老年患者的出院指导

出院指导是住院病人在医院进行护理的最后一个环节，作好出院指导有效的解决了病人出院后存在或潜在的健康问题，取得了良好的社会效益和经济效益，提高了满意度。[第一段]     

老年出院患者电话回访的体会

为进一步加强医患沟通、延伸医疗服务，我科自2005年10月以来开展了出院患者“电话回访”服务，取得了满意效果。     

护理干预对慢性乙型肝炎出院患者的影响

探讨护理干预对乙型肝炎出院患者的影响，对确诊的慢性乙型肝炎患者108例，随机分为两组，实验组出院后采取护理干预措施，对照组不施加任何影响，两组差别有显著性统计学意义，说明对慢性乙型肝炎出院患者实施护理干预是重要的，也是必须的。     

护理干预对急诊科心肺脑复苏后患者预后的影响

目的：探讨护理干预对急诊科心肺脑复苏后患者预后的影响。方法选取2011年2月—2014年5月期间在我院接受心肺脑复苏抢救的64例心搏呼吸停止患者,按照随机数字表法将患者分为观察组和对照组各32例,观察组进行系统的护理干预,对照组仅进行常规护理。第2周,进行脑复苏后格拉斯哥昏迷指数评分和神经功能评分（CPC）;并对28 d存活率和出院时存活率进行比较。结果观察组的格拉斯哥昏迷指数评分明显高于对照组,2组比较差异有统计学意义（P<0.05）;观察组的神经功能评分明显低于对照组,2组比较差异有统计学意义（P<0.05）;观察组患者在脑复苏后28 d存活率及出院时的存活率均高于对照组,但差异无统计学意义（P>0.05）。结论在急诊科心肺脑复苏后对患者进行护理干预,可以最大限度挽救患者的生命,降低病死率,值得在临床中推广应用。     

老年住院患者跌倒的原因分析及护理干预措施

跌倒是指患者突然或非故意地停顿,倒与地面或比初始位置更低的地方。老年人的跌倒问题已成为一个严重的公共健康问题,据世界卫生组织报告[1],2002年全球有39.1万人死于跌倒,≥60岁的老人占50%以上,≥70岁的老年人占40%。     

老年精神病患者院内感染调查与干预措施

目的：为了解精神病患者医院感染的情况,调查分析精神病医院老年患者院内感染特点和易感因素,提高认识,采取相应的干预措施,有效防控,降低医院感染的发生率。方法：对我院2004年1月至2009年1月的525例所有老年精神病患者的住院病历进行回顾性调查分析。结果：525例中有82例发生医院感染,其感染率为15．4％。呼吸系统感染占首位,为63．41％;其次为消化系统感染占17．07％;皮肤及软组织感染占7．32％;口腔感染占4．88％;泌尿系统感染占3．66％;其他3．66％。结论：老年精神病患者由于长期患病,住院时间相对较长,躯体合并症多免疫功能低下,趋避感染危险意识缺乏,封闭式集中管理,自理能力差,以及抗精神病药物的作用,易发生各种医院感染,精神科医护人员除掌握本专科知识外,还应加强卫生宣教与功能训练,做好基础及生活护理,改善病区内设施,以减少精神病医院感染的发生。     

脑卒中患者出院准备度现状及干预措施的研究进展

随着我国医疗改革的不断深入,在保证患者医疗质量的同时,应尽量缩短患者的住院时间,这使医护人员和患者均面临新的挑战。为了确保患者的医疗安全,患者的出院准备应运而生。出院准备是院内治疗与院外护理管理之间的桥梁,及时有效的评估脑卒中患者的出院准备现状并给予干预,可有效提高患者的院外生活质量。本文从脑卒中患者出院准备的相关概念、测评工具、影响因素和干预措施等方面进行综述,旨在为提高脑卒中患者的出院准备度、改善患者的长期生活质量提供参考。     

