移动医疗在脑卒中患者延续护理中的应用现状

介绍移动医疗在脑卒中患者延续护理中的必要性,总结移动医疗在脑卒中患者延续护理中用药、监测、康复知识、康复指导等方面的应用,提高脑卒中患者的康复效果.同时分析并指出了移动医疗目前存在的问题和其在脑卒中患者延续护理中应用的发展,以期为脑卒中患者开展延续护理提供更多参考.     

脑卒中病人延续护理需求调查

[目的]了解脑卒中病人出院后延续护理需求的现状。[方法]采用自行设计的脑卒中病人出院后延续护理服务需求调查表对2017年1月─6月我院神经内科出院的脑卒中病人或家属进行调查。[结果]脑卒中病人出院后延续性护理服务需求得分为103.51±19.18分,延续性护理需求较强烈;排在前3位的分别为:健康教育需求、社会支持需求以及康复指导需求。[结论]脑卒中病人出院后延续性护理需求处于较高水平,开展脑卒中病人延续护理服务非常必要。     

多学科协作在老年脑卒中患者延续康复中的应用效果

目的探讨多学科协作在老年脑卒中患者延续康复中的应用效果。方法选取2018年1月—2019年2月在本院康复出院的老年脑卒中患者78例,随机分为干预组41例、对照组37例;干预组采用多学科协作模式下的延续康复服务,包括组建MDT团队、建立个人健康档案、制定延续康复干预方案及MDT工作模式;对照组采用常规诊疗方法。比较两组患者肢体运动功能、日常生活活动(ADL)能力以及并发症的发生率。结果干预组出院后经过3个月的多学科协作延续康复服务,FMA及MBI评分与对照组同时间点比较,差异均具统计学意义(P0.05),且并发症的发生率低于对照组(P0.05)。结论多学科协作下的延续康复干预,能有效促进老年脑卒中患者肢体运动功能的恢复、改善ADL能力、减少并发症,提高生活质量。     

脑卒中病人实施过渡期护理服务模式的研究进展

脑卒中病人需要长期甚至终身的康复护理,而出院后早期进行康复锻炼是脑卒中病人康复的关键。过渡期护理即是病人出院后最早为其提供的一种康复护理服务形式。从过渡期护理模式概念、运行方式,脑卒中病人实施过渡期护理模式的必要性及现状等方面进行详细介绍,为构建能满足脑卒中病人需求的过渡期护理服务模式提供借鉴与参考。     

脑卒中病人延续护理模式研究进展

从延续护理的概念、脑卒中延续护理服务理念、服务对象、提供者、干预策略、护理措施、应用效果、面临的挑战等方面对脑卒中病人延续护理模式研究进展进行综述。     

“共情共呼吸”延续护理服务模式在呼吸专科护理门诊中的应用

[目的]探讨“共情共呼吸”延续护理服务模式在呼吸专科护理门诊中的应用。[方法]。将2018年1月—2018年6月门诊400例呼吸道慢性疾病病人以就诊顺序分为单双数,单数为对照组,双数为观察组,对照组采用常规“共呼吸”延续护理服务模式,观察组采用“共情共呼吸”延续护理服务模式。比较两组病人自我管理质量(吸入制剂规范使用率、家庭氧疗率、肺康复计划执行率、正规复诊率)以及病人及家属对专科护士满意率。[结果]观察组病人吸入制剂规范使用率、家庭氧疗率、肺康复计划执行率、正规复诊率以及病人及家属对专科护士满意率均高于对照组。[结论]在呼吸专科护理门诊中应用“共情共呼吸”延续护理服务模式可提高病人自我管理质量以及病人及家属对专科护士的满意度。     

二级综合医院脑卒中患者早期康复治疗现状及影响因素分析

目的：了解脑卒中患者接受早期康复治疗的现状,并分析探索人口社会学、经济、医疗保障、认知因素对患者接受早期康复服务治疗的影响。方法：自行设计调查问卷,选取国内2家提供康复治疗服务的综合医疗机构,对正在接受康复治疗服务的229例脑卒中患者进行问卷调查。结果：89．1％正在接受康复治疗的脑卒中患者在急性期住院时接受过早期康复治疗;不同居住地、医疗保险类型、费用支付方式、收入来源的患者,以及对制定康复治疗方案的方式有不同认识的患者,在脑卒中发作急性住院期是否接受早期康复治疗有明显差异。结论：综合医疗服务机构给予脑卒中患者早期康复治疗的模式有待改善;经济收入、医疗保障和认知态度因素是影响脑卒中患者接受早期康复治疗的重要因素。     

