头颈肿瘤气管切开带管出院患者家庭参与式延续护理的实施

目的 探讨头颈肿瘤气管切开带管出院患者实施家庭参与式延续护理的效果。方法 将头颈肿瘤气管切开带管出院患者78例随机分为观察组和对照组各39例，对照组采用常规出院指导和健康教育，观察组在此基础上实施家庭参与式延续护理，由护理团队对患者家属进行气管切开照护技能培训，通过互联网技术对患者及家属进行院外延续护理。比较两组患者家属气管切开护理技能水平和居家照护能力，同时比较两组患者气管切开相关并发症发生率、再入院率。结果 出院时观察组患者家属气管切开护理技能考核评分显著高于对照组，出院时及出院后1个月、3个月两组家属照护能力评分比较，差异有统计学意义（均P＜0.05）；出院后3个月观察组气管切开并发症发生率及相关再入院率显著低于对照组（均P<0.05）。结论 家庭参与式延续护理为头颈肿瘤气管切开带管出院患者供了连续、优质、专业的居家护理支持，可提高其家庭照顾者居家照护能力，有效降低患者并发症发生率。     

家庭干预对精神分裂症患者康复的影响

目的探讨家庭干预对精神分裂症患者康复效果。方法将80例出院的精神分裂症患者随机分为观察组和对照组各40例。两组均服用抗精神病药物治疗,对照组采用常规护理及出院指导;观察组于患者出院1个月末采用家庭干预,以后每2~3个月1次。出院时及2年后用阴性症状量表(SANS)、症状自评量表(SCL-90)进行评估。结果两组干预前后SANS各因素分比较,差异有显著性意义(均P<0.01),而干预后观察组显著低于对照组(均P<0.01);SCL-90各因子分和总分及复发率和再住院率明显低于对照组(P<0.01,P<0.05)。结论家庭干预对巩固和改善精神分裂症患者治疗效果、改善社会功能、控制其复发率和再住院率具有积极意义。     

家庭护理干预对白血病缓解期患者预后的影响

目的探讨家庭护理干预对白血病缓解期患者预后的影响.方法将50例白血病缓解期患者随机分为对照组与观察组各25例,对照组进行常规出院指导,观察组进行家庭护理干预.比较两组遵医率、白血病复发再住院率、并发症发生率及生活质量.结果观察组较对照组遵医率显著提高,复发率显著降低,生活质量显著提高(P<0.05,P<0.01).结论家庭护理干预可以明显改善白血病缓解期患者的预后.     

协同护理模式对妊娠糖尿病患者家庭功能和妊娠结局的影响

目的探讨协同护理模式对妊娠糖尿病患者家庭功能和妊娠结局的影响。方法选择妊娠糖尿病患者128例,采用随机数字表法分为对照组(64例)和观察组(64例)。对照组实施常规护理,观察组实施协同护理模式。以家庭功能评定量表(FAD)评价干预前和干预后家庭功能及比较两组的妊娠结局。结果干预后观察组家庭功能各维度得分显著高于对照组(P<0.05,P<0.01)。观察组剖宫产、早产、胎膜早破、羊水过多、产后出血感染、糖尿病急性并发症发生率较对照组显著降低(P<0.05,P<0.01)。观察组巨大儿、宫内窘迫、新生儿低血糖发生率较对照组显著降低(P<0.05,P<0.01)。结论应用协同护理模式能提高患者的家庭功能,降低围生期不良并发症,提高自然分娩率,改善母婴预后。     

院外留置导尿管患者的家庭随访指导

目的探讨家庭留置导尿管患者的护理管理方法。方法将128例家庭留置导尿管患者按时间顺序分为对照组(62例)和干预组(66例),对照组实施常规护理指导;干预组在此基础上首先调查评估再进行家庭随访指导,包括心理护理,尿路感染、尿液引流不畅、患者不适感、尿道口渗尿及拔管困难的预防等指导。结果干预组患者留置导尿管并发症发生率显著低于对照组(P<0.05,P<0.01),照顾者知识掌握情况显著优于对照组(P<0.05,P<0.01)。结论实施家庭随访指导能明显降低留置导尿管患者并发症的发生,提高家庭留置导尿管患者照顾者的管理能力。     

