Guidelines for a palliative approach for aged care in the community setting: A suite of resources

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.     

上海市中心城区居家临终患者生活状况及护理指导需求调查

选择2011年1月至2013年12月本社区诊断明确的恶性肿瘤患者、诊断明确的慢性病晚期生活失能患者及照护者各150例,采用自制定量问卷进行面对面调查.112例（74.7％）的照护者认为相对医院而言,患者本人更希望在家里接受护理;95例（63.3％）的照护者护理技术认知水平欠缺,照护技术能力较弱;97例（64.7％）照护者表示希望得到临终患者护理技术指导.说明居家临终关怀可以满足患者的身心需求,但需要社区医疗服务和资源的支持,借助居委会平台集中培训,提供居家照护的技能指导或疾病管理的相关信息支持;需要建立临终关怀互助小组,尽早建立护理规范.     

护理团队在手术室护理质量管理中的应用效果

目的：探讨护理团队对提高手术护理管理质量的效果。方法：将2013年1月至2013年12月在本院实施护理团队管理的80例手术患者设为观察组,将2012年1月至2012年12月实施常规性护理管理的80例手术患者设为对照组,分别于护理团队实施前后采用自行设计的护理质量调查问卷及患者满意度问卷了解患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分及满意度,并记录两阶段护理错差率。结果：与未实施护理团队相比,实施后患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分显著提高,差异有统计学意义（P〈0.05）。与未实施前相比,实施后配错药、文书归档错误、遵错医嘱、术后压疮发生率显著下降,患者满意度显著提高,差异有统计学意义（P〈0.05）。结论：对手术室实施护理团队管理模式能有效提高护理人员护理质量,降低护理风险,提高患者满意度,有利于建立和谐的护患关系。     

Value Driven Outcomes (VDO): a pragmatic,modular, and extensible software framework for understanding and improving health care costs and outcomes

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.     

糖尿病的护理

随着生活水平的提高,糖尿病的发病率越来越高。然而,糖尿病患者心理压力大,缺乏糖尿病的基本知识,导致自我护理能力差。需要对糖尿病患者进行自我护理指导,帮助患者制定治疗和护理计划,做好终生护理工作;维持血糖的稳定,控制并发症,提高糖尿病患者的生活质量。     

安宁缓和医疗志愿者培训平台建设

为了让全社会的普通大众,不论性别、年龄、职业、受教育程度,都能够了解安宁缓和医疗的核心理念,并运用在自己的生活当中,甚至传播并服务给更多人,北京协和医院安宁缓和医疗组于2021年成立了面向全社会的专业安宁缓和医疗志愿者培训平台。本文对安宁缓和医疗志愿者培训平台的培训设计、内容、方式和结果进行回顾性的梳理和总结,发现平台的培训设计有理论依据,培训内容逻辑完整,培训方法适宜志愿者,培训结果优异。安宁缓和医疗志愿者培训平台建设具有极好的可行性,需要进一步深入探索培训平台的有效性并拓展长期发展策略。     

An overview of neurocritical care in China: a nationwide survey

Background Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units （NICUs） across China. Methods The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated. Results Seventy-six questionnaires were returned （a 68% response rate）. Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half （53%） and one-third （33%-37%） of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs. Conclusion In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well- staffed NICUs across the nation currently.     

美国医疗保健经济演变历程及对我国启示

美国作为以市场配置资源著称的发达国家,其医疗保健演化和变革的探索历程,为人类积累了经验和教训,为国内着力优化配置医疗资源相关制度体系的深化设计提供了有益的启发和可贵的警示。本文旨在借"他山之石",结合国内医疗保健经济发展的现实,提取出对"健康中国"国家战略下未来相关制度发展的有益借鉴。     

伤口护理中的营养护理实践

现代伤口护理理论认为，营养护理应贯穿伤口护理的始终。实践证明，动态估计患者的营养状况，并区分营养不良的危险性和程度，是制订和实施个体化营养计划的基础；动态监测与评价营养状况是确保营养护理安全有效的重要环节。本文重点介绍有关伤口护理中营养护理的方法、内容、判断标准、监测指标及并发症预防。     

