医护合作决策危重患者身体约束缩减方案的实施

目的 探讨医护合作决策危重患者身体约束缩减方案的实施效果.方法 将ICU 2019年7月至2020年2月收治的273例患者设为对照组,2020年4～11月收治的307例患者设为干预组.对照组常规给予身体约束策略,干预组实施医护合作决策的身体约束缩减策略.比较两组身体约束率、身体约束时间及谵妄、非计划拔管、皮肤损伤发生率...     

以家庭为中心的探视对ICU肿瘤重症患者谵妄的影响

目的 探讨以家庭为中心的探视模式预防ICU肿瘤重症患者谵妄发生的作用.方法 将164例ICU肿瘤重症患者按照入院时间分为对照组和干预组各82例.对照组采用常规探视模式,干预组实施以家庭为中心的探视模式.比较两组谵妄发生率、ICU住院时间、ICU获得性感染发生率及ICU患者家属满意度.结果 干预组谵妄发生率显著低于对照组...     

ICU住院患者身体约束量表的设计与应用

目的探讨应用身体约束量表指导ICU护士对患者实施规范、安全身体约束的效果。方法将448例入住ICU患者按时间段分为对照组156例、观察组292例。对照组按常规和经验对患者实施约束;观察组采用自行设计的"ICU住院患者身体约束评估量表"对患者实施评估,根据评估结果实施身体约束。结果观察组身体约束、非计划拔管、约束部位皮肤受损、约束肢体肿胀、约束肢体未处于功能位发生率显著低于对照组,患者满意度显著高于对照组(P0.05,P0.01)。结论 ICU住院患者身体约束评估量表可为ICU患者实施身体约束提供客观、准确的信息,实现个性化、合理化的身体约束,降低ICU身体约束的使用频率,保证医疗护理安全,提高患者满意度。     

神经外科ICU患者身体约束缩减方案的制定与应用

目的探讨身体约束缩减方案在神经外科ICU患者中的应用效果。方法将神经外科ICU住院的263例患者按时间段分为对照组131例、干预组132例;对照组实施常规约束管理,干预组制定约束缩减方案,用于患者身体约束中。结果干预组身体约束率、约束致皮肤受损发生率显著低于对照组(P0.05,P0.01),非计划性拔管率两组差异无统计学意义(P0.05)。结论约束缩减方案的应用有效降低了神经外科ICU患者身体约束率及由此所致皮肤受损率,有利于患者自主活动和康复。     

基于最佳证据的危重症患者ICU谵妄三级护理管理

目的将ICU谵妄护理管理的最佳证据应用于危重症患者的护理实践,促进护士对ICU谵妄患者开展有效管理。方法根据住院时间将340例住院重症患者分为对照组和观察组各170例,对照组实施常规护理,观察组实施基于最佳证据的护理干预,即建立危重症患者ICU谵妄管理小组,确定最佳证据及调查证据应用障碍因素,开展护士ICU谵妄相关知识的培训、评估筛选ICU谵妄,ICU谵妄三级护理管理。结果观察组ICU谵妄发生率、ICU谵妄持续时间、机械通气时间、ICU住院时间、住院总费用与对照组比较,差异有统计学意义(P0.05,P0.01)。谵妄相关不安全事件发生率低于对照组。结论将ICU谵妄三级护理管理的最佳证据应用于危重症患者,可有效改善患者临床结局,减少不安全事件发生。     

健康教育路径在肝硬化家庭照顾者中的应用评价

目的：探讨健康教育路径在肝硬化家庭照顾者中的应用效果。方法将120例肝硬化患者随机分为观察组（60例）和对照组（60例）,每位患者选出一名主要照顾者为代表。对观察组的照顾者采用健康教育路径进行教育,对照组照顾者采用常规教育方法。比较两组照顾者对肝硬化患者照顾知识的掌握情况、患者并发症的发生率和对健康教育工作的满意度。结果观察组在相关疾病知识的掌握率、患者并发症的发生率和满意度方面均优于对照组（P＜0.05）,差异有统计学意义。结论通过健康教育路径对肝硬化家庭照顾者进行教育效果良好,降低了并发症的发生率,提高了患者及家属的满意度。     

综合护理干预在新生儿湿疹护理中的应用效果

目的 探讨综合护理干预在新生儿湿疹护理中的应用效果。方法 选取安徽省妇幼保健院新生儿 科2022年1月-2023年1月收治的60例湿疹患儿为研究对象，依据随机数字表法分为对照组和观察组，每 组30例。对照组开展科室常规干预，观察组开展综合性护理干预，比较两组湿疹症状恢复时间、生活质 量、感染事件发生率及家属满意度。结果 观察组湿疹消退时间、湿疹结痂时间、皮肤瘙痒消退时间均短 于对照组（P＜0.05）；观察组干预后瘙痒抓痒影响、睡眠质量、摄食状况、情绪影响评分均低于对照组 （P＜0.05）；观察组感染事件发生率低于对照组，家属满意度高于对照组（P＜0.05）。结论 综合护理干 预在新生儿湿疹护理中的应用效果确切，可有效缩短湿疹症状消退时间，减轻瘙痒等不适感，有利于提高 患儿的生活质量，降低感染事件发生率，提升家属满意度。     

