糖尿病专科护士主导个案管理在血糖控制欠佳患者中的应用

目的探讨糖尿病专科护士主导的个案管理在血糖控制欠佳的患者中应用的效果。方法选取72例2型糖尿病患者,由糖尿病专科护士为主,进行包括住院期间及出院后的长期个案管理,评估患者自我管理知识、自护行为、心理健康状况及血糖水平等指标的改善情况。结果自我管理知识得分出院时(15.0±3.6)及干预后(13.5±3.9)较干预前(10.4±4.0)提高,差异有统计学意义(均P0.01);干预后患者饮食控制、血糖监测及高低血糖处理自护行为改善(均P0.01),抑郁情况有所缓解,但与干预前比较,差异无统计学意义(P0.05)。结论以糖尿病专科护士主导的个案管理模式可以提高患者自我管理水平,改善健康状况,应大力发挥专科护士在糖尿病长期照护中的作用。     

分阶段随访管理对糖尿病患者血糖及自我管理的影响

目的探讨糖尿病专科护理门诊分阶段随访管理对糖尿病患者血糖和自我管理行为的影响。方法将200例糖尿病患者按时间段分为对照组和观察组各100例。对照组由糖尿病专科护理门诊实施常规随访,观察组依托糖尿病管理平台,由糖尿病专科护理门诊实施分阶段随访管理。比较患者入组后3、6、9、12个月血糖达标和自我管理行为。结果观察组空腹血糖、餐后2h血糖及糖化血红蛋白水平显著低于对照组(均P0.05),自我管理行为得分显著高于对照组(均P0.05)。结论利用糖尿病管理平台实施分阶段随访管理,可提高患者的自我管理能力,促进血糖达标。     

糖尿病足风险分级管理对患者自我管理能力和足溃疡发生的影响

目的探讨糖尿病足风险分级管理对糖尿病患者自我管理知识、行为及糖尿病足溃疡发生率的的影响。方法将有糖尿病足风险的2型糖尿病患者172例随机均分为实验组和对照组,两组治疗原则相同,根据Gavin′s糖尿病足危险因素加权值积分将两组患者分为低、中、高危组。对照组由专科护士定时采取集中大课堂授课的形式对患者进行饮食、运动、药物、血糖检测、并发症相关知识宣教;实验组实施分级管理,由2名糖尿病专科护士实施对应的一、二、三级管理。结果干预后实验组糖尿病足护理知识与行为得分显著高于本组干预前及对照组干预后(均P0.05)。随访24个月,实验组未发生足溃疡,对照组1例发生足溃疡发生;实验组低、中、高危足患者的分布与对照组比较,差异有统计学意义(P0.01)。结论糖尿病足风险分级管理可有效提高患者的自我管理知识和行为水平,降低糖尿病足溃疡的发生风险。     

糖尿病学组在三甲医院非内分泌专科同质化管理的作用

目的探讨糖尿病学组在三甲医院非内分泌专科同质化管理中的应用效果。方法采取前瞻性非同期对照设计,将2016年9月从全院81个护理单元抽取的79例糖尿病患者作为实施前组,实施常规护理。在护理部组织下成立医院糖尿病学组,从各科室招募81名联络护士,建立“糖尿病学组质控组-临床科室质控组-科室联络员”三级院内血糖管理模式,对全院实行同质化管理。实施2年后(2018年9月)再次抽取80例糖尿病患者为实施后组,比较实施前后联络护士和患者糖尿病知识水平及患者出院前空腹血糖水平。结果糖尿病学组建立后,联络护士的糖尿病知识及技能操作成绩显著优于实施前(均P<0.01);实施后组患者糖尿病知识知晓率显著高于实施前组,出院前空腹血糖显著低于实施前组(均P<0.01)。结论糖尿病学组的建立在三甲医院非内分泌专科糖尿病同质化管理方面有积极作用,可提升非内分泌科室护士的糖尿病知识及技能水平,提高患者糖尿病知识水平,有效降低空腹血糖水平。     

基于5G网络的复合型糖尿病AI管理平台的设计与应用

目的 构建基于5G网络的复合型糖尿病AI管理平台,观察在糖尿病患者管理及基层医护培训中的应用效果。方法 选取2型糖尿病出院患者340例,采用随机数字表法分为观察组和对照组各170例。对照组接受常规糖尿病院外管理,观察组基于5G网络的复合型糖尿病AI管理平台实施院外管理,于干预前和干预3个月后观察患者血糖控制相关指标和患者自我管理行为的变化。另在基层医院内选取护理人员60名,通过平台进行培训。比较干预前和干预6个月后基层护士综合能力评分。结果 干预3个月后,观察组患者空腹血糖、餐后2 h血糖及糖化血红蛋白显著低于对照组,自我管理行为评分显著高于对照组(均P<0.05)。项目开展6个月后,护理人员理论知识、实践操作及护理团队建设评分显著高于开展前(均P<0.05)。结论 基于5G网络的数字医疗平台的应用可改善糖尿病患者的血糖,提高患者的自我管理能力,且促进基层护士的能力提升,有利于区域内护理质量持续改进。     

