Evaluation of the uptake of the Australian standardized terminology and definitions for texture modified foods and fluids

This paper discusses the uptake of standardized terminology and definitions for texture modified foods and fluids. The Australian dietetic and speech-language pathology associations endorsed national standards in 2007. This project sought to determine the barriers and enablers for use of the national standards in clinical practice. Cross-sectional online surveys were developed, including open- and closed-response questions. The surveys targeted different professional groups in Australia including speech-language pathologists, dietitians, nurses, and food service personnel. Australian accredited universities were contacted to determine penetration of the standards. A total of 574 surveys were received. Sixty-five per cent of respondents indicated full implementation, 23% partial implementation, and 10% no implementation of the standards in their workplace. Speech-language pathologists and dietitians were most likely to have championed implementation of the standards. Barriers to implementation included: lack of knowledge about the standards, time, and resistance to change. Enablers included: encouragement to use the standards and 'buy-in' from stakeholders. Benefits of implementation included: consistent terminology and perceived improvements in patient safety. It was concluded that the standards have been successfully implemented in a majority of facilities and Australian universities. This study provides insight into the complexity of introducing and managing change in healthcare environments.     

基于饮食性状改变的卒中吞咽障碍患者经口进食管理的研究进展

吞咽障碍是卒中后严重危及生命的症状之一,其引起的吸入性肺炎、营养不良等并发症是卒中患者最常见的死亡原因之一。目前通过增稠液体和改变食物的性状来进行进食干预逐渐受到临床的认可和广泛应用。然而,这种干预的有效性会受到患者主观感受及其所致其他并发症的影响。本文就吞咽障碍患者进食能力的评估,液体及食物黏稠度、性状改变的定义、分级及其在临床实践中的应用及挑战等方面进行综述,以便为临床对卒中吞咽障碍患者的进食干预提供理论及实践依据。     

Viscosity of thickened fluids that relate to the Australian National Standards

Purpose: In 2007, Australia published standardized terminology and definitions for three levels of thickened fluids used in the management of dysphagia. This study examined the thickness of the current Australian National Fluid Standards rheologically (i.e. viscosity, yield stress) and correlated these results with the “fork test”, as described in the national standards.

Method: Clinicians who prescribe or work with thickened liquids and laypersons were recruited to categorize 15 different thickened fluids of known viscosities using the fork test. The mean apparent viscosity and the yield stress for each fluid category were calculated.

Result: Clear responses were obtained by both clinicians and laypersons for very thin fluids (<?90 mPa.s) and very thick fluids (>?1150 mPa.s), but large variations of responses were seen for intermediate viscosities. Measures of viscosity and yield stress were important in allocating liquids to different categories.

Conclusion: Three bands of fluid viscosity with distinct intermediate band gaps and associated yield stress measures were clearly identifiable and are proposed as objective complements to the Australian National Standards. The “fork test” provides rudimentary information about both viscosity and yield stress, but is an inexact measure of both variables.     

Robotic-assisted surgery and the need for standardized pathways and clinical guidelines

Robotic surgical techniques are revolutionizing the way surgery is performed in an effort to improve patient outcomes. Although current literature is limited, studies have shown that patients who undergo robotic-assisted procedures experience reduced surgical time, scarring, blood loss, pain, infection rates, and lengths of stay compared with patients who undergo open or laparoscopic procedures. Currently, start-up costs for robotic systems are high and include the major equipment purchase as well as supplemental equipment purchases and staff member training. There is a need to develop standardized perioperative procedures or clinical guidelines that define optimal application of robotic-assisted surgery to ensure a standard of care that is consistent across procedures and operators. Implementing a clinical pathway or guideline that is guided by evidence-based practice will involve change. Lewin's 1947 basic change theory and the Marker umbrella model may be of use to help facilitate change.     

