加速康复外科模式下结直肠癌患者出院准备度与出院指导质量现状调查

目的了解加速康复外科模式下结直肠癌患者出院准备度与出院指导质量现状,为优化出院指导质量、提高患者出院准备度提供参考。方法对加速康复外科流程管理模式下的130例结直肠癌出院患者使用出院准备度量表、出院指导质量量表进行调查。结果 80.0%结直肠癌患者表示做好出院准备,出院准备度总分为149.86±33.65,条目均分为6.81±1.53。出院指导质量总分为140.24±29.04,条目均分为7.79±1.61,需要内容得分显著高于获得内容得分(均P0.01)。结论加速康复外科模式下的结直肠癌患者出院准备度处于中等水平,出院指导质量总体水平较好,但患者获得的指导内容尚未满足需求。医护人员应依据患者需求开展出院健康教育,以提高患者出院准备度。     

心脏瓣膜置换术后患者与照护者出院准备度及出院指导质量比较分析

目的 对比心脏瓣膜置换术后患者及其照护者的出院准备度和出院指导质量差异.方法 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广州市1所三级甲等医院心胸外科的138例瓣膜置换术后患者及其照护者进行调查.结果 瓣膜置换术后患者的出院准备度总分为(160.33±38.92)分,家属为(168.25±35.17)分,差...     

老年骨质疏松性椎体骨折患者衰弱与出院准备度现状及相关性研究

目的 了解老年骨质疏松性椎体骨折患者衰弱及出院准备度现状,并探讨两者间的关系。方法 采用便利抽样的方法,采用老年人衰弱评估量表(Chinese version of tiburg frailty indicator, CTFI)及出院准备度量表(readiness for hospital discharge scale, RHDS)对182例老年骨质疏松性椎体骨折患者进行问卷调查,并分析其相关性。结果 老年OVCF患者衰弱得分为(15.74±5.37)分,54.2%的患者可诊断为衰弱;患者出院准备度得分为(66.71±15.63)分,以个人状态维度均分最低;患者衰弱与出院准备度呈负相关(r=-0.252,P<0.05)。结论 老年骨质疏松性椎体骨折患者衰弱程度较严重,出院准备度较差,医护人员应尽力扭转患者衰弱的进程,以提高患者出院准备度,减少再入院风险。     

系统性红斑狼疮患者出院准备度现状及影响因素分析

目的：调查系统性红斑狼疮患者出院准备度现状,并分析其影响因素,为制定提高出院准备度干预措施提供理论依据。方法：采用便利抽样法,选取2021年5月至2022年3月在山东省立医院就诊的191例系统性红斑狼疮住院患者作为研究对象,采用患者一般资料调查表、出院准备度量表、出院指导质量量表、社会支持评定量表及一般自我效能量表进行问卷调查。结果：系统性红斑狼疮患者出院准备度总分为(86.12±9.42)分,均分为(7.18±0.78)分。其中,23.1%的系统性红斑狼疮患者出院准备度低于平均水平。多元线性回归分析结果显示,患者家庭人均月收入(β=0.224,P=0.006)、出院时狼疮疾病活动指数(β=-0.247,P <0.001)和出院指导质量(β=0.332,P <0.001)为系统性红斑狼疮患者出院准备度的影响因素,3个因素可解释出院准备度33.5%的变异(调整后R²=0.335)。结论：系统性红斑狼疮患者的出院准备度水平有待提高。临床护理人员应重点关注家庭人均月收入较低、出院时狼疮疾病活动指数较高的患者,同时加大力度改善出院指导质量,进而提高患者的出院准...     

鼻咽癌放疗患者出院后康复训练依从性的影响因素调查

目的 调查出院指导质量对鼻咽癌放疗患者康复训练依从性的影响,分析出院准备度和患者疾病感知的中介作用.方法 采用出院指导质量量表、出院准备度量表、患者疾病感知量表对224例鼻咽癌放疗出院患者进行调查,于患者出院后1个月调查患者康复训练依从性的情况.结果 患者康复训练依从性均分为(2.62±0.59)分,患者出院准备度(β=0.120)和患者疾病感知(p=0.147)在护士出院指导质量和患者康复依从性间起部分中介作用.结论 患者康复训练依从性处于中等水平,护理人员可以通过提高出院指导质量,改善患者出院准备度和患者疾病感知,提升患者康复训练依从性.     

