外科高龄手术患者压疮评估与护理

目的对外科高龄手术患者进行评估,提高护理风险意识,减少压疮发生。方法将2012年74例65岁以上接受手术的患者作为对照组,将2013年78例65岁以上接受手术的患者作为观察组。对照组使用Braden量表对患者进行压疮风险评估,并采取压疮护理措施。观察组在患者入院、手术后使用高龄患者压疮评估表,对患者进行压疮护理评估,依据风险评估级别采取相应护理措施。比较2组压疮的发生率。结果观察组患者发生压疮5例,发生率为6.4%,均为Ⅰ期压疮,无Ⅱ期以上压疮发生。对照组患者发生压疮13例,发生率为17.6%,Ⅰ期压疮6例,Ⅱ期压疮7例,P0.05,差异有统计学意义。结论根据压疮护理评估结果采取护理措施,提高了护理人员对压疮的风险管理意识,增强了患者对压疮的认识和家属对压疮的预防知识,调动了护士、患者、家属的积极性,降低了压疮的发生率。     

自制皮瓣血液循环观察尺在皮瓣移植术后患者的应用

目的探讨自制皮瓣血液循环观察尺在皮瓣移植术后患者护理中的应用效果。方法将2017年1～12月60例行四肢皮瓣移植术患者设为对照组,采用常规观察法;2018年1～12月60例四肢皮瓣移植术患者设为观察组,使用自制皮瓣血液循环观察尺进行皮瓣血液循环观察。结果对照组6例、观察组7例发生静脉血管危象,观察组血管危象及时发现率为85.72%,对照组为33.33%;两组血管危象发生率、及时发现率、皮瓣移植成活率无统计学差异(均P0.05);观察组护理文书合格率显著高于对照组(P0.05)。结论自制皮瓣血液循环观察尺可规范护理文书书写,但对帮助医护人员及时发现皮瓣早期血管危象的效果,需扩大样本量进一步验证。     

乳癌术后患者使用自制多功能体位支持垫的效果研究

目的探讨乳癌术后患者使用自制多功能体位支持垫的效果。方法将96例乳癌改良根治术患者随机分成对照组45例和观察组51例,对照组用传统的枕头、衣物、棉被等作支撑物,观察组将自制多功能体位支持垫用于术后的体位护理。结果观察组使用自制体位支持垫后,患肢肿胀发生率显著低于对照组,舒适度显著高于对照组(P<0.05,P<0.01)。结论自制多功能体位支持垫用于乳癌患者术后的体位护理优于传统方法,患者舒适满意。     

Application of body position supporting cushion pads to post-operative breast cancer patients

目的 探讨乳癌术后患者使用自制多功能体位支持垫的效果.方法 将96例乳癌改良根治术患者随机分成对照组45例和观察组51例,对照组用传统的枕头、衣物、棉被等作支撑物,观察组将自制多功能体位支持垫用于术后的体位护理.结果 观察组使用自制体位支持垫后,患肢肿胀发生率显著低于对照组,舒适度显著高于对照组(P＜0.05,P＜o.01).结论 自制多功能体位支持垫用于乳癌患者术后的体位护理优于传统方法,患者舒适满意.     

坠积性肺炎的预防和护理效果分析

目的介绍坠积性肺炎的预防经验和护理体会。方法选择2016年5月到2016年11月我院收治的75例需长期卧床休息或治疗的患者,根据两个病区的护理方法不同分为观察组(39例)与对照组(36例),对照组给予住院病种常规护理,观察组在对照组护理的基础上采取更加积极的护理策略,包括强化营养、心理护理、口腔护理、湿化气道护理与卫生宣教。观察两组坠积性肺炎的发生情况,同时评估所有患者的肺功能指标。结果观察组患者坠积性肺炎发生率较对照组低(7.69% vs 25.00%,P0.05);同时病人家属对护士工作的满意度观察组优于对照组(92.31%vs 72.22%),χ~2=5.271,P=0.022)。结论更加积极的护理路径能改善坠积性肺炎患者状态,增加护理满意度,但同时也增加了护理工作量和护理人员。     

安全评估指导书应用于肝脏术后患者的效果观察

目的 探讨使用安全评估指导书对患者术后恢复的影响,以提高安全护理质量。方法 设计风险评估表和安全评估指导书,观察组根据风险评估参照安全评估指导书对患者进行护理,对照组采取常规的护理措施。结果 指导书运用2年来,观察组相比对照组总体并发症发生率低（x2=10.458,P＜0.05）,其中相对应的跌倒（x2=4.056,P＜0.05)和意外拔管（x2=5.692,P＜0.05)的发生率观察组低于对照组。结论 指导书作为管理工具,可有效提高护理人员的安全管理能力,保障患者安全。     

多功能压力性损伤评估板在晚期恶性肿瘤患者中的应用

目的观察多功能压力性损伤评估板在晚期恶性肿瘤患者中的应用效果。方法将160例晚期恶性肿瘤患者按照随机数字表法分为对照组和观察组各80例。对照组按照传统压疮评估方法进行评估和宣教。观察组应用多功能压力性损伤评估板进行评估和宣教。结果两组首次评估时间、护士满意率及患者和家属压力性损伤防护知识知晓率比较,差异有统计学意义(P0.05,P0.01)。结论自制的多功能压力性损伤评估板能缩短护士用于评估的时间,提高患者及家属压力性损伤防护知识知晓率及护士评估满意度。     