护理本科生规范化课间见习管理模式的实施与效果评价

对辽宁省两所教学医院护理本科课间见习教学的带教教师严格遴选、规范培训,实施聘任制、动态管理及新模式课间见习管理等措施。实施后带教教师教学能力、教学态度、对学生的管理能力及学生的学习成绩均有所改善或提升（P〈0.05）。规范化课间见习教学管理模式对师资队伍建设具有重要意义,为临床教学质量提供了有力保障。     

麻醉药品规范化管理培训的效果评价

目的了解麻醉药品规范化培训的效果,为进一步开展疼痛管理培训提供依据。方法采用自行设计的医生癌痛认知调查问卷,分别在培训前和培训后对参与培训的92例临床医生进行调查,比较培训前、后癌痛管理的态度和知识的掌握程度。结果培训前、后医生癌痛管理的态度有显著性差异(P<0.01),癌痛知识的回答正确率有显著性差异(P<0.05)。结论麻醉药品规范化管理培训能有效提高临床医生对疼痛管理的重视程度,改善临床医生疼痛管理知识的掌握程度,促进麻醉药品的规范化使用。今后应促进教育培训的不断开展,提高临床实际的应用能力。     

定科实习护士岗前规范化礼仪培训的做法及效果

目的 探讨定科实习护士岗前规范化礼仪培训的有效方法.方法 对157名定科实习护士进行服务礼仪规范化培训,培训时间为2周,内容包括医院文化、礼仪知识、角色扮演、行为规范等,并在培训前后进行测评考核.结果 实施规范化礼仪培训后,157名定科实习护士对培训的需求明显高于培训前,各项考核评价结果高于培训前,差异具有统计学意义(...     

大专和本科新护士规范化培训的做法与效果

目的 评价新毕业护士规范化培训的效果.方法 对72名新毕业的护士进行规范化培训,培训前后进行理论考试和技术操作考核.结果 培训后新护士理论知识和技术操作考核得分高于培训前(P<0.05),新护士对带教老师评价较高.结论 规范化培训可以使新毕业护士更好、更快适应护士角色,提高工作及学习能力,满足临床护理需求.     

标准化见习路径对医学生小学期基础护理教学质量的研究

目的探讨标准化见习路径对医学生小学期基础护理教学质量的研究。方法选择2011年上海中医药大学医学生小学期见习生72名,随机分为实验组和对照组各36名。在为期2周的临床教学中,两组均按照护理教研室教学日历进行护理理论与实践的教学,实验组则采用标准化见习路径表。比较两组医学生的理论成绩、综合考评、出科总评情况,同时了解医学生对教学方法、人文关怀和教师素质测评等情况。结果实验组医学生在理论成绩、综合考评和出科总评各项指标与对照组比较,差异有统计学意义(P<0.05);实验组医学生对教学方法、人文关怀和教师素质测评等方面与对照组比较,差异有统计学意义(P<0.05)。结论标准化见习路径能明显提高医学生对学习基础护理教学理论与实践知识的兴趣和积极性,使其在较短的时间里掌握更多的基础护理知识。它不仅提高了临床教学质量更有助于提升医学生的职业素养,有利于职业发展。     

我院规范聘用护士管理的实施方法与效果

聘用护士是军队医院护理队伍的重要组成部分。为不断提高聘用护士整体素质,对聘用护士的招聘管理环节进行规范,形成了一套行之有效的制度,严格聘用护士录用、培训、管理,全院聘用护士队伍稳定,护理队伍结构趋于合理,护理质量不断提高。     

Assessing the flow rate of different bottles and teats for neonates with feeding difficulties: An Australian context

AimsTo compare flow rates for Australian bottle/teat systems marketed as ‘slow’ or ‘extra-slow’ flow, and to examine flow consistency within each teat type.MethodsEstablished assessment methods were used to test 27 types of teats. Fifteen teats of each type were tested by measuring the amount of infant formula extracted in 1-min by a breast pump system. Teats were compared within ‘slow’ and ‘extra-slow’ categories, a coefficient of variation was calculated for each teat type, and a cluster analysis was performed to group teats with similar flow.ResultsThere was significant variability observed between teats in the same 'slow' and 'extra-slow' categories, and sometimes between teat brands. Cluster analysis revealed 5 clusters. Many teats were considered to have moderate to high variability in flow rate.ConclusionsThis study provides information regarding Australian bottle/teat systems. This is of relevance to those who support the neonatal bottle-feeding journey, particularly with premature or medically complex neonates.     