细节护理在儿科静脉穿刺中的应用

目的:探讨细节护理在儿科静脉穿刺中的应用效果。方法:将683例儿科住院患儿,按照治疗先后随机分为对照组和试验组。对照组给予常规护理,实验组实施细节护理,并对两组患儿输液结束后情况(静脉穿刺成功率、护理差错率及患者满意度等)进行比较分析。结果:试验组实施细节护理后,提高了护士静脉穿刺成功率和患者满意度,护理差错率明显降低,与对照组比较,差异有统计学意义(P<0.05)。结论:细节护理在儿科静脉穿刺中应用价值较高,可以提升患者满意度和护理质量,值得在临床中进一步推广与使用。     

人文关怀及心理护理在核磁共振检查中的应用

目的分析人文关怀及心理护理在核磁共振（MRJ）检查中的积极作用。方法选取2012年6月～2013年1月在东莞市太平人民医院接受MPJ检查的患者245例。对照组120例,给予常规护理;观察组125例,在此基础上辅以人文关怀及心理护理。对比2组SAg与SD9评分与护理效果。结果观察组SAS与SDS评分均显著低于对照组,差异有统计学意义（P〈0．05）;2组护理总有效率分别为96.80％、89．17％,观察组显著优于对照组,差异有统计学意义（P〈0.05）。结论在M刚检查中加强对患者的人文关怀与心理护理,可有效缓解患者负性情绪与提升护理效果,为MRJ检查顺利完成提供了可靠保证。     

嗜铬细胞瘤围手术期处理

报告１２例嗜铬细胞瘤，均经病理证实。就嗜铬细胞瘤的围手术期处理进行了讨论，认为以下几点是重要的：①充分的术前准备，包括控制血压、扩容、纠正心律失常，改善一般情况。②合理麻醉方式，术中轻柔操作及监测中心静脉压。③术后密切观察。并提出术前术中处理较术后处理更重要。     

急诊危重症患者40例转运过程中预见性护理分析

目的：研究急诊危重症患者40例转运过程中预见性护理效果。方法方便简单选取2015年3月-2016年3月该院接诊的40例急诊危重症患者作为该次研究对象。对照组患者在转运过程中采取常规护理,观察组患者在转运过程中采取预见性护理,观察两组患者实施不同护理后不良事件发生率情况、满意度比较。结果观察组不良事件发生率10.00%(2/20)小于对照组40.00%(8/20)(P<0.05);观察组家属满意度、科室满意度90.00%(18/20)、95.00%(19/20)均优于对照组60.00%(12/20)、50.00%(10/20)(P<0.05)。结论通过对40例急诊危重症患者转运过程中采取预见性护理后,认为预见性护理能够预见性发现问题,并采取正确的护理,能够有效的减少在转运过程中不良事件的发生。     

在中国开展姑息治疗与临终关怀会面临哪些挑战？

在美国,姑息治疗与临终关怀已经开展多年。然而,人口老龄化等问题的出现仍然使其开展面临挑战。在我国,癌症患者每年有200多万,其中2／3以上不能治愈。姑息治疗与临终关怀的开展使患者可以获得合理的治疗和妥善的安置。那么在我国开展姑息治疗与临终关怀会面临哪些挑战呢？本文针对中国在开展姑息治疗与临终关怀方面可能面临的问题展开讨论,期望能够引起同行们的争鸣。     

剑突—脐联体双胎分离手术前后的儿科处理初探

本文报导剑突至脐孔联体男婴一对,共重4400g,肝方叶呈实质性融合,各有独立的胆道系统和消化道。于生后28天行联体分离术获得成功,术中肝断离面为3cm×6cm。术后经过不平稳,大双曾患败血症,经积极处理,手术后58天,两婴健康出院。     

