随访情况较好组和随访差组,分析随访差的原因,同时比较两组患者的一般情况及预后。[结果]162例患者中位随访率是84％,其中随访好组98例（60．49％）,随访差组64例（39．51％）。随访差的原因主要包括家到医院距离远（占35．94％）,经济条件不允许（占17．19％）,还有部分患者嫌麻烦（占26．56％）和认为没有必要（18．75％）,另外有18．75％的外地患者受到医保政策的限制,在当地进行随访。两组患者在年龄、合并糖尿病以及腹膜透析操作方式中并无统计学差异,但随访好组男性及仍从事工作患者的比例要高于随访差组,本地患者的比例也明显高于随访差组（ P ＝0．002）。随访差组患者的住院率要明显高于随访好组（ P ＜0．001）,而退出率,无论是死亡还是转血液透析者也明显高于随访好组。两组腹膜炎发生率及退出患者腹膜透析时间相比较差异无显著性（ P ＞0．05）。[结论]腹膜透析部分患者,尤其是外地患者会因各种原因导致门诊随访依从性差,且与患者不良预后相关,应针对性采取有效干预措施提高门诊依从性,进而改善患者预后。     

Outcome of patients who refused out-of-hospital medical assistance

Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient. Telephone follow-up was conducted to determine the patient's condition and if the patient sought further care after RMA. Primary endpoints were whether the patient sought further care, was admitted to a hospital, or died subsequent to RMA. Follow-up was successfully obtained for 199 of 321 patients enrolled (62%). Of these 199 patients, 95 (48%) sought further medical care within 1 week for the same complaint, with 13 being admitted to the hospital. Six of the 13 admitted patients had chief complaints of a cardiac or respiratory nature. One patient died during hospital admission. Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.     

强化病人随访促进护患关系和谐性的探讨

目的 加强护患之间的协作,以促进护患关系的和谐性。 方法 实施专职随访人员对住院病人全程随访和出院病人追踪访视。 结果 连续访视能及时、有效地加强护患沟通,满足病人需求,对护理服务中的不足能够得到病人的理解和宽容,减少了医疗纠纷的发生。 结论 实施专职人员对病人进行连续性的随访对构建和谐的护患关系,对进一步开发医疗服务市场、提高优质服务均有促进作用。     

出院患者电话随访中出现的问题分析及对策

目的完善出院患者电话随访工作,更好地为出院患者服务。方法通过对840例普通外科出院患者电话随访资料进行分析、总结,发现主管医生在此项工作中参与率低,责任护士指导的健康教育内容欠规范,工作中求数量而忽略质量等问题,并提出相应对策。结果随访工作质量提高,出院患者院外满意率由94.8%上升至98.0%。结论出院患者电话随访工作的不断改进,能有效提高出院患者的生活质量,值得进一步深化、推广。     

Telephone follow-up after urological surgery

A significant minority of patients will require specialist advice or further treatment after undergoing a TURP. Nurse-led telephone follow-up provides such patients with easy continued access to a specialist centre. When setting up a post-surgical telephone follow-up clinic, issues relating to patient selection, staff availability and administrative support needs must be considered.     

Limiting loss to follow-up in a multicenter randomized trial in orthopedic surgery

Even the best-designed, randomized controlled trials suffer when patients are lost to follow-up. Incomplete follow-up biases the results of a trial when patients who drop out are different from those who complete follow-up. This is exaggerated further when there are differential dropout rates between study groups. Previous randomized controlled trials in orthopedic trauma have reported up to 28% loss to follow-up. Only by striving to achieve a 0% loss to follow-up rate can we be certain that this type of bias does not affect our results. In our ongoing multicenter, randomized controlled trial comparing reamed and nonreamed intramedullary nailing of tibial shaft fractures, we have implemented several innovative strategies to minimize loss to follow-up. The exclusion criteria and consent process are designed to minimize losses. Study staff are carefully trained in communication and negotiation with patients. Additionally, a central methods center monitors all patient follow-up and aids in finding lost patients. Through these primary, secondary, and tertiary interventions, we have achieved 94% complete 1-year follow-up for the first 440 patients enrolled in the trial. Eleven patients withdrew consent, and we are unable to locate 17 patients. We have successfully minimized the loss to follow-up rate in our trial by incorporating innovative prevention and retention strategies into its design and conduct. Through planning, organization, and committing time and resources to minimizing loss to follow-up, other orthopedic trauma trials can hope to achieve the same high rates of follow-up.     

Nurse specialist led follow-up in lung cancer: The experience of developing and delivering a new model of care

Data from an earlier paper reporting on a study comparing conventional medical follow-up with nurse specialist follow-up of patients with lung cancer demonstrated that follow-up by nurse specialists is safe, effective and can lead to greater levels of patient satisfaction. The process and experience of developing a nurse specialist role in lung cancer follow-up care has not yet been described. The aims of this paper are to describe the preparation and development of a model of nurse led follow-up care, identify key nursing interventions provided within nurse led follow-up care and provide insights into the experiences of nurse specialists providing follow-up care. Data were collected from nurse specialists' patient case-records and from meetings held with the study team. Semi-structured interviews were conducted with the nurse specialists providing follow-up care and the study coordinators. The nature of the nursing role in lung cancer follow-up care is described. In addition, four themes relating to the process of developing a nurse led follow-up role are identified. These are: 'training', 'becoming credible', 'emotional burden' and 'making a difference'. Managing follow-up care for patients with lung cancer can be rewarding for nurse specialists. However, it can also be emotionally demanding. Training and support for such roles is vital and requires further in-depth research.