高尿酸血症及痛风患者饮食控制知信行现状及影响因素

目的了解高尿酸血症及痛风患者饮食控制知信行现状及其影响因素,为制定干预措施提供参考。方法采用一般资料问卷和高尿酸血症及痛风患者饮食控制知信行量表对370例高尿酸血症及痛风患者进行调查。结果患者知识、信念、行为以及知信行得分分别为(49.83±6.21)分,(53.25±6.67)分,(38.07±6.61)分,(141.15±15.84)分。回归分析结果显示,文化程度、接受过治疗、了解目前尿酸值是饮食控制知识得分的影响因素;接受过饮食建议、有糖尿病、了解目前尿酸值是饮食控制信念得分和知信行总体得分的影响因素;接受过饮食建议、有高血脂、家庭人均月收入是饮食控制行为得分的影响因素(P0.05,P0.01)。结论高尿酸血症及痛风患者饮食控制知信行现状不容乐观,医护人员应制定和实施针对性干预措施,提高患者饮食控制知信行水平。     

护理人员个人发展计划知信行现状及影响因素分析

目的 调查护理人员个人发展计划知信行现状及影响因素,为开展个人发展计划培训和人力资源管理提供参考.方法 采用自制护理人员一般资料问卷和个人发展计划知信行问卷对3298名护理人员进行调查.结果 护理人员个人发展计划知信行总分为(100.01±15.50)分,知识维度得分(17.82±6.07)分,态度维度得分(52.13±7.06)分,行为维度得分(30.06±7.13)分.多元线性回归分析显示,学历、职称、婚姻状况、岗位及对个人发展计划了解程度是护理人员个人发展计划知信行的影响因素(P＜0.05,P＜0.01).结论 护理人员的个人发展计划知信行水平处于中等水平,受护理人员个人特征的影响.医院管理者可通过开展相关培训以提高护理人员个人发展计划知信行水平.     

护理人员对住院患者自杀预防知信行的调查研究

目的 对护理人员住院患者自杀预防的知识、态度、行为水平进行现况调查,为开展护理人员 自杀预防学习提供参考.方法 采用自制护理人员对住院患者自杀预防知信行调查问卷,对445名护理人员进行调查.结果 护理人员对住院患者自杀预防的知识、态度、行为得分分别为(42.56±6.96)分、(30.02±4.31)分、(52.45±8.02)分,总分为(125.00±15.15)分.是否使用过心理评估量表、是否使用过自杀风险评估工具、是否参与患者自杀预防培训是护理人员 自杀预防知信行的主要影响因素(均P＜0.01).结论 护理人员对住院患者自杀预防知识态度行为总体呈中等偏上水平,管理者应当重视并针对护士开展自杀预防的培训学习.     

IMB模型在老年乳腺癌患者及配偶跌倒预防健康教育中的应用

目的 探讨基于IMB模型的健康教育提高老年乳腺癌患者及其配偶跌倒预防知信行水平，规避风险。方法 将96例老年乳腺癌患者及其配偶按照住院先后顺序分为对照组(48例)和观察组(48例)。对照组行常规健康教育，观察组在此基础上实施以IMB模型为基础的健康教育。比较干预前、干预完成时及干预完成3个月患者跌倒预防知信行及跌倒恐惧得分。结果 对照组45例、观察组46例完成本研究。两组干预完成时及干预完成3个月跌倒预防知信行得分、跌倒恐惧得分的组间效应、时间效应及交互效应差异有统计学意义(均P<0.01)。结论 以IMB模型为基础的跌倒预防健康教育能提高老年乳腺癌患者及其配偶跌倒预防知信行水平，降低其跌倒恐惧，具有较好的临床借鉴意义。     

医护人员医疗告知知信行现状及影响因素分析

目的 调查分析医护人员医疗告知知信行现状及影响因素,为促进医疗告知质量,保障患者权利提供参考.方法 应用 自制的医护人员医疗告知知信行问卷对新疆3所三级甲等医院的3 329名医护人员进行调查.结果 医护人员医疗告知知信行问卷总均分(121.45±15.41)分,知识、态度、行为各维度得分为(4.71±0.84)分、(5...     