新医改与我国医疗卫生体制的公平性

医疗体制的公平是每个人基本权利的保证条件之一,我国经济快速平稳增长,医疗体制的公平性却不断受到质疑。在宏观形势与医疗体制自身需要的契机下,2009年中国开始了被称为"新医改"的医疗卫生体制改革。从医疗体制公平性角度,分析了改革方案中对医疗筹资、医疗支付和医疗服务机构3个方面的公平性考虑,提出加强累进性最强的税收筹资的力度,以及将财政资金更多地用于医疗需求方,即社会医疗保险的支持,以提高医疗筹资和支付的公平程度。坚持公立医院为主导,充分体现医院服务机构的公益性,也是改革方案中对公平性地体现,反映了新医改对公平性问题的高度关注。最后提出有待进一步明确的关于政府主导与市场调节的兼顾问题,农村医疗保障的完善、医疗筹资中公共资金的适度比例以及中医药的重新定位和重点发展。     

浅谈剖宫产术后的观察及护理

目的 探讨剖宫产术后护理方法及效果.方法 将收治的120例行剖宫产术的孕产妇,随机分为对照组和观察组,对照组采用常规护理方法,观察组根据患者病情采用个性化护理方式,分析两种护理方式的效果.结果 两组护理效果差异无统计学意义（P＞0.05）,观察组住院时间短于对照组,差异有统计学意义（P＜0.05）.结论 个性化护理效果好,住院时间明显缩短,可显著减轻患者经济负担,不良反应少,值得临床推广应用.     

心理护理在自然分娩孕妇产前护理中的应用

目的：研究心理护理在自然分娩孕妇产前护理中的应用。方法：将108例产妇随机分成两组,即对照组和实验组,每组54例,对照组采用常规护理方法,实验组在对照组基础上加强心理护理,比较两组产妇产程进展情况、分娩方式及产后出血及新生儿窒息情况。结果：实验组第一、二产程时间较对照组明显减少,差异具有统计学意义（P〈0.05）,实验组患者剖宫产术少于对照组,阴道分娩例数多于对照组,差异具有统计学意义（P〈0.05）,实验组产后出血、新生儿窒息少于对照组,差异有统计学意义（P〈0.05）。结论：产前心理护理能促进产妇自然分娩,减少产妇不良情绪,利于阴道分娩。     

常规护理和个性化护理在 120 例肱骨骨折患者中的应用效果对比疗效观察

目的：观察比较常规护理和个性化护理在肱骨骨折患者中的临床应用效果。方法：选取2010年3月-2013年4月来本院就诊治疗的120例肱骨骨折患者,按照随机数字表法将其分为对照组和观察组各60例,对照组采用常规护理,观察组则采用个性化护理,比较两组患者术后的疼痛视觉模拟评分（VAS评分）、焦虑（SAS）、抑郁（SDS）评分及护理质量评分差异。结果：观察组患者的术后VAS评分、SAS、SDS评分及护理质量较对照组均具有明显优势,比较差异均有统计学意义（P〈0．05）。结论：对肱骨骨折患者采用个性化护理可以明显改善患者的术后疼痛及焦虑、抑郁情况,明显提高护理质量,值得临床推广应用。     

个案护理管理计划在痴呆综合征护理中的应用

目的: 探讨个案护理管理计划在痴呆综合征患者护理中的应用效果。方法: 80例痴呆综合征患者随机分为观察组和对照组各40例。对照组给予常规护理干预;观察组在常规护理基础上采用个案护理计划,包括日常生活技能、记忆能力、逻辑思维与表达能力训练以及社交活动和心理护理。对比2组患者出院时主要护理问题的改善情况,并采用日常生活能力评定量表(ADL)和痴呆严重程度临床评定量表(WNS)分别评价2组患者入院和出院时日常生活能力以及痴呆严重程度。结果: 出院时,观察组的主要护理问题中不知饥饱、躁动不安、激越、昼夜颠倒、便秘等问题发生率均低于对照组(P<0.05～P<0.01),2组患者的妄想行为、两便失禁发生率差异均无统计学意义(P>0.05)。2组患者入院时ADL和WMS评分差异均无统计学意义(P>0.05);观察组出院时ADL评分降低程度明显大于对照组(P<0.01);观察组出院时WMS评分显著高于对照组。结论: 个案护理管理计划能够明显减少痴呆综合征患者的主要护理问题,提高护理效果及患者康复效果。