人性化优质护理在老年股骨颈骨折中的应用

目的探讨人性化优质服务在老年股骨颈骨折围术期的临床效果。方法对58例股骨颈骨折患者分别从术前、术后等多方面给予个体化护理,观察患者术后恢复情况。结果通过实施人性化优质护理,58例股骨颈骨折患者均手术顺利,切口I期愈合,术后未发生并发症,随访均能生活自理。结论人性化优质服务能有效预防老年股骨颈骨折围术期各种并发症的发生,值得临床推广。     

髋部骨折并糖尿病患者的围手术期处理

目的 探讨髋部骨折合并糖尿病患者围手术期的处理.方法 分析32例需行髋部骨折手术的糖尿病患者血糖控制及并发症的预防.结果 32例糖尿病患者手术过程顺利,术中、术后因合理使用胰岛素而血糖控制良好,均安全度过围手术期,无严重并发症发生.结论 对于糖尿病患者,术前较好地控制血糖,术中、术后积极监测及治疗糖尿病,使围手术期的血糖相对稳定,是手术成功及减少并发症的关键.     

Pharmacologic management of foot pain in the older patient

Foot pain, if not effectively managed, can result in significant disability and loss of function in older patients. This article reviews treatment strategies for acute and persistent pain, emphasizing new pharmacologic approaches. Indications, guidelines, and precautions for acute-pain treatment with acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, and opioids are discussed. Strategies for management of persistent pain using opioids, tricyclic antidepressants, gabapentin, and topical medications are reviewed. Common pain-management and prescribing errors are highlighted.     

Collaborative medication management services: improving patient care

OBJECTIVE: To implement and evaluate a collaborative medication management service model. DESIGN: Participatory action research. SETTING AND PARTICIPANTS: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated. INTERVENTIONS: A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented. OUTCOME MEASURES: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken. RESULTS: Overall, 2764 problems were identified. The most common medication-related problem (17.5% of all problems) was the need for additional tests. Thirty-seven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving". CONCLUSION: This implementation model was successful in engaging GPs and pharmacists and in assisting in the resolution of medication-related problems.     

人性化服务理念在门急诊管理中的具体应用

随着医疗环境和广大人民群众对医疗需求的不断变化，要求医院提供更加优质的人性化服务。我院一直本着“以人为本”、“医疗质量与安全第一”和“注重安全隐患”的服务宗旨，转变服务理念，提高门急诊管理水平，改进服务措施，满足百姓需求，推进我院门急诊医疗工作的发展。     

神经内科老年病人护理管理的要点分析

目的：分析探讨神经内科老年病人的护理管理要点,并根据分析结果进行护理。方法：回顾性分析该院神经内科发生护理不良事件的发生类型和发生率,根据相关情况提出护理评估并给予相关措施。结果：在经过有效的分析和改进后我院神经内科老年病人的不良事件发生率明显减低。结论：针对神经内科的老年病人,应根据患者自身的情况制定合理的具有针对性和安全性的护理管理方法,并结合神经内科的护理特点,才能有效的提高老年患者的安全管理效果,保证患者在住院期间的护理满意度。     

人工髋关节置换术治疗老年股骨颈骨折的护理体会

目的 总结人工髋关节置换术治疗老年股骨颈骨折患者的护理体会.方法 对32例老年股骨颈骨折患者行人工髋关节置换术,术前密切观察患者情况,加强营养,配合医生作好术前准备,术后针对人工关节置换术后主要并发症进行预见性护理.结果 32例患者均治愈出院.结论 人工髋关节置换术治疗老年股骨颈骨折后,进行综合性治疗护理,收到了良好的效果.     

Patient safety and medical errors: a focus on care transitions of the vulnerable older patient

The delivery of quality medical care includes the reduction of patient exposure to potentially adverse events that can lead to unnecessary suffering and disability or possibly death. Elderly patients residing in long-term care facilities are often transferred to emergency rooms for evaluation and management of an exacerbation of a chronic medical condition or an acute injury. Studies show that nursing home residents may be at higher risk for experiencing adverse medical events that lead to serious patient safety and quality of care concerns. These risks may be attributable to lack of effective communication among caregivers who help transition patients across acute care settings. This article reviews some of the challenges inherent in a complex system of care as elderly patients traverse healthcare settings and discusses the need to create system wide changes that will help prevent medical errors and improve patient safety for an at risk vulnerable population.     

