风险评估管理在医疗器械消毒供应中心的应用

目的 探讨风险评估管理在医疗器械消毒供应中心的应用效果。 方法 选取2017年1-3月消毒供应中心采用传统消毒管理模式时抽取的300件器械作为对照组,将2017年4-6月实施风险分级管理模式时抽取的300件器械作为观察组,2组均启用专业质控员,采用目测法、放大镜法、ATP法检测灭菌合格率检测。比较2组医疗器械灭菌合格率。结果 观察组的灭菌合格率明显高于对照组(χ²=34.713,P＜0.001)。 结论 消毒供应中心对医疗器械采用风险评估管理,能明显提高医疗器械灭菌合格率,降低医疗感染的风险,值得推广。     

Methodological problems in comparing audits from the Nordic countries. A critical review of results from audit on Nordic general practitioners' management of patients with psychiatric problems

The language of risk has many meanings, and in this article we demonstrate a discrepancy between individually perceived risk and the medical understanding of risk as understood and communicated by general practitioners (GPs). Risk is experienced and interpreted by people in a cultural context, i.e. the same objective risk can be perceived in many different ways and given a different meaning in daily life. GPs' evaluation of risk is made on the basis of our epidemiological knowledge, the medical culture of risk perception and the GP's personal experience and interpretation. The theoretical focus in the article is a synthesis of two theories: patient-centred general practice and theory based in anthropology about risk as culturally and socially constructed. We use empirical data from a qualitative study to illuminate the discussion.     

实施风险管理提高护理安全与质量

通过运用风险管理理念实施风险管理,防范或减少护理缺陷的发生以保证护理安全与工作质量的持续改进。首先进行全员培训,强化意识,提高防范能力。定期分析可能引起护理安全风险的相关因素,制定防范措施。同时,建立安全管理的考核制度,提高系统的实效性,推动护理质量的控制与持续改进。     

英美加澳和中国台湾地区医疗风险管理方法与评估工具的比较研究

目的 比较英美加澳与中国台湾地区医疗风险管理方法与评估工具,为我国医疗风险管理提供决策依据和政策建议.方法 计算机检索英美加澳与我国台湾地区政府机构和行业协会或学术团体的官方网站,查找并纳入与医疗风险管理与监测相关的法律、规范性文件、研究报告、综述和评价表格等,而后采用描述性对比分析方法,综合比较上述四国一区医疗风险管理方法与评估工具.结果①共纳入17篇规范性文件,41篇指南,37篇综述和49篇一般信息,共计146篇文献;②英国采用整合风险管理,澳大利亚和台湾采用经典风险识别、分析、评估与控制方法,美国和加拿大采用前瞻性FMEA方法识别与评估临床风险;③在医疗风险评估分级方面,英、澳将医疗风险严重程度分为5级,台湾分为6级;发生频率均分为5级;应对响应均按4级标准.④四国一区RCA分事件对象略有不同,RCA步骤与工具基本一致.结论 英美加澳与我国台湾地区主要采取前瞻性风险评估、基于已发生不良事件的风险评估及整合风险管理三种医疗风险管理模式,且评估工具相同;英、澳和我国台湾地区临床医疗风险分级大致相同,但分级定义有差异;四国一区不良事件分析方法与过程基本一致.     

实施风险防范预案降低护理风险事件的效果评价

目的 降低风险事件发生率,提高护理质量及风险防范能力.方法 分析护理风险事件产生的原因,制定相关的风险防范预案,比较实施前后的效果.结果 2组在风险事件发生率、服务满意率以及夜班风险事件发生率上有统计学意义(P<0.05);在具体的风险事件类型方面,2组在治疗执行不当、医嘱处理不当、不规范护理记录发生率上有统计学意义(P<0.05);在护理投诉、意外事件发生率上无统计学意义(P>0.05).结论 实施风险防范预案能降低护理风险事件的发生率,提高护理质量及病人满意率.     

Medical doctors' perception of the "number needed to treat" (NNT)

