Hospital-acquired complications in a randomized controlled clinical trial of a geriatric consultation team

As part of a controlled clinical trial of a geriatric consultation team (GCT), we investigated whether a GCT could affect the incidence of hospital-acquired complications in elderly patients. One hundred eighty-five patients, aged 75 years and older, were randomized into an intervention (N = 92) and a control (N = 93) group. Members of the intervention group received a GCT consultation and were routinely followed up throughout their hospitalization. The incidence of hospital-acquired complications for the entire study population was 38%. The type and rate of hospital-acquired complications in the intervention and control groups were not significantly different. Functional status on admission and admission to the psychiatry service were predictive for the occurrence of a hospital-acquired complication. In a broadly selected population such as this, the intensity of care available through a GCT was unable to reduce the occurrence of hospital-acquired complications. However, since this is only one aspect of a GCT function, and others may be of great importance, such aspects, and more targeted populations, must be evaluated before final conclusions can be reached about GCT efficiency.     

Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization

Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.     

综合性护理干预对老年髋部骨折患者术后治疗依从性、髋关节功能和并发症的影响

目的：探讨综合性护理干预对老年髋部骨折患者术后治疗依从性、髋关节功能和并发症的影响。方法选取老年髋部骨折患者76例,分为常规护理组和护理干预组,每组38例;两组患者均予以相同的手术治疗。常规护理组予以围手术期骨科常规护理,护理干预组予以综合性护理,两组的疗程均为6个月。观察并比较两组患者术后髋关节功能恢复和术后并发症情况。结果随访6个月,护理干预组总依从率明显高于常规护理组（94.74%vs 76.32%）（χ2=5.21,P〈0.05）;护理干预组患者术后髋关节功能恢复优良率明显高于常规护理组（92.11% vs 73.68%）（χ2=4.55,P〈0.05）;护理干预组患者术后并发症的发生率明显低于常规护理组（7.89%vs 26.32%）（χ2=4.55,P〈0.05）。结论综合性护理干预用于老年髋部骨折手术患者的效果较确切,可提高患者治疗依从性,促进术后髋关节功能的恢复,减少患者术后并发症的发生,降低其致残率。     

复发性外阴阴道假丝酵母菌病患者心理健康状况及个性疏导干预效果分析

目的 调查复发性外阴阴道假丝酵母菌病(RVVC)患者的心理健康情况,并探讨个性疏导干预的临床效果.方法 选取2014年1月至2015年12月秦皇岛市妇幼保健院妇产科收治的150例RVVC患者作为病例组,将其以随机数表法分为干预组(n=75)和对照组(n=75),另选50例同期体检并行阴道分泌物假丝酵母菌检查且显示阴性者为阴性组.问卷调查病例组、阴性组临床信息,采用心理症状自评量表(SCL-90)评估心理健康情况.对照组患者及性伴侣在口服伊曲康唑治疗基础上给予常规护理干预,干预组在此基础上给予个性疏导干预,护理干预时间均为1个月.统计病例组、阴性组患者心理健康评估结果 ,比较干预组和对照组遵医嘱情况、干预前后心理健康改善情况及1年内按时复诊、疾病复发情况.结果 ①病例组人际关系敏感、抑郁、焦虑等症状评分均显著高于阴性组,差异均有显著统计学意义(P<0.01);②干预组患者的遵医嘱服药、夫妻同时治疗、坚持自我护理的患者占比92.00%、84.00%、96.00%,明显高于对照组的72.00%、65.33%、77.33%,差异均有统计学意义(P<0.05);③干预组、对照组干预后心理健康各项评分均较干预前明显降低,且干预组人际关系敏感、抑郁、焦虑等等症状评分均显著低于对照组,差异均有显著统计学意义(P<0.01);④干预组按时复诊率为81.33%,明显高于对照组的60.00%,疾病复发率为12.00%,明显低于对照组的28.00%,差异均有统计学意义(P<0.05).结论 RVVC患者可伴发严重的焦虑、抑郁、人际交际敏感等不良心理情绪,个性疏导干预可明显改善患者心理健康状况,并可增强患者遵医嘱意识,有效减少复发.     

