Preference for gender of health care provider in management of erectile dysfunction

We investigated whether a preference by patients regarding the gender of a health care provider to manage erectile dysfunction (ED) may be a factor in the diagnosis and care of this condition, whose broader medical significance is an area of increasing interest. A brief questionnaire was completed by 1087 adult males in a primary care setting. The questionnaire explored provider gender preference and other possible biases. The prevalence of ED in the 40-69 age group in our population was 68.8%. The prevalence was 81% in the age group of 70 and more. Of those who reported having experienced ED, 51.5% had discussed it with a provider, and 28.1% had been treated. Approximately, 57% expressed no provider gender preference, regardless of history of ED. Of those who stated a preference, approximately 75% prefer male providers. However, also among those who state a preference, Hispanics are not as likely as non-Hispanics to prefer a male provider (P=0.03). Most believe that males and females are equally qualified to manage ED, but among those who have a different opinion, the gender perceived more favorably is male. The issue of privacy during the discussion of ED was also very important to the respondents in this study.     

Advancing SCI health care to avert rehospitalization

Abstract

This commentary reflects on the high rate of health care utilization among individuals with traumatic spinal cord injury (SCI) in the first year of injury as reported by Skelton et al. in the current issue of this journal. Commentary argues that the variation in risk-adjusted rehospitalization rates suggests that there is considerable opportunity for improvement. Authors note that we need better strategies to prevent the onset of the 3 conditions that drive most of the rehospitalization, namely, urinary tract infections, pneumonia, and pressure ulcers. Commentary also urges providers to rethink and reinvent the process of care in acute, rehabilitation, and post-discharge phases of care. It recommends that SCI centers take greater advantage data resources already available such as the National Spinal Cord Injury Database to openly share and compare center-to-center differences in practice and outcomes. It also urges SCI centers to reinvent their systems of care in ways being made possible under health care reform, especially systems that make all providers in a given episode of care—from acute to rehabilitation to post-discharge care, mutually and financially accountable for both outcomes and costs including emergency room use and rehospitalization.     

Critical care nurses' knowledge about pressure ulcer in southeast of Iran

Pressure ulcer prevention needs nurses' awareness of sore classification/onset, its item characteristics, and its prevention. Using Pieper's Pressure Ulcer Knowledge Test, 126 critical care nurses' knowledge about pressure ulcer was examined. The questionnaire was divided into three categories including: (1) sore classification/onset; (2) wound characteristics, and (3) preventive measure. The level of nurse's knowledge was insufficient. The highest rate of correct answers belonged to section 2 - prevention of pressure ulcer. Programs aimed at raising nurses' knowledge accompanied by interventions intended to decrease incidence of pressure ulcer are important parts in educational programs. Continuing education may need to be added to the pressure ulcer care to improve the quality of care at intensive care units.     

Exploring provider attitudes and perspectives related to men's health in cystic fibrosis

BackgroundNew modulator therapies have markedly improved the health of people with cystic fibrosis (CF), allowing an increased focus on quality-of-life improvements for men with CF, including those related to sexual and reproductive health (SRH). This study explored CF providers’ attitudes and experiences with addressing men's health in CF.MethodsWe interviewed geographically diverse adult and pediatric United States (U.S.) CF program directors via semi-structured telephone interviews exploring their perspectives and practices related to men's SRH in CF. Two coders analyzed transcribed interviews and created a codebook to identify key themes.ResultsWe interviewed 20 providers and identified the following themes: 1) Men's SRH is important to address within CF care, but there is no standardization around this aspect of care; 2) There is no consensus about the recommendation or utilization of semen analysis to assess men's infertility; 3) There are many barriers to men's SRH care provision in CF centers, including the low priority of SRH concerns and provider discomfort and lack of expertise in SRH; 4) Providers desire clear evidence-based guidelines and patient resources related to men's SRH in CF; and 5) Providers believe future research should focus on testosterone and the impact of modulators on men's SRH.ConclusionsCF center directors acknowledge the importance of addressing SRH with men with CF, but there is a lack of standardization and research in this aspect of care. Existing barriers to optimal SRH care and identified facilitators in this study can serve as targets for interventions in the CF care model.     

Role of topical negative pressure in pressure ulcer management

The literature suggests that topical negative pressure can be an effective treatment for severe pressure ulcers. However, research is needed on its effects on variables such as dressing change frequency, quality of life, pain relief and cost-effectiveness.     

压疮患者的远程家庭护理

目的探讨远程家庭护理在压疮延续护理中的应用效果。方法选择8例院外带入的Ⅳ期压疮患者,经过住院期间清创、抗感染等处理出院后利用网络服务平台(微信、QQ、邮件、电话等)开展远程家庭护理,指导出院患者居家护理,为患者提供延续护理服务。结果 8例患者中,2例省外患者行全程远程护理居家指导;6例省内患者除做好远程家庭护理外,嘱患者不定期来门诊复诊,平均每人4次,远程家庭护理持续2~8个月,7例愈合,1例明显好转。结论远程家庭护理帮助患者实现了压疮延续住院期间的治疗和护理,效果佳,节约医疗费用。     