骨科护士站前移提升关怀护理服务质量

目的探讨骨科护士站前移对提升人文关怀护理服务质量的效果。方法选择护士站前移后收治的600例患者为观察组,采用护士站前移的工作方式;护士站前移前收治的550例患者为对照组,使用传统护理方式。比较两组关怀护理服务满意度以及响铃次数、响铃后护理人员到达患者床旁的时间。结果观察组关怀护理服务满意度显著高于对照组;护士站前移后铃响次数显著减少,响铃后护理人员到达患者床旁的时间显著缩短(均P0.01)。结论实施护士站前移可以提高护理人员的工作效率,提升人文关怀护理服务质量及患者满意度。     

新型护理干预在耳鼻喉科门诊顽固性疾病患者中的应用

目的探讨新型护理干预在耳鼻喉科门诊顽固性疾病患者中的应用效果。方法将358例具有焦虑症状的患者(真菌性外耳道炎120例、反流性咽喉炎120例和变应性鼻炎118例)分为2组,每组179例。对照组采用常规护理,观察组采用新型护理干预。比较2组护理干预后患者焦虑症状改善情况及对护理人员的满意度。结果观察组护理干预后焦虑好转率为69.27%,明显高于对照组(22.34%),观察组对护理工作满意度为(95.50±3.85)分,明显高于对照组(75.05±3.05)分,2组比较,差异均有统计学意义(P0.05)。结论采用新型护理干预对患者进行心理疏导、健康教育及延续性护理有助于缓解耳鼻喉科门诊顽固性疾病患者焦虑症状,提高护理满意度。     

尺神经保护垫在平卧位心脏直视手术患者中的应用

目的探讨使用自制尺神经保护垫避免平卧位心脏直视手术患者尺神经损伤,提高术后上肢舒适度的效果。方法选择90例全身麻醉后行平卧位心脏直视手术患者,随机分为观察组和对照组各45例。观察组采用尺神经保护垫托起患者双上肢,对照组采用布类敷料安置患者双上肢,观察两组患者术后尺神经损伤症状及上肢舒适度。结果观察组术后未发生神经损伤,而对照组发生5例;患者上肢舒适度显著优于对照组(P0.01)。结论尺神经保护垫可避免平卧位心脏直视手术患者术后尺神经损伤,提高患者上肢舒适度。     

Preoperative assessment in patients presenting for elective surgery

Preoperative assessment of patients undergoing elective surgery is vital to ensure patients have underlying comorbidities identified, appropriate investigations performed and are optimized prior to the day of surgery. Anaesthetic pre-assessment is usually initiated at the pre-assessment clinic. A thorough assessment should include a careful history and examination as well as assessment of both the airway and functional capacity. This article provides a systematic approach to the assessment process.     

Preoperative assessment in patients presenting for elective surgery

Preoperative assessment of patients undergoing elective surgery is vital to ensure patients have underlying comorbidities identified, appropriate investigations performed and are optimized prior to the day of surgery. Anaesthetic pre-assessment is usually initiated at the pre-assessment clinic. A thorough assessment should include a careful history and examination as well as assessment of both the airway and functional capacity. This article provides a systematic approach to the assessment process.     

形成性评价之“美容外科学”教学实践与研究

目的:对中西医临床专业(美容医学方向)"美容外科学"课程,引入形成性评价考核,通过设立多元指标、多元主体参与、实施多元形式的评价,激发学生学习主动性和积极性,使之改进学习方法,提高学习能力,亦可促进教师教学改革,增强教学效果。方法:本课程形成性评价考核指标为考勤、提问和讨论、实验三项,建立了详细的评分标准,评价主体为本课程教师、学生和实习单位临床指导教师三个层次,采取提问讨论随堂反馈、布置作业随机检查、小组实验协调配合等多样化方式,对教学全过程进行考评。结果:征求学生的反馈意见,对学生试卷卷面成绩与综合成绩分布进行统计学分析。结果显示,经过形成性评价考核,学生的综合成绩构成并不会改变学生试卷卷面成绩的分布构成,加入了学习过程考核因素后,更能全面反映学生的学习状态以及学生对该门课程的综合素质;综合评价的离散趋势较卷面成绩下降,意味加入过程化考核的综合评价尚有降低学生成绩的变异度,增强集中趋势的作用,更能让学生成绩分布符合正态分布,也更符合学生学习规律。结论:严格教学纪律对培养医学生有必要,实行形成性评价考核教学效果良好,因课时有限带来的一些问题需要得到解决。     

From Wooden Limbs to Biomaterial Organs: The Ethics of Organ Replacement and Artificial Organs

Abstract: This paper discussed issues of ethical assessment and moral concern associated with organ replacement and physical enhancement: research, allocation, organ donation, artificial organs, xenografts, biomaterials, and neuromaterials. While emphasizing the medical and moral benefits over associated risks, it calls for a better integration of moral assessment into technology assessment and for the establishment of a cross-cultural and interdisciplinary International Ethics Committee for Organ Replacement Therapy.     

