头颈癌住院手术患者营养管理的循证实践

目的促进最佳证据在头颈癌住院手术患者营养管理中的应用,提高临床医疗护理质量。方法采用复旦大学循证护理中心制定的基于证据持续质量改进模式,对头颈癌住院手术患者营养管理主题进行系统检索和质量评价,形成14条最佳证据,通过基线调查了解障碍因素,并制定相应的行动策略,将证据应用到临床实践。根据最佳证据,制订了12条质量审查指标,在头颈癌住院患者手术病房开展基于循证的营养管理流程的优化和质量审查,实践变革前后分别纳入19例护士、125例患者和19例护士、149例患者作为研究对象。结果 12条质量审查指标中,护士的执行率由基线审查时的0～48.8%提高到证据运用后的81.8%～100%。患者住院期间体质量下降例数由基线审查时的77.6%减少到证据运用后的56.3%,体质量增加由20%上升至40.3%,体质量不变由3%上升至5%;患者术后住院天数由12.48 d缩短至10.94 d;手术并发症发生率从11.2%减少至4.02%,差异均有统计学意义(P<0.05)。结论循证实践对开展头颈癌住院手术患者营养管理具有重要意义,可改善患者的临床结局,提高护理质量。     

循证护理干预对乳腺癌病人生活质量的影响

[目的]探讨循证护理干预对乳腺癌病人生活质量的影响。[方法]将我院乳腺外科收治的72例乳腺癌住院病人随机分为实验组和对照组，实验组依据循证护理的要求进行全面准确评估护理问题、系统分析、制订护理干预措施并予以实施；对照组只进行常规护理。采用癌症病人生命质量核心量表（EORTCQTQ—C30）对两组病人的生活质量进行评价。[结果]实验组在实施循证护理干预后，病人生活质量有了明显的提高（P〈0．05），且明显优于对照组（P〈0．05）。[结论]循证护理干预能显著提高乳腺癌病人的生活质量。     

循证护理干预对乳腺癌病人生活质量的影响

[目的]探讨循证护理干预对乳腺癌病人生活质量的影响。[方法]将我院乳腺外科收治的72例乳腺癌住院病人随机分为实验组和对照组,实验组依据循证护理的要求进行全面准确评估护理问题、系统分析、制订护理干预措施并予以实施;对照组只进行常规护理。采用癌症病人生命质量核心量表(EORTCQTQ-C30)对两组病人的生活质量进行评价。[结果]实验组在实施循证护理干预后,病人生活质量有了明显的提高(P<0.05),且明显优于对照组(P<0.05)。[结论]循证护理干预能显著提高乳腺癌病人的生活质量。     

循证护理干预在糖尿病足患者中的应用及效果

目的探讨循证护理干预在糖尿病足患者中的应用效果。方法选择本院收治的83例糖尿病足患者为研究对象,将其随机分为对照组43例与护理组40例,分别行临床常规护理和增加了健康教育的循证护理,并对两组的护理效果及患者满意度等进行对比。结果研究组患者在治愈率、总有效率、患者满意度等方面显著优于对照组,体现了综合循证护理方式的优越性。结论通过对糖尿病足患者临床特点进行分析并制定符合患者特点的有效、实用的循证护理措施,能有效提高临床治愈率,值得推广。     

循证护理干预在预防产后抑郁症中的应用

<正>产后抑郁症是指既往无精神病史,而在产后出现情绪障碍,可持续整个产褥期或更长时间,主要表现为兴趣减退或丧失、悲观、无助感、精神疲惫、自我评价降低,重者出现幻觉或自杀等一系列症状为特征的精神紊乱,是产妇常见的心理行为异常[1]。此症常常发生在产后1~10 d内,特别     

循证护理在早产儿早期干预中的应用

循证护理(EBN)是护理人员在计划其护理活动过程中,将科研和临床经验、病人需求相结合获取实证作为l临床护理依据的过程.循证护理已成为指导临床护理实践的一门学科.随着医学的发展,早产儿成活率越来越高,对早产儿实施早期护理干预,降低早产儿的并发症,提高早产儿生存质量已成为I临床护理人员追求的目标.我院2006年1月开始将循证护理应用到早产儿的早期护理干预中,取得了满意效果.报告如下.     

循证护理在高血压患者护理干预中的应用

<正>高血压是以体循环动脉压增高为主要表现的临床综合征,是最常见的心血管病,原发性高血压又称高血压病,占总高血压患者的95%以上,只有不足5%的患者被诊断为继发性高血压,其血压升高是某些疾病的一种临床表现。随着人们生活条件的改善,出行状况以车代步的优选,高血压患者正呈现逐年上升趋势,以每年300万左右患者的速度递增[1],也是引发心脑血管发病及死亡的主要危险因数,对健康危害极大。目前,高血压     

循证护理在外科护理学教学中的实践

以循证护理理论为基础,改变外科护理学传统教学模式。在理论教学与实践教学中应用循证护理理念,缩小教学与临床的差距,培养学生的循证思维与循证实践能力,学会应用护理科研成果以提高临床护理质量。     

循证护理干预在预防产后抑郁症中的应用研究

目的 探讨循证护理干预在预防产后抑郁症中的应用.方法 随机抽取2010年1月至2011年12月在本院产前检查及住院分娩且同意接受循证护理干预的产妇50例为观察组;选择同期、同数量定期产前检查及住院分娩但未实施循证护理干预的产妇50例为对照组.比较两组产妇产后抑郁症的发生率.结果 两组产妇中SDS评分≥0.5分且EPDS评分≥13分者观察组为10例,对照组21例,两组比较差异有统计学意义(P＜0.01).结论 将循证护理应用于产后抑郁症的防治,能显著降低产后抑郁症的发生率,提高其生活质量,效果满意.     