老年股骨脆性骨折患者基于骨折联络服务模式的出院计划干预研究

目的 探讨基于骨折联络服务模式的出院计划对老年股骨脆性骨折患者的干预效果。方法 将120例老年股骨脆性骨折患者按病区分为对照组和观察组各60例,对照组按常规临床护理路径实施围手术期护理和出院随访,观察组住院期间按常规临床护理路径实施围手术期护理,同时实施基于骨折联络服务模式的出院计划干预方案。结果 对照组53例、观察组50例完成研究,出院后3个月和6个月,观察组功能锻炼依从性和Morisky服药依从性评分显著优于对照组,出院后9个月观察组居家跌倒发生率及新发脆性骨折再入院率显著低于对照组(均P<0.05)。结论 基于骨折联络服务模式对老年股骨脆性骨折患者实施出院计划干预,有助于增强老年患者功能锻炼依从性和遵医行为,降低新发脆性骨折风险和居家跌倒发生率,从而提高患者远期生活质量。     

家庭护理干预对白血病缓解期患者预后的影响

目的 探讨家庭护理干预对白血病缓解期患者预后的影响。方法 将50例白血病缓解期患者随机分为对照组与观察组各25例，对照组进行常规出院指导．观察组进行家庭护理干预。比较两组遵医率、白血病复发再住院率、并发症发生率及生活质量。结果 观察组较对照组遵医率显著提高，复发率显著降低．生活质量显著提高（P〈0．05．P〈0．01）。结论 家庭护理干预可以明显改善白血病缓解期患者的预后。     

妇产科急腹症的综合护理干预方法及效果观察

目的探讨妇产科急腹症的综合护理干预方法及效果。方法随机将100例妇产科急腹症患者分为2组,每组50例。观察组行综合护理干预,对照组进行基础护理。比较2组患者的护理依从性、术后应用镇痛药物次数、平均住院时间、并发症发生率及患者的满意度。结果观察组患者的护理依从性、术后应用镇痛药物次数、平均住院时间、并发症发生率及患者的满意度均显著优于对照组,差异有统计学意义(P0.05)。结论对妇产科急腹症患者进行综合护理干预,可显著提高患者的护理依从性及其满意度,减少术后应用镇痛药物次数、平均住院时间和并发症发生率,效果确切。     

医院-家庭过渡期老年冠心病患者的用药偏差管理

目的 探讨老年冠心病患者医院-家庭过渡期的用药偏差管理效果。方法 将71例老年冠心病患者按不同病区分为对照组35例与观察组36例；对照组给予常规护理，观察组在此基础上进行用药偏差管理。结果 干预后观察组用药偏差发生率显著低于对照组(均P<0.05),干预8周后观察组药物素养及服药依从性评分显著高于对照组(均P<0.05)。结论 实施用药偏差管理可减少医院-家庭过渡期患者用药偏差发生率，提高患者药物素养和服药依从性。     

跟踪干预对门脉高压上消化道出血患者再出血的影响

目的探讨跟踪干预对门脉高压症患者上消化道再出血的影响。方法将有门脉高压症上消化道出血病史的 107例患者按出院顺序,奇数分为对照组,偶数分为观察组。对照组54例按常规行出院宣教;观察组53例在对照 组基础上增加跟踪护理干预,连续12个月后比较两组效果。结果焦虑值、再出血发生率,观察组显著低于对照组 (均P<0.05),健康行为依从优良率显著高于对照组(P<0.01)。结论跟踪护理干预能有效提高患者健康行为依 从性,降低再出血发生率。     

A comparison of costs for abdominal, laparoscopic, and robot-assisted sacral colpopexy