Waterlow score for risk assessment in surgical patients: a systematic review

IntroductionThe Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients.MethodsA systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle–Ottawa scale.FindingsOverall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice.ConclusionsThe WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.     

Quality assessment of computer-assisted semen analysis (CASA) in the andrology laboratory

If quality is assessed with regard to computer-assisted semen analysis (CASA), the evaluation of seminal fluid in the andrological laboratory has to be considered. Three levels of quality assessment are generally accepted: structure, process and results. Quality of structure mainly concerns the quality of laboratory assessment, in particular the skill of the staff and the equipment used. The quality of the CASA system itself is difficult to assess. Process quality concerns the quality of performing a diagnosis. When the parameter settings of the CASA system and the handling of the sample are defined, the reproducibility of the CASA values is clearly better than that of the visual estimation of motility. CASA systems are also superior to other methods regarding the documentation of laboratory values, as all the values are obtained directly online. Result quality comprises the precision, reliability and reproducibility of measurement as well as the significance of values with respect to their biological relevance. Concluding from the definitions as quoted above and from reports of the literature it may be stated that: (i) in the dimensions of structure and process quality, CASA is superior to other methods of measuring sperm motility; (ii) the evaluation of results and quality of results, however, is highly problematic; (iii) CASA systems do not appear to be superior to the visual estimation of sperm motility with respect to the fertilizing capacity of spermatozoa; (iv) the guidelines of the WHO task force form a basis for sufficient process quality; (v) further efforts should actually focus not on the improvement of investigation technology, but on the improvement in the qualification of investigators.     

Burn scar assessment: A systematic review of objective scar assessment tools

Purpose

All deep second and third degree burns are at risk to develop hypertrophic scars which can severely undermine the quality of survival. To assess the severity of scarring, several technical devices or tools have been introduced to evaluate one or more aspects of the scar, enabling comparison of different treatment protocols and allowing an objective follow-up. The objective of this study was to review which tools can be used in objective burn scar assessment.

Basic procedures

The Systematic literature search involving PubMed, the Web of Science (incl. Science Citation Index).

Main findings

51 articles with burn scar assessment as main topic were found. Several characteristics of the scar can be assessed, such as color, metric features and elasticity, but none of the available tools covers the whole aspect of the scar. Especially subjective factors such as pain and itching cannot be assessed with those tools, in spite of their great impact on the patient's quality of life.

Conclusions

Scar tools enable objective and reproducible evaluation of scars, which is essential for scientific studies and medico-legal purposes, and in selected cases for the clinical follow-up of an individual patient. Further studies to evaluate these tools on scars are nevertheless required.     

维持性血液透析患者营养状况的评价

目的：评价维持性血液透析(MHD）患的营养状况。方法：对57例维持性血透患进行人体测量、生化指标的测定、饮食评估、主观综合营养评估(SGA)及综合性营养评估(GNA)。结果：不同指标评估营养不良的发生率分别为：三头肌皮皱厚度(TSF)66．7％，上臂中段肌肉周径(MAMC)33．3％，白蛋白(Alb)31．6％，前白蛋白(PA)45．6％，转铁蛋白(TRF)63．2％，饮食蛋白摄入(DPI)33．3％，SGA38．6％，GNA47．4％。各项指标均属正常仅占14，0％。依据GNA评分，营养不良组与营养良好组进行比较，Alb、PA、蛋白分解率(nPCR)、DPI、SGA评分均有统计学差异。结论：综合评价结果表明86．0％透析患存在不同程度的营养不良。GNA对血透患具有良好的营养评价作用。对MHD患进行常规的营养评价及合理的营养指导对预后有重要意义。     

Pain assessment in children

Acute pain in children can occur following trauma and injury or secondary to medical and surgical intervention. Before acute pain can be effectively treated, it must be accurately assessed. In spite of many years of research to enhance our understanding of pain, the assessment of pain in children continues to be a challenge and is often inconsistent and suboptimal in many organizations. Pain and its perception are multifactorial, hence an approach to pain assessment and treatment must also be multifaceted and multidisciplinary. Painful experiences are dynamic, with huge inter- and intra-individual variation; therefore pain assessment tools must be adaptable, reproducible and accurate to accommodate such variation. This article outlines the different tools available for pain assessment in infants and children (excluding neonates).     

Pain assessment in children

Acute pain in children can occur following trauma and injury or secondary to medical and surgical intervention. Before acute pain can be effectively treated, it must be accurately assessed. In spite of many years of research to enhance our understanding of pain, the assessment of pain in children continues to be a challenge and is often inconsistent and suboptimal in many organizations. Pain and its perception are multi-factorial, hence an approach to pain assessment and treatment must also be multi-faceted and multidisciplinary. Painful experiences are dynamic, with huge inter- and intra-individual variation; therefore pain assessment tools must be adaptable, reproducible and accurate to accommodate such variation. This article outlines the different tools available for pain assessment in infants and children (excluding neonates).