共管模式在老年髋部骨折患者围手术期静脉血栓栓塞症预防中的应用

目的:探讨共管模式在老年髋部骨折患者围手术期静脉血栓栓塞症（VTE）预防中的应用效果。方法:采用便利抽样法,选取2019年1—12月郑州大学第一附属医院收治的146例老年髋部骨折患者为研究对象,将2019年1—6月收治的73例患者设为对照组,接受常规静脉血栓风险评估、治疗、宣教等,将2019年7—12月收治的73例患者...     

Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study.

BACKGROUND: Recent changes in the management of hip fracture surgery patients may have modified the epidemiology of postoperative complications. OBJECTIVES: We performed an observational study of a cohort of patients undergoing hip fracture surgery to update the epidemiological data on this population. The primary study outcome was the incidence of confirmed symptomatic venous thromboembolism (VTE) [defined as deep vein thrombosis, pulmonary embolism (PE), or both] at 3 months. Overall mortality at 1, 3 and 6 months was also evaluated. Patients/methods: Consecutive patients aged at least 18 years hospitalized in French public or private hospitals (531 centers) undergoing hip fracture surgery were recruited prospectively during 2 months in 2002 and a follow-up at 6 months. Predictive factors for VTE at 3 months and for death at 6 months were also analyzed. RESULTS: Data from 6860 (97.3%) of the 7019 recruited patients were included in the analysis. The median age was 82 years. Low molecular weight heparins were administered perioperatively in 97.6% of patients; 69.5% received this treatment for at least 4 weeks. The actuarial rate of confirmed symptomatic VTE at 3 months was 1.34% (85 events, 95% CI: 1.04-1.64). There were 16 PEs (actuarial rate: 0.25%), three of which were fatal. Overall, 1006 (14.7%) patients were dead at 6 months. Cardiovascular disease was the most frequent cause of death (270 patients; 26.8%). CONCLUSIONS: The current rate of postoperative VTE is low, but overall mortality remains high. Indeed, hip fracture patients belong to a vulnerable group of old people with comorbid diseases and a high risk of postoperative morbidity and mortality. An interdisciplinary approach could be the challenge to improve short and long-term outcome.     

脑卒中患者自我预防静脉血栓栓塞症知信行现状研究

目的：了解脑卒中患者自我预防静脉血栓栓塞症的知识、信念、行为现状。方法：采用目的抽样法,选取某三级甲等综合医院脑卒中患者121例,采用自行设计的脑卒中患者自我预防静脉血栓栓塞症知信行问卷进行调查。结果：脑卒中患者自我预防静脉血栓栓塞症的知信行得分为（164.18±15.73）分,其中知识、信念、行为得分依次为（29.12±4.74）分、（99.16±10.71）分、（35.90±5.60）分。结论：脑卒中患者自我预防静脉血栓栓塞症整体知信行水平不高,预防知识处于较低水平、预防血栓的信念和行为处于中等水平。临床医务人员应进一步加强对脑卒中患者自我预防静脉血栓知识的指导力度,提升预防信念水平,以增强患者预防血栓行为,降低脑卒中后静脉血栓栓塞症的发生率。     

Venous thromboembolism in patients with COVID-19. A prevalent and a preventable complication of the pandemic

Coronavirus disease 2019 or most commonly known as COVID-19 is a trending global infectious disease which a few months ago was affirmed as a global health emergency or a pandemic by the WHO Emergency Committee. The common symptoms manifested in this pandemic disease are high grade fever, cough, fatigue, shortness of breath and flu like symptom which can evolve into severe respiratory disorders such as pneumonia, acute respiratory distress syndrome (ARDS) and/or end-organ failure. Factors that contribute to the severity or high mortality rate in COVID-19 include old age, comorbidities like hypertension, diabetes, hyperlipidaemia, neutrophilia, and organ and coagulation dysfunction. Disseminated intravascular coagulation and other various coagulopathies including Venous thromboembolism have known to become a major contributing factor to high mortality rate. Venous thromboembolism is a disease which is a combination of deep vein thrombosis and pulmonary embolism. Prophylactic anticoagulation in patients prone to or with a pre-existing history of venous thromboembolism is associated with decreased mortality in severe COVID-19 pneumonia. This review article focuses upon COVID-19 and increased incidence of venous thromboembolism in patients infected by COVID-19 along with the role it has in high mortality rate in COVID-19 patients.     

