住院患者出院计划实践工具的范围综述

目的 系统综述国内外住院患者出院计划实践工具相关研究及指南、政府文件。 方法 聚焦出院计划实践工具,系统检索中英文数据库和相关指南、政府网站,各类工具提取的信息包括：作者/发布机构、年份、国家/地区、工具名称、适用对象、工具内容简介和使用时机。 结果 沿患者入院至出院时间轴,将出院计划实践工具分为入院时-评估、住院期间-实施、出院前24 h-核查、出院时-转介和出院后-随访5个类别、共29个促进出院计划顺利实施的工具。 结论 建议卫生保健人员在综合和了解国外出院计划实践工具的基础上,制订和发展适合本国国情和医疗环境的出院计划实践工具,以标准化的工具有效推进出院计划的实施,优化患者结局,提升患者医疗护理服务的延续性。     

Quality management in general surgery: a review of the literature

IntroductionTotal quality management is a systematic approach focused on satisfying customers' expectations, identifying problems, analytically solving patient's problems and to implement continuous quality improvement.MethodSystematic review of the English language medical literature, using electronic search of the Pubmed, ProQuest and ScienceDirect databases with different combinations of the keywords: total quality management, healthcare, trauma, and minimally invasive surgery.ResultsThe assessment of outcomes in surgery represents a part of the quality assurance of patients' care. Usually, the surgeons have their own set of mental variables that can predict good and bad outcomes Surveys of complication rates and outcome are a poor substitute for quality control. For the reported complications it is impossible to know which complications are real (inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment. For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room.ConclusionsRomanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays European Union competitive market.     

Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis

The objective of this systematic review was to compare the effectiveness of individualized patient education interventions to standardized patient education interventions on the rate of readmission, performance of specific health behaviours, depression, anxiety, and cognition during the post-hospital discharge recovery period following cardiovascular surgery.Design and data sourcesRandomized controlled trials that included study participants who underwent their first bypass and/or valve replacement surgery; were eighteen years of age or older; and were recovering in the community.Review methodsFor all data analyzed, data was entered based on the principle of intention to treat. To be included in a given comparison, outcome data had to have been available for at least 80% of those who were randomized. Assessment of statistical heterogeneity was tested. Generic inverse variance methods based on random effects models were used to pool effect estimates across included studies.ResultsSeventeen trials involving 2624 study participants where individualized patient education was the primary interventional intent was included in this review. Four studies that included 930 participants reported on hospital readmissions. The sources of bias that remain unclear or were judged as containing high risk of bias most frequently across included trials were blinding of outcome assessment, incomplete outcome data, and selective reporting. An effect of the individualized patient education in reducing hospital readmission rates (Mean Difference: −1.28, 95% CI −1.87 to −0.68, p < 0.00), depression (Mean Difference: −23.32, 95% CI −23.70 to −22.95, p < 0.00), and anxiety (Mean Difference: −19.34, 95% CI −20.46 to −18.23, p < 0.00) was noted. While an increase in the performance of specific health behaviours (Mean Difference: 3.45, 95% CI 3.27–3.63, p < 0.00) and cognition (Mean Difference: 11.17, 95% CI 10.66–11.68, p < 0.00) was found. Most effect estimates were prone to statistical heterogeneity among the trials.ConclusionThe findings from this systematic review suggest favorable effects on the readmission rates. However, a major limitation notes in the current body of evidence relates to the small number of or even lacking number of trials for clinically important outcomes. As well, the individualized patient education intervention is effective in promoting statistically significant changes in quality of life, performance of health behaviours, depression, and anxiety.     

在腹部手术全麻患者中实施基于小组管理模式的预见性护理的效果

目的：分析在腹部手术全麻病人群体中实施预见性护理（基于小组管理模式）效果。方法：挑选2021年3月-2023年3月本院实施腹部相关手术的全麻病人共112例为此次试验的对象,随机将上述全部病人分成2组。对照组56实施常规的麻醉护理,研究组56予以预见性护理（基于小组管理模式）。比较两组静息期和苏醒期相关手术指标、苏醒期质量、苏醒期不良事件发生情况、术后恢复质量和护理满意度。结果：苏醒期心率、舒张压和收缩压均上升,且研究组心率和血压波动小于对照组（P＜0.05）;研究组意识情况、呼吸情况、循环情况、氧合情况以及活动情况得分均均高于对照组（P＜0.05）;研究组患者苏醒期不良事件发生率为5.36%明显低于对照组患者不良事件发生率17.86%（P＜0.05）;研究组心理支持、躯体舒适度、躯体独立性、疼痛情况和情绪状态得分均高于对照组（P＜0.05）;两组患者护理满意度比较无明显差异（P＞0.05）。结论：预见性护理（基于小组管理模式）应用于腹部手术全麻患者能有有效提高患者苏醒期质量和术后恢复质量,降低不良事件发生率,值得推广。     

Nurse-led interventions to manage hypertension in general practice: A systematic review protocol

AimThis systematic review seeks to synthesise randomised controlled trials reporting the impact of interventions delivered by nurses in primary care to enhance blood pressure control and minimise lifestyle risk factors in hypertensive patients.BackgroundGiven the growing demand for chronic care management, there has been a rapid increase in the primary care nursing workforce and emerging diversity in their roles. The primary care nurse’s role has evolved to work in collaboration with general practitioners to manage patients with chronic conditions like hypertension. Despite the nurse’s role in lifestyle modification and behaviour change, there is limited evidence exploring the impact of primary care nurse-initiated interventions for lifestyle modification in those with hypertension.Design/methodsA systematic review of randomised controlled trials will be conducted. Electronic databases will be searched from January 2000 to January 2019, using a structured search strategy. Two reviewers will review title and abstract, screen full-text papers and extract data. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) will be used to appraise study quality. Data will be synthesised using either meta-analysis or narrative synthesis depending on the heterogeneity of included studies.DiscussionThis review will assist in understanding the evidence available on the impact of general practice nurse interventions to manage hypertension. The findings will assist in informing effective nurse-directed interventions for controlling hypertension and will identify gaps in the literature for future research to address.     