三甲医院ICU护士身体约束知信行现况及影响因素分析

目的 调查ICU护士对患者身体约束知信行现况及影响因素,为身体约束持续质量改进提供参考。方法 采用一般资料调查问卷、患者身体约束知信行问卷,对湖北省15所三甲医院777名ICU护士进行调查。结果 ICU护士对患者身体约束知识得分(93.73±6.95)分,态度得分(70.99±12.59)分,行为得分(197.47±28.28)分。多元线性回归分析显示,年龄和学历对ICU护士患者身体约束知识产生影响,重症专科护士认证及知识、态度、工作年限对其行为产生影响(均P<0.05)。结论 ICU护士身体约束知识处于较高水平,身体约束的知识、行为分别受年龄、学历、工作年限、重症专科认证等因素影响。护理管理者应针对不同影响因素实施针对性培训,进一步提高ICU护士患者身体约束管理水平。     

肿瘤患者口服化疗药物安全管理知信行现状调查

目的 调查口服化疗肿瘤患者药物安全管理知信行现状,为制定口服化疗药物健康教育方案提供参考。 方法 采用自行编制的口服化疗药物安全管理知信行调查问卷,对182例口服化疗肿瘤患者进行问卷调查。 结果 口服化疗药物肿瘤患者安全管理知识得分为（43.71±8.70）分,态度（51.10±9.37）分,行为（49.00±7.37）分,知识、态度、行为之间呈正相关（均P＜0.01）;多元线性回归分析显示,影响肿瘤患者口服化疗药物安全管理行为的因素为文化程度、服用口服化疗药物的时间、接受安全管理教育次数（P＜0.05,P＜0.01）。 结论 行口服化疗的肿瘤患者安全管理知信行处于较低水平,应加强肿瘤患者的健康宣教,以保证口服化疗药物的安全使用。     

不同级别医院护士延续护理知信行状况及障碍因素调查

目的了解不同级别医院护士延续护理知信行状况及障碍因素。方法采用护士延续护理知信行量表对三级医院、二级医院及社区医院的687名护士进行调查。结果三级、二级和社区医院护士延续护理知信行评分分别为(127.60±1.10)分、(119.70±1.49)分和(120.40±1.39)分;不同级别医院护士延续护理知信行总分、知识、行为得分比较,差异有统计学意义(均P0.01),态度得分差异无统计学意义(P0.05)。护士开展延续护理服务主要障碍因素有工作太忙(73.2%)、人力资源有限(63.6%)、缺乏激励机制(51.2%)、社区服务跟不上(50.1%)等。结论各级医院护士延续护理知信行状况处于中等水平,所面临的障碍因素较多,需要尽快健全法律法规,加强医联体建设,借助上级医院对下级医院的帮扶指导,推动优质护理资源上下贯通,促进延续护理服务顺利进行。     

糖尿病患者规范注射知信行状况与生活质量的相关性研究

目的了解接受胰岛素治疗的糖尿病患者对规范注射行为的认知、态度和行为状况及生活质量,为针对性干预提供参考。方法采用自行设计的胰岛素规范注射知信行问卷、中文版"接受胰岛素治疗的患者生活质量量表(ITR-QOL-CV)"对142例接受胰岛素治疗的糖尿病患者进行问卷调查。结果胰岛素规范注射知信行问卷中知识维度得分4.33±1.77,态度维度得分34.72±5.78,行为维度得分14.07±1.65;ITR-QOL-CV得分93.59±18.05。影响患者生活质量的因素是对规范注射的态度、行为、糖化血红蛋白和低血糖知识水平(P0.05,P0.01)。结论糖尿病患者规范注射的知信行水平不高,生活质量呈中等水平,应结合患者的知信行状况及血糖水平实施针对性干预,以提高患者的自护水平及生活质量。     

社区老年人亲属照顾者对跌倒预防知信行调查研究

目的:调查社区老年人亲属照顾者跌倒预防知识、态度、行为情况及影响因素,以便有针对性地制定社区居民养老老年人跌倒预防措施,预防老年人跌倒的发生.方法:采用自行设计的预防跌倒知信行调查问卷,对北京市某社区112名老年人亲属照顾者进行调查.结果:老年人亲属照顾者跌倒知识得分优良仅为30.4％,且缺乏正规的培训途径.结论:社区及社区护士应根据老年人亲属照顾者不同文化程度进行预防跌倒相关知识的教育普及,提供其知识水平,从而能更重视跌倒的预防,促进老人健康,提高生活质量.     

Characteristics of patients who are acutely admitted to hospital under surgical care and do not have a surgical procedure – Is there an alternative to admission?

Introduction

Previous work has shown that 56% of all acute surgical admissions in Ireland in 2012 did not have a formal surgical procedure. In light of the pressures on health systems internationally and the lack of relevant data on this topic in the literature, we examined the characteristics of this cohort of patients in Ireland.