一站式护理对农村HIV/AIDS患者抗病毒治疗依从性的影响

目的：探讨一站式护理模式对农村HIV/AIDS患者抗病毒治疗依从性的影响.方法：选择农村HIV/AIDS患者100例作为对象,将患者随机分为干预组50例和对照组50例,干预组实施一站式护理服务模式,即关爱门诊专职护士进行一站武护理服务模式,从心理、认知、行为等进行全程护理干预,对照组采用一般护理服务模式.比较两组护理措施对患者抗病毒治疗依从性的影响效果.结果：对照组治疗依从性良好占62％,干预组治疗依从性良好占96％,两组比较差异有统计学意义（P＜0.05）.结论：一站式护理干预能够明显提高农村艾滋病患者抗病毒治疗依从性,对治疗效果有积极影响,降低死病率,提高生活质量.     

Effect of a geriatric consultation service on management of patients in an acute care hospital.

Elderly patients present particular management challenges. We conducted a randomized clinical trial of the effect of a geriatric consultation service on the management of elderly patients in an acute care hospital. A total of 113 patients aged 75 years or more who met certain criteria were assigned to either receive (57 patients) or not receive (56) care by the service. At the end of their hospital stay the patients were assessed with regard to predetermined outcomes. The patients were followed up for 1 year after discharge to determine death rates and direct health care expenditures. The intervention group showed significantly greater improvement in mental status (p less than 0.01), were receiving fewer medications at discharge (p less than 0.05) and had lower short-term death rates (p less than 0.05) than the control group. A geriatric consultation service can improve the hospital care and health of the elderly.     

Physicians' Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objective s The in-hosptial palliative care consultation (PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital. Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally (requested from the department other than the Geriatrics) and informally (by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform. Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine (n=8), Gynaecology (n=16) and Surgery (n=13), rotating residents (n=30), visiting doctors (n=16) in Geriatric department, and PCC team members (n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients’ life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree “PCC service helps the physicians better understand palliative care” than PCC members (97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine (100% vs. 96.4%, P>0.05). Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.     

Effects of intervention on medication compliance in children with asthma

We have assessed the effects of intervention on medication compliance in asthmatic children. The intervention comprised both written information about the medications and behavioural strategies effected by the physician. Children were assigned at random to either control (received no intervention) or test (received the intervention) groups. Compliance was assessed by questionnaire. The mean compliance for the test (78.0%; n = 93) and for the control (54.5%; n = 103) groups differed significantly (P less than 0.001; Mann-Whitney U-test). The test group had a better knowledge of asthma and of the medications, and was more satisfied with the physician and with the regimen than was the control group. These variables were also related to good compliance. This study demonstrates that a programme of intervention can significantly improve medication compliance and can be accompanied by increases in the knowledge of, and satisfaction with, treatment.     

Pharmacist participation on physician rounds and adverse drug events in the intensive care unit.

CONTEXT: Pharmacist review of medication orders in the intensive care unit (ICU) has been shown to prevent errors, and pharmacist consultation has reduced drug costs. However, whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied. OBJECTIVE: To measure the effect of pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events (ADEs) caused by ordering errors. DESIGN: Before-after comparison between phase 1 (baseline) and phase 2 (after intervention implemented) and phase 2 comparison with a control unit that did not receive the intervention. SETTING: A medical ICU (study unit) and a coronary care unit (control unit) in a large urban teaching hospital. PATIENTS: Seventy-five patients randomly selected from each of 3 groups: all admissions to the study unit from February 1, 1993, through July 31, 1993 (baseline) and all admissions to the study unit (postintervention) and control unit from October 1, 1994, through July 7, 1995. In addition, 50 patients were selected at random from the control unit during the baseline period. INTERVENTION: A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning, and was available on call throughout the day. MAIN OUTCOME MEASURES: Preventable ADEs due to ordering (prescribing) errors and the number, type, and acceptance of interventions made by the pharmacist. Preventable ADEs were identified by review of medical records of the randomly selected patients during both preintervention and postintervention phases. Pharmacists recorded all recommendations, which were then analyzed by type and acceptance. RESULTS: The rate of preventable ordering ADEs decreased by 66% from 10.4 per 1000 patient-days (95% confidence interval [CI], 7-14) before the intervention to 3.5 (95% CI, 1-5; P<.001) after the intervention. In the control unit, the rate was essentially unchanged during the same time periods: 10.9 (95% CI, 6-16) and 12.4 (95% CI, 8-17) per 1000 patient-days. The pharmacist made 366 recommendations related to drug ordering, of which 362 (99%) were accepted by physicians. CONCLUSIONS: The presence of a pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially lower rate of ADEs caused by prescribing errors. Nearly all the changes were readily accepted by physicians.     

