Impact of Surgical Checklist on Mortality,Reoperation, and Readmission Rates in Brazil,a Developing Country,and Canada,a Developed Country

PurposeTo compare the mortality, reoperation, and readmission rates before and after the implementation of a surgical checklist in Brazil and Canada.DesignAn epidemiological, retrospective study was conducted.MethodsPreimplementation and postimplementation data were collected via patient chart reviews to determine mortality, reoperation, and readmission rates.FindingsIn Brazil, a decrease in readmission rate from 2.9% to 1.7% (P = .518) was observed after the implementation of the checklist. In Canada, reoperation rate decreased from 5.6% to 4.8% (P = .649) and mortality from 1.7% to 0.9% (P = .407) after implementation. In the Brazilian institution, patients with incomplete checklists had increased rates of readmission, from 1.4% to 2.4% (P = .671), and reoperation, from 6.8% to 10.4% (P = .232).ConclusionsThe use of surgical checklist did not translate into improvements in the outcomes studied after its implementation in any of the scenarios evaluated. This result is possibly justified by the socioeconomic structure of each of these settings.     

Evaluation of the agreement between guidelines and initial antihypertensive drug treatment using a national health care reimbursement database

Rationale, aims and objectives To test the agreement between guidelines for the management of hypertension and medical practices while avoiding frequent limitations such as the use of non‐representative samples of practitioners and self‐reporting of their practices over a short period of time. Methods The characteristics of initial antihypertensive drug treatment in a large representative sample of the French population aged 50–80 (n = 17 855) were collected from a national health care reimbursement database and compared with national guidelines over a 5‐year period. Results Major discrepancies are observed including the use of non‐recommended drug classes such as loop and potassium sparing diuretics alone or in association and the absence of distinction between patients according to their age. More minor discrepancies are the preferential use of mono‐therapies over drug combinations and of some bi‐therapies among those recommended. Some degree of concordance with the guidelines is also observed including the specific characteristics of the treatment of diabetics compared with other categories of patients and the preferential use of long‐acting dihydropyridine calcium antagonists and of low‐dose thiazide diuretics when these drug classes are chosen. Several of these discrepancies or concordances, which mainly reflect general practitioner (GP) activity, show time trends over the entire follow‐up period with no significant effect of the guideline released during this period. Conclusions At the French national level, the agreement between initial antihypertensive drug treatment and guidelines varies considerably depending on the characteristics of the treatment that are considered. The GPs who delivered the treatment do not seem to have been influenced by the guidelines released over the last decade.     

Organization of primary health care for diabetes and hypertension in high,low and middle income countries

Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.     

高血压患者心理卫生状况与生活满意度的关系

目的:探讨高血压患者生活满意度和精神卫生状况间的关系。方法:以生活满意度调查表和SCL-90为测量工具,对68例高血压患者进行对照研究和直线相关分析。结果:高血压患者生活满意度平均得分23.4,处于中等偏下水平,除居住和子女孝顺外与正常对照均有显著性差异(P<0.01)。精神卫生状况除强迫和精神病性外与正常对照均有显著性差异(P<0.01)。直线相关分析提示生活满意度低导致患者抑郁、焦虑、人际敏感和躯体化症状多。结论:高血压的发病与心理应激和生活满意度有关,家庭和睦、社会保障体系健全、良好的人际关系和经济状况,是减少应激和提高患者精神卫生状况的重要环节。     

健康素养在原发性高血压患者社会支持与自我健康管理能力的中介作用

摘要:目的 探讨健康素养在原发性高血压患者社会支持与自我健康管理能力之间的中介作用。方法 方便抽样抽取230例住院原发性高血压患者并使用一般情况调查表、成年人健康自我管理能力测评量表（AHSMSRS）、慢性病病人健康素养量表（HLSCP）和社会支持量表（SSRS）进行调查。结果 高血压患者的自我健康管理能力与健康素养成正相关（P＜0.01）、与社会支持成正相关（P＜0.01）;健康素在社会支持与自我健康管理能力之间起着中介的作用,且中介作用占总效应的31.3％。结论 关注和提高健康素养对促进高血压患者社会支持及自我健康管理能力有较好的作用。     