人工髋关节置换术治疗髋部骨折内固定失败的 效果观察

目的 探究人工髋关节置换术治疗髋部骨折内固定失败的效果.方法 利用回顾性分析法,选取接受髋部骨折固定失败患者25例进行研究,对固定失败的原因进行分析,观察将人工髋关节置换术应用在患者治疗上的效果.结果 经过研究发现,髋部骨折内固定的失败原因主要有骨骼质量、复位不良、内固定技术使用错误等,进行Logistic回归性分析之后发现,骨折类型、骨折质量以及复位程度是造成髋部骨折内固定失败失败的独立危险因素,其中骨骼质量的回归系数为0.720,骨折类型的回归系数为0.421,骨折复位程度的回顾系数为1.350.在进行人工髋关节置换术之后,出现1例患者死亡现象.在经过6个月的随访之后,髋关节功能Harris评分、疼痛评分、行走评分、功能评分、活动评分别为(87.54±5.82)分、(31.27±2.47)分、(26.84±1.06)分、(15.87±1.63)分、(5.03±2.4)分,明显高于手术实施之前,差异具有统计学意义(P<0.05).结论 人工髋关节置换术应用在髋部骨折内固定失败患者的治疗中具有明显的治疗效果,能够有效改善患者的髋关节功能,值得临床推广应用.     

Primary care anticoagulant management using near patient testing

Background Indications for anticoagulant treatment are increasing and new approaches to anticoagulant services require a shift from hospital to primary care. Aim To pragmatically test the validity and effectiveness of primary care anticoagulant management using near patient testing. Methods Twelve CoaguCheck monitors were supplied to 16 rural practices that had previously provided supervision of anticoagulant therapy. Practices were required to record data for eligible patients from September 1998 to April 1999 and to forward one blood sample per week to the regional hospital laboratory for parallel testing. Results Nine practices returned data on 122 patients. Indications for anticoagulation included atrial fibrillation (n=56), valve replacement (n=12) and deep venous thrombosis or pulmonary embolus (n=12). Regression of the mean of 185 paired readings against their difference confirmed the validity of the CoaguCheck monitor (r2 = 0.00 [95% CI -0.38 to 0.38]). There were 692 International Normalised Ratio (INR) tests performed representing an average of 5.7 tests per patient. The desired therapeutic range was provided for 609 (88%) of these tests; 294 (48.3%) were within the desired therapeutic range. Results differed significantly between practices. Conclusions This study confirmed the validity of anticoagulant management using the CoaguCheck monitor in primary care.     

Neurosurgery in the older patient

The outcome of brain and spinal surgery has been assessed in 141 patients who were over the age of 65 at the time of operation. Patients tolerated investigation and surgery remarkably well and good results were obtained for benign lesions. Survival times and the contribution of surgery to reducing disability in malignant disease were disappointing.     

HIPAA and patient care: the role for professional judgment

Bernard Lo, MD; Laurie Dornbrand, MD, MPH; Nancy N. Dubler, LLB

JAMA. 2005;293:1766-1771.

Federal health privacy regulations, commonly known as the Health Insurance Portability and Accountability Act (HIPAA) regulations, came into effect in April 2003. Many clinicians and institutions have relied on consultants and risk managers to tell them how to implement these regulations. Much of the controversy and confusion over the HIPAA regulations concern so-called incidental disclosures. Some interpretations of the privacy regulations would limit essential communication and compromise good patient care. This article analyzes misconceptions regarding what the regulations say about incidental disclosures and discusses the reasons for such misunderstandings. Many misconceptions arise from gaps in the regulations. These gaps are appropriately filled by professional judgment informed by ethical guidelines. The communication should be necessary and effective for good patient care, and the risks of a breach of confidentiality should be proportional to the likely benefit for the patient’s care. The alternative for communication should be impractical. We offer specific recommendations to help physicians think through what incidental disclosures in patient care are ethically permissible and what safeguards ought to be taken. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy.