门诊猝死患者的急救与护理

目的:探讨门诊护士在猝死患者急救与护理中的作用,强化院内门诊猝死的护理干预.方法:回顾性分析2000年1月～2009年6月发生于我院门诊猝死患者54例,将2000年1月～2004年12月的21例作为对照组,由急诊科的医生、护士携带抢救药品及器械到现场进行抢救;2005年1月～2009年6月的33例作为观察组,由门诊的医生、护士携带抢救药品及器械到现场进行抢救.结果:观察组抢救猝死患者33例,成功9例,成功率为27.27%,有效11例,有效率为33.33%.对照组抢救猝死患者21例,成功2例,成功率为9.52%,有效5例,有效率为23.81%.两组比较有统计学意义(P<0.05).结论:应进一步对门诊护士组织培训,熟练掌握抢救技术,提高猝死患者的抢救成功率.     

Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison

Abstract

Objectives:

(1) To attain a quantitative estimate of patient satisfaction with physiotherapy care for musculoskeletal conditions in Australia; (2) to compare the observed level of patient satisfaction with care in Australia with those from other countries; and (3) to compare factors contributing to patient satisfaction between Australia and the United States (US).

Methods:

We conducted a prospective study of 274 patients presenting for physiotherapy treatment of a musculoskeletal disorder in Australian clinics. Patient satisfaction was measured using the 20-item MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) and satisfaction scores were compared with those from Northern Europe, North America, the United Kingdom, and Ireland. To investigate factors contributing to patient satisfaction between Australia and the US, we compared 20-item MRPS data from Australian and Spanish-speaking US cohorts.

Results:

Mean Australian MRPS satisfaction score was 4·55 (95% confidence interval: 4·51–4·59) on a scale of 1 to 5, where 1 indicates high dissatisfaction and 5 indicates high satisfaction. This high level of patient satisfaction is consistent with international data. Australian respondents specifically valued interpersonal aspects of care, including advice and information about their condition and an explanation about self-management. The correlation between treatment outcomes and global patient satisfaction was low (r?=??0·22). A comparison of data collected from Australia and the US showed that MRPS items regarding interpersonal aspects of care, such as the therapists’ communication skills, correlated strongly with global satisfaction in both countries. However, there were other questionnaire items for which the correlation with global satisfaction was significantly different between Australia and the US.

Conclusions:

Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe, North America, the United Kingdom and Ireland. Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common, country-specific differences also exist.     

Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison

Objectives:

(1) To attain a quantitative estimate of patient satisfaction with physiotherapy care for musculoskeletal conditions in Australia; (2) to compare the observed level of patient satisfaction with care in Australia with those from other countries; and (3) to compare factors contributing to patient satisfaction between Australia and the United States (US).

Methods:

We conducted a prospective study of 274 patients presenting for physiotherapy treatment of a musculoskeletal disorder in Australian clinics. Patient satisfaction was measured using the 20-item MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) and satisfaction scores were compared with those from Northern Europe, North America, the United Kingdom, and Ireland. To investigate factors contributing to patient satisfaction between Australia and the US, we compared 20-item MRPS data from Australian and Spanish-speaking US cohorts.

Results:

Mean Australian MRPS satisfaction score was 4.55 (95% confidence interval: 4.51–4.59) on a scale of 1 to 5, where 1 indicates high dissatisfaction and 5 indicates high satisfaction. This high level of patient satisfaction is consistent with international data. Australian respondents specifically valued interpersonal aspects of care, including advice and information about their condition and an explanation about self-management. The correlation between treatment outcomes and global patient satisfaction was low (r = −0.22). A comparison of data collected from Australia and the US showed that MRPS items regarding interpersonal aspects of care, such as the therapists’ communication skills, correlated strongly with global satisfaction in both countries. However, there were other questionnaire items for which the correlation with global satisfaction was significantly different between Australia and the US.

Conclusions:

Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe, North America, the United Kingdom and Ireland. Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common, country-specific differences also exist.     

