老年期精神障碍患者意外因素分析及预防

本文对１０２例老年期精神障碍患者住院期间常见意外：跌倒、噎食所致窒息因素进行探讨，主张采取一些措施加以防范，以降低意外事件的发生。     

老年人跌倒和神经系统疾病

该文概述了患有神经系统疾病老年人跌倒发生的流行病学现况，神经系统疾病及其用药对跌倒的影响，跌倒危险性的评估及预防。以便为临床防治提供参考。     

手术室护生意外伤害70例分析

目的通过对手术室职业危害因素的认识,提高护生职业防护意识。方法通过调查我科实习护生工作中发生的职业危害进行分析。结果通过进行护生进科前教育及实习工作中督察来减少职业危害。结论护生对职业性危害因素认识普遍不足,对职业防护教育不够重视。     

老年精神障碍患者跌倒预防的研究进展

跌倒是常见的医院不良事件,患有精神障碍的老年患者跌倒风险增加,一般的危险因素包括认知障碍、痴呆、抑郁状态、焦虑状态、谵妄状态、服用抗精神病药物、电休克治疗、合并躯体疾病、给药过多、睡眠障碍等。相关的精神科疾病有阿尔茨海默病、抑郁症、焦虑症等。常见的预防措施有功能训练、认知－运动训练、多感官治疗、药物管理、员工培训等。现在越来越多的学者认为多因素风险评估与针对性的多元化干预措施是预防老年精神障碍患者跌倒的关键。     

预防老年精神病患者跌倒的原因及对策

老年精神病患者易发生跌倒现象,导致组织损伤、骨折等严重后果,极易引起医疗纠纷,本文将从跌倒危险因素,预防跌倒干预措施进行探讨.     

青年人脑血管意外危险因素分析及护理对策

目的探讨青年人脑血管意外患者危险因素,为早期防治干预提供依据。方法对169例经CT报告确诊为脑血管意外的患者分为2组。青年组(≤40岁)43例,老年组(≥60)126例,分析2组患者的脑血管意外危险因素,并对危险因素进行多元回归分析。结果青年组吸烟、高脂血症、肥胖、脑血管病家族史明显高于老年组(P<0.01),老年组高血压、糖尿病较多。青年脑血管病患者主要危险因素是男性、吸烟、脑血管病家族史和高脂血症。结论青年脑血管意外患者的发病有其特殊性,对其进行相应的健康教育,提高自我保健水平,对于降低青年人脑血管意外的发病率是十分必要的。     

社区老年人群预防跌倒干预措施：美国预防服务工作组推荐声明

重要性 跌倒是美国老年人群中首位伤害相关的致残和致死原因。2014年,28.7%社区65岁及以上老年人经历过跌倒,导致2015年2900万次跌倒（37.5%需要药物治疗或1 d及以上的限制活动）,估计有3.3万人死亡。      

预防住院脑卒中患者跌倒的护理对策

近年来,由于医院管理理念的进步和患者自主意识的增强,患者安全问题已经引起世界卫生组织及众多国家医务界的高度关注。许多国家已经或正在把住院患者跌倒作为临床护理质控的显性指标。评估住院患者跌倒的危险性也被公认为是有效和必要的防范对策[1]。跌倒是脑卒中患者的     

经皮冠状动脉介入治疗后脑血管意外：发生率、危险因素及转归

脑血管意外是经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）后最严重的并发症之一。研究表明,高龄、高血压、糖尿病、卒中史、肾脏衰竭、心力衰竭、主动脉内球囊反搏（intra-aortic bal oon pump,IABP）、紧急冠状动脉造影等是PCI后脑血管意外的危险因素。PCI后发生脑血管意外的患者住院时间延长,住院费用增加,致死致残率高,多数患者在出院后有持久的神经系统缺陷。研究认为可以通过优化药物治疗,减小导管口径,避免低血压等措施来降低脑血管意外的发生率。     

帕金森病患者跌倒相关因素的研究进展

本文从帕金森病(PD)患者的临床症状、药物、环境、照顾者等方面总结其跌倒相关危险因素的研究现状,分析针对PD患者跌倒的一系列防护措施,以期降低PD患者跌倒的发生率,提高其生活质量,为研究PD患者跌倒问题指出方向。     

Prevention of falls in older people with dementia

Summary Falls are a major cause of morbidity and mortality in older people with dementia. However, although we know that people with dementia can comply with interventions known to reduce falls in cognitively normal populations, and that these interventions can modify certain risk factors for falls in patients with dementia, direct evidence that falls can be prevented in older people with dementia is lacking. Further research is required specifically targeting fall prevention in older people with dementia.     

Falls prevention in persons with intellectual disabilities: Development,implementation, and process evaluation of a tailored multifactorial fall risk assessment and intervention strategy

In the general elderly population, multifactorial screening of fall risks has been shown to be effective. Although persons with intellectual disabilities (ID) fall more often, there appears to be no targeted screening for them. The aim of this study was to develop, implement, and evaluate a falls clinic for persons with ID. Based on guidelines, literature, and expert meetings, a falls clinic for persons with ID was developed. In total, 26 persons with ID and a fall history participated in the study. Process evaluation was conducted with evaluation forms and focus groups. Fifty interventions (0–8 per person) were prescribed. The (para)medical experts, clients, and caregivers described the falls clinic as useful. Advice for improvement included minor changes to clinic content. Logistics were the largest challenge for the falls clinic, for example organizing meetings, completing questionnaires prior to meetings, and ensuring that a personal caregiver accompanied the person with ID. Furthermore, the need for a screening tool to determine whether a person would benefit from the falls clinic was reported. In conclusion, the falls clinic for persons with ID was considered feasible and useful. Some minor content changes are necessary and there is a need for a screening tool. However, logistics concerning the falls clinic need improvement. More attention and time for multifactorial and multidisciplinary treatment of persons with ID is necessary. Implementation on a larger scale would also make it possible to investigate the effectiveness of the falls clinic with regard to the prevention of falls in this population.     