出院前综合评估干预和出院后连续护理对老年慢性病患者健康知识和自理能力的影响

目的 探究对患有慢性疾病的老年患者在出院前行以综合性评估干预,并在出院后行以连续性护理干预可能对其健康知识的熟悉程度以及自理能力两项指标上的影响.方法 随机择取患有慢性疾病的老年患者共200例,将其按照抽签的方式分成实验组和参照组两组,每组100例,对参照组患者行以常规性的治疗、护理干预;对实验组则在此基础之上加以行专业的出院前评估干预以及出院后跟踪(时长6个月)护理干预,观察两组患者在健康知识的熟悉程度以及自理能力上的变化情况并做以记录.结果 实验组的患者在健康知识的掌握程度上以及自理能力上均明显好于参照组,差异有统计学意义(P<0.05).结论 对患有慢性疾病的老年患者在出院前行以综合性评估干预,并在出院后行以连续性护理干预,可对其健康知识的熟悉程度以及自理能力两项指标产生良好影响.     

老年患者《出院护理卡》的建立及临床应用

为了解护理服务和健康指导效果,将200例65岁以上老年患者,随机分为观察组和对照组各100例,通过建立老年患者<出院护理卡>,对观察组患者进行定期、详细的电话回访和健康宣教,对照组不建卡,6个月后对患者的依从性和保持健康行为等情况进行比较分析.结果 观察组患者依从性、保持健康行为和自我护理能力明显好于对照组.使用<出院护理卡>进行院外电话回访式健康教育可有效地干预老年患者不良的健康行为,促进其对健康指导的依从性,提高患者出院后的生活质量.     

引起老年患者医院感染的原因及护理干预

随着社会经济和医疗保健的进步及发展，人的寿命不断增加，人口老龄化已成为21世纪一个重要的社会问题。老年期是人生命过程的重要阶段，此阶段人处于衰老的过程，身体各系统退行性改变逐渐明显。影响脏器功能。各类疾病尤其是慢性病患病率呈上升趋势，严重影响老年人的生活质量与自理能力。同时在这一时期，老年人也面临许多实际问题，易产生各种效率障碍，造成了老年人就医高，需求复杂化，使老年住院者越来越多。住院后由于各种原因造成的院内感染正日益受到广大医护人员的重视，如何实现健康老龄化是摆在护理工作者面前一个严峻的挑战。制定必要的护理干预尤为重要。     

Educational and organizational interventions to improve the management of depression in primary care: a systematic review

Context  Depression is commonly encountered in primary care settings yet is often missed or suboptimally managed. A number of organizational and educational strategies to improve management of depression have been proposed. The clinical effectiveness and cost-effectiveness of these strategies have not yet been subjected to systematic review. Objective  To systematically evaluate the effectiveness of organizational and educational interventions to improve the management of depression in primary care settings. Data Sources  We searched electronic medical and psychological databases from inception to March 2003 (MEDLINE, PsycLIT, EMBASE, CINAHL, Cochrane Controlled Trials Register, United Kingdom National Health Service Economic Evaluations Database, Cochrane Depression Anxiety and Neurosis Group register, and Cochrane Effective Professional and Organisational Change Group specialist register); conducted correspondence with authors; and used reference lists. Search terms were related to depression, primary care, and all guidelines and organizational and educational interventions. Study Selection  We selected 36 studies, including 29 randomized controlled trials and nonrandomized controlled clinical trials, 5 controlled before-and-after studies, and 2 interrupted time-series studies. Outcomes relating to management and outcome of depression were sought. Data Extraction  Methodological details and outcomes were extracted and checked by 2 reviewers. Summary relative risks were, where possible, calculated from original data and attempts were made to correct for unit of analysis error. Data Synthesis  A narrative synthesis was conducted. Twenty-one studies with positive results were found. Strategies effective in improving patient outcome generally were those with complex interventions that incorporated clinician education, an enhanced role of the nurse (nurse case management), and a greater degree of integration between primary and secondary care (consultation-liaison). Telephone medication counseling delivered by practice nurses or trained counselors was also effective. Simple guideline implementation and educational strategies were generally ineffective. Conclusions  There is substantial potential to improve the management of depression in primary care. Commonly used guidelines and educational strategies are likely to be ineffective. The implementation of the findings from this research will require substantial investment in primary care services and a major shift in the organization and provision of care.      