基于加速康复外科理念的健康教育下结直肠癌患者出院准备度及出院指导质量现状调查

为调查基于加速康复外科(ERAS)理念的健康教育下结直肠癌患者出院准备度及出院指导质量现状,对2018年1月至2019年6月我院收治的120例结直肠癌患者实施基于ERAS理念的健康教育,采用出院准备度评估量表(RHDS)评估患者出院准备度,采用出院指导质量量表(QDTS)评估患者出院指导质量.结果显示,120例患者中,...     

宫颈癌根治术后居家清洁间歇导尿患者出院准备度及影响因素调查

目的调查宫颈癌根治术后居家清洁间歇导尿患者出院准备度及影响因素,为实施针对性护理干预提供参考。方法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132例宫颈癌根治术后需要居家清洁间歇导尿患者进行调查。结果患者出院准备度总分为92.45±12.34;多元线性回归分析显示,居住地、主要照顾者、出院指导质量是宫颈癌根治术后居家清洁间歇导尿患者出院准备度的主要影响因素(P0.05,P0.01)。结论宫颈癌根治术后居家清洁间歇导尿患者出院准备度处于中等水平,临床医护人员应加强出院指导,根据患者情况给予针对性的干预措施,确保患者出院后的安全。     

冠心病患者出院指导质量的调查分析

目的了解冠心病患者出院指导质量,为进一步提高出院指导质量,满足患者出院后的康复需求提供参考。方法采用方便抽样法抽取武汉市2所三级甲等医院心血管内科的冠心病患者324例,应用一般资料调查表和出院指导质量量表进行调查。结果冠心病患者出院指导质量总分为(136.36±31.81)分,需要的出院指导内容总分为(42.04±14.29)分,获得的出院指导内容总分为(40.92±14.02)分,指导技巧及效果维度得分为(95.44±19.69)分,其得分最高的条目是"护士与其他健康工作者提供的信息一致";有无合并症、住院时间与次数不同的冠心病患者出院指导质量得分比较,差异有统计学意义(P0.05,P0.01);医疗付费方式不同的冠心病患者需要的出院指导内容得分差异有统计学意义,文化程度不同的冠心病患者获得的出院指导内容得分差异有统计学意义,独居患者对指导技巧及效果的评价高于非独居患者(P0.05,P0.01)。结论冠心病患者获得的出院指导内容基本可以满足患者的需要,但出院指导技巧及效果仍有待提高。护理人员应重视患者的心理护理,创新指导策略、重视细节指导,并通过反复检查确保患者对相关知识和技能的掌握,同时给予自我保健意识淡薄的患者更多关注。     

腹膜透析置管患者出院准备度现状及影响因素分析

目的调查腹膜透析置管患者出院准备度现状并分析其影响因素,以指导出院准备服务。方法采用一般情况调查表、出院准备度量表对62例腹膜透析置管患者出院前进行问卷调查。结果腹膜透析置管患者出院准备度总分(155.05±21.36)分,条目均分为(7.05±1.26)分,各维度得分从高到低依次为出院后应对能力、可获得的社会支持、自身状况、疾病知识;多元线性回归分析显示,性别、教育程度、居住方式、疾病知识知晓程度是患者出院准备度的重要影响因素(均P0.05)。结论患者出院准备度处于中等水平。医护人员应高度关注腹膜透析置管患者出院准备度水平及其影响因素,根据具体情况给予针对性的干预措施,确保患者出院后的安全。     

基于加速康复外科理念肺癌患者出院准备度与出院指导质量现状及相关性分析

目的分析加速康复外科模式下肺癌手术患者出院准备度与出院指导质量现状,并探讨二者的相关性。方法本研究为横断面调查研究。采用一般资料调查表、出院准备度量表和出院指导质量量表,对2018年7～8月我院胸外科141例出院当天肺癌手术后患者进行问卷调查。其中男65例、女76例,年龄18～85(55.35±12.15)岁。结果 88.65%肺癌手术后患者出院准备充分,出院准备度总分为(78.36±16.48)分,出院指导质量总分为(90.94±18.62)分,出院准备度与出院指导质量呈正相关(r=0.57,P0.01)。结论肺癌手术后患者出院准备度处于中等水平,出院指导质量较好,其出院准备度和出院指导质量呈中度正相关;加速康复外科模式下,医务人员应对患者疾病相关信息认知水平和身体机能恢复情况投入更多关注,同时进一步丰富出院指导内容,以更好地提高肺癌患者的出院准备度。     

Hospital discharge criteria following colorectal surgery:a systematic review

Aim The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the colorectal surgery literature. Methods A systematic literature search was conducted using eight bibliographic databases. Searches were limited to English language journal articles published between January 1996 and October 2009. Primary research applying hospital discharge criteria following colorectal surgery was included. Study selection was made independently by two reviewers. Discharge criteria were extracted from each included study. Results The 156 studies identified by the search strategy described 70 different sets of criteria to indicate readiness for discharge. The majority of studies applied a combination of three or four criteria; those most frequently cited were tolerance of oral intake (80%), return of bowel function (70%), adequate pain control (44%) and adequate mobility (35%). End‐points employed to determine the achievement of criteria were generally poorly defined. Conclusion A variety of hospital discharge criteria were applied in the colorectal surgery literature. Development of standardized criteria will allow more accurate comparison of results between studies assessing hospital length of stay or other discharge‐related outcome measures.     