医护人员对脑卒中病人适时需求认知调查的质性研究

目的以适时模式为框架,采用质性研究,对医护人员进行深入访谈,从医护人员角度探索脑卒中病人不同疾病阶段(从住院期间至出院后)中存在的动态适时需求,为脑卒中病人采取动态医疗服务提供理论依据。方法采用现象学研究法,采用目的抽样法选取10名医护人员为研究对象,依据相关文献和适时模式框架形成开放式问题,采用面对面半结构化法收集资料,资料分析运用Colaizzi 7步分析法。结果对10名医护人员进行访谈,提炼出5个不同阶段的病人需求:急性期重点在决策参与和家庭支持;稳定期重点是健康教育和康复锻炼;出院准备期重点在出院准备服务及延续性康复锻炼需求;出院后调整期实施期重点在居家护理和对康复锻炼的需求;适应期重点是回归社会的需求。结论本研究通过从医护人员的角度揭示脑卒中病人从住院期间至出院后不同疾病阶段的适时动态需要,并发现自身工作不足,提出建议,可为建立脑卒中病人动态医疗服务提供理论依据。     

青光眼病人出院随访的护理效果分析

出院病人随访是将医疗护理服务延伸至出院后和家庭的一种新型服务模式,能有效解决病人出院后面临的康复问题,使出院病人的院外康复和继续治疗得到科学、专业、便捷的技术服务和指导,充分体现以人为本的服务宗旨。开展出院病人随访已成为拓展医疗服务的一种措施和手段,并被广泛应用[1]。本研究通过对青光眼手术病人出院后进行定期电话、短信随访,延续     

基于互联网医疗与保护动机理论的医联体模式对脑卒中全程康复的干预效果

目的 探讨基于互联网医疗与保护动机理论指导下的医联体对脑卒中患者全程康复的干预效果。方法将50例病情稳定后出院的脑卒中患者随机分为对照组和观察组,每组25例。对照组给予常规出院护理指导干预,每月1次电话回访,同时与当地医疗部门签约家庭医生服务;观察组在对照组基础上实施基于互联网医疗与保护动机理论指导下的医联体模式对脑卒中患者全程康复进行干预。干预治疗3个月后,采用Barther指数、Fugl-Meyer运动功能量表评定2组运动功能康复情况,采用格林伯格情境、情绪评估法测评患者的情绪状态。结果干预后观察组Barther指数、Fugl-Meyer运动功能评分均显著高于对照组(均P<0.001),3种情境下情绪状态评分均显著低于对照组(均P<0.01)。结论 建立基于互联网与医联体的上下联动运行机制,应用保护动机理论对脑卒中患者实施全程康复延续服务,有利于改善患者情绪状态与运动功能,提高脑卒中康复效果。     

脑卒中吞咽困难的康复护理进展

综述脑卒中吞咽困难的康复护理进展,包括吞咽困难的康复评估方法、护理模式在康复护理中的应用以及康复护理、摄食护理等。     

Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.     

过渡期护理模式在断指再植出院患者手功能恢复中的应用

目的 探讨过渡期护理模式在断指再植出院患者手功能恢复中的应用及效果.方法 对2009年行断指再植手术的276例出院患者（试验组）施行过渡期护理模式,术后6个月统计随访到的病例数、遵医嘱定期复查的患者及随访患者的手功能评定等级,并与2008年同期患者（对照组）进行比较.结果 试验组276例患者在术后6个月全部得到随访,能够定期复查者252例（91.30%）,手功能恢复评定优良259例（93.84%）,均高于对照组（P＜0.001）.结论 过渡期护理模式为出院患者提供了不问断连续性护理服务,满足了患者的健康需求,改善了患者的健康转归,增强了护理工作的价值.     

Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial

ObjectivesTo examine the effect of a comprehensive transitional care model on the use of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke.DesignCluster randomized pragmatic trialSettingForty-one acute care hospitals in North Carolina.Participants2262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (SD) age of 74.9 (10.2) years and a mean ± SD National Institutes of Health stroke scale score of 2.3 (3.7).InterventionComprehensive transitional care model (COMPASS-TC), which consisted of a 2-day follow-up phone call from the postacute care coordinator and 14-day in-person visit with the postacute care coordinator and advanced practice provider.Main Outcome MeasuresTime to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission.ResultsOnly 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (hazard ratio, 1.20, with a range of 0.95-1.52) compared to usual care. This estimate was robust to additional covariate adjustment (hazard ratio, 1.23) (0.93-1.64). Both clinical and non-clinical factors (ie, insurance, geography) were predictors of SNF/IRF use.ConclusionsCOMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care.     

Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study

Purpose: Early identification of predictive factors relevant to the utilization of long-term care institution for stroke patients is important and thus investigated in this study on stroke patients receiving rehabilitation therapy. Methods: This prospective follow-up investigation carried out during patients' clinical visits, at homes or long-term care institutions, was conducted at least 6 months after stroke on 151 stroke survivors. Functional ability was evaluated with the functional independence measure (FIM TM ) instrument at discharge of the inpatient rehabilitation programme. Balance status was measured using the seven item balance scale of the Fugl-Meyer sensorimotor assessment (FMSA). Major medical, rehabilitative and sociodemographic factors were also examined during hospitalization period as independent variables. Results: Of all the patients surveyed, 23 (15.2%) had been living in long-term care institutions. Univariate statistical analysis indicated that the significant factors related to longterm care institution utilization included recurrence of attack, bilateral involvement, impaired orientation, and functional and balance status at discharge. Conclusions: Basing on the significant predictors identified, analysis using the logistic regression model correctly classified three quarters of the subjects as long-term care institution residents. The strongest predictors of long-term care institution utilization for stroke patients following rehabilitation therapy were: bilaterally affected, impaired orientation and poor standing ability at discharge.     

