心肌梗死的急救方法

据医学统计资料表明，在心肌梗死发生的最初几小时是最危险的时期，大约有2／3的患者在就医之前即死亡。而此时慌乱搬动患者、背负或搀扶患者勉强行走去医院，都会加重心脏负担使心肌梗死的范围扩大，甚至导致患者死亡。其实在突发心梗时，如果医护人员尚未到达，陪伴者可以根据情况，采取以下措拖，也许可以挽救患者的生命。     

留意糖尿病足的早期信号

<正>糖尿病患者在生活中要多注意脚部变化,及时发现早期糖尿病足的信号。糖尿病足的具体表现为:间歇性跛行、足出汗异常、皮肤改变和静息痛、足部感觉异常等。一旦出现了早期糖尿病足的危险信号,一定要引起重视,及时就医。如果拖延不治,会使糖尿病足症状加重,最终可能会导致截肢。要有效预防糖尿病足:糖尿病患者应每天用低于40℃的温水洗脚,洗脚后及时擦干趾间,及时修剪脚趾甲,但要避免将趾甲修剪过     

如何做好医院预防保健工作

如何做好医院预防保健工作解放军四二二医院李荣林健康教育工作是医院预防保健工作的一项重要内容，医院健康教育是通过各种宣传教育方式把卫生保健知识教给广大医务人员及伤病员，使他们了解和掌握最基本的卫生保健常识，提高自我保健意识及能力，达到增进健康素质和提高...     

威海市急性脑梗死院前延迟的原因分析与对策

目的研究威海市区2家医院脑梗死患者到达医院前时间（院前延迟）的影响因素及对策。方法回顾性研究了进入医院急诊就诊的急性脑梗死病人的院前延迟影响因素，并制定相应对策。对所有资料分别采用KruskalWal—lis检验方法和logistic回归进行单变量和多变量分析。统计学软件采用SPSS12．0和SAS6．0。结果患者平均到达医院急诊时间为312min，27．27％于发病2h内到达医院急诊，42．08％于发病5h内到达医院急诊。单因素分析显示：女性、非独居、有医疗保险、首发症状为传统症状、病人能识别卒中症状、病人或救助者能认识脑梗死治疗紧迫性、由120救护车或110警车进行运送有利于及早到达医院急诊。多因素回归模型显示：影响及早到达医院急诊最重要因素是运送方式和首发症状，使用120救护车或110警车运送病人而非使用其他运送方式和卒中表现为传统症状能缩短入院时间。结论57．92％急性脑梗死患者不能在发病后5h内到达医院。为了缩短到达医院急诊时间，应加强对民众急性脑梗死知识的宣传教育；提高社区医生脑梗死诊治水平；进一步完善城镇基本医疗保险制度和新型农村合作医疗制度建设，扩大参保、参合率；重视敬老院、老年公寓建设，减少独居老年人比例。     

中风患者及家属健康教育需求分析与教育体会

目的：通过对中风患者及家属的健康教育需求进行调查及分析，继而总结出符合两者需求的健康教育措施。方法：选取在我院进行入院治疗的47例中风患者，并通过自制问卷的方式对患者及其家属的健康需求进行调查，调查需求内容包括危险因素、用药治疗、预防方法、康复训练、急救常识以及病中护理等。结果：通过调查结果表明，本文所选取的47例中风患者及其家属的健康知识水平较低，其中想了解中风危险因素的有42例、想了解用药治疗知识的有38例、想懂得预防方法的有34例、想掌握康复训练知识和方法的有45例、想了解中风急救常识的有43例、向了解患者病中护理技巧的有31例。结论：通过调查可以得知，当前我国的中风患者及其家属的健康知识教育普遍落后，本文通过对中风患者及其家属的健康教育需求进行分析，总结出了相应的中风健康知识教育体会。     

留意糖尿病足的早期信号

正糖尿病患者在生活中要多注意脚部变化,及时发现早期糖尿病足的信号。糖尿病足的具体表现为间歇性跛行、足出汗异常、足形状变化、皮肤改变和静息痛、足部感觉异常等。一旦出现了早期糖尿病足的危险信号,一定要引起重视,及时到医院内分泌及相关科室查治。如果拖延不治,会使糖尿病足的症状加重,最终可能会导致截肢。如何有效预防糖尿病足?糖尿病患者应每天用低于40℃的     

中风患者及家属健康教育需求分析与教育体会

目的:通过对中风患者及家属的健康教育需求进行调查及分析,继而总结出符合两者需求的健康教育措施。方法:选取在我院进行入院治疗的47例中风患者,并通过自制问卷的方式对患者及其家属的健康需求进行调查,调查需求内容包括危险因素、用药治疗、预防方法、康复训练、急救常识以及病中护理等。结果:通过调查结果表明,本文所选取的47例中风患者及其家属的健康知识水平较低,其中想了解中风危险因素的有42例、想了解用药治疗知识的有38例、想懂得预防方法的有34例、想掌握康复训练知识和方法的有45例、想了解中风急救常识的有43例、向了解患者病中护理技巧的有31例。结论:通过调查可以得知,当前我国的中风患者及其家属的健康知识教育普遍落后,本文通过对中风患者及其家属的健康教育需求进行分析,总结出了相应的中风健康知识教育体会。     