Management strategies for patients with nipple discharge

BACKGROUND AND AIMS: The aim of this study was to assess management strategies for patients with nipple discharge (ND). PATIENTS AND METHODS: The records of 13,443 women with breast-related complaints who were examined by the same surgeon between 1 January 1960 and 31 December 2000 were retrospectively assessed. Patients with ND were grouped according to whether they had had a spontaneous or provoked discharge. The parameters investigated in each group were age, physical findings, number of pregnancies, duration of lactation, duration of discharge, colour of discharge, and histopathological features. Chi-square and Mann-Whitney U-tests were used for statistical analysis. RESULTS: ND was the presenting symptom in 603 (4.5%) of the cases. Two hundred and eighty-seven (48%) of the 603 patients showed spontaneous nipple discharge (SND group) and the other 316 (52%) showed provoked nipple discharge (PND group). In the SND group, 124 (43%) tissue specimens were obtained by either biopsy or sub-areolar exploration. Histopathological examination revealed that the most frequent causes of ND in these cases were intraductal papilloma (49 patients; 40%), intraductal carcinoma (35 patients; 28%), and cystic disease (15 patients; 12%). Twenty tissue specimens were obtained from the group with PND. In these cases, the most frequently identified causes of ND were cystic disease (seven patients; 35%), intraductal papilloma (six patients; 30%), ductal ectasia (two patients; 10%), and carcinoma (one patient; 5%). The SND and PND groups differed significantly with respect to age (P = 0.001) and duration of ND (P = 0.008). The incidence of cancer was higher in the SND specimens than in the PND specimens (28% vs 5%, respectively; P = 0.01). The number of pregnancies was significantly higher and the duration of lactation was significantly longer in the SND group (P = 0.03 and P = 0.02, respectively). CONCLUSION: The study confirms previous reports that patients with SND have a higher incidence of carcinoma than those with PND. The results suggest that older age, higher number of pregnancies, and longer duration of lactation may predispose to cancer development in patients with SND. The possibility of breast cancer should also be kept in mind when one is assessing patients with PND. Careful physical examination and close follow-up is the optimal management strategy for patients with any type of ND.     

膀胱全切术后尿路造口患者出院准备服务方案的制订与实施

目的 制订膀胱全切术后尿路造口患者出院准备服务方案,并探讨其临床应用效果.方法 通过文献检索、回顾分析、质性访谈、德尔菲法、临床实证研究等环节,制订膀胱全切术后尿路造口患者出院准备服务方案.选取膀胱全切术后尿路造口患者140例进行非同期对照研究,对照组64例,采用常规出院方案;干预组76例,成立多学科协作管理团队,实施...     

Navigating murky waters: a modern treatment algorithm for nipple discharge

BACKGROUND: Many women with nipple discharge undergo operative duct excision with few actually having carcinoma. METHODS: We reviewed all patients with nipple discharge at our institution from 2001 to 2005. Clinical findings were analyzed to determine an appropriate treatment algorithm. RESULTS: Nipple discharge was present in 204 patients. Carcinoma was identified in 7 patients (3% of all, 9% of those undergoing biopsy). Age > or = 50 years, abnormal mammography, and abnormal sonography were the only significant predictors of carcinoma. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram, the carcinoma risk was 3%. Among patients with unilateral, spontaneous, bloody, or serous discharge with a negative mammogram and subareolar ultrasound, the carcinoma risk was 0%. CONCLUSIONS: Patients with nipple discharge can be divided into risk groups by combining clinical and radiologic findings. Low-risk patients can be offered close clinical follow-up rather than operation. A recommended management algorithm is presented.     

Throwing light on nipple discharge

Five percent of the patients presenting to a symptomatic breast clinic have nipple discharge. Conventional surgical management for the nipple discharge includes microdochectomy or total duct excision. Breast duct micro-endoscopy (BDME) is a new technique, which helps evaluate the underlying cause of nipple discharge. We describe a case of nipple discharge with a unique etiology: mammary duct foreign body.     

