73例生存期3年以上急性白血病患者生活质量及影响因素分析

目的：探讨生存期3年以上急性白血病患者生活质量及其影响因素。方法：采用一般状况调查问卷、癌症患者生活质量测定量表（European Organization for Research and Treatment of Cancer, EORTC QLQ-C30）中文版、体能状况评估表（ECOG）对73例生存期3年以上急性白血病患者进行问卷调查。结果：生存期3年以上急性白血病患者生活质量总分为（82.2±20.7）分,其中躯体功能得分最高,社会功能得分最低。在症状维度中,恶心呕吐症状最轻微,经济困难情况最严重。影响急性白血病患者生活质量总健康状况的因素为：体能状况、是否恢复工作。结论：生存期3年以上急性白血病患者生活质量得到改善,癌症相关症状得到控制。可根据患者体能状况及恢复工作情况给与康复指导,提高其生活质量。     

The value of a quality improvement project in promoting interprofessional collaboration

The teamwork that is required for interprofessional collaboration in healthcare is not an inherent attribute of the current system, and must be fostered. Education, training, and role modelling are important enablers. From our experience we posit that participating in a quality improvement project can be also be an excellent vehicle to promote interprofessional collaboration.     

医护合作模式对肝病区护理人员专科知识及护理质量的影响

目的：探讨医护合作模式对提高肝病区护理人员专科知识及护理质量的效果。方法2012年1月-2013年12月对肝病区实施医护合作模式,并与2011年1-12月未实施医护合作模式前进行对比,分析两阶段护理人员专科知识、医护合作态度及医、护、患三方面对护理模式的满意度。结果实施医护合作模式后护士专科知识考核评分（92．36±4．62）分、实操评分（91．25±3．76）分显著高于实施前（85．78±5．02）,（85．32±4．13）分,差异有统计学意义（t分别为4．323,4．116;P＜0．05）。实施医护合作后医生合作态度评分（65．36±10．46）分、护士合作态度评分（64．33±11．27）分显著高于实施前（52．36±8．28）,（51．98±9．75）分,差异有统计学意义（t分别为5．986,6．023;P＜0．05）。实施后医生、护士、患者满意度分别为100．00％,93．33％,96．00％显著高于实施前55．56％,53．33％,60．00％,差异有统计学意义（χ2分别为6．986,7．129,9．442;P＜0．05）。结论对肝病区应用医护合作模式可提高医护人员专科知识,增强护理人员工作积极性,提高护理质量,提高医生及患者满意度,促进科室发展。     

Quality management in general surgery: a review of the literature

IntroductionTotal quality management is a systematic approach focused on satisfying customers' expectations, identifying problems, analytically solving patient's problems and to implement continuous quality improvement.MethodSystematic review of the English language medical literature, using electronic search of the Pubmed, ProQuest and ScienceDirect databases with different combinations of the keywords: total quality management, healthcare, trauma, and minimally invasive surgery.ResultsThe assessment of outcomes in surgery represents a part of the quality assurance of patients' care. Usually, the surgeons have their own set of mental variables that can predict good and bad outcomes Surveys of complication rates and outcome are a poor substitute for quality control. For the reported complications it is impossible to know which complications are real (inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment. For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room.ConclusionsRomanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays European Union competitive market.     

Chiropractic program changes facilitated by the European Council on Chiropractic Education Accreditation reports:: A mixed methods audit and thematic analysis

ObjectiveThe European Council on Chiropractic Education (ECCE) currently accredits 10 programs throughout Europe and South Africa. It is assumed that ECCE evaluation activities lead to changes to the chiropractic programs but no systematic evaluation as to whether this is true, and the extent of changes has previously been done. The purpose of this study was to obtain feedback from program heads as to whether ECCE evaluation reports facilitated changes/improvements to their programs and to identify their reported changes.MethodsThis was a mixed methods audit study using questionnaires with 2 sections. Closed statements requesting the degree of change to each section of the “Standards” based on ECCE evaluation reports (substantial, some, none) were analyzed using frequencies. Written responses identifying the specific changes made based on previous evaluation reports were evaluated independently by 3 researchers using a modified “thematic analysis” approach.ResultsAll 10 accredited programs responded. Seven of the 10 programs (70%) reported “some” or “substantial” changes to ≥ 6 sections of the ECCE Standards. The most common section with reported changes was “Educational Program” (8 of 10). “Educational Resources” had the largest number of programs reporting “substantial changes” (4) and was the second most common section to have reported changes. The main themes identified emphasized changes in “infrastructure, equipment and faculty,” “increasing evidence-based practice,” and “instilling a research culture in faculty and students.”ConclusionECCE accreditation processes facilitate changes to the chiropractic programs, particularly in the areas of improved infrastructure and faculty, research, and evidence-based practice.     