对中风病的种种错误认识

国内医学专家认为，我国中风高死亡率不仅有客观因素，还有主观上的原因，那就是广大患者及家属对中风的认识不足，甚至有错误的认识。现将数种错误观念列举如下：1大难不死，必有后福有的人第一次中风治愈后，就忽略了复发的危险，不采取积极措施预防。据统计，中风约有30％是复发病人。患过中风的病人脑血管硬化容易破裂，或血液粘稠容易梗塞，较普通人更易患中风。所以，中风治愈后，仍应定期到医院检查，在医生指导下服药预防。2小中风无关紧要中风病人发病前数月多有先兆症状出现，即民间所说的小中风，如语言不清、吞咽困难、肢体麻木…     

中风的初级预防对策

中风是发病和死亡的首位病因。每年 ,大约5 0 0 0 0 0的美国人罹患中风 ,其中 ,大约 2 0 %的中风病人在 30天内死亡。本文简介了预防中风的有效对策 ,包括血压的控制、高脂血症的治疗、生活方式的改变 (如戒烟 ) ,以及心房纤颤患者的抗凝治疗。1　中风的危险因素　　中风最危险     

患者就医等候时间、就医便利性和就医感知价值关系研究

文章针对患者就医感知价值中的“看病难”问题,围绕患者就医等候时间、就医便利性和就医感知价值的关系展开理论研究,并结合台州医院的案例进行了实证检验。研究发现,在知名度较高的大型医院里,患者个人时间充裕程度与就医感知便利性无相关性,患者就医感知便利性与就医感知价值呈正相关性;患者个人就医时间充裕程度与就医感知价值无相关性,而患者特征对其时间充裕程度、就医感知便利性有一定影响。     

影响脑卒中患者入院延迟的相关因素调查研究

目的 探讨目前影响脑卒中患者人院延迟的相关因素.方法 对2008年4-9月确诊脑卒中住院患者179例进行问卷调查.根据发病至住院的时间将患者分为≤6h组(85例)和>6h组(94例),分析影响入院延迟的相关因素.结果 179例患者发病至住院的平均时间(26.2±0.1)h,中位时间为7.5 h.两组患者既往有心脏病和糖尿病病史、发病地点距医院较近、首发症状有抽搐或意识障碍、首诊地点为急诊室、选择急救120、就诊途中时间等因素比较差异有统计学意义(P<0.05).Logistic回归分析显示,发病地区远、门急诊处置时间长是影响入院延迟的主要因素.结论 目前脑卒中患者入院延迟现象严重,缺血性脑卒中溶栓率低.主要原因在于患者对脑卒中相关知识不了解,不能充分利用院前急救系统.     

Prehospital and hospital delays after stroke onset--United States, 2005-2006

Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase the proportion of ischemic stroke patients who are eligible to receive t-PA therapy and reduce their risk for severe disability from stroke.     

Difficulties leaving home: a cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan

This study used an analytical cross-sectional design to identify risk factors associated with delays in care-seeking among women admitted in life-threatening conditions to a maternity hospital in Herat, Afghanistan, from February 2007 to January 2008. Disease-specific criteria of 'near-miss' were used to identify women in life-threatening conditions. Among 472 eligible women and their husbands, 411 paired interviews were conducted, and information on socio-demographic factors; the woman's status and social resources; the husband's social networks; health care accessibility and utilisation; care-seeking costs; and community characteristics were obtained. Decision and departure delays were assessed quantitatively from reported timings of symptom recognition, care-seeking decision, and departure for health facilities. Censored normal regression analyses suggest that although determinants of decision delay were influenced by the nature and symptoms of complications, uptake of antenatal care (ANC) and the birth plan reduced decision delay at the time of the obstetric emergency. Access to care and social networks reduced departure delay. Programmatic efforts may be directed towards exploiting the roles of ANC and social resources in facilitating access to emergency obstetric care.     

The costs of caring for stroke patients in a GP-led community hospital: an application of programme budgeting and marginal analysis

There has been little evaluation of the role of community hospitals in the provision of integrated health care services in a primary care-led health system. The aim of this study was to model the probable changes in the use of NHS resources from the introduction of integrated stroke care in a general pracititioner-led community hospital. A programme budgeting and marginal analysis (PBMA) exercise was conducted combining practice data for the 'before' period and data from the literature to model the 'after' period. Data were collected from all patients discharged with a primary diagnosis of stroke 1994-96 in Nairn and Ardersier Total Fundholding pilot site, Highland Health Board, Scotland. Under several assumptions, a policy of early discharge of patients to the community hospital, and/or avoiding admission at the acute trust and admitting patients to the community hospital directly (except emergencies), is likely to result in a reduction of the total annual costs of treating stroke patients, from 183,000 pounds per annum to, at most, 74,000 pounds. The analysis of routine discharge data since integrated stroke care was set up has shown that progress has been made in shifting the treatment of patients from the acute trust to the community hospital. The care of stroke patients in a GP-led community hospital is likely to reduce the use of scarce health service resources. Current evidence suggests that health outcomes are unchanged due to early discharge, but further research is required to ensure that patients' health status and quality of life are maintained before such a policy is widely adopted.     