The aim of this study was to compare the short-term estimated hospital costs and charges for open, laparoscopic, and robot-assisted sacral colpopexy. The null hypothesis was that there would be no difference in costs and charges. Fifteen comparable cases were reviewed for demographics, surgical information, and estimated hospital charges and costs and then compared with analysis of variance. There were no differences in demographics and surgical variables among the three groups. For estimated hospital charges, minimally invasive sacral colpopexy was most expensive; open was the least expensive approach. The estimated direct costs were significantly higher for robot-assisted compared with open sacral colpopexy, but not different between robot-assisted and laparoscopic sacral colpopexy. Robot-assisted sacral colpopexy produces the highest estimated hospital charges and is more expensive than open sacral colpopexy. The least expensive surgical approach from the hospital costs perspective is open abdominal sacral colpopexy. Presented at the 34th American Urogynecologic Society Meeting, September 4–6, 2008, Chicago, Illinois     

口腔医院患者就诊影响因素调查分析

目的探讨影响口腔医院患者就诊的相关因素,了解消毒隔离的地位在影响因素中的变化及患者对其认知情况.方法自制调查问卷随机抽取200例患者进行相关调查.结果医疗技术、消毒隔离以及医务人员的服务态度是影响患者就诊的3大因素(分别占24.6%、20.6%、17.4%);患者对消毒隔离的概念认知不足(占77.0%).结论不断提升医疗质量,建立良好的护患关系是医院应该持续关注的问题;口腔科的消毒隔离在患者就诊影响因素的排序中较前,提示加强口腔科消毒隔离工作是提升医疗质量、吸引患者就诊的重要因素.     

Differences in hospital outcomes following traumatic injury for patients experiencing immediate transfer to a level I trauma facility versus resuscitation at a critical access hospital (CAH)

Background

Critical access hospitals (CAH) serve a key role in providing medical care to rural patients. The purpose of this study was to assess effectiveness of CAHs in initial care of trauma patients.

基于互联网的医院社区合作型慢病随访医方价值分析

目的研究基于互联网的综合医院-社区医院合作型慢病随访对医方的价值。方法将招募的180例慢病患者随机分为观察组和对照组各90例。观察组接受基于互联网的综合医院-社区医院合作型随访,对照组接受综合医院的电话随访和社区医院的社区随访。随访12个月后,评价两组患者满意程度和就诊次数、两组全科医生和社区护士的技术水平。结果随访12个月后,观察组患者满意度显著优于对照组(均P0.01)。两组因慢病至专科医生处非计划性就诊次数比较,差异无统计学意义(P0.05);观察组因慢病至全科医生处的就诊次数显著多于对照组(P0.01)。随访实施后12个月,观察组全科医生、社区护士的技术水平得分显著高于对照组(均P0.01)。结论基于互联网的合作型慢病随访能促进随访医护人员获得更好的认可及社区医院医护人员专业水平的提高,从而提升患者满意度。     

Morbid Obesity and Excessive Hospital Resource Consumption for Unilateral Primary Hip and Knee Arthroplasty

Two objectives of this study were (i) to estimate the number of primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) performed on morbidly obese people in the United States, and (ii) to estimate the economic impact of morbid obesity on hospital resource use. In 2006, approximately 2.9% (6713 cases) of primary THA and 4.2% (20 964 cases) of primary TKA recipients were diagnosed as morbidly obese. Despite the controversy associated with increased infection risk and failure rate, a large number of morbidly obese people seem to consider that the benefits outweigh the risks. When sex, age, race, and primary payer were held constant, the hospital resource consumption for unilateral primary THA and TKA was 9% ($1432) and 7% ($1025) higher among morbidly obese patients than among nonobese patients, respectively.     