Inaccuracy of international normalized ratio (INR) measurements and suggestions for improved WHO guidelines for calibration of reference preparations – a statistical study

Summary.  Numerous empirical studies show that the accuracy of international normalized ratio (INR) measurements is unsatisfactory and worse than generally expected. We demonstrate that a plausible reason for this large inaccuracy is a conventional calibration procedure of reference preparations with (i) an erroneous assumption that the line relating logarithmic prothrombin times (log PTs) of patients passes through the mean log PT of the 'normal' population (mean normal PT); (ii) non-perceived interactions between patients and PT systems; and (iii) systematic exclusions of 'outliers'. The same conventional procedure also results in serious overestimation of the accuracy of INR measurements, thus leading to a false sense of security in oral anticoagulant therapy. In an example with data from WHO guidelines, we show that the systematic overprediction of INR (which is believed to be 0) may be as large as 5%, when prediction is performed under the conventional WHO model. Under the same model the CV of the predicted vs. the true INR is believed to be only about 1% when it in reality is more than 4%. We suggest that the conventional calibration procedure is modified in order to reduce the twofold negative impact of lower true accuracy and overestimated reported accuracy on oral anticoagulant therapy and to allow for an unambiguous definition of true INR values.     

老年高血压患者自我效能与自觉健康控制的相关性研究

目的调查老年高血压患者自我效能与自觉健康控制的现状并分析其相关性。方法运用健康行为自我效能量表和自觉健康控制量表,对382例老年高血压患者进行调查。结果57．59％的老年高血压患者自我效能处于中等水平;自觉健康控制各维度评分：内部控制（19．99±7．25）分,外部权威人士控制（25．51±5．25）分,外部命运控制（20．10±6．20）分;自我效能与内部控制、外部权威人士控制呈正相关（P〈0．01）,与外部命运控制呈负相关（P〈0．01）。结论在I临床护理工作中应该注重增强患者自觉控制血压的信念与行为,改变患者健康由命运控制的思想,以提高自我效能。     

纽曼保健系统模式在老年高血压病患者中的护理效果观察

目的:观察纽曼保健系统模式在老年高血压病患者中的护理效果,探讨其可行性。方法:在我院就诊的老年高血压病患者240例纳入本研究。将患者随机分为对照组和干预组各120例。对照组给予高血压常规治疗和护理;干预组在常规护理的基础上,应用纽曼保健系统模式根据患者的不良生活方式和知识缺乏程度采取针对性行为指导。患者出院后,每个月对患者进行电话随访,重点询问患者有无吸烟、酗酒、高脂饮食等生活方式及高血压知识缺乏情况。出院后2周,检测两组患者的血压控制情况;出院后6个月,采用生活质量评定量表对两组患者的躯体功能、情绪功能、角色功能、社会功能及总的生活质量进行评分。结果:出院后2周干预组收缩压及舒张压均明显低于对照组,差异有统计学意义(P<0.05)。对照组和干预组患者在有无吸烟、酗酒、高脂饮食等生活方式及高血压知识缺乏情况比较,差异均有统计学意义(P<0.05)。对照组和护理组患者的躯体功能、情绪功能、角色功能、社会功能及总的生活质量评分比较,差异均有统计学意义(P<0.05)。结论:纽曼保健系统模式可降低老年高血压病患者的血压,改善患者生活质量,可用于指导老年高血压病患者的护理实践。     

Social participation following a stroke: an assessment in accordance with the international classification of functioning,disability and health

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.

Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12?months or >12?months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.

Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F?=?2.46; 95% confidence interval (CI)?=??23.67–0.34; p?=?0.05), degree of functional independence (F?=?2.40; 95% CI?=??33.0 to ?18.93; p?<?0.001) and marital status (married or widowed) (F?=?2.6; p?=?0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F?=?99.2; r²?=?0.57; p?<0.001) and the occurrence of depressive symptoms was a moderate predictor (F?=12.78; r²?=?0.40; p?=?0.001).

Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the “social roles” domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke.

• Implications for Rehabilitation

• The Brazilian stroke individuals analyzed exhibited a moderate level of participation.

• Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation.

• Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life.

• Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health.

