分级诊疗模式下社区护士参与慢性病健康管理的效果

目的探讨分级诊疗模式下社区护士对慢性病患者开展健康管理的效果。方法选取2018年4月至2019年6月已签约的834例慢性病患者,随机将其分为干预组(423例)和对照组(411例)。对照组按"家医"签约协议提供签约服务,干预组在对照组基础上实施由社区护士为主导的慢性病健康管理。比较两组的干预效果。结果干预组的慢性病相关知识、防治态度、健康行为评分整体情况显著优于对照组(P<0.05)。干预后,干预组服务满意度及健康档案合格率均高于对照组(P<0.05)。结论分级诊疗模式下由社区护士开展健康管理能显著提高慢性病患者的知信行水平、服务满意度和健康档案合格率。     

Six-month management of patients following treatment for gastroesophageal reflux disease symptoms -- a Norwegian randomized, prospective study comparing the costs and effectiveness of esomeprazole and ranitidine treatment strategies in a general medical practitioners setting

This study assesses the difference in direct medical costs between on-demand treatment with esomeprazole 20 mg, continuous treatment with esomeprazole 20 mg once-daily and continuous treatment with ranitidine 150 mg twice-daily to prevent symptomatic relapse in patients with gastroesophageal reflux disease over 26 weeks. Two hundred eighty-one GP clinics in Norway enrolled 2156 patients to an open, randomized, parallel group, Norwegian society perspective study during 2000-2001. The total direct medical costs of each strategy were 171.9 Euros for on-demand esomeprazole (n = 634), 221.6 Euros for ranitidine (n = 610) and 248.8 Euros for continuous esomeprazole (n = 658). The total costs for on-demand and continuous esomeprazole treatment and ranitidine treatment were 221.5, 286.5 and 295.8 Euros, respectively. The highest proportion of costs was because of the study medication cost in each strategy. The on-demand and continuous treatment strategies with esomeprazole were found to be cost-effective, compared with ranitidine.     

加压冷敷在桡骨远端骨折腕关节镜手术患者中的应用

目的 探讨伤后、术后、康复锻炼后早期循环加压冷疗对腕关节镜辅助治疗桡骨远端骨折患者加速康复的作用。方法 选择无锡市第九人民医院2016年06月至2017年10月行腕关节镜辅助治疗桡骨远端骨折的33例患者为对照组,采用普通冰袋在伤后及术后按常规方案行冷敷治疗;2017年11月至2019年02月另选取此类患者34例为实验组,采用循环加压冷疗系统在伤后、术后、康复锻炼后早期行持续联合间歇的加压冷敷治疗,比较两组患者患肢伤后及术后肿胀程度、疼痛评分及腕关节功能。结果 两组患者入院至手术时间、住院时间比较,P＜0.001;两组患者肿胀程度比较,除入院时及手术日晨外其余各时点,P＜0.05;两组患者各时点疼痛评分,实验组较对照组明显降低,P＜0.05;术后3月实验组腕关节功能及腕关节活动度较对照组有明显改善,P＜0.05。结论 桡骨远端骨折伤后及腕关节镜辅助治疗骨折术后、康复锻炼后早期采取循环加压冷疗法能减轻患者疼痛、快速消肿、减少骨折及手术创伤并发症,加速术后康复,充分体现了加速康复外科理念。     

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study

Purpose: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting.

Materials and methods: The study explored two different intensities of the hybrid model, 4?h/week (Hybrid-4) and 8?h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1?month to 5?years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n?=?5) or Hybrid-8 (n?=?4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment.

Results: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups.

Conclusions: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8?h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery.

• Implications for rehabilitation

• The present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings.

• Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8?h per week.

• The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.

     

Long-term management of patients with symptoms of gastro-oesophageal reflux disease -- a Norwegian randomised prospective study comparing the effects of esomeprazole and ranitidine treatment strategies on health-related quality of life in a general practitioners setting

This article reports quality of life (QoL) aspects of a study that investigated the efficacy of three treatment regimens in gastro-oesophageal reflux disease patients. Following a 4-week symptom-control phase (esomeprazole 40 mg once daily), patients were randomised to 6 months' esomeprazole 20 mg once daily continuously (n = 658), on-demand (n = 634) or ranitidine 150 mg twice daily continuously (n = 610). Esomeprazole 40 mg once daily improved QoL during the symptom-control phase. At 6 months, both esomeprazole regimens were more effective than ranitidine in all dimensions of the Quality of Life in Reflux and Dyspepsia questionnaire (p < 0.0001). Esomeprazole continuous and on-demand led to a significant improvement in symptoms (Overall Treatment Evaluation questionnaire) compared with ranitidine (continuous: 80.2%, on-demand: 77.8%, vs. ranitidine 47.0%; p < 0.001). Esomeprazole once daily continuously maintained QoL better than esomeprazole on-demand and was associated with greater patient satisfaction. In conclusion, esomeprazole 20 mg once daily continuously and on-demand were more effective than ranitidine continuously for maintaining QoL.     

‘The group was the only therapy which supported my needs,because it helped me feel normal and I was able to speak out with a voice’: A qualitative study of an integrated group treatment for dual diagnosis service users within a community mental health setting

Whilst the evidence for the efficacy of treatment interventions for individuals with dual diagnosis has been developing in recent decades, little is known about individual perceptions and the personal benefits of attending integrated treatment programmes within this population group. A qualitative methodology, Interpretive phenomenological analysis, was used to investigate the experiences of individuals with a range of complex mental health and coexisting substance misuse problems who took part in a psychoeducational group (PEG) programme. This comprised of social support and therapeutic peer group relationship facilitation. Semi‐structured interviews were undertaken with 15 service users who successfully participated in this treatment programme. Findings identify the complexity of the therapeutic process and understanding of the treatment from the service users perspective. This included the importance of forming meaningful therapeutic relationships as an influential factor in countering a range of distressing and incompatible environmental and situational stressors, such as self‐regulatory control, self‐awareness of a need for change and the importance of integrated treatment in reducing the sense of stigma and exclusion linked with using mental health services. The study findings support the use of integrated treatment programmes in mental health services with a dual diagnosis population group.