两表一书联用预防内科老年住院患者跌倒

目的减少老年患者住院期间意外跌倒的发生。方法自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表（两表一书）于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者：对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档。结果441例元1例发生跌倒意外。结论对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷。     

应用护理干预措施预防住院患者跌倒的研究

目的:探讨住院患者跌倒危险因素及规律,提高住院患者跌倒预防的实效.方法:建立住院患者跌倒评估表、预防措施表、宣教单、警示标志和使用流程,共同组成住院病人跌倒预防方案运用于临床,并对22600例住院患者进行回顾性调查分析.结果:经过对两年213例住院高危跌倒患者应用跌倒预防方案进行护理干预前后对比,全院住院患者跌倒发生率明显下降.结论:运用综合预防方案,采取必要护理干预措施,可以有效地预防住院患者跌倒的发生.     

基于患者参与框架的住院老年患者跌倒预防干预策略的实施

目的 探讨基于患者参与框架的住院老年患者跌倒预防干预策略的实施效果.方法 根据住院时间将2019年1～6月收治的58例老年患者作为对照组,2019年7?12月收治的58例作为观察组.对照组按常规实施预防跌倒措施,观察组基于患者参与框架制订并实施住院老年患者跌倒预防干预策略,包括"告知、参与、赋权、合作及电子化信息支持"...     

老年住院患者跌倒风险评估量表的构建及验证

目的构建老年住院患者跌倒风险评估量表并进行测评验证,考察其应用价值。方法采用专家问卷咨询、专家座谈会及病例(246例65岁以上老年住院患者)对照研究相结合的方式构建老年住院患者跌倒评估量表,运用SPSS20.0软件对量表进行信、效度检验,并与Morse跌倒评估量表比较预测准确性。结果老年住院患者跌倒风险评估量表共纳入14个大条目35个赋值子条目;内容效度(CVI)为0.916;量表总体Cronbach′sα系数为0.757;测量者间客观信度0.894;量表的ROC曲线下面积为0.980,Morse跌倒评估量表为0.927;老年住院患者跌倒风险评估量表总分21分、41分及60分时特异度分别为0.38、0.71及0.96;Morse跌倒评估量表总分25分、45分及80分时特异度分别为0.27、0.50及0.82。结论本次构建的老年住院患者跌倒风险评估量表有较好的信效度,对老年住院患者跌倒风险预测准确性好,可应用于临床。     

干预措施预防住院患者跌倒的实效研究

目的：探讨干预措施预防住院患者跌倒的实效。方法建立住院患者防跌工作计划,成立院防跌管理小组,分层次施行防跌工作知识培训．实施规范防跌护理程序,防跌干预措施启用和评定标准及指标以达到干预措施防跌的实效。结果全院住院患者跌倒发生率由7．55,万人下降到2．82／万人,严重伤害率由82．98％下降到63．42％;患者由宣教前平均掌握人次8．1％提高到76．6％,未掌握人次由51．9％下降到6．5％。护理人员能掌握相关知识由培训前30％提高到培训后82％,未掌握下降到0,陪护人员掌握防跌相关知识与年龄无关,但与学历和工龄有关联,培训前后有明显关联。结论综合性医院住院患者防跌采用干预措施降低了住院患者跌倒发生率和严重伤害率,宣教和指导是住院患者防跌回报率最高的措施,提高护理人员防跌意识和技能是降低跌倒发生率的关键,加强陪护人员教育培训和管理是住院患者防跌的保证。     

护理干预对老年住院患者跌倒预防知信行的影响

目的探讨护理干预对老年住院患者跌倒预防相关知识、态度及行为的影响。方法将420例老年住院患者随机分为对照组及干预组各210例。对照组患者采用跌倒预防常规护理,干预组在此基础上采取系统的护理综合干预,如编写发放老年患者跌倒预防知识图册,播放DVD宣教片,落实跌倒预防临床护理路径及流程;开展防跌倒教育课堂活动及防跌倒讨论分享会等。比较两组患者干预前后跌倒预防知识、态度、行为得分情况及跌倒的发生率。结果两组跌倒预防知识、态度及行为和跌倒发生率比较,干预组显著优于对照组及本组干预前,差异有统计学意义(均P<0.01)。结论护理综合干预在提高住院老年患者跌倒预防相关知识、态度、行为及降低跌倒发生率方面具有比较明显的效果。     

老年人跌倒的预防

在老年人群中由跌倒引发的损伤与老年人的发病率和死亡率密切相关，预防老年人跌倒对维系老年人生活质量具有重要意义。流行病学显示欧美等国居住在社区的65岁以上的老人每年有30％∽40％发生跌倒，长期生活在保健机构的老人有近半数的老人出现过跌倒；而日本和中国调查结果则低于20％。老年人的跌倒与年龄、性别、种族和功能水平(日常生活活动能力和日常生活独立活动能力)有关。跌倒的危险因素存在多因性，其中内因包括：生理学因素、病理、药理和心理因素；外因有老年人穿鞋的情况和环境因素。因此，预防老年人跌倒需从病史问诊、标准的体格检查和步态及平衡能力检查进行全面的评估；对处于不同类别危险因素的个人，最有效的干预措施应是多元化干预和个体化指导相结合。干预措施包括：①治疗相关疾病；②重新评估并调整所服药物；③纠正不良环境因素并补充有利平衡的辅助支持条件；④针对改善肌肉力量、平衡性和步态实施训练计划；⑤健康教育；⑥医疗保健人员对干预中再次发生的跌倒进行再评估；⑦利用政府和社会的力量保障及时到位的保健能力。     

预防跌倒管理流程在住院患者中的应用

目的 探讨预防跌倒管理流程在住院患者中的应用效果,保证患者安全.方法 对9个病区6 840例住院患者实施预防跌倒管理流程,包括全面评估、高危跌倒标识醒目、对高危跌倒患者采取有效预防措施、加强对患者及家属的健康教育、制订住院患者应急预案等.结果 实施预防跌倒管理流程后住院患者跌倒率由3.80‰下降至0.15‰,护理服务质量显著提高(均P＜0.01),患者满意度由90.80%上升至98.10%.结论 预防跌倒管理流程可以有效地预防住院患者跌倒,但尚需不断提高护士心理护理水平,制订更为有效的跌倒危险评估工具,提高后勤保障能力.     

预防住院患者跌倒的护理质量控制

目的减少住院患者跌倒发生率。方法成立住院患者跌倒预防管理小组,制定住院患者跌倒预防的管理流程,每月随机检查有跌倒风险住院患者的护理质量,对发生跌倒患者进行根本原因分析,针对跌倒原因改进管理方法和工作流程,并对护理人员进行跌倒预防相关知识培训。结果实施前全院跌倒发生率为0.094%,实施后下降至0.044%,实施前后比较,差异有统计学意义(P0.05);实施前后均未发生因跌倒引发的护理纠纷。结论对住院患者实施预防跌倒护理质量控制,规范了跌倒预防的管理流程,提高了护士跌倒预防相关知识和技能,降低了住院患者跌倒发生率。     

预防住院患者跌倒的护理质量控制

目的减少住院患者跌倒发生率。方法成立住院患者跌倒预防管理小组,制定住院患者跌倒预防的管理流程,每月随机检查有跌倒风险住院患者的护理质量,对发生跌倒患者进行根本原因分析,针对跌倒原因改进管理方法和工作流程,并对护理人员进行跌倒预防相关知识培训。结果实施前全院跌倒发生率为0.094%,实施后下降至0.044%,实施前后比较,差异有统计学意义（P〈0.05）;实施前后均未发生因跌倒引发的护理纠纷。结论对住院患者实施预防跌倒护理质量控制,规范了跌倒预防的管理流程,提高了护士跌倒预防相关知识和技能,降低了住院患者跌倒发生率。     

Recurrent Falls Among Elderly Patients and the Impact of Anticoagulation Therapy

Background

Falls are the leading source of injury and trauma-related hospital admissions for elderly adults in the USA. Elderly patients with a history of a fall have the highest risk of falling again, and the decision on whether to continue anticoagulation after a fall is difficult. To inform this decision, we evaluated the rate of recurrent falls and the impact of anticoagulation on outcomes.