Overall information needs of early-stage prostate cancer patients over a decade: highly variable and remarkably stable

PURPOSE: To assess the stability of information needs of early-stage prostate cancer patients by comparing needs in the same location, at two time points, almost 10 years apart. METHOD: Two groups of patients were surveyed (first, 1996; second, 2005) to identify retrospectively their information needs in the diagnosis-to-treatment-decision time interval. Both sampling cohorts were men diagnosed in one location in Canada within the previous 2 years. Participants rated the importance of getting answers to each of 92 questions (organized in eight categories) using four options: essential, desired, no opinion, or avoid. For each essential and desired question, respondents also indicated the reason(s) they wanted the question addressed: to understand, decide, plan, or other. RESULTS: The two groups had similar response rates: 38 (68%) in 1996 and 130 (70%) in 2005. They also had similar ages, marital status, or education. Both groups rated means of: 49 questions "essential" with wide ranges across respondents (12-90 vs 0-92 questions); 73 questions as "essential"/"desired"; and two questions to "avoid". At both times, every question was essential to some participants but only six (in 1996) and 12 (in 2005) questions were essential to over 80% of participants. In both groups, the most frequent reason for essential questions was for understanding (mean number of questions 34 vs 36), followed by decision making (means 13 vs 19), and then planning (means 10 vs 15). CONCLUSIONS: We have demonstrated reliably that, although many patients want a lot of information, the range in amount and in exact details varies considerably across individuals. Systematic patient education is needed, therefore, but it must be individualized.     

Written information: evaluation of an informative leaflet for patients undergoing colonoscopy

Client teaching and information on medical procedures and care organisation is recognised as one of the most important tasks for the nurse. The information must be complete, detailed, and personalized according to the client culture and learning capacity. To address these points, an information booklet has been designed to inform clients undergoing colonoscopy in the gastroenterology unit of Azienda Ospedaliera Careggi, Florence. The booklet, together with a multiple choice questionnaire aimed at evaluating clients' satisfaction with the information provided, was distributed to 100 clients undergoing a colonoscopy over a two-month period in 1998. The results of the survey suggest that the booklet has been instrumental in client learning about the procedure, as shown by the high positive satisfaction response provided to the questionnaire. Moreover, contents provided are clear and easy to understand. Clients would like to have specifically detailed information on the way the exam is performed, on its duration (22%) and on the disinfection procedures (21%). At present, all the patients booked for colonoscopy receive the booklet in their homes.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

Patients' views on the screening of a videotape on osteoarthritis in an orthopaedic outpatient department

This study explores both new and existing outpatients' views about the screening of an informational videotape on osteoarthritis in the waiting area prior to their appointment at an orthopaedic outpatient clinic in an outer London teaching hospital. The aim was to establish the usefulness of the videotape as perceived by patients, and to explore the extent to which the outpatient department environment affected patients' viewing of the tape. The findings revealed that over half the patients saw the entire tape, whilst over a quarter saw one part of it. The majority of patients rated the tape interesting, with over half reporting it as having practical value. However, noise in the outpatient environment was the main factor which affected patients' viewing of the tape.     

A nurse- and pharmacist-led treatment advice clinic for patients attending an HIV outpatient clinic

AIM: This paper is a report of a study to map care pathways, examine the approach of different treatment advisors and explore the acceptability of a nurse- and pharmacist-led treatment advice clinic in order to aid decision-making for the future development and evaluation of the clinic. BACKGROUND: High levels of adherence to antiretroviral drugs are a prerequisite for a successful and durable virological and immunological response to HIV. Treatment guidelines acknowledge that adherence is a process, not a single event, and that adherence support must be integrated into clinical follow-up for all patients receiving these drugs. METHOD: Data were collected between September 2004 and January 2005 through 17 consultation observations and 10 patient interviews in a specialist treatment advice clinic located within a central London HIV outpatient clinic providing care for over 2200 patients, of whom more than 1300 are taking highly active antiretroviral therapy. FINDINGS: The nurses and pharmacist had similar consultation approaches, although follow-up care varied in extent. Benefits of the clinic approach included permitting patients to observe real tablets, tailoring regimens to lifestyles and telephone follow-up. These factors, particularly telephone support, were perceived by patients to assist with adherence. CONCLUSION: The role of telephone support, perceived to assist with initial adherence, requires further investigation. Future work is also needed to explore the health economics of this approach and to determine the actual impact of the clinic on clinical and adherence outcomes.     

Service user experiences of information delivery after a diagnosis of cancer: a qualitative study

GOALS OF WORK: This paper presents findings from a qualitative study investigating service users' experiences of a patient information pathway after a diagnosis of cancer. MATERIALS AND METHODS: Patients (27) and relatives (20) were recruited from two identified Cancer Network sites representing a pathway that had been information mapped (Lung) and one which had not (Head and Neck). Respondents participated in up to three qualitative interviews in the year after diagnosis. MAIN RESULTS: The need for information in response to serious health problems has become widely accepted. Providing cancer patients and their carers with high-quality information throughout their care pathway is a policy priority. However, the study findings contribute to a growing body of evidence that far from embracing the active role of "expert patient", many patients continue to prefer verbal to written information, to trust in health professionals as their primary and preferred source of information, and to be quite cautious and selective about what they want to know about their illness. CONCLUSIONS: Good information is regarded as a prerequisite for informed decision making and a primary means of coping with the stress of illness. However, patient attitudes to information are complex and encompass resistance, ambivalence and indifference, active engagement and interest. The study findings reinforce the need for health professionals to develop competence as skilled communicators, and for efficient local systems of information transfer between service agencies and health professionals as prerequisites for delivery of the timely, tailored and personalized information which patients require.     

