优质护理临床路径在特需病房中的应用效果分析

目的探讨优质护理临床路径在特需病房中的应用效果。方法选取2015年1~6月在我院特需病房住院治疗住院号尾数为奇数的患者50例作为对照组,选取2015年7~12月在特需病房住院治疗住院号尾数为偶数的患者50例作为观察组。对照组患者给予常规护理,观察组患者采用优质护理临床路径护理,比较两组患者对护理的满意度,比较实施优质护理临床路径前后医师对护理的满意度、护理质量评分。结果观察组患者对护理的满意度(98.0%)高于对照组(76.0%),差异具有统计学意义(P0.01)。优质护理临床路径实施后医师对护理的满意度(100.0%)高于实施前(60.0%),差异具有统计学意义(P0.05)。实施优质护理临床路径后病房环境、护理操作技术、护理服务、护理知识技能评分均高于实施前,差异具有统计学意义(P0.05或0.01)。结论在特需病房中实施优质护理临床路径可显著提高患者、医师对护理的满意度,有效提高护理质量。     

患者整体素质和医疗资源对幽门螺杆菌耐药率的影响

[目的]探寻患者的整体素质和医疗资源对幽门螺杆菌(Hp)耐药率的影响。[方法]对2011年6～12月在我院普通消化内科门诊和特需消化内科门诊治疗的1 304例Hp阳性的患者进行回顾性分析。[结果]特需门诊患者的Hp耐药发生率明显低于普通门诊患者(P<0.05)。[结论]提高患者的整体素质和增加医疗投入,可明显降低患者的Hp耐药率。     

老年慢性病患者延续性医疗服务模式的构建及效果评价

目的探讨公立医院老年医学科参与中国养老服务体系运行模式的构建,分析老年慢性病患者延续性服务模式的临床价值及社会价值,以进一步评价老年医学科专科医疗延伸服务的重要性。方法选择安徽省立医院老年医学科住院患者200例,随机分为两组,其中观察组100例患者参与住院-居家延续性医疗服务模式(出院时,开展老年综合评估,出院后对各种慢病指导合理用药,并对慢病并发症进行三级预防,对半失能、失能老人进行居家环境评估、功能锻炼指导、家庭护理指导、营养及精神心理指导),另对照组100例患者住院-出院,出院时开展老年综合评估,但未参加延续性医疗服务模式,比较两组患者1年内再次住院的次数、人均年卫生支出费用及患者生活能力(Barthel指数评定表)、家庭及患者对患者自身状况满意度比较。结果观察组再次住院次数与人均年卫生支出费用明显低于对照组,观察组Barthel指数评分及患者自身状况满意度显著高于对照组。结论老年医学科参与的老年慢性病患者延续性服务模式能够有效地提高老年患者的生活质量。     

转诊评估和多学科诊疗模式对老年患者临床治疗效果的影响

目的 评估转诊前改良早期预警评分（MEWS）和转诊后老年多学科整合团队（GIT）查房结合的诊疗模式对老年患者转诊后诊疗的效果。方法 对2012年11月至2013年10月在上海市松江区中心医院和上海市第一人民医院（南院）急诊或留观的老年患者采用MEWS进行转诊前评估,转诊至松江区乐都医院老年医学科后分别进行GIT查房（观察组）和传统医疗模式查房（对照组）,比较两组患者的平均住院天数、好转率、死亡率、医疗费用、再住院率和患者家属满意度等指标。结果 共转诊老年患者306例,其中156例（观察组）接受GIT查房诊疗,好转出院150例（96.2%）,死亡1例（0.64%）。其余150例（对照组）接受传统医疗模式查房,好转出院134例（89.1%）,死亡3例（2.0%）。观察组平均住院天数（17.7±13.1）d,好转率96.2%,平均医疗费用（8275.32±4680.33）元,再住院率1.28%,家属满意率95.5%,均优于对照组,差异具有统计学意义（P＜0.05）。结论 老年患者住院需求较高,转诊评估和GIT查房诊疗能为老年共病患者提供有效的医疗管理手段,并提供连续性医疗服务,提高患者及家属的满意度。     

临床路径对大面积脑梗死神经功能康复及费用控制影响

目的探讨临床路径对大面积脑梗死患者神经功能康复及费用控制的作用。方法将61例大面积脑梗死患者随机分为两组,观察组31例采用制订好的临床路径进行治疗,对照组30例采用传统的治疗方法。观察两组患者的NIHSS评分、Barthel指数、并发症发生率、病死率、住院天数、医疗费用及病人满意度。结果与对照组比较,观察组患者NIHSS评分有明显下降,Barthel指数有显著提高,并发症的发生率显著减少,住院天数明显缩短,医疗费用显著减少,差异均有统计学意义（ P＜0.05,＜0.01）;病死率虽有降低,满意度虽有提高,但无统计学意义（ P＞0.05）。结论临床路径在大面积脑梗死患者中的应用,能显著改善神经功能缺损,提高医疗质量,具有良好的社会、经济效益,值得进一步推广。     

住院患者抱怨的原因分析及对策

目的了解住院患者抱怨产生的原因及对策，以减少医疗护理纠纷的发生。方法对我科28名髓记在案的抱怨患者产生抱怨的原因进行分析。结果无1例医疗护理纠纷发生。结论及时合理应对患者的抱怨，避免将患者的抱怨向丰十会传播，对于密切医护患关系，减少医疗护理纠纷的发生有重要的作用，同时也是医疗服务补救的有效方法。     

检验服务质量100例调查分析

目的 探讨检验科工作患者满意率情况。方法 问卷调查100例住院和门诊患者，对检验工作的服务质量、技术水平、医疗质量、检验效率、服务设施和就诊环境进行评价，根据患者性别、年龄、工作和学历情况进行分析。结果 不同年龄、职业和学历患者对检验服务内容有不同的要求。结论 检验人员对不同患者服务内容应有所侧重，在保持目前服务质量和技术水平的基础上，提供人性化的规范服务，优化检验流程，提高科技含量并不断拓展检验服务范围。     

中老年脂肪肝患者血清载脂蛋白A1,B及血脂检测的临床意义

中老年脂肪肝患者血清载脂蛋白Ａ_１、Ｂ及血脂检测的临床意义陈鸿脂肪肝系中性脂肪在肝脏蓄积过多所致，本文对中老年脂肪肝患者的载脂蛋白Ａ１、Ｂ及血脂水平进行分析，旨在进一步了解其脂质代谢的改变。对象与方法对象对照组：１０８例，系门诊及住院体检健康人群，男?..     

脑出血患者实施临床护理路径的效果研究

目的探讨脑出血患者实施临床护理路径的效果。方法选取2012年4月—2013年5月我科收治的脑出血患者50例,将其随机分为试验组和对照组,各25例。对照组采用传统的护理模式,试验组采用临床护理路径对患者实施有针对性、连续性的优质护理服务。比较两组患者对护理服务满意率、住院费用满意率、疾病相关知识认知率及住院天数满意率。结果试验组患者对护理服务满意率、住院费用满意率、疾病相关知识认知率、住院天数满意率均高于对照组(P0.05)。结论对脑出血患者应用临床护理路径,可降低患者医疗成本,缩短住院天数,增加患者满意率,提高医疗护理质量。     

慢性心力衰竭患者院外督导治疗的临床观察

目的探讨规范化督导治疗对慢性心力衰竭的影响。方法将慢性心力衰竭患者116例随机分成督导治疗观察组(58例)和对照组(58例)。所有心力衰竭患者均按常规治疗。观察组通过医生每周电话随访对每一个患者进行督导治疗,包括健康教育、药物调整、改良生活方式等。而对照组3月电话随访1次。观察1年后所有患者遵医嘱服药情况、不良生活方式改变情况、年住院次数、年住院总日数、年医疗费用、出院时及观察终点时6 min步行试验、生活质量评分对比。结果观察组与对照组相比,在遵医行为、生活方式改良、年住院次数、年住院总日数及年医疗费用、心功能改善、生活质量评分等方面均较后者有明显改善,二者比较有统计学意义(P0.05)。结论通过心内科医生对慢性心力衰竭患者长期、规范的督导治疗,能提高患者对治疗的依从性,可有效改善患者生活质量,减少年住院总日数,降低再住院率及医疗费用。     

Perspektiven einer fachlich angemessenen, bedarfs- und bedürfnisgerechten gesundheitlichen Versorgung für ?ltere Menschen

This contribution deals with the question of how existing health care systems can be sufficiently and adequately adapted to ageing patients in general, and to patients with special needs for nursing care and assistance. Simultaneously, it advocates explicit consideration of the dimensions of social inequality and health hazards related to biographical factors. It demonstrates that health care involves much more than just adequate medical care in the event of illness. The reasons that change is needed are given and reform options for relevant segments of health care (such as medical practitioners, hospital care, health care for patients in need of nursing care, palliative care, prevention and rehabilitation) are presented. Special emphasis is placed on standards and guidelines relating to old age morbidity and integrated health care systems as well as rehabilitation, prevention and health promotion. A key role is attributed to the qualification of health services staff. More intensive research into health care and health services in respect of the elderly is also advocated.     

The adequacy of informed consent for placement of gastrostomy tubes

BACKGROUND: Gastrostomy tubes are placed commonly in patients with limited life expectancy. However, it is unclear whether the process of informed consent is adequate in these patients. This study examined the quality of informed consent in hospitalized patients undergoing placement of gastrostomy tubes. METHODS: Retrospective review of the medical records of a cohort of 154 consecutive hospitalized adults undergoing placement of gastrostomy tubes in the context of chronic progressive illness, in the setting of a large community-teaching hospital. RESULTS: The medical record documented a procedure-specific discussion of benefits and burdens of and alternatives to tube feeding in only 1 of 154 patients. Only 12 of 33 definitely or probably competent patients signed the hospital consent form; in the remaining 21, a surrogate decision-maker signed the form. The cumulative 1-year mortality for this cohort was 50%. CONCLUSIONS: The quality of informed consent for placement of gastrostomy tubes was inadequate in a large community-teaching hospital. Indirect evidence from the literature suggests that these results are not unique to this institution. Physicians should become more familiar with the medical and ethical issues relevant to medically administered nutrition near the end of life, and institutions should develop procedures to improve the quality of decision-making for patients considering this intervention.     

Are older patients more satisfied with hospital care than younger patients?

OBJECTIVE: Determine relationships between age, self-reported health, and satisfaction in a large cohort of hospitalized patients. DESIGN: Cross-sectional survey. SETTING: Thirty-one hospitals in a large Midwestern metropolitan area. PATIENTS/PARTICIPATION: Randomly selected medical and surgical patients (N = 64,900; mean age, 61 years; 56% female; 84% white) discharged during specific time periods from July 1990 to March 1995 who responded to a mailed survey (overall response rate, 48%). MEASUREMENTS AND MAIN RESULTS: Patients' overall ratings of hospital quality and satisfaction with 5 aspects of care (physician care, nursing care, information provided, discharge instructions, and coordination of care) were measured by a validated survey, which was mailed to patients after discharge. Analyses compared satisfaction in 5 age groups (18 to 35, 36 to 50, 51 to 65, 66 to 80, and > 80 years). Scores for the 5 aspects of care initially increased with age (P <.001) and then declined (P <.001). A similar relationship was found in analyses of the proportion of patients who rated overall quality as "excellent" or "very good." Satisfaction was also higher in patients with better self-reported health (P <.001). In analyses of patients with poor to fair health, satisfaction scores peaked at age 65 before declining. However, for patients with good to excellent health, scores peaked at age 80. Moreover, declines in satisfaction in older patients were lower in patients with better health. These findings were consistent in multivariable analyses adjusting for potential confounders. CONCLUSIONS: Satisfaction exhibits a complex relationship with age, with scores increasing until age 65 to 80 and then declining. This relationship was consistent across individual satisfaction scales, but was modified by health status. The results suggest that age and health status should be taken into account when interpreting patient satisfaction data.     

耐药肺结核患者出院准备度现状及影响因素分析

目的 调查耐药肺结核患者出院准备度,分析其影响因素。方法 采用便利抽样方法,搜集2020年5月至2021年3月在同济大学附属上海市肺科医院住院的117例耐药肺结核患者为研究对象。采用一般资料调查表、出院准备度量表、出院指导质量量表对研究对象进行问卷调查,共发放问卷117份,回收有效问卷117份,有效回收率为100.0%。分析研究对象出院准备度及出院指导质量得分情况;采用线性回归分析影响耐药肺结核患者出院准备度水平的因素。结果 研究对象出院准备度总得分为(91.03±16.06)分,条目均分为(7.59±1.34)分,处于中等水平;出院指导质量总得分为(142.09±18.76)分,条目均分为(7.91±1.52)分,为中等偏上水平。多元线性回归分析显示,年龄>60岁(标准回归系数为-0.209,t=-2.345,P=0.021)、小学及以下文化程度(标准回归系数为0.216,t=2.199,P=0.030)、家庭人均月收入低于2000元(标准回归系数为0.210,t=2.411,P=0.018),以及出院指导质量差(标准回归系数为0.229,t=2.857,P=0.005)的患者出院准备度不足。结论 耐药肺结核患者出院准备度不足,应加强对年龄大、文化程度低、经济条件差的耐药肺结核患者的出院指导,并且提高出院指导质量,根据患者情况给予针对性的干预措施。     

Self-reported comorbidities,perceived needs,and sources for usual care for older and younger homeless adults

BACKGROUND: While older individuals who are homeless tend to be in poorer health, it is less clear how they view their health care needs and whether their self-reported patterns for accessing health services differ from younger homeless counterparts. METHODS: Cross-sectional, community-based survey of homeless adults in Pittsburgh and Philadelphia using face-to-face interviews from population proportionate sampling of sites and random sampling of subjects. Survey questions included physical and mental health comorbidities, self-reported health care, social services and personal needs, means of economic support, and sources for usual health care. For analysis purposes, respondents were grouped by age 18 to 49 years old and 50 years old or older. RESULTS: Overall, 531 adults were interviewed, with 74 respondents 50 years old or older (13.9%). Older homeless persons were 3.6 times more likely to report a chronic medical condition, 2.8 times more likely to have health insurance, and 2.4 times more likely to be dependent on heroin than homeless persons less than 50 years old. However, they also tended to use shelter-based clinics and street outreach teams more commonly as their source of usual care (20.9% vs 10.6%, P=.02) and were significantly less likely to report a need for substance abuse treatment despite high rates of abuse. CONCLUSION: Older homeless adults have a greater disease burden than their younger counterparts. However, it is unclear whether these needs are being appropriately identified and met. There is a need for specific and targeted outreach to connect them to appropriate services.     

Costs of pulmonary medicine and DRGS. Access and quality of care for the future

Many changes are under way for the payment of physician and hospital care of patients in medicine and the medical subspecialties, i.e., the hospitalized pulmonary medicine patient. The purpose of this study was to characterize hospital resource consumption and outcome by age for pulmonary patients. All pulmonary medicine admissions treated at a large academic medical center from January 1, 1985 through December 31, 1986 were analyzed using the Diagnostic Related Group (DRG) format. Total costs (exclusive of physician fees) for the 2,647 pulmonary patients studied were $19,751,192. Mean hospital cost per patient, hospital length of stay, percentage of outliers, and mortality increased with age. Under the DRG reimbursement mechanism (i.e., All Payor System), a loss was incurred for all patients 45 yr of age and older, which led to an overall fiscal deficit for pulmonary medicine admissions. Medicare patients (n = 930) demonstrated a stronger expression of these trends. DRG case-mix index and the mean number of diagnoses per patient increased steadily with age. Emergency admissions were highest for the young (i.e., 18 to 35 yr of age), for some middle-aged (i.e., 45 to 65 yr of age), and for the very old (80 yr of age). Utilization of the intensive care unit and blood transfusions was higher for older patients; utilization of plasma products showed a more variable pattern, although older patients had greater consumption than their younger cohorts. This study demonstrated several trends with regard to resource utilization and age for pulmonary patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Social services utilization and need among a community sample of persons living with HIV in the rural south

HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV (PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV and those receiving medical care suggest that use of social services can enhance quality of life and some medical outcomes, but little is known about patterns of social service utilization and need among rural southern PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and 26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social services, and used regression models to determine demographic predictors of those most likely to need each service. We then conducted an exploratory factor analysis to determine whether certain services clustered together for the sample. Case management, assistance obtaining medical care, and financial assistance were most commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs; respondents without spousal or partner relationships had higher SUN scores for substance use treatment. Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical needs. These data provide important information about rural southern PLWHIV and their needs for ancillary services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case managers and other service providers work proactively to identify important gaps in care.     

Hospitalization for prostate cancer among the older men in the longitudinal study on aging, 1984-1991

BACKGROUND: Factors associated with being hospitalized with indications of prostate cancer were examined. A secondary analysis of the older men in the Longitudinal Study on Aging (LSOA) used baseline (1984) interview data and Medicare hospital claims for 1984 through 1991. METHODS: The analytic sample consisted of 2254 men who were 70 to 95 years old (mean 75.8 years) at baseline and who were self-respondents to the LSOA. Case-identification involved primary prostate cancer (ICD9-CM code 185) and personal history of prostate cancer (ICD9-CM code V10.46) hospital discharge diagnoses. Multivariable logistic regression techniques were used. RESULTS: There were 154 cases (6.8%) of prostate cancer, including 109 identified by active diagnostic codes only, 15 identified by personal history codes only, and 30 identified by both. No associations with age, race, or ethnicity were observed. Being hospitalized with indications of prostate cancer was more likely in the presence of a history of cancer at any site, urinary control problems, greater body mass, maximum social interaction, or living in core Standard Metropolitan Statistical Area counties. Men who regularly attended religious services, had not seen a physician for 2 years, and did not feel in control of their health were less likely to have been hospitalized with indications of prostate cancer. CONCLUSIONS: These data suggest that the traditional associations between prostate cancer and age, race, and ethnicity do not apply to being hospitalized with indications of the disease among older men. However, body mass, history and symptoms, personal beliefs, access, and geographic practice patterns are associated with being hospitalized with indications of prostate cancer.     

Importance of family for quality of life of the elderly in a social and cultural comparison

This paper explores the role of the family and its contribution to quality of life in old age under a comparative perspective, looking at different European welfare states (Norway, Germany, Spain and Israel). The literature demonstrates a consistent association between well-being and social networks in old age. Intergenerational family relations seem to be of special relevance in their contribution to health and well-being of older family members. Key features of intergenerational relationships include association, help, and support. However, in modern welfare states, certain tasks traditionally performed by families are covered by services. To assess the relative impact of families and the welfare state and to understand the interaction between them both a comparative perspective is needed analyzing diverse cultures and welfare regimes. Cultural and societal contexts are of central importance in exploring and understanding the complex association between family relations and the quality of life of the elderly. It is hypothesized that there is an interaction between family structure and welfare state transfers. This hypothesis states that the relationship between family structure and quality of life depends on the type of welfare state and welfare state transfers and services. Hence, the relationship between quality of life and family support should be strong only in those cases where welfare state transfers are low. The empirical results partly confirm the theoretical assumptions of welfare state regime dependence of the children's effect on the elder's quality of life. Three out of the four analyzed countries show results that strongly support the hypothesis of an intervening effect of welfare state systems on the connection between family and overall quality of life in old age. However, further analyses are needed. First, more sensitive indicators of parent-child relations have to be used. Second, needs and their intervening effects on the direct linkages between children and quality of life have to be taken into account in more complex analyses. Third, more elaborated indicators of "quality of life" should be used in future analyses.