Methods

All patients of age ?≥?65 years and hospitalized for a fall in the first 6 months of 2013 and 2014 were identified in the nationwide readmission database, a nationally representative all-payer database tracking patient readmissions. Readmissions for a recurrent fall within 6 months, and mortality and bleeding injuries (intracranial hemorrhage, solid organ bleed, and hemothorax) during readmission were identified. Logistic regression evaluated factors associated with mortality on repeat falls.

Results

Of the 331,982 patients admitted for a fall, 15,565 (4.7%) were admitted for a recurrent fall within 6 months. The median time to repeat fall was 57 days (IQR 19–111 days), and 9.0% (1406) of repeat fallers were on anticoagulation. The rate of bleeding injury was similar regardless of anticoagulation status (12.8 vs. 12.7% not on anticoagulation, p?=?0.97); however, among patients with a bleeding injury, those on anticoagulation had significantly higher mortality (21.5 vs. 6.9% not on anticoagulation, p?<?0.01).

Conclusion

Among patients hospitalized for a fall, 4.7% will be hospitalized for a recurrent fall within 6 months. Patients on anticoagulation with repeat falls do not have increased rates of bleeding injury but do have significantly higher rates of death with a bleeding injury. This information is essential to discuss with patients when deciding to restart their anticoagulation.

     

Comprehensive Interventions Including Vitamin D Effectively Reduce the Risk of Falls in Elderly Osteoporotic Patients

ObjectiveTo evaluate the effects of different intervention measures to prevent falls in elderly osteoporotic patients.MethodsA randomized controlled trial was conducted in our outpatient ward from August 2014 to September 2015. A total of 420 patients over 60 years of age were assigned to four groups. NA VitD group took 800 mg calcium and 800 IU non‐active vitamin D. P‐NA VitD group took 800 mg calcium, 800 IU non‐active vitamin D, and received physical exercise. A VitD group took 800 mg calcium and 0.5 μg active vitamin D. P‐A VitD took 800 mg calcium, 0.5 μg active vitamin D, and received physical exercise. Physical exercise includes guidance in improving muscle strength and balance ability. Short physical performance battery (SPPB), grip strength, modified falls efficacy scale (MFES), blood calcium, and 25‐hydroxyl vitamin D were measured before interventions and at 3, 6, and 12 months after interventions. Bone mineral density (BMD) was detected before interventions and at 12 months after interventions. The incidence of falls and fractures, adverse events, and drug reactions were recorded for 12 months.ResultsA total of 420 patients were allocated in the four groups: 98 cases into the NA VitD group (11 males, 87 females), 97 cases into the P‐NA VitD group (13 males, 84 females), 99 cases in the A VitD group (15 males, 84 females), and 98 cases into the P‐A VitD group (11 males, 87 females). At 6 months after interventions, the SPPB of A VitD group significantly increased from 6.9 ± 1.9 to 8.0 ± 2.4 (P < 0.05), and the SPPB of A VitD group significantly increased from 7.2 ± 2.1 to 8.6 ± 1.7 (P < 0.05). At 6 months after interventions, MFES of P‐NA VitD group 7.0 ± 1.6 to 7.6 ± 1.6 (P < 0.05), and MFES of P‐A VitD group significantly increased from 6.7 ± 1.6 to 7.5 ± 1.6 (P < 0.05). At 12 months after interventions, SPPB of all groups, grip strength, and MFES of P‐NA VitD group, A VitD group, P‐A VitD group were significantly improved (P < 0.05). The BMD of lumbar vertebrae of A VitD group significantly increased from 0.742 ± 0.042 to 0.776 ± 0.039, and P‐A VitD group significantly increased from 0.743 ± 0.048 to 0.783 ± 0.042 (P < 0.05). No serious adverse events occurred during the 12 months of follow‐up.ConclusionActive vitamin D is better than non‐active vitamin D to improve physical ability and the BMD of lumbar vertebrae and reduce the risk of falls.     