The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department

OBJECTIVE: When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department. METHODS: A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache. RESULTS: Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04). CONCLUSION: Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.     

Quality of web-based information for osteoarthritis: a cross-sectional study

Background

Osteoarthritis (OA) is a chronic condition that affects over 8.75 million people in the UK. Approximately 43% of people in the UK search for health and medical information online. However, health information on the internet is of variable quality. Research into the quality of online OA information is dated and there is a need to evaluate the existing information.

The role of day hospital in optimization of medical care for patients of a therapeutic department of an outpatient clinic

Day hospital (DH) provides consultations and treatment for all referred patients according to standards of medical care quality. DH has facilities for therapeutic and gastroenterological patients. Treatment in DH is performed according to current standards which cover basic treatment of the diseases (documented medicines, duration of treatment). Efficacy of DH's use of the Standards of Diagnosis and Therapy of Acid-Dependent Diseases associated with Helicobacter pylori (standards of Moscow consensus) is used as illustration. As a result of treatment in DH 93% outpatients resumed their jobs, improvement occurred in 96.7% patients, a complete response was seen in 23%, 1.9% cases failed treatment. Most DH patients (83%) were satisfied with treatment given in DH and think it a convenient replacement of hospital stay.     

Meeting information needs on cancer-related fatigue: an exploration of views held by Italian patients and nurses

Background Interest in cancer-related fatigue has been growing over the last two decades and efforts have been dedicated to investigate this topic. However, research addressing the adequacy of educational resources for patients with this distressing and common symptom is lacking. Only one study has been undertaken and this explored Swiss and British patients’ views. Materials and methods The current study replicated and extended the study previously undertaken in the United Kingdom (UK) and Switzerland. It sought views on the adequacy of materials on cancer-related fatigue available to patients with cancer living in Italy, and to determine the educational preferences and needs of Italian patients with cancer-related fatigue. These were attained through conduct of two focus groups. One was undertaken with Italian patients and the other with a group of Italian nurses. Main results Findings from this study supported patients’ desire for timely, accurate and individualised information. Barriers to effective fatigue education included the limited dialogue regarding fatigue initiated in clinical settings. It appeared that nurses and patients held different priorities in symptom management. Further, it was acknowledged that there was often insufficient time to inform patients adequately about fatigue. Participants considered written materials as helpful complements to oral information, thus supporting the provision of information in both forms. However, it was clear that fewer written resources concerning cancer-related fatigue were available in Italy compared to either in Switzerland or in the UK. Conclusion The study supported the view within the current literature that whilst cancer-related fatigue is recognised as a frequent and disruptive symptom, patient education about this symptom and its management still needs to be enhanced. The resources available to educate patients about cancer-related fatigue should be improved and made more accessible to patients who experience it.     

Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department

Objective: To study the wishes of a sample of French patients about medical information and surrogacy, at a time when the French Ministry of Health is supporting increased patient autonomy.¶Design: A cohort of competent patients with non-critical illnesses or injuries completed an intention-to-act questionnaire on the amount of medical information they would want to receive should they be hospitalized or in a life-threatening situation. The percentage of patients who would want to have a surrogate if they were in a coma was determined, as well as the identity of the preferred surrogate. The subgroup of patients who were married or living with a partner was evaluated separately to determine how often the spouse/partner was the preferred surrogate. Associations were looked for between patients' wishes and age, sex, educational level, occupation, hierarchical order in the family, and level of confidence in medicine.¶Setting: The emergency room of a teaching hospital in the Paris area (France).¶Results: Of the 1089 patients included in the study, 5.5 % reported that they would not want any information, 25.3 % that they would want to participate actively in all decisions about their care, and 87.3 % that they would want to be fully informed if they were in a life-threatening situation. Slightly less than one-third of the patients (29.6 %) believed they would not want a surrogate if they developed a coma. Among the patients living with a spouse/partner, 40.6 % (229/561) indicated they would want their spouse/partner to be their surrogate. A significant correlation was observed between wanting more information and wanting a surrogate. Younger patients with a higher educational level were significantly more likely to predict a desire for information and for a surrogate than the other patients.¶Conclusion: Our patients expressed a strong desire to receive extensive information should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living with a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.