科室质量控制组长规范化管理的做法及体会

通过设立科室护理质量控制组长岗位,并对其进行规范化选拔、培训、考评,确定工作职责和工作标准,加强了全体护理人员的质量意识,提高了质量控制缺陷的针对性,为护理管理队伍培养了后备人才,促进了质量控制与持续改进。     

乙型肝炎相关性肝细胞癌DEB-TACE治疗前后增强CT扫描获取的纹理参数变化及临床意义

目的  研究乙肝相关肝细胞癌患者经载药微球-经导管动脉化疗栓塞（DEB-TACE）治疗前后增强CT纹理参数变化,并探讨其临床意义。方法  选择我院2018年6月~2021年6月收治的117例乙肝相关肝细胞癌患者作为研究对象,均采用DEBTACE治疗,分别于患者治疗前、治疗后6周行增强CT扫描,获得纹理参数,分析增强CT纹理参数在评估DEB-TACE治疗疗效中的价值。结果  DEB-TACE治疗后,HCC患者增强CT纹理参数偏度、熵值、平均值及峰度均较治疗前降低,能量较治疗前上升,差异有统计学意义（P < 0.05）。经DEB-TACE治疗后,共86例患者预后良好,31例预后不良。不同预后患者经治疗后,偏度、熵值、平均值及峰度均较其治疗前降低,能量均较其治疗前上升,差异有统计学意义（P < 0.05）。预后良好组患者治疗前后偏度、熵值、平均值及峰度均低于预后不良组,治疗前后能量均高于预后不良组,差异有统计学意义（P < 0.05）。DEB-TACE治疗前纹理参数在预测HCC患者预后中的效能均较高(AUC>0.75),各参数联合应用的预测价值最高（AUC=0.920,95% CI：0.870~0.970）。DEB-TACE治疗后纹理参数在预测HCC患者预后中均具有一定的效能（AUC>0.70）,各参数联合应用的预测价值最高（AUC=0.810,95% CI：0.731~0.888）。结论  增强CT纹理参数在评估HCC患者DEB-TACE治疗预后中具有一定的价值,可为临床HCC的治疗提供参考。     

《教学干事手册》的设计与应用

针对临床护理教学工作中存在的计划性不强、工作内容记录不完整的现状,为规范临床护理教学工作,在广泛征求教学干事意见的基础上,结合我院临床护理教学工作实际情况,自行设计《教学干事手册》,自2005年1月开始使用至今,收到了较好的效果。     

Evaluation of the kodak ektachem slide assays for iron and lactate

We evaluated the analytical performance of two clinical chemistry slides developed recently by Eastman Kodak Company for the analysis of lactate and iron with the Kodak Ektachem 700 XR analyzer. Tested with supplemented serum pool materials we found imprecisions of the lactate analysis between 0.7% and 1.3% (within-run), resp., 1.0% and 1.5% (between-run). The imprecision of the iron analysis was between 1.0% and 2.2%, resp., 1.2% and 2.7%. Linearity of the methods was proven between 0.7 mmol/L and 13.0 mmol/L (lactate analysis) and between 5.4 μmol/L and 82.4 μmmol/L (iron analysis), respectively. We found no significant interferences by hemolysis, lipemia, or bilirubin. The Kodak lactate results (x) correlated well with those of enzymatic methods (y) of Boehringer Mannheim (r = 0.995; y = 1.095x ? 0.128) and of DuPont (r = 0.990; y = 1.015x ? 0.242). The Kodak iron analysis (x) was correlated with the FerroZine® methods (y) of Boehringer Mannheim (r = 0.988; y = 1.031x + 0.091), Hoffman LaRoche (r = 0.989; y = 0.868x + 1.111), and with atomic absorption (y) (r = 0.960; y = 0.826x + 3.416). We conclude that the newly developed methods for the analysis of lactate and iron with the Kodak Ektachem analyzer are acceptable alternatives to other common methods.     