A Framework for Hospice Nursing

The paper presents a conceptual framework for hospice nursing. Nursing is viewed as assistance to the person whose self-care activities are insufficient to meet self-care needs. A literature review on needs of the hospice client is included toward developing a hospice nursing philosophy. The paper shows how guidelines for nursing practice in hospice can be structured around the client’s self-care needs. Such guidelines include common nursing diagnoses, standards, policies and procedures. A suggested nursing documentation system is built upon the nursing process and structured around the patient’s self-care needs.     

Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center

Goals

Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?

Materials and methods

This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).

Main results

Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10–20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.

Conclusions

Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.     

Knowledge,practice and faith on Total Quality Management principles among workers in the Health Care System: Evidence from an Italian investigation

Background The implementation of Total Quality Management (TQM) principles in the sanitary field, in order to be effective, requires a radical change in management practice as well as the organizational culture and its philosophy. The need to monitor such a transformation emerges too. Objectives This study surveys how well TQM principles are known and understood by health care professionals from the employees' point of view and the factors affecting it. Research design and subjects The Health Care System in Trieste was surveyed. Measures The Total Quality Test was used, a novel and quick instrument aimed at routine assessment of the penetration and interiorization of TQM principles within the health care structure. Results Direct exposure to public, job role and time spent working within the same structure have been proved related to the penetration of TQM principles, whereas previous formative intervention did not prove to be associated with the penetration of TQM principles. Conclusions The implementation of a quick and simple instrument to monitor the TQM implementation highlighted several critical areas for intervention.     

医疗失效模式与效应分析在口腔器械清洗中的应用

目的:探讨应用医疗失效模式与效应分析(HFMEA)对提高口腔器械清洗质量的效果。方法:运用医疗失效模式与效应分析,分析口腔器械清洗质量不合格的主要原因,找到潜在失效模式,计算危机值,风险优先排序,制定改进措施,进行前瞻性的干预。结果:实施HFMEA管理后,风险性最大的4项失效模式危机值均低于实施前(P0.05),器械清洗合格率高于实施前(P0.05)。结论:应用医疗失效模式与效应分析可有效地提高口腔器械清洗的质量。     

优质护理对卵巢癌化疗患者生命质量及睡眠质量的影响观察

目的:分析优质护理模式对卵巢癌化疗患者生命质量及睡眠质量的影响.方法:选取2017年5 月至2019年6月福建医科大学附属肿瘤医院门诊随访的卵巢癌化疗患者84例作为研究对象,按照随机数字表法分为对照组和观察组,每组42例.对照组进行常规护理,观察组进行优质护理.比较2组的生命质量及睡眠质量评分.结果:护理后观察组的生理功能、心理功能、社会功能以及物质生活评分显著高于对照组,睡眠质量评分低于对照组,差异有统计学意义(P<0.05).结论:优质护理模式可显著提高门诊卵巢癌化疗患者的生命质量以及睡眠质量,临床应用及临床推广价值极高.     

Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury

OBJECTIVE: To evaluate the effectiveness of an intensive cognitive rehabilitation program (ICRP) compared with standard neurorehabilitation (SRP) for persons with traumatic brain injury (TBI). DESIGN: Nonrandomized controlled intervention trial. SETTING: Community-based, postacute outpatient brain injury rehabilitation program. PARTICIPANTS: Fifty-six persons with TBI. INTERVENTIONS: Participants in ICRP (n=27) received an intensive, highly structured program of integrated cognitive and psychosocial interventions based on principles of holistic neuropsychologic rehabilitation. Participants in SRP (n=29) received comprehensive neurorehabilitation consisting primarily of physical therapy, occupational therapy, speech therapy, and neuropsychologic treatment. Duration of treatment was approximately 4 months for both interventions. MAIN OUTCOME MEASURES: Community Integration Questionnaire (CIQ); and Quality of Community Integration Questionnaire assessing satisfaction with community functioning and satisfaction with cognitive functioning. Neuropsychologic functioning was evaluated for the ICRP participants. RESULTS: Both groups showed significant improvement on the CIQ, with the ICRP group exhibiting a significant treatment effect compared with the SRP group. Analysis of clinically significant improvement indicated that ICRP participants were over twice as likely to show clinical benefit on the CIQ (odds ratio=2.41; 95% confidence interval, 0.8-7.2). ICRP participants showed significant improvement in overall neuropsychologic functioning; participants with clinically significant improvement on the CIQ also showed greater improvement of neuropsychologic functioning. Satisfaction with community functioning was not related to community integration after treatment. Satisfaction with cognitive functioning made a significant contribution to posttreatment community integration; this finding may reflect the mediating effects of perceived self-efficacy on functional outcome. CONCLUSIONS: Intensive, holistic, cognitive rehabilitation is an effective form of rehabilitation, particularly for persons with TBI who have previously been unable to resume community functioning. Perceived self-efficacy may have significant impact on functional outcomes after TBI rehabilitation. Measures of social participation and subjective well-being appear to represent distinct and separable rehabilitation outcomes after TBI.     

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists

Background and Purpose. The ‘Comprehensive ICF Core Set for obstructive pulmonary diseases’ (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient‐oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists. Method. A three‐round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD. Results. Fifty‐one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 ‘not classified’ concepts. The identified ICF categories were mainly third‐level categories compared with mainly second‐level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 ‘not classified’ concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD. Conclusion. The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation. Copyright © 2009 John Wiley & Sons, Ltd.     

责任制护理小组模式在外科的实践与效果

目的 探讨责任制护理小组模式在外科病区中的应用效果.方法 回顾性分析采取传统护理模式200例患者和采用责任制护理小组模式200例患者.责任制护理小组将全体护士分成若干个小组,每组设立一名组长,责任护士2～3名,负责该组病人所有的健康教育和治疗护理工作.结果 实施责任制护理小组后,责任制护理小组模式呼叫后护士到位时间、日均输液呼叫铃声次数明显缩短,差异有显著意义(P＜0.05);责任制护理小组模式患者的护理满意率(96％)和对疾病知识知晓率(94.5％)高于传统模式的护理满意率(81％)和对疾病知识知晓率(86％),差异具有显著意义(P＜0.05).结论 责任制护理小组模式体现了人性化护理的理念,提高了护士的工作效率,提升了护理质量.     

Georgia’s healthcare system and integration of complementary medicine

BackgroundAn increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients’ CAM use and their perspectives of CAM complementation of existing services in Georgia’s health care system.MethodologyWe conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia.ResultsStudy participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration.ConclusionPatients favor an integration of CAM into Georgia’s current healthcare systems to ensure CAM’s broad availability as well as effective regulation and financing, including coverage by health insurance.     

When and how should new therapies become routine clinical practice?

The process by which new therapies enter clinical practice is frequently suboptimal. Often, ideas for new therapies are generated by clinical observations or laboratory studies; therapies based on those ideas may enter clinical practice without any further scrutiny. As a consequence, some ineffective practices become widespread. This article proposes a six-stage protocol for the implementation of new therapies. Hypotheses about therapy based on preclinical research should be subject to clinical exploration and pilot studies prior to rigorous assessment with randomised clinical trials. If randomised clinical trials suggest that the intervention produces clinically important effects, further randomised studies can be conducted to refine the intervention. New interventions should not be recommended, or included in teaching curricula, or taught in continuing education courses until their effectiveness has been demonstrated in high-quality randomised clinical trials.     

Health-related quality of life in 975 patients with complex regional pain syndrome type 1

There are limited data available on health-related quality of life (QoL) in patients with complex regional pain syndrome (CRPS). In the present study we examined QoL in 975 CRPS patients attending 6 different clinics in the Netherlands. QoL was assessed using the MOS 36-Item Short-Form Health Survey (SF-36) with the Mental Health Summary Score (MHS) and the Physical Health Summary Score (PHS) as dependent variables. The influences of gender, type of affected limb, disease duration, pain scores, CRPS severity and set of diagnostic criteria used were investigated. We found the lowest scores of QoL in the physical domains of the SF-36, with lower-limb CRPS patients reporting poorer results than patients with an affected upper limb. Influence of gender on QoL was not observed, and correlations of QoL with disease duration and the CRPS severity score were weak. Pain correlated moderately with QoL. In addition, patients fulfilling stricter diagnostic criteria (ie, the Budapest criteria) had lower QoL scores than patients fulfilling less strict criteria (ie, the Orlando criteria). We conclude that loss of QoL in CRPS patients is due mainly to reduced physical health. A comparison with data available from the literature shows that CRPS patients generally report poorer QoL than patients with other chronic pain conditions, particularly in the physical domains. Pain correlated moderately with QoL and therefore deserves ongoing attention by physicians. Finally, patients meeting the diagnostic Budapest criteria have lower QoL scores than patients meeting the Orlando criteria, highlighting the impact of different sets of criteria on population characteristics.     

医疗失效模式与效应分析在新生儿卡介苗安全接种管理中的应用

目的探讨医疗失效模式与效应分析（healthcarefailuremodeandeffectanalysis．HFMEA）在新生儿卡介苗安全接种管理中的应用效果。方法选取2009年出生的1000名新生儿为对照组,按常规进行卡介苗接种;选取2010年出生的1000名新生儿为观察组,应用HFMEA对卡介苗接种进行管理,从接种流程中找出潜在失效模式、潜在失效原因与潜在失效后果,进行危害分析与决策树分析,对于需优先解决的问题制订并实施有效的控制措施。结果应用HFMEA管理后,卡介苗接种过程中风险顺序指数≥8分的高危流程经过实施控制措施后其风险顺序指数均≤6分,卡介苗接种不良反应发生率由0．6％降至0．0％（x^2=4．2,P〈0．05）。结论运用HFMEA对新生儿卡介苗接种进行管理,能降低卡介苗接种不良反应发生的风险,提高卡介苗接种工作的安全性。