过渡期护理模式在重度颅脑损伤患者重症监护过渡护理中的应用效果

目的探讨过渡期护理模式(transitional care model,TCM)在重度颅脑损伤患者重症监护过渡护理中的应用效果。方法便利抽样法选取2008年5月至2010年4月在宿州市立医院重症监护室(intensive care unit,ICU)治疗后转入神经外科的重度颅脑损伤患者193例作为对照组;同法选取2010年5月至2012年5月重度颅脑损伤患者198例作为观察组。对照组患者在过渡期实施传统护理模式,而观察组患者实施TCM。护理干预1周,比较两组患者重症监护过渡期护理不良事件发生率、重返ICU率及焦虑、抑郁情况;出院时比较两组患者的平均住院日和患者家属满意率。结果观察组患者重症监护过渡期不良事件的发生率、重返ICU、焦虑与抑郁发生率均低于对照组,差异有统计学意义(P0.05或P0.01)。观察组患者的平均住院日为(23.43±1.00)d,短于对照组的(30.20±0.90)d,差异有统计学意义(t=7.41,P0.01)。观察组患者的满意率为98.4%,高于对照组的95.5%,差异有统计学意义(χ2=2.19,P0.05)。结论实施TCM,有利于重症监护过渡期患者的救治,同时可有效提高患者家属的满意度。     

Transitional rehabilitation goals for people with spinal cord injury: looking beyond the hospital walls

Abstract

Purpose: This study aimed to identify, describe and classify the transitional rehabilitation goals of people with spinal cord injury (SCI) and map these goals to the International Classification of Functioning, Disability and Health (ICF). Method: The five most important rehabilitation goals as rated by clients were extracted from records for 220 clients of a transitional rehabilitation service for people with SCI in Australia over a 5-year period. These goals were thematically classified into domains and then mapped to the ICF framework. Goals were compared across age, gender, length of hospital stay, compensation status, level and completeness of injury. Results: A total of 1100 goals were classified into 18 different goal domains, representing most aspects of the ICF framework. Age was negatively related to vocational goals. Length of hospital stay was positively related to personal care goals but negatively related to community access and vocational goals. Goals did not differ across gender or compensation status but did differ across level and completeness of injury. Conclusions: People with SCI have a range of transitional rehabilitation goals that represent most aspects of the ICF framework. Client-centred community rehabilitation during this transition period offers continuity of care to support the realisation of these rehabilitation goals.

• Implications for Rehabilitation

• Transitional rehabilitation is a relatively new community service model in the rehabilitation literature, especially for people with spinal cord injury.

• Client-centred goal setting is integral to these types of community rehabilitation models.

• Rehabilitation goals in transitional rehabilitation are varied and map well to the International Classification of Functioning, Disability and Health (ICF) with a focus on environmental goals.

• A typology of rehabilitation goals in this setting will assist in service planning and evaluation of hospital and community rehabilitation services.

     

Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study.

PURPOSE: Early identification of predictive factors relevant to the utilization of long-term care institution for stroke patients is important and thus investigated in this study on stroke patients receiving rehabilitation therapy. METHODS: This prospective follow-up investigation carried out during patients' clinical visits, at homes or long-term care institutions, was conducted at least 6 months after stroke on 151 stroke survivors. Functional ability was evaluated with the functional independence measure (FIM) instrument at discharge of the inpatient rehabilitation programme. Balance status was measured using the seven item balance scale of the Fugl-Meyer sensorimotor assessment (FMSA). Major medical, rehabilitative and sociodemographic factors were also examined during hospitalization period as independent variables. RESULTS: Of all the patients surveyed, 23 (15.2%) had been living in long-term care institutions. Univariate statistical analysis indicated that the significant factors related to long-term care institution utilization included recurrence of attack, bilateral involvement, impaired orientation, and functional and balance status at discharge. CONCLUSIONS: Basing on the significant predictors identified, analysis using the logistic regression model correctly classified three quarters of the subjects as long-term care institution residents. The strongest predictors of long-term care institution utilization for stroke patients following rehabilitation therapy were: bilaterally affected, impaired orientation and poor standing ability at discharge.     

延续性护理在癌症出院患者中的实践研究进展

延续性护理是为满足出院患者实际需要而提供的一种有序、协调、不间断的医疗保健服务,近年来已逐渐成为癌症出院患者健康照护研究的热点。本文从延续性护理的概念、在癌症出院患者中的实践现状以及延续性护理对癌症出院患者的影响等方面对国内外研究进展进行综述,为下一步构建适合我国癌症患者的延续性照护模式提供理论依据。