Clinical review: How to optimize management of high-risk surgical patients

For many patients optimal perioperative care may require little or no additional medical management beyond that given by the anaesthetist and surgeon. However, the continued existence of a group of surgical patients at high risk for morbidity and mortality indicates an ongoing need to identify such patients and deliver optimal care throughout the perioperative period. A group of patients exists in whom the risk for death and serious complications after major surgery is in excess of 20%. The risk is related mainly to the patient's preoperative physiological condition and, in particular, the cardiovascular and respiratory reserves. Cardiovascular management of the high-risk surgical patient is of particular importance. Once the medical management of underlying disease has been optimized, two principal areas remain: the use of haemodynamic goals to guide fluid and inotropic therapy, and perioperative beta blockade. A number of studies have shown that the use of goal-directed haemodynamic therapy during the perioperative period can result in large reductions in morbidity and mortality. Some patients may also benefit from perioperative beta blockade, which in selected patients has also been shown to result in significant mortality reductions. In this review a pragmatic approach to perioperative management is described, giving guidance on the identification of the high-risk patient and on the use of goal-directed haemodynamic therapy and beta blockade.     

Facilitators and barriers for nurses in providing sexual education to myocardial-infarction patients: A qualitative systematic review

BackgroundMyocardial infarction (MI) greatly impacts an individual’s sexual health. It is reported that almost 40 to 80% population with MI are not able to resume their sexual routine after the illness due to organic or psychological sexual dysfunction. To reduce the prevalence of sexual dysfunction after MI, cardiac nurses are required to provide sexual counselling to their stable patients. However, this responsibility is seldom fulfilled by nurses due to several barriers. These barriers are not explicitly explored from the nurses’ perspective, which is necessary to understand in order to promote sexual counselling in cardiac health care settings.ObjectiveTo explore the facilitators and barriers of cardiac nurses in providing sexual education to post-MI patients.Design and methodA qualitative systematic review was undertaken by performing a systematic search from six databases along with search from reference lists of related studies.FindingsFour studies revealed 49 findings, which formed 10 categories and yielded four synthesised findings. These are: (1) Institutional Barriers such as lack of education, guidelines and material resources can prevent nurses from providing sexual education to MI patients; (2) Personal barriers such as uncertainty about the nurse’s role in sexual education, giving least priority to sexual counselling and lack of comfort with discussing sexuality can affect how nurses provide sexual education to MI patients; (3) Socio-cultural and religious barriers such as contradictory beliefs and gender differences can challenge nurses when providing sexual education to MI patients and (4) Nurses consider different strategies for addressing sexual education with MI patients, in individual or group settings.ConclusionTo promote sexual counselling, strategies are proposed by nurses, which can help in limiting barriers and facilitate in conducting counselling sessions. These strategies need to be validated from extensive research before implementing them into nursing practice.     

基于网络平台多学科参与的术前访视健康教育系统在普外科患者中的应用效果

目的探讨基于网络平台多学科参与的术前访视健康教育系统的构建及在普外科患者中的应用效果。 方法选择2018年1月至12月在中山市人民医院中心手术室行全身麻醉下普外科择期手术的患者为研究对象,按单双日分为试验组和对照组。实验组采用基于网络平台的多学科术前访视,共纳入630例患者;对照组采用常规术前访视,共纳入559例患者。通过视觉模拟量表评价2组患者访视前后的焦虑程度的改变情况,采用t检验比较组间差异。通过调查问卷评价2组患者的访视效果,应用χ²检验比较组间差异。通过满意度调查表对2组患者的满意度进行评价,采用秩和检验比较组间整体满意度的差异。 结果访视后试验组焦虑评分低于对照组［（1.69±1.19）分vs（3.23±0.93）分］,差异具有统计学意义（t=56.628,P<0.001）。针对访视效果的调查问卷,在是否了解手术麻醉的基本过程,是否了解麻醉风险,是否了解术后镇痛的相关知识,是否按照指引安排饮食,是否按照指引着装与穿戴、是否排空膀胱6项内容中,试验组均要高于对照组,差异均具有统计学意义（P均<0.05）。试验组满意度总体要高于对照组,差异具有统计学意义（Z=9.852,P<0.001）。 结论基于网络平台多学科参与的术前访视系统,能有效减轻患者的手术应激,改善访视效果,提高患者的满意度,提高手术室工作质量。     

The effectiveness of education in the recognition and management of deteriorating patients: A systematic review

BackgroundSurvival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown.AimThe aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness.MethodsA mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form.ResultsTwenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with > 87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44 h however one of the most educationally effective programs was based upon a 40 min simulation program.ConclusionEducational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes. In situ simulation has demonstrated sustained positive impact upon the real world implementation of rapid response systems. Outcome measures should include knowledge and skill developments but there are important benefits in understanding patient outcomes.     

Neuropathic pain in the general population: A systematic review of epidemiological studies

Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3–17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9–42.0/100,000 person–years [PY]), trigeminal neuralgia (12.6–28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3–72.3/100,000 PY), glossopharyngeal neuralgia (0.2–0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%.