Reasons for delayed discharge of trauma patients

BACKGROUND: In the trauma population, increased length of stay is associated with age, comorbidities, and injury severity. We hypothesized that a significant contributor to a delay in length of stay was unrelated to these variables. MATERIALS AND METHODS: All trauma patients admitted for > 48 h with acute injury from 7/1/2000 to 9/30/2000 were evaluated daily for discharge readiness. Actual discharge time was recorded from the time discharge orders were written. A discharge-ready patient not discharged within 24 h was a Delay discharge. Discharge delay was categorized as availability of rehabilitation beds, family reasons, or system-related delay. Payer was classified as commercial, government, Medicare, or uninsured. Actual hospital costs were used. RESULTS: One hundred twenty-eight patients were evaluated; 30 patients had a delay in discharge. The average delay was 2 days (range 1-15 days). Mean hospital stay for Delay patients was 13.4 days, and 8.1 days for Timely patients (P < 0.05). Injury severity, age, and comorbidities were not different among groups. The main reason for delay was lack of a rehabilitation bed. Hospital costs were $39,013 per patient in the Delay group and $24,414 in the Timely group. Delay patients were more likely to be uninsured, have an orthopedic injury, and require ICU care. CONCLUSION: Discharge delays significantly lengthen hospital stay for nonmedical reasons in trauma patients. Improved efficiency in a trauma system will require changes from acute care to rehabilitation.     

患者出院计划核心评价指标的构建

目的 构建出院计划核心评价指标,为出院计划实施效果评价提供参考.方法 运用文献分析法分析、整合出院计划评价指标,运用小组讨论法制定专家咨询问卷,通过德尔菲法对16名专家进行3轮咨询,完成指标筛选与修改,确定出院计划核心评价指标.结果 专家权威系数为0.945,每轮问卷有效回收率均为100％.第3轮专家咨询结束后,最终形成的出院计划核心评价指标集涵盖患者相关、照护者相关和医疗机构相关3大类共12项.各指标重要性赋值均数为8.88～9.63,变异系数为0.064～0.187;适用性赋值均数为8.75～9.63,变异系数为0.064～0.235.结论 构建的出院计划核心评价指标具有可靠性,可用于患者出院计划实施质量评价.     

病理性乳头溢液病因的再认识

目的 认识病理性乳头溢液的病因.方法 从1990年来,对连续81例浆液性或血性乳头溢液患者行乳管切开检查.结果 发现乳管内乳头状瘤67例,乳管内乳头状瘤病5例,导管癌6例,3例未找到病变.结论 可能只有乳头状瘤(病)和导管癌是病理性乳头溢液的病因.     

乳管镜诊断乳头溢液性疾病的后续治疗

目的探讨乳头溢液性疾病乳管镜诊断后的治疗措施。方法采用乳管镜对51例乳头溢液的病变导管进行观察、评估，并根据乳管镜下的不同表现特征实施治疗。乳头溢液性疾病的乳管镜下病变表现特征可分为隆起性病变和非隆起性病变，隆起性病变又分为结节状隆起和不规则隆起。本组结节状隆起29例，采取病灶局部切除23例，单纯乳腺切除6例；不规则隆起1例，病灶切除活检证实为乳腺癌后按恶性肿瘤的原则治疗；非隆起性病变21例，行乳管镜下冲洗治疗18例，3例有血性病变导管及其所属小叶切除术后石蜡切片病理诊断乳腺癌后按恶性肿瘤治疗。结果51例随访6～21个月，平均14个月，B超及胸片未见复发转移。结论乳管镜下的病变表现特征是乳头溢液性疾病制定治疗措施的重要依据。     

脑卒中患者出院安置现状及预测因子分析

目的 了解脑卒中患者出院安置现状并探索其预测因子,为临床医护人员实施出院准备服务提供参考。方法 采取整群抽样法抽取神经内科收治的脑卒中患者238例,对患者一般资料、疾病相关资料、身体功能资料及出院安置情况展开调查。结果 84例(35.3%)患者出院安置发生改变;居家照护、基层医疗机构与康复机构3种安置类型的患者ADL功能、步行功能、带管情况、合并症指数、经济状况比较,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析结果显示,患者ADL功能、压力性损伤风险与居住状况是出院安置的预测因子(P<0.05,P<0.01)。结论 脑卒中患者出院安置改变发生率较高,入院时ADL功能差、压力性损伤风险高或独居患者更易发生出院安置改变。临床医护人员应结合患者病情严重程度、活动功能、照护支持、经济状况为其出院安置选择提供指导意见,同时出院后医疗卫生服务与转诊制度建设亟需加强。