Analysis of complications following partial and total nephrectomy for renal cancer in a population based sample

PURPOSE: We determined the frequency and predictors of complications of partial and total nephrectomy in a population based sample. MATERIALS AND METHODS: There were 3,019 partial and 18,575 total nephrectomies identified from the Nationwide Inpatient Sample data set of the Healthcare Cost and Utilization Project (2000 to 2003). The prevalence of International Classification of Diseases, 9th Revision coded complications following nephrectomy was determined. Hospital and patient related factors associated with the occurrence of a complication were determined by logistic regression analysis. We evaluated the impact of complications on in-hospital mortality, length of stay and hospital charges. RESULTS: Respiratory, digestive and bleeding complications were the most common, with similar patterns for partial nephrectomy and total nephrectomy. Significant predictors of complications after total nephrectomy included age, male sex, comorbidity severity index and hospital location (rural vs urban), while comorbidity was the only significant predictor for partial nephrectomy complications. Any complication had a significant impact on in-hospital mortality, total charges and length of stay. Digestive and urinary complications, hemorrhage, and postoperative infections had a significant impact on in-hospital mortality after partial nephrectomy, while these same complications, in addition to respiratory and cardiac complications, had a significant impact on total charges and length of stay. All except digestive complications had a significant impact on mortality, hospital charges and length of stay for patients undergoing total nephrectomy. CONCLUSIONS: In a population based cohort partial nephrectomy and total nephrectomy are associated with low morbidity and mortality profiles, and all complications affect mortality, length of hospital stay and charges.     

Time to treatment for patients receiving BCS in a public and a private university hospital in Atlanta

Delays in treatment for breast cancer can lead to poorer patient outcome. We analyzed time to treatment among female patients receiving breast-conserving surgery in two different hospital settings, public versus private. Retrospective chart review revealed 270 patients diagnosed during 2004-2008. Three consecutive time intervals were defined (Initial abnormal imaging [I] to core biopsy [II] to surgery /pathology staging [III] to oncology evaluation for adjuvant treatment). Multivariate analyses investigated hospital type and demographic factors. Overall median treatment time was 83 days, Interval II accounting for the longest (43 days). Only 55% of patients received the entire spectrum of care within 90 days; for each consecutive 30-day interval, percentages varied dramatically: 80.7%, 31.1%, and 68.9%.Public hospital patients experienced longer overall time to treatment than private patients (94 versus 77 days, p < 0.001); these differences persisted throughout the intervals. Longer wait times were experienced by African Americans versus Caucasians (89 versus 64 days, p = 0.003), unmarried versus married patients (93 versus 70 days, p < 0.001), and Medicaid-insured patients, p < 0.001. In multivariate analyses, hospital type, race, marital status, and insurance predicted timely treatment within one or more intervals. For patients undergoing breast-conserving therapy, time to treatment differs between private and public settings. However, barriers to timely treatment arise from both system-based issues and patient socio-demographic factors. Studies are needed to evaluate and intervene on this intricate connection.     

Hospital factors associated with higher costs in pediatric blunt abdominal trauma: A national study

Background/PurposeOur objective was to evaluate hospital factors, including children's hospital status, associated with higher costs for blunt solid organ pediatric abdominal trauma.MethodsWe queried the 2012 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) for patients 18 years or younger with low-grade and high-grade blunt abdominal trauma. We calculated total hospital costs and adjusted cost ratios (CR) controlling for patient and hospital-level characteristics.ResultsThe 2012 KID included 882 low-grade and 222 high-grade pediatric abdominal trauma patients. Median (interquartile range) per hospitalization costs were similar at children's and nonchildren's hospitals for both low-grade (children's = $6575 [$4333–$10,862], nonchildren's $7027 [$4230–$12,219] p = 0.47) and high-grade (children's = $10,984 [$6211- $20,007] nonchildren's $10,156 [$5439–$18,404] p = 0.55) groups. Adjusted cost ratios demonstrated higher costs in the West and among investor owned hospitals for low-grade and high-grade injuries, respectively. Costs at rural hospitals were higher in both groups (low-grade CR = 2.35 95% CI 2.02, 2.74, high-grade CR = 2.78 95% CI 2.13, 3.63) compared to urban teaching hospitals. Cost ratios did not differ based on children's hospital status.ConclusionHospital costs were similar for children's and nonchildren's hospitals caring for pediatric abdominal trauma. Costs at rural hospitals are higher and may suggest financial instability or nonstandardized care of pediatric trauma patients.Level of evidenceIII