Modifiable determinants of delayed hospital admission following a cerebrovascular accident

OBJECTIVE: To identify the modifiable determinants of delayed hospital admission of stroke patients. DESIGN: Multicentre observational study. METHOD: In the period from 1 October 1998 to 31 May 1999, before thrombolysis was an accepted treatment for ischaemic stroke in the Netherlands, we interviewed 252 consecutively admitted patients with stroke upon admission. The patients were asked to describe their symptoms and personal reaction to the stroke event in everyday language. The study was carried out in 14 regional hospitals and one university hospital in the Netherlands. The determinants of delay were calculated by means of multiple linear regression analysis. RESULTS: A total of 252 patients took part in the study: 136 men and 116 women, of whom 130 (52%) were 75 years of age or older. The median time from onset of symptoms to calling in any professional assistance was 60 minutes. The median time from onset of symptoms to arrival at the hospital was 5 hours and 10 minutes. One-third (n = 87; 34%) of the patients reached the hospital within 2.5 hours. Nearly half of the patients (46%) recognised their symptoms as a stroke. Patients who had not recognised their symptoms as a stroke (54%) and patients who had waited until their symptoms had worsened (20%) waited longer before calling in professional assistance than those who did not. Hospital admission was delayed in patients who had waited until their symptoms had worsened, and in those who had first called a family physician (87%). On the other hand, a more rapid admission was achieved in case of referral by the family physician by telephone and also after transportation by ambulance (77%). CONCLUSION: The modifiable determinants of delayed calling for professional help by stroke patients were the fact that they did not recognise the symptoms as a stroke, and the circumstance that they waited until the symptoms would disappear or become worse. This latter circumstance, referral by the family physician by telephone and transportation by ambulance, were modifiable determinants of delayed hospital admission.     

Patient factors associated with delay in primary care among patients with head and neck carcinoma: a case-series analysis

BACKGROUND: Head and neck cancer patients are often diagnosed with advanced stage disease, while the location is easily accessible for examination or distinct symptoms are present. Professional delay in primary care affects tumour stage and survival. There has been little research on the role of the patient in delaying referral or diagnosis once the patient has visited a primary health care professional. OBJECTIVES: Our aim was to identify patient-related factors which are associated with delay in primary care and the referral to hospital. METHODS: Case-series analysis using semi-structured interviews combined with questionnaires was conducted among 306 consecutive patients newly diagnosed in a tertiary referral centre for head and neck oncology patients in The Netherlands. The main outcome measure was delay in returning to the GP or dentist after the first consultation. Logistic regression analyses were performed to test which patient-related variables made delay more likely. RESULTS: 155 patients (53%) were not referred or followed up after the first medical contact with the GP or dentist. Fifty per cent (n = 78) of them delayed returning to the health professional for more than three weeks. Patients were more likely to delay when they experienced voice change, were not familiar with head and neck cancer, were not suspicious of cancer or were generally not inclined to seek support. CONCLUSIONS: Delay in returning to the health professional is partly dependent on patient-related factors. Therefore, patients should be educated about the possible meaning and expected time-course of the symptoms and be strongly advised to return, or be followed up, within three to four weeks if the symptoms do not disappear.     

Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.     

社区中老年高血压患者出现卒中症状的影响因素分析

目的 了解社区中老年高血压患者出现卒中症状的影响因素,为脑卒中的预防控制提供参考依据.方法 在武汉市2个行政区随机抽取410例在社区卫生服务中心(或卫生院)登记的中老年高血压患者进行统一问卷调查,采用χ2检验、方差分析和logistic回归分析影响高血压患者出现卒中症状的因素.结果 31.83％的研究对象出现了卒中症状...     

Sexuality in Stroke Care: A Neglected Quality of Life Issue in Stroke Rehabilitation? A Pilot Study

Although there is a substantial body of literature on the physical and psychosexual consequences of stroke, there is a paucity of empirical studies on the experiences of rehabilitation professionals in addressing sexuality issues with patients during the rehabilitation process. This is the first small-scale pilot study in Northern Ireland, informed by a comprehensive literature review, which explores the experiences of health and social care professionals in addressing sexuality issues with patients and their perceptions of the training they require in this area of stroke rehabilitation. Questionnaire survey data were collected from community and hospital based stroke professionals in a Health and Social Services Trust in Northern Ireland. The study groups comprised nurses, doctors, physiotherapists, occupational therapists, speech and language therapists and social workers. The findings revealed that although the majority of staff had been asked for advice on sexuality issues during rehabilitation, most of them had received no training in this aspect of stroke rehabilitation since joining stroke services. The findings suggest that all rehabilitation professionals need to become more knowledgeable about sexuality issues in stroke care and could benefit from further education and training in comprehensive sexual health care.