The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

Background

Many patients experience difficulties in adhering to long-term treatment. Although patients'' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence.

Objective

To examine the effectiveness of interventions using electronic reminders in improving patients'' adherence to chronic medication.

Methods

A comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. Electronic searches were supplemented by manual searching of reference lists and reviews. Two reviewers independently screened all citations. Full text was obtained from selected citations and screened for final inclusion. The methodological quality of studies was assessed.

Results

Thirteen studies met the inclusion criteria. Four studies evaluated short message service (SMS) reminders, seven audiovisual reminders from electronic reminder devices (ERD), and two pager messages. Best evidence synthesis revealed evidence for the effectiveness of electronic reminders, provided by eight (four high, four low quality) studies showing significant effects on patients'' adherence, seven of which measured short-term effects (follow-up period <6 months). Improved adherence was found in all but one study using SMS reminders, four studies using ERD and one pager intervention. In addition, one high quality study using an ERD found subgroup effects.

Conclusion

This review provides evidence for the short-term effectiveness of electronic reminders, especially SMS reminders. However, long-term effects remain unclear.     

No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.

OBJECTIVE: To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes. DATA SOURCES: MEDLINE, SCISEARCH, CINAHL and the Research and Development Resource Base in CME were searched for trials of educational interventions in the health care professions published between 1970 and 1993 inclusive. STUDY SELECTION: Studies were selected if they provided objective measurements of health professional performance or health outcomes and employed random or quasi-random allocation methods in their study designs to assign individual subjects or groups. Interventions included such activities as conferences, outreach visits, the use of local opinion leaders, audit and feedback, and reminder systems. DATA EXTRACTION: Details extracted from the studies included the study design; the unit of allocation (e.g., patient, provider, practice, hospital); the characteristics of the targeted health care professionals, educational interventions and patients (when appropriate); and the main outcome measure. DATA SYNTHESIS: The inclusion criteria were met by 102 trials. Areas of behaviour change included general patient management, preventive services, prescribing practices, treatment of specific conditions such as hypertension or diabetes, and diagnostic service or hospital utilization. Dissemination-only strategies, such as conferences or the mailing of unsolicited materials, demonstrated little or no changes in health professional behaviour or health outcome when used alone. More complex interventions, such as the use of outreach visits or local opinion leaders, ranged from ineffective to highly effective but were most often moderately effective (resulting in reductions of 20% to 50% in the incidence of inappropriate performance). CONCLUSION: There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.     

急诊科心肺复苏患者存活出院的影响因素观察

目的对急诊科心肺复苏患者存活出院的相关影响因素进行分析。方法选取急诊科心搏骤停患者200例作为本次研究对象,其均接受心肺复苏治疗,时间为2014年1月~2017年1月,对其临床资料进行回顾性分析,对比不同分组患者心肺复苏的效果,分析影响心肺复苏效果的影响因素。结果性别、目击者、心搏骤停地点、转运方式、首次监测心律、心搏骤停病因、心肺复苏开始时间、心肺复苏持续时间、肾上腺素用量等是影响患者存活出院的单因素(P0.05);心搏骤停地点、首次监测心律、心肺复苏持续时间≤15 min是影响患者存活出院的主要独立预测因素(P0.05)。结论急诊科心搏骤停患者接受心肺复苏干预意义重大,临床应加强其心肺复苏存活出现相关影响因素的分析,并实施相应的干预措施,从而尽量提高患者心肺复苏的存活出院率,改善其预后。     