APACHEⅡ评分在ICU分级护理中的应用

目的探讨急性生理学和慢性健康状况（APACHEⅡ）评分在ICU分级护理中的应用价值。方法将120例ICU患者分为观察组（62例）和对照组（58例）。对照组按特级护理及疾病种类执行常规护理;观察组应用APACHEⅡ评分评估患者病情,依据评分在特级护理的基础上进一步细化护理措施,分特一、特二、特三级护理系统对患者进行护理。比较两组护理质量以及护士对护理资源配置和患者／家属对护理工作的满意度。结果观察组护士对护理资源配置和患者／家属对护理工作的满意率显著高于对照组（P〈0．05,P〈0．01）;护理质量优于对照组,但差异无统计学意义（P〉0．05）。结论依据APACHEⅡ评分对ICU患者实行分级护理可更合理地配置ICU护理资源,提高护理满意度。     

重症医学新镇静镇痛评分在ICU的应用

目的：观察新型镇静镇痛评分的重症监护疼痛观察工具(CPOT)和躁动镇静评分（RASS）在重症监护患者中的临床应用效果。方法将ICU需行机械通气治疗的160例患者随机分为治疗组（80例）和对照组（80例）,治疗组根据CPOT和RASS指导镇痛镇静治疗,对照组根据护士主观判断进行镇痛镇静。记录两组患者使用镇痛镇静药物前、使用药物1、6、12小时的生命体征指标;同时记录患者所需镇痛次数、非计划性拔管、人机对抗、低血压及28天病死率;当患者意识清醒且转出ICU后,对护士及患者镇痛镇静满意度进行评估。结果在镇痛次数、护士及患者满意度、非计划性拔管、人机对抗、低血压和使用镇痛镇静药物剂量方面,治疗组与对照组相比有显著差异,具有统计学意义（P＜0.05）;在28天病死率和镇静镇痛前后生命体征比较方面无明显差异（P＞0.05）。结论 CPOT与RASS在达到预期镇痛镇静的目标下均可获得良好的临床效果。这两种评估工具是目前危重症患者镇痛镇静评估的可靠和有效手段。     

PICC置管患者医护协同全程管理效果探讨

目的探讨医护一体化管理模式在PICC置管及规范化维护全程管理中的应用效果。方法采用非同期对照实验将164例患者分为对照组与观察组各82例,对照组给予PICC置管常规护理,观察组给予医护一体化管理模式干预。比较两组非计划性拔管、患者对护理工作的满意度以及导管相关并发症的发生率。结果观察组非计划拔管率显著低于对照组;对护理工作满意度显著高于对照组(P0.05,P0.01);两组导管相关并发症比较,差异无统计学意义(均P0.05)。结论对PICC置管患者实施医护一体化管理模式能有效降低非计划拔管率,从而提高患者满意度。     

消毒供应中心参与医学美容科医疗器械清洗包装质量管理的效果

研究消毒供应中心参与医学美容科医疗器械清洗包装质量管理的效果。方法 选择蒙阴县人 民医院2022年6月-2023年6月的15名消毒供应中心工作人员，按照随机数字表法分为基础组（7名）和科研 组（8名）。基础组采取常规管理，科研组采取医疗器械清洗包装质量管理，比较两组消毒灭菌质量、不 良事件及工作人员满意度。结果 科研组管理后器械拆装、消毒质量、清洗质量、包装质量评分均高于基 础组（P ＜0.05）；科研组不良事件发生率低于基础组（P ＜0.05）；科研组满意率为100.00%，高于基础组 的57.14%（P ＜0.05）。结论 消毒供应中心参与医学美容科医疗器械清洗包装质量管理可提高消毒灭菌质 量，保证器械消毒合格并避免发生不良事件。     

Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department

Purpose: The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients. Methods: The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience nonrandom manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome. Results: The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8e12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach''s alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients. Conclusions: The study tool has a sensitivity to predict the BAT patients’ outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.     