高龄髋部骨折合并脑卒中后遗症患者的治疗对策

目的探讨高龄髋部骨折合并脑卒中后遗症患者的治疗方案,探讨其预后的影响因素。方法回顾性分析62例高龄髋部骨折合并脑卒中后遗症患者的临床资料,根据治疗方法分为保守治疗组（12例）、关节置换组（18例）、内固定组（32例）。综合分析比较美国麻醉师协会（ASA）评分、日常生活活动能力指数（Barthel生活指数）、合并症、简易精神状态量表（MMSE）、股骨近端骨小梁类型指数（Singh指数）、骨折后并发症（感染、再发脑卒中、褥疮、深静脉血栓、心力衰竭）等指标。结果3组患者年龄及性别、ASA评分、合并症比较差异均无统计学意义。保守治疗组、关节置换组、内固定组Barthel生活指数分别为52．1±11．4、74．5±21．3、63．84-15．7;骨折后并发症分别为10、3、13例。3组患者组间Barthel生活指数、并发症比较差异均有统计学意义（F=2．45,P〈0．05;X2=9．32,P〈0．05）。保守治疗组与手术治疗的两组Singh指数（X2=11．10,P〈0．05）及MMSE量表（X2=7．40,P〈0．05）比较差异均有统计学意义,而手术治疗的两组间比较差异均无统计学意义（P均〉0．05）。ASA评分、合并症、MMSE量表、治疗策略、骨折前Barthel生活指数均与骨折后Barthel生活指数存在相关性（OR值分别为5．726、7．152、0．047、1．221、5．312,P均〈0．05）。结论对于高龄髋部骨折合并脑卒中后遗症患者应首选关节置换术治疗,预后受患者身心整体状态的影响较大,完整的评估是选择治疗方案前必不可少的步骤。     

Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival

ObjectiveTo study the adherence of an Early Inpatient Exercise Program in patients with acute hip fracture, identify variables associated with its performance, and its association to one-year survival.MethodsObservational longitudinal study of a cohort of 509 patients, admitted consecutively with a hip fracture in La Paz University Hospital (Madrid, Spain). Data included sociodemographic variables, pre-fracture physical functioning, cognitive impairment, comorbidities, measure of exercise adherence (pre-surgery exercise, post-surgery exercise, and rehabilitation sessions) and vital status at follow-up. One year after the fracture, either patients or relatives were contacted by telephone to ascertain their vital status. Data were analyzed using logistic regressions and multivariate Cox proportional hazards regression.ResultsThree quarters of patients (76.0%) were able to comply with the Early Inpatient Exercise Program. Factors associated with adherence were: living at home (Odds Ratio (OR) = 3.39; 95% Confidence Interval (CI): 2.03, 5.64), absence of pre-fracture disability (OR = 3.78; 95% CI: 2.21, 6.47), absence of pre-fracture cognitive impairment (OR = 2.36; 95% CI: 1.36, 4.07) and comorbidities (OR = 1.66; 95% CI: 1.03, 2.67). Early Inpatient Exercise Program adherence was associated with one-year survival (HR = 1.62; 95% CI: 1.06, 2.49).ConclusionsThe adherence with an Early Inpatient Exercise Program is high and is associated with 1-year survival. It is important to make a stronger effort to encourage participation in Early Inpatient Exercise Program in the 24% currently non-compliant, and in those with cognitive and physical impairments.     

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial

BackgroundLittle evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls.ObjectiveTo compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality.DesignRandomised experimental trial.SettingA 3000-bed medical centre in northern Taiwan.ParticipantsPatients with hip fracture aged 60 years or older (N = 299).MethodPatients were randomly assigned to three groups: comprehensive care (n = 99), interdisciplinary care (n = 101), and usual care (control) (n = 99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients’ self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission.ResultsThe comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up.ConclusionComprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care.     