Pulmonary thromboembolism after head and neck surgery

In a retrospective study of all patients who had pulmonary embolism during a 37-year span at M. D. Anderson Hospital, we identified 502 patients, 30 of whom had a primary malignancy in the head and neck region. Only five of these patients had a clinically significant pulmonary embolus during the immediate postoperative period; these patients are the subject of a more detailed review with a case study as an example. Three of these patients died. Heart disease was identified as the most common predisposing factor. We review the results of this clinical study of pulmonary thromboembolism in patients having head and neck surgery as well as the natural history, diagnosis, and current treatment of pulmonary embolism.     

Rehabilitation of patients following major head and neck cancer surgery

Cancer rehabilitation is accepted as an essential part of patient care, aiming to maximise the patient's quality of life. Patients who have received major surgery for head and neck cancer face many challenges and require a tailored rehabilitation programme. This review collate the evidence specific to head and neck cancer patients and divides the programme into five areas: functional, medical, aesthetic, psychological and social. This provides an overall framework in which to consider these unique rehabilitation requirements.     

腹腔镜胆囊手术后颈肩痛的护理干预

目的：探讨腹腔镜胆囊手术后引发颈肩痛的护理干预措施,以降低腹腔镜胆囊手术后颈肩痛的发生率和减轻术后颈肩痛的程度。方法：将我院2001年5月～2004年4月住院的90例行腹腔镜胆囊手术的患者作为对照组,将2004年5月～2007年12月住院的114例行腹腔镜胆囊手术的患者作为实验组,实验组采取适当调节气腹压力、改变手术体位、术后尽量排出残余气体、术后持续吸氧等护理干预措施,观察颈肩痛发生情况。结果：两组术后颈肩痛发生率比较,P〈0.001。结论：适当调节气腹压力、改变手术体位、术后尽量排出残余气体、术后持续吸氧等护理措施能有效预防及减轻腹腔镜胆囊手术后的颈肩痛。     

提高妇科手术后留置导尿管相关管理水平的循证实践

目的评估目前与留置导尿管相关管理的循证实践,将留置导尿管相关管理的最佳证据应用到护理实践中,通过质量审查促进临床护理质量的改进。方法 2015年7-10月在一个妇科病房完成留置导尿管管理质量审查。用澳大利亚乔安娜·布里格斯研究中心(Joanna briggs institute,JBI)根据最佳证据制订的4条审查标准,进行临床留置导尿管相关管理的基线审查,制定相应的循证实践方案。并运用JBI临床证据实践系统,将现有的最佳证据整合到护理实践中,再实施干预后的审查。结果将最佳证据引入护理实践后,四条审查标准的依从性均达到100%,妇科术后留置导尿患者的知识水平显著提升。结论本次循证护理实践项目改进了导尿管管理的护理实践,但仍需结合临床实际,不断完善,以促进护理质量的提升。     

Antimicrobial prophylaxis for major head and neck surgery in cancer patients.

A total of 113 patients were randomly allocated to receive either ticarcillin plus clavulanic acid (total dose, 20.8 g) or clindamycin (total dose, 2.4 g) plus amikacin (total dose, 1 g) as perioperative antimicrobial prophylaxis for major head and neck surgery. The two groups were similar in age, prior antineoplastic treatment (surgery, chemotherapy, and radiotherapy) or tracheostomy, and the various types of surgery including radical neck dissection. The wound infection rate was 10% in the group of patients receiving clindamycin plus amikacin and 36% in the group receiving ticarcillin plus clavulanic acid (P less than 0.05). Initiation of systemic antibiotic therapy within 15 days of surgery was necessary for 20 and 45% of these patients, respectively (P less than 0.05). The distribution of microorganisms causing wound infections was comparable in both groups, except for anaerobes, which were isolated predominantly from patients who had received ticarcillin plus clavulanic acid.     

Educational intervention for patients with head and neck cancer in the discharge phase

PurposeThe consequences of head and neck cancer (HNC) treatment have great impact on patients' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients.MethodsA total of 48 patients participated in this quasi-experimental study. The control group (n = 26) received standard care, which included a short interview using the patients' discharge letter dictated by the nurse. The intervention group (n = 22) received the educational intervention, namely a discharge interview where trained nurses used a checklist to inform patients about: general information, wound-care, physical-social problems, work and finances. Effects associated with discharge interview were measured with the Patient Information Need Questionnaire (PINQ) and the Satisfaction with Cancer Information Profile.ResultsThe findings showed that patients need information concerning: illness, treatment, side-effects, physical fitness, impact on functioning, duration of recovery time and impact on quality of life. The educational intervention had no significant effect on the informational needs or the level of satisfaction with information.ConclusionsA nurse-led intervention to provide discharge information was developed however no effects on patient outcomes were found. Nurses need to use an instrument to assess the informational needs of patients prior to the discharge interview. The effects of the educational intervention need to be tested in a larger group of patients.     

Nicardipine infusion for postoperative hypertension after surgery of the head and neck

The therapy of postoperative hypertension (POH) after head and neck surgery was evaluated in a prospective, randomized, double-blind trial. Nicardipine hydrochloride, a Ca channel-blocker for iv use, was compared with placebo. Patients were initially randomized to receive nicardipine infusion or placebo. Those not responding to placebo were given nicardipine infusion on an open basis. Hypertension was significantly better controlled in patients treated with nicardipine infusion compared with placebo (83% vs. 22%, p less than .002). Subsequently, six (86%) of seven of the placebo failures were successfully treated with nicardipine. There were no significant complications in either group. We conclude that the titratable infusion of nicardipine is an effective and safe method for the control of POH after surgery of the head and neck. Further studies are now warranted comparing nicardipine with other drugs currently used to treat this condition.