我国46所医院门急诊护理质量指标使用现况调查

目的了解医院门急诊护理质量指标的应用现状,为构建门急诊护理质量指标体系提供参考。方法采用自行设计的"医院护理门急诊质量指标调查表"对全国52所医院进行调查。结果收回有效调查表46份。根据护理质量指标名称、定义及公式,经合并整理,归纳为18项门诊护理质量指标,24项急诊护理质量指标。46所医院使用门诊指标数3.96±2.92,使用急诊指标数5.24±2.45。结论我国门、急诊护理质量指标涉及结构-过程-结果3个维度,但各医院使用的门急诊指标数量和指标构成不一,离散程度较大,现行门、急诊护理质量指标尚未形成完整体系。     

Maxillofacial and concomitant serious injuries: An eight-year single center experience

Purpose: Maxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians'' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas. Methods: We retrospectively evaluated data of 240,833 patients admitted at the ED of the University Hospital of Messina from January 2008 to December 2015 because of maxillofacial injuries leading to hospitalization and surgical treatment. Patients who primarily received treatment care at different institutions, pediatric trauma patients and adult patients who were transferred in accordance with preexisting agreements in case of paucity of beds were excluded. Finally we included 447 (0.2%) patients over the 8 years. Data were evaluated with emphasis on epidemiology (age, gender, mechanism of trauma), primary survey and abnormalities and pattern of trauma. Results: The most frequent cause of maxillofacial trauma was road accidents (319 patients, 71.4%), among which motorcycle ones were prevalent. The maxillofacial injured who presented major lesions were 98 patients and minor lesions occurred in 349 patients; 443 (99.1%) patients underwent maxillofacial surgery, immediate or delayed depending on the severity of concomitant injuries (x²=557.2, p < 0.0001). Five concomitant neglected lesions were found to be associated with severe maxillofacial traumas (x²=17.13, p < 0.0001 vs minor lesions). All of the neglected lesions occurred in paucisymptomatic patients who showed painless abdomen, no hemodynamic instability, no signs of hematoma of anterior and posterior abdominal wall or other suspicious clinical signs and symptoms. Conclusion: Among the patients admitted firstly in other surgical wards different from the Maxillofacial Surgery Unit, diagnosis was more difficult, especially for blunt abdominal traumas, in which patients showed only vague and nonspecific symptoms concealing serious and life-threatening injuries. We recommend the routine use of whole body CT scan, when the maxillofacial injuries appear prevalent, mainly in patients affected by maxillofacial major lesions.     

Predictors of postoperative emergency department visits after laparoscopic bariatric surgery

BackgroundPostoperative emergency department (ED) visits are a quality metric for bariatric surgical programs. Predictive factors of ED visits that do not result in readmission are not clear.ObjectivesWe aimed to identify predictors of ED visits in patients without readmission after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).SettingThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.MethodsThe MBSAQIP database was queried for patients who underwent LSG and LRYGB from 2015 through 2017. Patients were grouped by those who presented to the ED (ED group) and those who did not. ED visits analyzed included only those that did not result in readmission. Multivariable forward selection logistic regression was used to report adjusted odds ratios (AORs) with 95% CIs for ED visits.ResultsOf 276,073 patients, 257,985 (93.4%) were in the group who did not present to the ED, and 18,088 (6.6%) were in the ED group. Most underwent LSG (71.9%) versus LRYGB (28.1%). Multivariable forward logistic regression identified outpatient treatment for dehydration (AOR, 22.26; 95% CI, 21.30–23.27; P < .001) as the most predictive factor of an ED visit, followed by urinary tract infection (AOR, 7.25; 95% CI, 6.22–8.46; P < .001), wound disruption (AOR, 4.63; 95% CI, 3.09–6.96; P < .001), and surgical site infection (AOR, 3.80; 95% CI, 3.38–4.28; P < .001).ConclusionsPostoperative complications were the strongest predictors of ED visits after laparoscopic bariatric surgery. Quality improvement initiatives should target these variables to decrease postoperative ED visits.     

Non-randomized comparative study on the efficacy of a trauma protocol in the emergency department

Purpose: Trauma is a major health problem in developing countries and worldwide which requires many resources and much time in an emergency department (ED). Although Advanced Trauma Life Support (ATLS) is the gold standard, operator dependence can affect the quality of care. The objective was to identify differences in numbers and time to lifesaving interventions, investigation, ED length of stay, and mortality between an in-house protocol and conventional practice. Methods: This was a single-center prospective non-randomized study for adult trauma patients in the ED. The trauma protocol was developed from the recent ATLS guideline. Results: Thirty-two and 41 cases were in the in-house protocol group and conventional practice group, respectively. Endotracheal intubation was done more frequently in the in-house protocol group (84% vs. 59%, p = 0.03). Intercostal drainage tube insertion was done faster (6e26 min, median 11 min vs. 15-84 min, median 35 min, p = 0.02) and pre-arrival notification by emergency medical service increased in the in-house protocol group (66% vs. 30%, p = 0.01). Hypothermia in the operating room was found only in the conventional practice group (62% vs. 0, p = 0.007) and a warm blanket was used significantly more often in the in-house protocol group (25% vs. 0, p < 0.001). A directed acyclic graph with multivariate analysis was used to identify confounders. Time to Focused Assessment Sonography in Trauma was significantly shorter in the in-house protocol group (6.5-15.6 min, median 11 min, p = 0.019). Conclusion: In addition to the ATLS guideline, the trauma protocol could improve trauma care by reduced time to investigation, early notification of the trauma team in pre-hospital situations, reduced incidence of hypothermia in the operating room, and increased use of a warm blanket.