Experiences of pain and distress in hip fracture patients

The aims were to investigate: (1) experiences of physical pain in elderly patients with hip fracture; (2) if background variables, confusion, experiences of pain and distress and interventions aimed at reducing pain and distress, functional ability, pain in the ambulance, and type of fracture varied between patients with more intense physical pain and patients with less intense physical pain. The sample included 49 patients, 70 years or older, with hip fracture. Structured instruments were used to interview and observe the patients on four occasions during the hospital stay. The patients’ experiences of physical pain decreased during the hospital stay. Physical pain at rest was lower than pain with movement. Patients who scored physical pain as more intense (group B) during the visit to the hospital had significantly more unfavourable experiences in the sensory, emotional, and existential dimensions the day before discharge from the hospital compared with the patients who scored pain as less intense (group A). The patients in group B perceived the interventions as less favourable than group A. Furthermore, group B had more intense physical pain in the ambulance than the patients in the other group. More patients in group B than in group A had additional health problems.     

基于移动健康平台的延续护理对静脉血栓栓塞症出院患者延续治疗知信行的影响

目的探讨基于移动健康平台的延续护理对静脉血栓栓塞症(VTE)出院患者延续治疗知识、态度、行为的影响。方法采用方便抽样法,选取2017年2月—2018年1月重庆市某三甲医院出院的342例VTE患者作为研究对象,根据住院号随机分为对照组(169例)和观察组(173例)。对照组采用常规出院健康指导方式,观察组基于移动健康平台实施延续性康复护理健康指导模式。采用自制的VTE出院患者延续治疗问卷调查表比较两组患者的VTE延续治疗知信行情况。结果干预6个月后,观察组患者的VTE相关知识、延续治疗态度及依从行为得分均高于对照组,差异有统计学意义(P<0.01)。结论基于移动健康平台对VTE出院患者实施延续护理健康指导,有利于提高VTE出院患者延续治疗知识、态度水平,改善依从行为。     

引导式健康教育改善髋部骨折手术患者术后功能、负性情绪及并发症的效果

目的:探讨引导式健康教育对髋部骨折手术患者功能恢复、负性情绪及并发症的影响。方法:选择福建医科大学附属闽东医院82例髋部骨折手术患者,入院时间为2019年1月至2020年1月,分为观察组与对照组。对照组实施常规健康教育,观察组在常规宣教的基础上实施引导式健康教育。比较两组的Harris评分、视觉模拟评分法(VAS)评分...     

冷敷与温敷对股骨粗隆骨折患者术后疼痛与髋关节活动度的影响

目的探讨冷敷与温敷对股骨粗隆骨折患者术后疼痛与髋关节活动度的影响。方法将2007年6月至2010年6月182例股骨粗隆骨折患者按照随机数字表法分为对照组（85例）和观察组（91例）。对照组予以常规护理及康复训练指导,观察组在此基础上采取如下措施：术后立即间断冷敷术侧髋关节的前、内、外侧20min,间隔20min,连续3d,第4天起康复训练前用40℃热水袋温敷20min,训练结束后立即冷敷20min,连续3d。对两组患者术后不同时间段髋关节疼痛、肿胀及活动度进行比较。结果观察组患者术后6,12,24,48h髋关节疼痛度较对照组减轻,两组比较,差异有统计学意义（Z分别为-4．154,-3．608,-2．923,-2．261;P〈0．05）,观察组患者术后24,48,72h肢体肿胀评分较对照组明显降低,两组比较,差异有统计学意义（Z分别为-2．934,-3．033,-3．854;P〈0．01）;观察组患者术后第4—6天康复训练后肢体疼痛度、肿胀度与对照组比较,差异有统计学意义（z分别为-3．693,-2．879,-2．778,-2．921,-3．339,-2．708;P〈0．01）;术后1,3个月髋关节功能优良率方面,观察组分别为79．1％,92．3％,明显优于对照组的62．3％,80．0％,两组比较,差异有统计学意义（x。分别为6．004,5．653;P〈0．05）。结论冷敷与温敷能有效减轻股骨粗隆骨折患者髋关节术后疼痛与肿胀,有助于术后康复训练,提高髋关节活动度。     

Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study

Purpose: The aims of the study were to assess self-reported fear of falling (FOF) and functional ability among community-dwelling elderly people 3–6 months post hospital discharge after a hip fracture, to investigate the association between FOF and functional ability, and to explore the lived experience of FOF and disability when recovering from a hip fracture. Method: A sequential explanatory mixed method design was used in a “face-to-face” survey assessing FOF (Falls Efficacy Scale-International, FES-I), avoidance of activities (Modified survey of Activities and Fear of Falling, mSAFFE), functional ability (Functional Recovery Score, FRS), and mobility (New Mobility Score, NMS) followed by in-depth interviews of four participants. Interviews were analyzed using systematic text condensation. Results: Among the 33 participants 58% had a high degree of FOF and avoided more activities, needed more assistance in activities of daily living, and were less mobile than participants who had a low degree of FOF (p < 0.0001). According to the informants FOF reduced their functional ability and seriously altered their lives. Conclusions: FOF was common and significantly associated with activity avoidance, disability, and affected the lives of elderly recovering from a hip fracture. Some patients were physically incapacitated by FOF.

Implications for Rehabilitation

• Fear of falling can affect post discharge recovery following a hip fracture and is a factor limiting functional ability in elderly patients.

• Fear of falling should be addressed in clinical practice and future research as fear of falling-screening at hospital discharge might be beneficial in tailoring rehabilitation efforts to the individual patient.

• Older patients recovering from hip fracture need to perform activities of daily living independently and overcome fear of falling to sustain quality of life and contain costs to society.

     

Dementia -- involving patients and their caregivers in a drama programme: the caregivers' experiences

A cultural drama programme was designed for patients with dementia and was led by teachers trained in drama in education and storytelling. The focus was on dance, rhythm, song, storytelling and conversations. The aim of this study was to describe how a drama programme for patients with dementia and their caregivers was experienced by the caregivers. Twelve strategically selected patients, 10 women and two men, with moderate and severe dementia, and their seven female caregivers participated in the programme. Sessions were held for one and a half hour, weekly once for 2 months. A focus group interview was held with the caregivers 1 month after the programme had ended. The interview and analysis of data were carried out according to the principles of phenomenography. Two categories, 'interaction' and 'professional growth', and five subcategories emerged in the analysis. In these, the caregivers described how fellowship developed between the participants and how they shared joy and sorrow. The patients communicated with each other and the leaders, and the programme seemed to help the patients to remember and make associations with situations experienced earlier in their lives. The patients also showed knowledge and ability in things about which the caregivers were unaware until the time of the drama programme. In other daily life situations, the patients showed their feelings, both joy and sorrow, more openly, their self-confidence grew and they showed greater interest in their surroundings. The caregivers furthermore expressed that they felt confirmed in their roles as caregivers. The programme prompted them to reflect upon their roles as caregivers. In conclusion, a drama programme with cultural features seems to increase the quality of life in patients with dementia and strengthen the caregivers in their profession.     

农村妇女宫颈癌知识知晓情况调查研究

目的:了解农村妇女对宫颈癌相关知识的认知水平,为今后有针对性地对山区镇农村妇女开展宫颈癌普查普治以及健康教育提供方向和重点。方法:在"两癌"筛查活动现场,由调查研究人员随机抽取调查对象资料,使用自编的"宫颈癌知识调查问卷"进行问卷调查并分析。结果:800名研究对象中80.95%认为与吸烟、喝酒等不良生活习惯有关,66.00%认为与多个性伴侣有关,46.30%认为与性生活卫生状况差有关;青年、中年和老年组人群知晓率分别是38.36%,16.47%,6.35%,高中及以上、初中、小学、文盲/半文盲不同文化程度人群的总平均知晓率分别是85.42%,53.78%,9.52%,2.53%;宫颈癌相关知识信息获取的途径高低顺序为听别人说、传单折页宣传画、宣传栏墙报、集会宣传、电视广播、报纸杂志、网络。结论:农村妇女对宫颈癌知识认知不足;不同年龄组和不同文化程度人群对宫颈知识知晓率具有明显差异;农村妇女获取宫颈癌防治信息主要途径是听别人说。     

Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process

Background Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the “awareness of dying,” which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of “awareness” becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. Materials and methods One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants’ understanding of the treatment goals were measured by interview questions at weeks 1 and 12. Results One-third of both patients and caregivers understood that the treatment goal was not curative; however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. Conclusions Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.