• This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

     

脑卒中国际功能残疾和健康分类简要核心组合的信度与效度研究

目的:分析研究脑卒中国际功能、残疾和健康分类(ICF)简要核心组合的信度和效度。方法:选择50例脑卒中患者,采用国际脑卒中ICF简要核心组合、美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能量表(FM)、Barthel指数(BI)进行评定。评定者间信度采用Kappa一致性分析方法;同步效度采用Spearman相关分析。结果:身体功能中的四个类目意识功能、定向功能、语言精神功能和肌肉力量功能的kappa值为0.664—1.000,信度中度到优;身体结构的类目脑的结构kappa值为0.976,信度优;活动和参与的四个类目的kappa值为0.696—0.846,信度中度到优;环境因素的类目直系亲属家庭kappa值为0.450,信度中度。ICF除"e310直系亲属家庭"外的其他项目的总分与NIHSS、Fugl-Meyer、BI评分的Spearman相关系数分别为0.795、-0.866、-0.795(P<0.01)。结论:采用国际脑卒中ICF简要核心组合对脑卒中患者进行综合评定可靠有效。     

国内外高血压病健康教育的现状与建议

高血压病是心脑血管疾病的主要危险因素,晚期易造成心、脑、肾等靶器官损害,患者致残、致死率高。其对高血压患者健康带来的严重损害,已经引起广泛的重视。健康教育是防治高血压病的重要手段,使高血压患病率得到有效控制,在帮助患者树立健康观、改善治疗依从性、有效控制血压等方面起着重要作用。     

中老年高血压患者的社区综合健康管理模式探索

目的 探索中老年高血压患者的社区综合健康管理模式.方法 选取中老年高血压120例,以调查对象的入院顺序进行编号,根据随机数字表分成两组.对照组按照普通管理,观察组按照社区健康管理模式管理.在饮食、运动及心理、中医等一系列健康的生活方式予以详细指导.1年后比较两组患者血压变化情况.结果 两组患者血压均较前有下降,其中社区...     

《国际功能、残疾和健康分类儿童和青少年版》类目在儿童脑外伤随访中的应用

摘要 目的：通过《国际功能、残疾和健康分类儿童和青少年版》（ICF-CY）在儿童脑外伤康复评定和随访的应用的研究,促进其在康复工作中的应用。 方法：建立2009年1月—2012年1月在温州医学院附属第二医院康复科首次住院脑外伤患儿的档案,选取19个ICF-CY身体功能及活动和参与的二级类目、Barthel指数（BI）、格拉斯哥结局量表（GOS）对受伤年龄在2岁以上的患儿伤后1—2年的预后情况进行随访评定,并分别对ICF-CY与BI、GOS进行相关分析。 结果：①47例住院患儿中,有结果的随访病例数40例（85.11%）,失访人数6例,死亡人数1例,随访时间平均（16.60±4.89）个月,随访结束时平均年龄（84.63±37.52）个月。②身体功能方面,智力功能（b117）、记忆功能（b144）、步态功能（b770）恢复情况较差。活动与参与方面,精巧手的使用（d440）、四处移动（d455）、盥洗自身（d510）、学校教育（d820）/学龄前教育（d815）、参与游戏（d880）恢复情况较差。③相关性分析提示ICF-CY评分与BI得分、GOS分级呈显著负相关。 结论：ICF-CY类目作为儿童脑外伤的随访内容,可以从整体水平上评估儿童脑外伤的健康状态,但要在临床上得到广泛应用仍需要很长的路要走。     

社区健康教育对高血压病人生活方式及服药依从性的影响

目的 探讨社区家庭健康教育对高血压病患者生活方式及服药依从性的影响.方法 120例高血压患者随机分为干预组、对照组各60例,对照组单纯对患者本人进行健康教育,干预组在对患者进行健康教育的同时,将患者家庭成员纳入健康教育的范围,两组在健康教育前后进行生活方式和服药依从性的评价.结果 在改善患者生活方式、提高服药依从性、改善血压方面,两组相比P<0.01,差异有统计学意义.结论 对患者本人及其家庭成员进行社区健康教育,较单纯对患者本人进行健康教育,可以更好地改善患者的生活方式、提高服药依从性,改善患者血压.     

Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension

Since the 1960s, calcium antagonists have been available for the treatment of angina pectoris and hypertension. The first of this class, nifedipine, was introduced and readily accepted as the third treatment option for angina, alongside β-blockers and nitrates. However, the short-acting formulations of nifedipine had pharmacokinetic properties that were far from ideal and in 1995, several studies involving various dosing regimens reported possible dangerous effects in secondary prevention. Since then, large-scale, randomized controlled trials with new controlled-released formulations of nifedipine have demonstrated the effectiveness and safety of this drug. As a consequence of these results, guidelines for both hypertension and angina pectoris have been recently reconsidered, and have put the modern formulations of calcium channel blockers in a pole position. Within this group of therapeutics, nifedipine gastrointestinal therapeutic system has a unique position and it cannot be replaced by other controlled-release formulations of nifedipine, the pharmaceutical properties of which have yet to be tested in large-scale outcome trials.     

超声医学科住院医师规范化培训:妇产超声培训中国指南(2024版)

为进一步提升妇产超声亚专业规范化培训质量,中国医师协会超声医师分会组织国内相关专家,参考《住院医师规范化培训基地标准（2022年版）》及《住院医师规范化培训内容与标准（2022年版）》,结合自身经验,经过充分讨论形成本指南,旨在指导实施妇产超声教学工作。     

简明版骨质疏松国际功能、残疾和健康分类核心分类组合的信效度研究

目的:探讨简明版骨质疏松国际功能、残疾和健康(ICF)核心分类组合的信度和效度。方法:122例骨质疏松症患者进行简明版骨质疏松ICF核心分类组合和欧洲骨质疏松症基金会生活质量问卷(QUALEFFO-41)评定。信度研究采用重测信度、观察者间信度和内部一致性信度,效度研究采用效标效度、结构效度和内容效度。重测信度和观察者间信度检验采用组内相关系数(ICC);内部一致性检验采用Cronbachα值分析;效标效度用Spearman相关;内容效度应用德尔菲法;结构效度采用因子分析法。结果:(1)信度:重测信度ICC 0.762—0.921;观察者间信度ICC 0.781—0.941;内部一致性信度Cronbachα系数0.953。(2)效度:校标效度:简明版骨质疏松ICF核心分类组合中功能和残疾部分总分与QUALEFFO-41总分呈中度相关(r=0.654);内容效度:经德尔菲法确定内容效度好;结构效度:公因子1包括条目d430、d450和d920,公因子2包括条目b710、b730、s750、s760,公因子3包括条目e110、e355、e580,公因子4包括条目b152、b280。结论:简明版骨质疏松ICF核心分类组合的信度、校标效度和内容效度较好。除b710和b730、s750和s760归为同一维度外,其余条目的结构效度与目前ICF成分结构一致。     

Consensus guidelines for the promotion and management of continence by primary health care teams: development, implementation and evaluation

A project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health care teams, through the process of managed consensus based on scientific review. The guidelines were then implemented at one urban general practice. This article outlines the development and implementation of the guidelines and describes the study undertaken to evaluate the impact of implementation on clinical outcomes. The study involved a pre-and post-implementation postal survey of a random sample of 17% of patients aged 18 years and over from the practice (n=1503). The pre-implementation survey determined the period prevalence of incontinence, related biological data and data on the pre-implementation management of incontinence. Incontinence sufferers were invited to have their condition assessed or reviewed. All sufferers who agreed to be followed-up were sent the post-implementation survey, which identified those patients who had sought help, and ascertained reasons for not seeking help. Data on the management of incontinence post-implementation were also obtained. Clinical outcomes measured pre- and post-implementation were a validated severity index for urinary incontinence, (also adapted for faecal incontinence) and perception of the incontinence as a problem. A 3-month period was allowed between pre- and post-implementation surveys. The study confirmed previous research which showed that few incontinence sufferers respond to invitations to seek help, and that help-seeking behaviour was significantly related to severity of incontinence. The guidelines did not have any positive impact on the clinical outcomes measured, although slight improvements in approaches taken by the primary health care team to the promotion and management of continence were recorded. However, the study was limited by the small sample size and short time scale. Further evaluation of the impact of the guidelines on these outcomes is therefore recommended.