心理干预在高龄原发性高血压患者中的护理应用及干预效果分析

目的探讨心理干预对原发性高血压病患者依从性、心理健康、血压控制情况的影响。方法将120例老年原发性高血压病患者随机分为对照组和观察组,每组各60例,给予对照组一般护理,给予观察组有针对性的心理行为干预,干预后6个月对两组患者在依从性、心理状态、血压等情况进行随访分析。结果心理行为干预6个月后,观察组患者依从性显著优于对照组（P〈0.01）;剔除不按时服药的23例患者后,观察组患者血压、焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分显著低于对照组（P〈0.05）。结论心理干预能有效地控制患者的血压、提高患者的依从性和心理健康水平。     

Randomized Trial of a Clinical Decision Support System: Impact on the Management of Children with Fever without Apparent Source

Objective

To assess compliance with a clinical decision support system (CDSS) for diagnostic management of children with fever without apparent source and to study the effects of application of the CDSS on time spent in the emergency department (ED) and number of laboratory tests.

Design

The CDSS was used by ED nursing staff to register children presenting with fever. The CDSS identified children that met inclusion criteria (1–36 months and fever without apparent source (FWS)) and provided patient-specific diagnostic management advice. Children at high risk for serious bacterial infection were randomized for the ‘intervention’ (n = 74) or the ‘control’ (n = 90) group. In the intervention group, the CDSS provided the advice to immediately order laboratory tests and in the control group the ED physician first assessed the children and then decided on ordering laboratory tests.

Results

Compliance with registration of febrile children was 50% (683/1,399). Adherence to the advice to order laboratory tests was 82% (61/74). Children in the intervention group had a median (25^th–75^th percentile) length of stay at the ED of 138 (104–181) minutes. The median length of stay at the ED in the control group was 123 (83–179) minutes. Laboratory tests were significantly more frequently ordered in the intervention group (82%) than in the control group (44%, p < 0.001, χ² test).

Conclusion

Implementation of a CDSS for diagnostic management of young children with fever without apparent source was successful regarding compliance and adherence to CDSS recommendations, but had unexpected effects on patient outcome in terms of ED length of stay and number of laboratory tests. The use of the current CDSS was discontinued.     

“互联网+”延续护理对全膝关节置换术后功能康复及口服抗凝药物依从性的影响

目的 探讨“互联网+”延续护理对全膝关节置换术后功能康复及口服抗凝药物依从性的影响。方法 随机选取2018年6月至2019年6月我院接受全膝关节置换手术(Total knee arthroplasty,TKA)的患者60例,根据出院后采取的护理模式,分为常规家庭护理患者(对照组)32例和“互联网+”延续护理患者(干预组)28例。采用美国特种外科医院(Hospital for special surgery,HSS)膝关节评分、生活质量(Quality of life,QOL)评分比较两组患者膝关节功能及生活质量。根据是否按时连续口服抗凝药物评价比较两组患者的服药依从性。结果 出院后第1、3个月,干预组患者HSS评分分别为(65.310±7.981)分和(86.342±9.101)分,明显高于对照组的(60.432±7.319)分和(71.138±7.733)分(P0.05);干预组患者QOL评分分别为(77.530±2.682)分和(94.408±3.912)分,明显高于对照组的(69.228±2.481)分和(86.611±2.141)分(P0.05)。出院后1个月内,干预组患者口服抗凝药物依从性高于对照组(P=0.043),深静脉血栓发生率为3.6%,明显低于对照组的9.4%(P=0.704)。结论 “互联网+”延续护理能够提升TKA术后归家患者口服抗凝药物的依从性,改善膝关节功能,从根本上提高患者的生活质量,值得临床推广。     