授权在压疮管理中的应用

目的探讨授权管理模式在降低医院压疮发生率中的应用效果。方法成立伤口造口专科护理小组,通过授权管理方法,明确被授权人职责,对被授权人进行授权管理培训。建立压疮风险管理小组,制定压疮质量控制及会诊制度,实时监控全院压疮情况并进行质量分析、总结反馈。结果通过实施授权管理,医院压疮发生比例由2015年0.050%下降至2017年0.042%,2015～2017年24 h内压疮及时上报率、复核准确率、压疮防护处置正确率均逐年上升。结论授权管理模式能降低住院患者压疮发生风险,提升压疮护理管理质量。     

Use of a total quality management model to reduce pressure ulcer prevalence in the acute care setting

As the population ages and becomes more frail, pressure ulcer prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. All patients on the adult medical, surgical, and critical care units were examined regularly by the “Rear Admirals,” a team comprising a skin care resource person and a nursing unit representative. The Total Quality Management model, characterized by the phrase “Plan-Do-Check-Act,” was used to address barriers to quality care. Findings during that time prompted changes in policies, products, protocols, work assignments, and documentation tools. The outcomes achieved demonstrate the effectiveness of those strategies. After implementation of the Total Quality Management model at our institution, the prevalence of patients with nosocomial pressure ulcers was reduced by 83%.     

A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI

BACKGROUND: Pressure ulcers are a common secondary condition that occur post-spinal cord injury (SCI). These ulcers come at tremendous personal and societal cost. There are a number of scales that can be used to identify those who are at risk. OBJECTIVES: This review critically evaluates risk assessment scales designed for identifying and predicting skin ulcers. Specifically, studies on the psychometric properties and utility for individuals with SCI were assessed. METHODS: The MedLine, CINHAL, Embase, HaPI, Psycinfo, Sportdiscus and Cochrane databases were searched to identify studies. To be included, the scale needed to have at least one study, published in a peer-reviewed journal, which examined its psychometric properties with a sample of individuals with SCI. RESULTS: Seven scales were included in this review: Abuzzese, Braden, Gosnell, Norton, SCIPUS, SCIPUS-A and Waterlow. None of the tools reported reliability data with this population. Validity evidence ranged from poor to adequate across scales. Most were readily available, quick to administer and had minimal respondent burden; however, the SCIPUS-A and SCIPUS, two scales developed specifically for individuals with SCI, required laboratory blood testing. CONCLUSION: Although the SCIPUS-A and SCIPUS show promise, utility issues and limited psychometric testing suggest that these tools cannot be recommended at this time. While the Braden scale has the best combined validity and utility evidence, more specific testing with individuals with SCI is required for it and all other scales included in the review.     

质量管理工具在基层医院难免性压疮管理中的应用

目的 探讨将质量管理工具应用到难免性压疮管理中的效果.方法 采用质量管理工具中的查检表对难免性压疮高危患者上报及发生例数进行统计、绘制特性要因图（鱼骨图）后进行原因分析,确定和解决难免性压疮管理中的问题.结果 质量管理工具应用前后难免性压疮发生率比较,差异有统计学意义（P＜0.05）.结论 将质量管理工具应用到难免性压疮管理中可有效减少难免性压疮的发生,达到护理质量与安全的持续改进.     

Surgeons'' attitudes to the operative management of duodenal ulcer perforation and haemorrhage.

The currently preferred operative management of duodenal ulcer haemorrhage and perforation was assessed by means of a questionnaire sent to 274 consultant general surgeons in England. A 70% response rate was achieved. Simple closure, with or without H2 antagonist treatment, was the most popular management of a perforated acute duodenal ulcer. For perforation of a chronic duodenal ulcer occurring during H2 antagonist therapy, truncal vagotomy and drainage was the definitive procedure of choice. There was no consensus about the operative management of perforation complicating non-steroidal anti-inflammatory drug treatment in the elderly patient. Proximal gastric vagotomy appears to have few advocates in the definitive management of either duodenal ulcer perforation or haemorrhage. Of our sample 70% selected truncal vagotomy and drainage with underrunning of the ulcer as the operative treatment of choice for bleeding. Endoscopic coagulation appears to be used only rarely.     

质量管理工具在基层医院难免性压疮管理中的应用

目的探讨将质量管理工具应用到难免性压疮管理中的效果。方法采用质量管理工具中的查检表对难免性压疮高危患者上报及发生例数进行统计、绘制特性要因图(鱼骨图)后进行原因分析,确定和解决难免性压疮管理中的问题。结果质量管理工具应用前后难免性压疮发生率比较,差异有统计学意义(P0.05)。结论将质量管理工具应用到难免性压疮管理中可有效减少难免性压疮的发生,达到护理质量与安全的持续改进。     

图片资料用于晚期肺癌患者压疮防治的效果

目的探讨图片资料用于晚期肺癌患者压疮防治的效果。方法将160例压疮高危患者分为对照组78例和观察组82例。对照组给予常规护理干预,观察组在此基础上给予图片资料进行健康教育干预。结果与对照组比较,观察组压疮防治依从性提高,压疮发生率显著降低,压疮治疗效果提高(P0.05,P0.01)。结论图片资料的使用提高压疮高危患者对压疮防治的依从性,降低压疮发生率和促进压疮治疗。     

细胞因子在压疮护理中的应用研究进展

综述细胞因子的概念,在压疮修复中的作用机制及其分类、在各种不同压疮分型中的应用及效果评价。提出对高危压疮患者进行伤口护理时,应先全面地评估,因人制宜,动态选择有效的护理措施,可尝试联合细胞因子培养或干细胞与细胞因子协同作用有效护理创面。