The "number needed to treat" is assumed to be readily understood, but empirical evidence to support this assumption is sparse. 72% of medical doctors recommended a preventive drug therapy when NNT was 50 compared to 52% when NNT was 200. 77% of doctors recommending against a preventive drug therapy thought that only one out of NNT patients benefits from therapy. Since this assumption may be misleading, we suggest that the NNT should be used with caution in clinical practice. Objective &#114 - &#114 While the number needed to treat (NNT) is in widespread use, empirical evidence that doctors or patients interpret the NNT adequately is sparse. The aim of our study was to explore the influence of the NNT on medical doctors' recommendation for or against a life-long preventive drug therapy. Design &#114 - &#114 Cross-sectional study with randomisation to different scenarios. Setting &#114 - &#114 Postal questionnaire presenting a clinical scenario about a hypothetical drug as a strategy towards preventing premature death among healthy people with a known risk factor. Benefit after 5 years of treatment was presented in terms of NNT, which was set at 50 for half of the respondents and 200 for the other half. Subjects &#114 - &#114 Representative sample (n=1616) of Norwegian medical doctors. Main outcome measures &#114 - &#114 Proportion of doctors that would prescribe the drug. Reasons for recommending against the therapy. Results &#114 - &#114 With NNT set at 50, 71.6% (99% CI 66.8-76.4) of the doctors would prescribe the drug, while the proportion was 52.3% (99% CI 47.5-57.1) with an NNT of 200 ( &#104 2 =50.7, p<0.001). Multivariate logistic regression analysis indicated that the effect of NNT on the likelihood for recommending the therapy was age-dependent; young doctors (<36 of age) were more sensitive to the difference in NNTs than older doctors. Thirty-six percent (n=464) of the doctors would not prescribe the drug, and 77.4% (99% CI 68.5-86.2) of those agreed with an argument stating that only one out of NNT patients would benefit from the treatment. Conclusion &#114 - &#114 Medical doctors appear to be sensitive to the magnitude of the NNT in their clinical recommendations. However, many doctors believe that only one out of NNT patients benefits from therapy. Clinical recommendations based on this assumption may be misleading.     

住院患者静脉血栓栓塞症的风险评估:护理的价值

静脉血栓栓塞症(VTE)是住院患者常见的并发症之一,住院患者可能存在VTE高危因素。护理作为VTE防治的重要组成部分,护士应准确识别危险因素、及时正确进行VTE风险评估,采取恰当的预防措施对预防VTE意义重大。     

呼吸内科猝死患者原因分析与护理

对呼吸内科2006～2009年38例猝死患者的原因进行回顾性分析,发现猝死原因主要有气道阻塞、用力大便、肺栓塞、重度电解质紊乱等.针对猝死原因,对2010年1月至2011年8月的患者进行全面的评估,同时与临床医生合作,采取护理干预措施和针对性管理,结果减少了猝死风险的发生率.     

护士主导的心血管疾病高危人群发病风险沟通策略研究进展

对国外心血管疾病高危人群发病风险沟通团队构成、护士主导的心血管疾病高危人群发病风险沟通策略及沟通流程进行综述,以期为护士开展心血管疾病高危人群发病风险沟通理论研究及实践工作等提供借鉴和参考.     

Assessment of the accuracy of the CALCULATE scale for pressure injury in critically ill patients

IntroductionPressure injury is damage to the skin and underlying soft tissue that occurs in response to intense and/or prolonged skin pressure. The Braden scale is the most used in health services to assess pressure injury. However, this scale was not specifically developed for critically ill patients. The Critical Care Pressure Ulcer Assessment Tool Made Easy (CALCULATE) scale was developed for patients in intensive care units.ObjectiveThe objective of this study was to compare the accuracy of the CALCULATE scale with that of Braden in predicting the risk of pressure injury in critically ill patients.MethodsThis was a prospective cohort study, involving patients who did not have pressure injury on admission to the intensive care unit of a tertiary hospital in the city of Porto Alegre, Brazil. Data collection took place between January and July 2020 using the Braden and CALCULATE scales, in addition to clinical and sociodemographic variables. Patients were followed up until discharge from the intensive care unit or death.ResultsFifty-one patients were included in the study. Of these, 29 (56.9%) developed pressure injury. To predict pressure injury onset, the areas under the receiver operator characteristic curve of the Braden scale on the first day and the lowest score during the first 3 days were 0.71 (0.56–0.86) and 0.70 (0.53–0.87), respectively. The areas under the receiver operator characteristic curve of the CALCULATE scale on the first day and the highest score during the first 3 days were 0.91 (0.82–0.99) and 0.92 (0.85–1.00), respectively. In the logistic regression analysis, the CALCULATE scale on the first day remained an independent predictor of pressure injury onset after controlling for age and length of stay in the intensive care unit.ConclusionWe found that the CALCULATE scale may be more accurate than the Braden scale as a tool to assess the risk of developing pressure injury in critically ill patients.     

Perception of cardiovascular risk following a percutaneous coronary intervention: a cross sectional study

Background

An individual's perception of the risk of, and their susceptibility to, future cardiovascular events is crucial in engaging in effective secondary prevention.

Aim

To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk.

Methods

This study examined the individual's perception of the risk of a subsequent cardiac event among 220 patients hospitalised for a percutaneous coronary intervention (PCI) at a metropolitan, tertiary referral hospital in Sydney, Australia. Baseline clinical and demographic characteristics were collected, and actual risk (Personal Risk Score) calculated based on the presence or absence of nine cardiovascular risk factors: diabetes, hypertension, high cholesterol, cigarette smoking, previous history of CHD, family history of CHD, depression, overweight or obesity, and physical inactivity. Perception of risk was determined using an investigator-developed 4-item, 11-point Likert scale instrument (Perceived Heart Risk Questionnaire - PHRQ) which measured two dimensions of health threat: perceived seriousness, and perceived susceptibility. The correlation between the Personal Risk Score and the PHRQ was assessed using the Pearson product-moment correlation coefficient.