护理干预对预防老年髋部骨折术后深静脉血栓形成的影响

目的:分析护理干预对预防老年髋部骨折患者术后深静脉血栓形成的影响。方法:将108例老年髋部骨折手术患者随机分为干预组和对照组,每组54例,对照组给予常规术后药物治疗和护理,干预组在此基础上,加强围术期护理干预,并比较两种护理模式的护理效果。结果:干预组术后深静脉血栓发生率为3.71%,显著低于对照组的14.81%,差异具有统计学意义(P<0.05);干预组平均住院时间为(1.79±0.19)d,显著短于对照组的(2.98±0.32)d,差异亦具有统计学意义(P<0.05);干预组对疾病知识知晓率、遵医用药、坚持功能锻炼等健康行为执行情况均显著优于对照组(P<0.05)。结论:加强对老年髋部骨折患者进行围术期护理干预,有利于预防下肢深静脉血栓的形成,提升患者生活质量。     

家庭支持对门诊老年高血压病人的作用

目的：探讨家庭支持对门诊老年高血压病人非药物治疗依从性和血压控制的影响。方法：435例门诊老年高血压患者,根据是否有家庭支持分为实验组（171例）和对照组（264例）。对照组患者仅给予一般的健康教育;实验组患者在对照组的基础上,每月定期随访和行家庭支持因素干预,并对家庭成员进行相关疾病知识的教育。观察记录两组患者非药物治疗依从性和血压控制情况。结果：干预后,实验组的非药物治疗依从性及血压控制情况均明显优于对照组,差异具有统计学意义（P〈0．01）。结论：家庭支持有助于提高老年高血压患者非药物治疗依从性和控制血压。     

精益六西格玛管理模型对糖尿病患者糖化血红蛋白检测频率和达标率的影响研究

背景　糖尿病患者作为全科团队重点签约服务对象，其糖化血红蛋白（HbA1c）检测频率及达标率是绩效考核指标之一。为了提高糖尿病患者管理效果，如何协调好全科团队成员在糖尿病患者管理运作中的关系，是目前迫切需要解决的问题。目的　探讨全科团队运用精益六西格玛（LSS）管理模式对糖尿病患者HbA1c的检测频率和达标率的影响。方法　于2017年1月-2018年12月，在上海市浦东新区金杨社区卫生服务中心由两个全科团队经LSS培训为LSS team，即干预组，剩余两个全科团队为team 2，即对照组，分别随机分配200例糖尿病患者。干预组按六西格玛理念运用黑带、绿带等角色构建项目组织架构，使用DMAIC循环，即定义（define）、测量（measure）、分析（analyze）、改进（improve）、控制（control）5个阶段构成的过程改进方法进行项目推进，同时利用鱼骨图、RACI、行动计划表等工艺改进工具，通过发现原社区糖尿病患者HbA1c检测管理的薄弱点并提出改善方案，全过程进行有效监控。对照组仅按照上级业务部门要求进行常规随访管理。结果　对照组平均测量次数（3.7±1.3）次，干预组平均测量次数（4.6±1.3）次，差异有统计学意义（t=7.073，P<0.001）；对照组HbA1c均值（7.1±1.0）mmol/L，干预组HbA1c均值（6.5±0.6）mmol/L，差异有统计学意义（t=-7.401，P<0.001）。对照组达标率为55.5%（111/200），干预组达标率为84.5%（169/200），差异有统计学意义（χ2=40.048，P<0.05）。按HbA1c测量次数分为3组：<4次，122例，HbA1c均值为（7.0±1.1）mmol/L；4~6次，250例，HbA1c均值为（6.7±0.7）mmol/L；>6次，28例，HbA1c均值为（6.6±0.4）mmol/L。3组HbA1c均值比较差异有统计意义（F=6.885，P<0.001）。结论　应用LSS，可以有效提高签约糖尿病患者的HbA1c检测频率，而通过HbA1c检测频率的提高，可以同时改善HbA1c达标率，这种改善可能与随着HbA1c检测频率提升，医患双方对血糖控制的重视度提高有关。LSS的改善过程符合医护人员的临床诊疗思维，其独特的组织架构尤其适用于目前全科团队中的各职能岗位的协调工作，能有效提高慢性病管理效率。     