Falls in Parkinson's disease: A complex and evolving picture

Falls are a major determinant of poor quality of life, immobilization, and reduced life expectancy in people affected by Parkinson's disease (PD) and in older adults more generally. Although many questions remain, recent research has advanced the understanding of this complex problem. The goal of this review is to condense new knowledge of falls in PD from prodromal to advanced disease, taking into account risk factors, assessment, and classification as well as treatment. The fundamental steps of clinical and research‐based approaches to falls are described, namely, the identification of fall risk factors, clinical and instrumental methods to evaluate and classify fall risk, and the latest evidence to reduce or delay falls in PD. We summarize recent developments, the direction in which the field should be heading, and what can be recommended at this stage. We also provide a practical algorithm for clinicians.© 2017 International Parkinson and Movement Disorder Society     

Balance impairment in chronic antiepileptic drug users: A twin and sibling study

Purpose: Patients taking antiepileptic drugs (AEDs) have an increased incidence of fractures. This study investigated chronic AED use and physical contributors to falls risk using an AED‐discordant, twin and sibling matched‐pair approach, and assessed clinically relevant subgroups: AED polytherapy; longer‐duration AED; and falls history. Methods: Twenty‐nine same‐sex (mean age 44.9 years, 59% female), ambulatory, community‐dwelling twin and sibling pairs, discordant for AED exposure (and AED‐indication), were recruited. Validated clinical and laboratory tests of strength, gait, and balance were performed. Relevant AED levels, and fasting serum samples for 25‐hydroxyvitamin D (25OHD), 1,25‐dihydroxyvitamin D [1,25(OH)₂D], and immunoreactive parathyroid hormone (iPTH) levels were taken. Results: There were significant mean within‐pair differences in tests of static and dynamic balance, with the AED user having poorer balance function than the AED nonuser. No difference was seen in lower limb strength or gait measures. Increased duration of AED therapy and AED polytherapy were independent predictors of increased sway. No significant within‐pair differences were seen in fasting serum levels of 1,25(OH)₂D, 25OHD and iPTH after Bonferroni correction. Discussion: Balance performance is impaired in AED users compared to their matched nonuser siblings. Pairs where the AED users took AED polytherapy, or had a longer duration of AED use, had more impaired balance performance. These balance deficits may contribute to the increased rate of fractures in this population.     

Cognitive impairments in patients with cerebrovascular risk factors: A comparison of Mini Mental Status Exam and Montreal Cognitive Assessment

Objective and background

Recent evidence suggests that cerebrovascular risk factors are contributing factors, not only to vascular cognitive decline, but also for Alzheimer's disease. The study aim was to compare Montreal Cognitive Assessment (MoCA) and MMSE tests in subjects with cerebrovascular risk factors.

Patients and methods

Fifty patients with cerebrovascular risk factors were administrated the MMSE and MoCA tests. Data collected for all subjects and the results were compared.

Results

Cognitive impairments revealed on both tests were more frequent in females, and correlated with the level of education (for MoCA r = 0.75, p = 0.001 and for MMSE r = 0.662, p = 0.001). Mean values of MoCA score were significantly lower in patients with two or more cerebrovascular risk factors compared with those with only one risk factor (19.92 ± 5.99 versus 23.81 ± 4.06; p = 0.049), a finding that was not evidenced by MMSE.

Conclusions

The most frequent impaired domain in MMSE (for scores both less and more than 26) was attention; but in MoCA the most frequent impaired domains were delayed recall (for scores above 26), and visuo-executive (for scores ≤26), which is a common domain involved in vascular cognitive decline. MoCA may be superior to MMSE in early detection of cognitive decline in patients with vascular risk factors.     

A Demonstration of a Presurgical Behavioral Medicine Evaluation for Categorizing Patients for Implantable Therapies: A Preliminary Study

Objectives. The aim of the current study was to evaluate the potential efficacy of a presurgical behavioral medicine evaluation screening algorithm with patients undergoing evaluation for implantable pain management devices. Methods. Sixty patients were evaluated for prognostic recommendations regarding outcomes from surgery for spinal cord stimulators and intrathecal pumps. Diagnostic interviews, review of medical charts, and psychosocial and functional measures were used in the initial evaluation. Results. Patients were classified into one of four prognostic groups, from low to increasing risks: Green, Yellow I, Yellow II, and Red. The Green group showed the most positive biopsychosocial profile, while the Red groups showed the worst profiles. Conclusions. This preliminary study suggests that the presurgical behavioral medicine evaluation algorithm may be an effective method for categorizing patients into prognostic groups. Psychological and adverse clinical features appear to have the most power in the classification of such patients.     

Clinical assessment of prognostic factors for long‐term pain and handicap after whiplash injury: a 1‐year prospective study

Background and purpose: Physical mechanisms are the possible factors involved in the development and maintenance of long‐term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra‐cervical pains, as well as non‐painful complaints after a whiplash injury as predictors for subsequent handicap. Methods: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high‐ or a low‐risk group by an algorithm based on pain intensity, number of non‐painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high‐risk patients and 230 low‐risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high‐risk patients (n = 458) and 41 consecutive low‐risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. Results: The relative risk for a 1‐year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non‐painful complaints. Conclusion: Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non‐painful complaints are the important prognostic factors for a 1‐year handicap after acute whiplash.     

A follow-up study of postpartum psychoses: prognosis and risk factors for readmission.

OBJECTIVE: The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis. METHOD: Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models. RESULTS: An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission. CONCLUSION: Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.