A Randomized Trial of Modified Prolonged Exposure to Prevent the Development of Posttraumatic Stress Disorder in Patients Hospitalized With Traumatic Injuries

Individuals who require hospitalization after traumatic injuries are at increased risk for developing posttraumatic stress disorder (PTSD); however, few early behavioral interventions have been effective at preventing PTSD within this population. The aim of this pilot study was to assess the feasibility and effectiveness of modified prolonged exposure therapy (mPE) to prevent PTSD and depression symptoms among patients hospitalized after a DSM‐5 single‐incident trauma. Hospitalized patients were eligible if they screened positive for PTSD risk. Participants (N = 74) were randomly assigned in a parallel‐groups design to receive mPE (n = 38) or standard of care treatment (SoC; n = 36) while admitted to the hospital after a traumatic injury. Individuals randomized to the intervention condition received one (42.1%), two (36.8%), or three sessions (15.8%) of mPE, mainly depending on length of stay. There were no significant differences between groups regarding PTSD or depression severity at 1‐ or 3‐months posttrauma, except for more PTSD diagnoses in the intervention group after 1 month, ? = ?.326. Intervention differences were nonsignificant when we took baseline PTSD symptoms and the nonindependence of the repeated measurements within the data into account. No adverse events were reported. Overall, mPE was no more effective than SoC for hospitalized, traumatic injury survivors with a high PTSD risk. The results may point to a need for a stepped‐care approach, where intervention protocols focus on first briefly treating individuals who are actively exhibiting acute stress reactions, then extensively treating those whose symptoms do not decrease over time.     

Characteristics of Falls and Risk of Hip Fracture in Elderly Men

The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture. In this case–control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7–302). Hitting the knee in a fall was associated with reduced risk (OR = 0.24; 95% CI = 0.09–0.67). Other factors that were associated with reduced risk of hip fracture among men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73–0.97, for each additional 4 h per week), a greater body mass index (OR = 0.60; 95% CI = 0.40–0.90, for each additional 4 kg/m²), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10–0.69). Reported lower limb dysfunction was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09–19.6) among fallers. The increased risk associated with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength training programs may also reduce the risk of hip fracture among men who fall. Received: 12 May 1997 / Accepted: 14 October 1997     

102例老年临终住院患者生活质量及其影响因素分析

目的了解老年临终住院患者的生活质量(QOL)及其影响因素.方法对102例临终患者的生活质量情况,以社会支持、生活满意度(LSIA)、焦虑抑郁(HAD)、疼痛程度(VRS)、日常生活活动指数(ADL)等评分作为相关因素进行调查及多元逐步回归分析.结果QOL与ADL及社会支持总分呈正相关,与HAD及VRS呈负相关.结论老年临终住院患者QOL受多种因素的影响,应针对性地给予临终关怀措施,提高生活质量.     

102例老年临终住院患者生活质量及其影响因素分析

目的了解老年临终住院患者的生活质量(QOL)及其影响因素。方法对102例临终患者的生活质量情况,以 社会支持、生活满意度(LSIA)、焦虑抑郁(HAD)、疼痛程度(VRS)、日常生活活动指数(ADL)等评分作为相关因素 进行调查及多元逐步回归分析。结果QOL与ADL及社会支持总分呈正相关,与HAD及VRS呈负相关。结论 老年临终住院患者QOL受多种因素的影响,应针对性地给予临终关怀措施,提高生活质量。     

中老年自发性气胸2种手术方法的比较

目的探讨2种手术方法在中老年自发性气胸中的临床应用价值。方法1997年11月~2007年1月我科对38例单侧中老年气胸行肺大疱切除及胸膜固定术,其中小切口手术20例,胸腔镜手术18例。结果2组手术均获成功,无手术死亡及严重并发症发生。小切口组手术费用(1593.4±411.0)元明显低于胸腔镜组(2357.2±255.8)元(t=6.786,P=0.000),小切口组术后住院时间(14.4±14.1)d明显长于胸腔镜组(9.0±8.2)d(U=95.500,P=0.012),小切口组手术时间、哌替啶用量、术后第1天氧分压、术后第1天二氧化碳分压与胸腔镜组无显著差别(P>0.05)。胸腔镜组16例随访20~88个月,平均42.9月,无复发;小切口组18例随访18~71个月,平均41.2月,无复发。结论2种手术方法在中老年气胸的治疗中效果满意,但首选胸腔镜手术。