微信健康教育联合饮食运动干预对2型糖尿病合并牙周病患者牙周状况及生活质量的影响

目的探讨微信健康教育联合饮食运动干预对2型糖尿病合并牙周病患者牙周状况及生活质量的影响。方法对149例患者进行研究,随机分为对照组(n=74)和观察组(n=75)。对照组患者实施常规护理干预,观察组在对照组的基础上给予微信健康教育联合饮食运动干预。对比干预前后两组患者血糖控制情况、口腔健康情况、患者口腔护理知识及饮食依从性,并采用糖尿病患者生活质量量表(Diabetes mellitus quality of life scale,DMQLS)评估干预后患者的生活质量。结果观察组总有效率为98.61%,高于对照组的88.88%,差异有统计学意义(P0.05);观察组空腹血糖、餐后2 h血糖值及糖化血红蛋白与对照组相比均较低,差异有统计学意义(P0.05);干预前两组患者牙周检查指标无明显差异(P0.05),干预后观察组牙周检查指标相比对照组有较大改善,差异有统计学意义(P0.05);干预后观察组患者口腔保健知识及行为、饮食治疗依从性等与对照组比较具有明显差异(P0.05);干预后观察组患者DMQLS评分明显高于对照组(P0.05)。结论 2型糖尿病合并牙周病患者在进行微信健康教育联合个体化饮食及强化运动指导后,患者的血糖水平控制能力提高,牙周症状明显缓解,同时患者口腔保健及饮食控制的依从性提高,有利于提高患者生活质量。     

护理综合干预对精神分裂症患者院外康复效果的影响

目的探讨护理综合干预对精神分裂症患者院外康复效果的影响。方法将168例院外精神分裂症患者随机分为干预组86例及对照组82例。对干预组实施个性电话随访、社区集体服药督导及健康教育等护理综合干预措施,比较两组患者服药依从性和复发率。结果干预组在出院6个月、12个月时的服药依从性均明显好于对照组,复发率均明显低于对照组;患者出院12个月时与出院6个月时服药依从性及复发率比较,干预组差异无统计学意义,对照组差异有统计学意义。结论护理综合干预可提高院外精神分裂症患者的服药依从性,降低复发率,有效促进患者院外康复。     

心理护理干预对多发性硬化患者治疗效果的影响

[目的]观察心理护理干预对多发性硬化(multiple sclerosis,MS)患者治疗效果的影响,探讨提高MS疗效的护理措施.[方法]随机将2006年12月-2010年12月的126例MS住院患者分为对照组和干预组各63例,对照组给予常规护理措施,干预组在常规护理措施的基础上加强心理护理干预.应用汉密顿抑郁量表(HAMD)及汉密顿焦虑量表(HAMA)评估患者的精神状况,对两组患者治疗前后焦虑、抑郁及治疗依从性情况进行评分.[结果]治疗后,两组患者的焦虑和抑郁程度均有所下降,而干预组焦虑和抑郁评分均低于对照组,差异有统计学意义(P＜0.05);干预组的治疗依从性(90.5％)高于对照组(74.6％),差异有统计学意义(x2=5.507,P＜0.05).[结论]在MS治疗过程中,重视加强心理护理干预,有助于改善其抑郁、焦虑情绪,以提高MS患者的治疗效果,提高生活质量.     

阳性强化法控制小儿静脉输液时穿刺疼痛的效果分析

目的：探讨阳性强化法在控制小儿静脉输液时穿刺疼痛的效果。方法便利抽样选择于我院儿科进行静脉输液的5～9岁患儿200名,经患儿家属知情同意后,将其分为试验组和对照组,每组100人,并在患儿进行静脉输液的第1天收集患儿的性别、年龄、疼痛程度、配合程度、依从性等资料。给予对照组患儿常规护理干预,在此基础上给予试验组患儿以阳性强化法为主的护理干预,利用面部疼痛表情量表、患儿配合程度评分标准评估患儿的疼痛程度和配合程度,并测定出患儿静脉穿刺的依从性、护理人员的首次穿刺成功率和患儿家长满意度。结果试验组和对照组患儿在干预前的疼痛程度、配合程度、依从性、穿刺成功率和家长满意度对比差异无统计学意义（P＞0．05）。干预后,试验组患儿疼痛程度显著低于对照组,对比差异显著（χ2＝24．954, P＜0．05）,试验组患儿的配合程度、依从性、穿刺成功率和家长满意度均显著优于对照组,对比差异有统计学意义（χ2＝7．419～36．012, P＜0．05）。结论阳性强化法能够有效控制患儿静脉穿刺的疼痛感,提高患儿的静脉穿刺配合程度和依从性,也提高了护理人员的首次穿刺成功率和家长的满意度。