专科护士主导的社区协同服务在椎体骨折患者中的实践

目的 研究以骨科专科护士为主导的社区协同服务在骨质疏松性椎体压缩骨折患者出院后的应用效果。方法 选取骨质疏松性椎体压缩骨折患者117例,按住院时间先后分为对照组（n=58)和干预组（n=59）。对照组给予常规出院指导和随访,干预组在此基础上通过医联体建立以骨科专科护士为核心的社区协同服务小组,由专科护士制定个体化出院护理方案、培训社区护理人员、畅通医院和社区信息共享机制,指导社区护理人员协同实施出院后的护理服务。干预时间为1年,在干预结束后获取两组研究对象的各项数据,比较两组患者自我管理能力、生活质量、骨密度值及再骨折发生情况。结果 干预组1年后患者自我管理能力、生活质量各维度得分及骨密度均值显著高于对照组（P<0.05,P<0.01）,椎体再次骨折发生率显著低于对照组（P＜0.05）。结论 以骨科专科护士为主导的社区协同服务能综合医院和社区的优势,提高骨质疏松性椎体骨折患者出院后自我管理能力及生活质量,使患者的骨质密度增加,降低椎体再次骨折发生率。     

糖尿病专科护士主导的住院糖尿病患者系统化健康教育

目的探讨糖尿病专科护士主导的系统化健康教育模式对住院糖尿病患者的影响。方法收集某三甲医院住院的183例2型糖尿病患者,按照时间顺序分成干预组(85例)和对照组(98例)。干预组采用糖尿病专科护士主导的系统化健康教育模式,对照组按照传统的健康教育模式,对两组患者糖尿病自我管理知识水平、空腹血糖值进行比较。结果干预后两组糖尿病自我管理知识得分比较,干预组显著高于对照组,差异有统计学意义(P0.05)。两组空腹血糖值比较,差异无统计学意义(P0.05)。结论糖尿病专科护士主导的系统化健康教育有利于提高住院患者自我管理知识水平,护理管理者应重视和加强发挥专科护士的作用。     

个案管理师为主导的妇科日间手术护理流程的实施

目的建立以个案管理师为主导的妇科日间手术护理流程,使患者得到安全便捷的治疗和护理服务。方法将300例妇科日间手术患者随机分为观察组和对照组各150例,对照组实施日间手术常规护理,观察组实施以个案管理师为主导的妇科日间手术护理流程。结果观察组手术临时取消率、住院费用、转科率、出院后并发症发生率及72 h急诊就诊率、7 d非计划再入院率显著低于对照组(P0.05,P0.01)。观察组患者满意度显著高于对照组(P0.01)。结论对妇科日间手术患者实施以个案管理师为主导的妇科日间手术护理流程,可以有效缩短患者诊疗时间,减轻经济负担,降低医疗资源浪费,促进患者早日出院,提高患者满意度。     

中青年糖尿病患者基于微信平台的延伸护理

目的探讨基于微信平台的延伸护理对中青年糖尿病患者自我管理行为及血糖的影响。方法将158例中青年糖尿病患者随机分为对照组(80例)和观察组(78例),对照组按常规行健康教育及出院随访,观察组在常规护理基础上实施基于微信平台的延伸护理。结果出院6个月后观察组在正确服药、合理饮食、坚持运动、血糖监测、足部护理的自我管理行为得分显著高于对照组,空腹血糖、餐后2h血糖、糖化血红蛋白、BMI显著低于对照组(均P0.01)。结论基于微信平台的延伸护理能提高中青年糖尿病患者的自我行为管理能力,进而使患者血糖和BMI得到有效控制。     

专科护理门诊个案管理对永久性起搏器植入患者的影响

目的 探讨专科护理门诊个案管理对永久性起搏器植入患者复诊及服药依从的影响。方法 将首次植入永久起搏器患者134例采用随机数字表法分为对照组和干预组各67例。对照组给予微信或电话方式进行常规随访,干预组实施专科护理门诊个案管理,即通过线上及专科护理门诊方式对患者进行随访与个性化健康教育。比较两组出院后1、3、6个月的复诊率、服药依从性。结果 出院后1、3、6个月干预组复诊率、服药依从性显著高于对照组(P<0.05,P<0.01)。结论 对永久性起搏器植入患者实施专科护理门诊个案管理,促进患者出院后专业化护理的延续和全程管理,可以显著提高其术后复诊率、服药依从性。     

Potential prognostic factors for delayed healing of common,non‐traumatic skin ulcers: A scoping review

Healing of non‐traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta‐analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non‐traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta‐analysis to quantify their prognostic value for delayed ulcer healing.     

The effect of high-voltage monophasic pulsed current on diabetic ulcers and their potential pathophysiologic factors: A systematic review and meta-analysis

The present review was conducted to determine the efficacy of high-voltage monophasic pulsed current (HVMPC) in treating diabetic ulcers, assess its effect on skin lesions with each of the pathophysiologic factors potentially contributing to diabetic ulcers, evaluate its safety, and identify treatment parameters. Electronic search of PubMed, Scopus, PEDro and Google Scholar databases was conducted. The revised tool for assessing risk of bias in randomised trials (RoB 2), the risk of bias in non-randomised studies-of interventions (ROBINS-I) and the Joanna Briggs Institute (JBI) critical appraisal tool were used to assess risk of bias and methodological quality. Overall quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principles. Thirty-two studies matched the eligibility criteria, and included 1061 patients with 1103 skin lesions of selected aetiologies; 12 randomised controlled trials were included in quantitative synthesis. HVMPC plus standard wound care (SWC) likely increased the probability of complete wound healing of pressure ulcers (PrUs) compared with sham/no stimulation plus SWC; relative risk (RR) 2.08; 95% CI: [1.42, 3.04], p = 0.0002; I² = 0%, p = 0.61; eight studies, 358 ulcers. Although conclusive evidence regarding the effect of HVMPC on diabetic ulcers was not found, collateral evidence might suggest a potential benefit. Direct evidence, with moderate certainty, may support its efficacy in treating PrUs, albeit few adverse reactions were reported. Other observations, moreover, might indicate that this efficacy may not be limited to PrUs. Nonetheless, several aspects remain to be clarified for safe and effective application of electrical stimulation for wound healing.     

Effect of noncontact normothermic wound therapy on the healing of neuropathic (diabetic) foot ulcers: An interim analysis of 20 patients

This is the interim analysis of a prospective, randomized, controlled study comparing diabetic foot ulcer healing in patients being treated with either noncontact normothermic wound therapy (Warm-UP; Augustine Medical Inc. Eden Prairie, MN) applied for 1 hour 3 times daily until healing or 12 weeks, or standard care (saline-moistened gauze applied once a day). Surgical debridement and adequate foot off-loading was provided to both groups. Evaluations were performed weekly and consisted of acetate tracings, wound assessment, and serial photography. Twenty patients have completed the trial and both treatment groups were distributed evenly (N = 10). Ulcers treated with noncontact normothermic wound therapy had a greater mean percent wound closure than control-treated ulcers at each evaluation point (weeks 1-12). After 12 weeks, 70% of the wounds treated with noncontact normothermic wound therapy were healed compared with 40% for the control group. In this subset of patients there have been no adverse events associated with noncontact normothermic wound therapy.     

PLATELET ACTIVATING FACTOR ANTAGONISM IN PURE SKIN FLAPS EXPOSED TO ISCHAEMIA-REPERFUSION INJURY

Seventy-six consecutive patients were operated on for advanced Dupuytren's contracture and the results evaluated after nine months with special reference to the use of a dynamic extension splint. The patients were separated into three groups: those in whom the splint was used according to our guidelines (n = 15); those in whom the splint was used, but inadequately (n = 15); and those who did not require splinting (n = 24). Our results nine months postoperatively were similar to those of other studies in showing that the fifth proximal interphalangeal joint constituted the greatest problem. Comparison of the three groups indicated that splinting the way we used it did not influence the natural course of the disease after operation.     

Laser photocoagulation of bleeding gastroduodenal ulcers: A morphological study

The efficacy of photocoagulation by the neodymium-doped yttrium aluminium garnet (Nd-YAG) laser in the endoscopic control of upper gastrointestinal bleeding has been demonstrated previously. Yet rebleeding remains possible. In the present report the results are presented of a histological study of resection specimens from patients who required emergency surgery for recurrent upper gastrointestinal bleeding after endoscopic laser treatment. The study was set up in order: (1) to describe the changes induced by laser treatment and (2) to identify possible causes of recurrent bleeding. The findings show that laser photocoagulation can induce major vascular changes but that these may be incomplete. Incomplete photocoagulation may be responsible for the rebleeding and may itself be caused by poor accessibility to the bleeding site.     

THE POINT PREVALENCE OF WOUNDS IN A TEACHING HOSPITAL

Background : Wounds are a common problem, particularly in the elderly population. The scale of wound problems in hospital is largely unknown because wounds are widely dispersed. The present study examined the point prevalence of hospital wounds and undertook a pressure ulcer risk assessment of all patients on one day. Methods : All 360 inpatients were surveyed and thoroughly examined. A risk scale for pressure sore development, the Norton score, was applied. When wounds were found, information was collected to determine their aetiology. Results : Forty leg ulcers, 40 pressure sores, 85 surgical wounds and seven other types of wounds were found. Most leg ulcer and pressure sore cases were admitted for other reasons. The Norton score did not predict all cases of pressure ulceration. A total of 52% of wounds did not qualify for additional funding under current funding criteria. Conclusion : The prevalence of non-surgical wounds in Heidelberg Repatriation Hospital was easily underestimated. Wound care management can be optimized by staff education and protocol design, early identification of troublesome wounds and of at-risk patients, and a cross-sectional approach that incorporates wound-management teams.     

Six‐month mortality risks in long‐term care residents with chronic ulcers

Chronic ulcers are a common problem in long‐term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6‐month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six‐month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6‐month mortality with an odds ratio of 1·32 (95% CI 1·07–1·63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1·75. Higher haemoglobin and venous insufficiency were protective of 6‐month mortality. Ulcer number is an important predictor for 6‐month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.     

Preventing iatrogenic facial pressure ulcers during spinal surgery: Prospective trial using a novel method and review of literature

To assess the outcome of a novel method of preventing facial pressure ulcers in spinal surgery and a review of literature. A prospective trial using a novel method of facial protection using paraffin tulle gras dressing to cover bony prominences during spinal surgical procedures was performed. Patients were reviewed at 24 hours and 6 weeks. A telephone survey was also conducted post discharge. Over an 8‐month period, 12 patients (7F:5M, age 9‐72 years) underwent spine surgery for tumour stabilisation (n = 7), deformity correction (n = 4), and degenerative presentation (n = 1) with mean operative time of 472 minutes (range 150‐785 minutes) in prone position. All patients were managed by the same team using an agreed protocol. No pressure ulcers were noted in our study. One patient sustained minimal erythema, which resolved after 24 hours. All patients were satisfied with the care received. Facial pressure ulcers though much reduced are still common in spinal surgery. The common factors are the long duration of surgery, shear, friction, moisture, and intrinsic factors. Our strategy of an appropriate facial support and constant vigilance helped eliminate the incidence of iatrogenic facial ulcers in spinal surgery.     

Surgical and reconstructive management of pressure ulcers

Despite significant advances in therapeutic options, pressure ulcers continue to pose a challenge to physicians and surgeons and frequently require multidisciplinary input. In addition, they place huge financial burdens on health care providers. Generally classified as grades I to IV depending on the extent and severity of the ulcer, grades I and II are usually amenable to conservative management. Grades III and IV may require surgical intervention, which could either be simple debridement or complex reconstructive microsurgery. Direct closure or skin grafting is useful in only a small number of early pressure ulcers. For non-healing and advanced pressure ulcers, reconstructive surgery is indicated, which consists of soft tissue flap coverage such as fasciocutaneous, musculocutaneous, perforator, or free flaps. The selection of a particular flap depends on a variety of factors, for instance, the location and grade of the ulcer, vascularity of the surrounding tissue, mobility of the patient, and the experience and expertise of the surgeon. There are no clear guidelines at present regarding the suitability of a particular flap in the management of pressure ulcers at different stages. This article aims to provide an overview of the etiology, pathophysiology, and management of pressure ulcers in various anatomical locations, with particular emphasis on current advances in reconstructive surgical procedures.     

A Neurovascular Flap for Coverage of Distal Plantar Defects

Ulcers on the sole of the foot are very uncomfortable. A poor blood supply and a tendency to slow healing are common in these patients. Because of its weight-bearing and unique sensory function the glabrous skin of the sole is very specialized. To obtain a functional skin coverage, glabrous skin with a good blood supply and an intact nerve supply may be superior to other methods of soft tissue reconstruction. A neurovascular axial or island flap from the fibular side of the great toe may fulfill this demand with minimal donor site morbidity. Three cases are reported and the literature on the subject is summarized.