实习护生护理关怀行为及影响因素的调查

目的了解实习护生护理关怀行为实施现状及相关影响因素。方法采用方便抽样方法,使用美国学者Wolf关怀行为量表修改版,对在江苏省某三甲医院实习的150名护生进行调查。结果实习护生护理关怀行为得分为(80.98±8.92)分。护生的护理关怀行为主要体现在对患者信息保密(3.76±0.49)、懂得注射和滴注(3.69±0.54)、倾听主诉(3.71±0.50)、对患者表示关心(3.63±0.52)、按时治疗和给药(3.61±0.64)方面;但帮助患者成长(2.91±0.77)、让患者参与护理计划制定(2.88±0.91)得分最低。影响实习护生实施护理关怀行为的因素为护理关怀课程的学习及学历(P<0.05,P<0.01)。结论实习护生护理关怀行为得分呈中等偏上水平,并主要侧重于治疗性关怀,对患者的人文关怀尚欠缺。护理教育者应探讨合适的教学方法,开设护理关怀课程并付诸实践,不断提高护生护理关怀意识和行动力。     

Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

With a history of steadily rising healthcare costs, the United States faces an unprecedented set of health and financial challenges. The COVID-19 pandemic will only exacerbate these challenges, and it is of paramount importance to reform and refine health systems to maximize the value of care delivered to the patient. Recent developments related to value improvement in total joint arthroplasty suggest that episode-based payment is likely to become standard practice given the current healthcare environment. Consequently, developing episode-based care models for total joint arthroplasty is in the best interests of surgeons, health systems, and patients. In this article, we review important developments related to value-based care in total joint arthroplasty and present an episode-based framework for delivering high-value, patient-centric care. We examine each phase of a total joint arthroplasty episode—preoperative, acute, post-acute, and follow up—and present several ideas with developing bodies of evidence that can improve the value of care delivered to the patient.     

嗜铬细胞瘤的围手术期处理

报告８１例嗜铬细胞瘤，完善的围手术期处理使手术成功率达９７．４％（７９／８１）。结合文献讨论了围手术期处理的经验：（１）控制血压；（２）纠正心律失常；（３）解决扩容问题；（４）改善一般情况及心理准备工作；（５）密切观察各项生命指标的变化。并提出术前术中处理较术后处理更重要。     

Using the intensive care unit to teach end-of-life skills to rotating junior residents

Background

This study tested the effectiveness and perceived value of a palliative/end-of-life (P/EOL) curriculum for junior residents implemented during an intensive care unit (ICU) rotation.

Methods

Residents rotating through the ICU over a 6-month period completed pre- and post-curriculum surveys evaluating their self-assessed efficacy in providing P/EOL care and attitudes towards P/EOL care. Scores were analyzed using a paired Student t test.

Results

Seventeen of 19 (90%) residents completed both the pre- and post-curriculum evaluations. The P/EOL curriculum increased self-assessed efficacy ratings in the domains of pain management (P = .04), psychosocial knowledge (P = .001), communicator knowledge (P = .001), professional knowledge (P = .002), and manager knowledge (P < .001). The rotation was rated as being valuable in preparing residents to care for patients near the end-of-life (P < .05), with surgery residents indicating it to be the most valuable rotation in their training program for learning about P/EOL care.

Conclusions

An ICU P/EOL curriculum improves self-assessed efficacy scores across multiple domains in P/EOL care and is seen as a valuable educational experience.     

A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs

Integration of pharmacists into multidisciplinary transplant patient care has advanced in recent years, with limited data available to evaluate the current status of the profession. This was a national survey developed as an AST Pharmacy COP initiative. Responses were solicited from pharmacists practicing at U.S. transplant programs based on UNOS listing; 176 participants from 113 centers (41%) responded, with 79% practicing ≤10 years. There is a median of 1.4 pharmacist full‐time equivalents (FTEs) (range 0.1–7.1) for every 100 transplants. The predominant activities performed by pharmacists during the transplant phase include medication review (95%), lab review (92%), allergy review (88%), medication therapy management (92%), bedside rounds (87%), medication education (79%), documentation (71%), and coordinating discharge medications (58%). Similar activities were reported during the other phases, but participation was less common. The involvement of dedicated transplant pharmacists within multidisciplinary care has become standard at a large number of centers, although expansion is still needed to ensure core pharmaceutical care components are provided to all transplant recipients across all centers. These results inform on the typical responsibilities of pharmacists practicing within the field of transplantation and illustrate that the level of pharmacist involvement significantly varies across transplant centers and the phases of transplantation.     

Edgar J. Poth Memorial Lecture: Lessons learned inside the Beltway: one surgeon's encounters with health care policy

Our health care system continues to undergo transformation in a context of extreme financial pressures. New models of care delivery and financing challenge us to rethink our practices as individual surgeons and as system participants. Understanding the fiscal realities of health care and how we are perceived by health care policy makers can help us to be meaningful participants in channeling reform to create better delivery systems for our patients. This article presents some background information about health care in America with a focus on government programs, and shares insights from my health care policy colleagues.