系统化干预护理在血液内科PICC带管出院患者中的预后效果评价

目的 评价系统化干预护理在血液内科PICC（peripherally inserted central catheter,经外周静脉置入中心静脉导管）带管出院患者中的应用效果。方法 在2017年12月～2019年5月抽取本院血液内科收治的78 例PICC带管出院患者作为研究对象,回顾所有病例临床资料,根据不同的护理措施将其分为对照组、观察组。对照组（39 例）用常规护理,基于此,观察组（39 例）用系统化干预护理,对比两组患者出院后依从性、并发症发生率、自我护理能力评分、患者满意度。结果 患者出院后依从性、自我护理能力评分、患者满意度与对照组相比,观察组较高,差异有统计学意义（P＜0.05）;观察组并发症发生率较低,差异有统计学意义（P＜0.05）。结论 在血液内科PICC 带管出院患者护理中,配合科学的系统化干预护理,既可提高患者自我护理能力与出院后依从性,还可减少并发症发生率、提高护理满意度,值得临床推广应用。     

精神科患者出院回访满意度调查

目的:了解精神科患者出院回访调查满意度。方法:以电子信息化系统为平台研制一套回访软件,设置3名护士负责回访工作,以出院即时及离院后电话两种方式100%回访,并统计数据。结果:2012年1月至2014年12月共对10 126例次精神科患者出院做了回访,回访率100%,回访成功9 718例次,成功率95.97%。满意度2012年98.89%,2013年99.06%,2014年99.59%,平均满意度99.18%。表扬医务人员659人次。提出意见建议等不满意问题224条。医务人员服务态度问题136条。结论:通过出院回访,能够全面掌握患者对医院服务满意度,及时发现医疗、护理、服务等方面存在的问题,有利于提升服务水平,构建和谐医患关系。     

A retrospective review of trampoline-related injuries presenting to a paediatric emergency department in Singapore

INTRODUCTIONTrampolining is a popular activity. However, to our knowledge, no studies on paediatric trampoline-related injuries (TRIs) have been conducted in Asia. We aimed to provide an Asian perspective on paediatric TRIs and evaluate current safety measures.METHODSPatients aged under 16 years who presented to the emergency department at KK Women’s and Children’s Hospital, Singapore, from March 2012 to June 2016 with a TRI were identified from the National Trauma Registry. Data was collated retrospectively focusing on age, location of the trampoline, mechanism and location of injury, treatment, disposition, and follow-up treatment.RESULTS137 children were seen for a TRI during this period. There was even representation across age groups (< 6 years, 6–11 years and 11–16 years). 60.6% of these injuries occurred in a public trampoline park, and a smaller proportion involved home and school trampolines. 61.3% of injuries occurred on the trampoline and 25.5% involved a fall off it, while the remaining were incurred by hitting the trampoline frame. The most common injury was soft tissue injury, followed by fractures and dislocations, of which 16.7% required surgical intervention. Most patients were discharged to an outpatient clinic. 14.6% of all patients required admission and 9.5% eventually required surgical intervention. There were three stable head injuries and no cervical spine injuries or deaths.CONCLUSIONThe existence of trampoline parks has contributed to a rise in TRIs. We recommend measures such as general education, changes in the setup around the trampoline, increasing the age limit for trampolining, adult supervision and discouraging double bouncing.     

Frequent users of the emergency department: a program to improve care and reduce visits

The authors describe a case-management program for frequent users of the emergency department. The study had a single-subject design, with evaluation for each patient of the number of visits to the emergency department for a 12-month period before referral to the program and a similar period after implementation of an individualized care plan. Referrals were made on the basis of 2 or more of the following criteria: chronic medical condition, complex medical condition, drug-seeking behaviour, violent behaviour and abusive behaviour. A multidisciplinary team developed the individualized care plans. Twenty-four patients agreed to participate. For the 12-month period before their referral, these patients accounted for a total of 616 (median 26.5) visits to the emergency department; for a similar period after implementation of the care plans, they accounted for 175 (median 6.5) visits. The difficult-case management program appeared to be effective in reducing the total number of visits to the emergency department during the study period and in improving the care for these patients.