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

ObjectivesDifferences in mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) are speculated in studies that analyzed differences in the patients'' background. However, the etiologies of each type of AFF have not been studied in detail. This study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs.Materials and MethodsEighty consecutive Japanese patients with 91 diaphyseal AFFs (AFF group) and 110 age-matched women with osteoporosis (non-AFF control group) were included. Their clinical data were compared; factors affecting AFFs were investigated, and the etiologies of the risk factors for diaphyseal AFFs were examined.ResultsMultivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were risk factors for diaphyseal AFFs (p < 0.0011, p = 0.0137, and p < 0.0001, respectively). Multivariate analyses revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p = 0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p = 0.0006), each significantly affected the femoral curvature. High serum calcium (Ca) levels, lateral femoral curvature, and anterior femoral curvature were predictors of serrated changes (p = 0.0146, 0.0002, and 0.0098, respectively).ConclusionRisk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. Low serum 25(OH)D levels and serrated changes are risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.     

Evaluation of a nurse consultant's clinical activities and the search for patient outcomes in critical care

Aim. To describe the actual clinical activities undertaken by a critical care nurse consultant in an eight‐bedded adult surgical high dependency unit within a large NHS Teaching Hospitals NHS Trust. Background. In the United Kingdom, the first critical care nurse consultants were approved in 2000 following the Department of Health's (1999) revised career structure for nurses. Expert practice is a core function of the role although the nature of expert practice in the context of critical care is unclear. Expert practice is often deemed to be a feature of advanced practice and although a number of studies have investigated this in context of critical care, there is little insight into the nature of advanced practitioners’ clinical practice and how it might influence patient outcome. Design methods. A diary was used by a critical care nurse consultant to record activity during scheduled clinical sessions. Data were collected for four months: 39 sessions were evaluated. Qualitative data were content analysed and coded into categories. Clinical activities were coded, categorized and analysed using SPSS 11.0 for windows (SPSS Inc., Chicago, IL, USA). Findings. Clinical activities included direct care activities, clinical leadership, education and training. Two main themes emerged from the qualitative data and were categorized as clinical reasoning and clinical instruction. Clinical activities arising from clinical reasoning and clinical instruction were aimed at minimizing risk and the provision of quality care. In doing this, one of the outcomes was the detection and resolution of untoward clinical occurrences. Conclusion. The level of achievement – or end point – of clinical activities was that the patient was established in ‘a state free from risk or harm that optimises rehabilitation’. ‘A state free from risk or harm that optimizes rehabilitation’ might be one outcome reflecting the needs of individual critically ill patients that is sensitive to individual nursing contribution. Relevance to clinical practice. There is increasing pressure on health‐care professionals to identify and measure their individual impact on the outcome of patients. This study adds further insight into the complexities associated with evaluating the influence of individual contribution on patient outcome, especially when it is characterized by complex processes involving clinical judgement and decision‐making.     

Evaluation of Plecanatide for the Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation in Patients 65 Years or Older

PurposeChronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are common functional gastrointestinal disorders. The prevalence of constipation-related issues tends to increase with age. This analysis pooled data from Phase III trials in CIC and IBS-C to assess the safety and efficacy of plecanatide in patients aged ≥65 years.MethodsPatients randomized to receive plecanatide (3 or 6 mg) or placebo from two CIC and two IBS-C trials were pooled. Efficacy end points common to all trials included changes in stool consistency (Bristol Stool Form Scale), changes in weekly frequency of complete spontaneous bowel movements (CSBMs) and spontaneous bowel movements (SBMs), and time to first CSBM and SBM. Efficacy and safety profile results are reported per age group (≥65 and <65 years of age).FindingsThe pooled intention-to-treat population comprised 451 patients aged ≥65 years (mean age, 70 years) and 4364 patients aged <65 years (mean age, 41.9 years), of whom 287 and 2914, respectively, were randomized to receive plecanatide. Compared with placebo, plecanatide produced statistically significant improvements in stool consistency from baseline at week 12 (both age groups), CSBM and SBM frequency from baseline at week 12 (plecanatide 3 mg group aged ≥65 years and both plecanatide groups aged <65 years), and time from start of therapy to first CSBM (both age groups) and SBM (plecanatide 6 mg group aged ≥65 years and both plecanatide groups aged <65 years). No new safety issues were observed.ImplicationsPlecanatide is a well-tolerated and effective treatment option for patients aged ≥65 years with CIC or IBS-C.Clinicaltrials.gov identifiersNCT01982240, NCT02122471, NCT02387359, and NCT02493452.