Results

The calculated mean Personal Risk Score was 4.63 ± 1.71 and the PHRQ was 25.5 ± 7.04. The correlation between the Personal Risk Score (actual risk) and the PHRQ (perceived risk) was r = 0.26 (p < 0.01).

Conclusions

The weak relationship between actual and perceived risk is of concern, particularly in a population at higher risk for future cardiovascular events. Implementing strategies to personalise risk should be explored to improve the accuracy of risk perception, and facilitate tailoring of behaviour change strategies.     

Febrile neutropenia risk assessment tool: Improving clinical outcomes for oncology patients

PurposeTo develop, implement and evaluate the effectiveness of a nurse-led risk assessment tool to reduce the incidence of febrile neutropenia (FN) and evaluate the nurse's role in FN risk assessment in a hospital-based oncology unit.Methods and sampleA FN risk assessment tool was developed, implemented and evaluated. A comparative prospective observational chart review was undertaken to evaluate the tool. Clinical data were collected from 459 patients' records from August 2008 through July 2009. Patients had no intervention during the first six months (n = 233). Patients in the following six months (n = 226) had the FN risk assessment completed and appropriate granulocyte-colony stimulating factor prescribed. A self-questionnaire was utilised to evaluate the nurses' role in FN risk assessment.Key resultsThe incidence of FN was reduced by 52% (p = 0.02). Hospital days, dose reductions and treatment delays were reduced. Nurses felt they were the most appropriate person to carry out the assessment.ConclusionsThrough consistent risk assessment, nurses could determine which patients were at high risk of developing FN leading to significant reduction in life-threatening infections, hospitalisations, dose reductions and delays. Nurses can be confident and competent in decision-making to reduce life-threatening infections through the use of an FN risk assessment tool.     

Nurses' and students' perception of risk from medical practices

ObjectivesTo determine the risk perceptions of a series of medical practices in non-expert (undergraduates) and expert (nurses) samples.MethodsFour hundred and forty-seven nurses and 246 undergraduate students participated in this study. They all answered questionnaires about the risk dimensions and acceptance for medical practices.ResultsAn exploratory factor analysis on participants' answers to various dimensions of risk yielded a two-factor structure for risk perception in both samples: for nurses, the factors were “Unknown” and “Dread,” while for students, they were “Dread” and “Lack of Independence.” For both nurses and students, the factor scores of Dread negatively related to individual risk acceptance of medical practices. Furthermore, nurses tended to be more accepting of practices that they knew well (i.e., low Unknown scale scores). For students, the subscale scores of the Lack of Independence factor negatively related to individual risk acceptance only for health examination practices. Nurses conceived risks more correctly and concretely compared to students. This was especially pronounced for practices related to medication use.ConclusionsAlthough both nurses and students conceived various risk contents from medical practices, their conceptions still differed. Knowledge of these differences in the structure of risk perception and conceived risk contents of various medical practices between nurses and students could be utilized to improve risk communication in clinical practice.     

正常高值血压与心血管危险因素的分析

目的：观察正常高值血压者与心血管危险因素之间的关系及其进展为高血压的危险因素。方法选取内蒙古自治区3年以上常住居民年龄20～59岁的正常高值血压伴心血管危险因素者共1112例,对所有研究对象收集年龄、身高、体质量、血压及心率等临床资料;采空腹血测定血脂、血糖、 hsCRP等生化指标。分别进行偏相关分析、多元逐步回归分析、 Logistic逐步回归分析。结果与结论①正常高值血压者收缩压与年龄、心率、甘油三酯、空腹血糖呈正相关;舒张压与年龄、心率、饮酒呈正相关;②年龄、心率、甘油三酯、家族史是收缩压的主要影响因素;年龄、性别、心率、 BMI、饮酒、家族史是舒张压的主要影响因素。③甘油三酯、 hsCRP 、饮酒、收缩压的增加是收缩期进展为高血压的主要危险因素, OR 值分别为1.967、1.377、2.197、1.995; BMI、hsCRP、饮酒、家族史及收缩压、舒张压的增加是舒张期进展为高血压的主要危险因素, OR值分别为1.516、1.847、0.234、2.908、1.749、1.600。     

Risk: a concept analysis

TOPIC: Concept analysis of risk. PURPOSE: To analyze the concept risk and provide a new definition of risk. SOURCES: Published literature. CONCLUSIONS: A new definition of risk that emerged from this concept analysis can provide clarity and direction for future research. Nurse researchers can look to this definition to expand what is known about health-seeking behaviors as opposed to "risk" behaviors and seek to further our understanding of the cognitive and experiential process of risk identification.     

合肥市公务员高血压患病危险因素调查

目的　通过合肥市公务员健康体检 ,分析高血压病患病的危险因素。方法　以 2 0 0 0年合肥市公务员体检中诊断为高血压病的 793例患者作为高血压组 ,在无高血压者中随机抽取 10 4 5例作为对照组 ,对年龄、性别、体重指数 (BMI)、空腹血糖 (FBG)、血脂、吸烟等因素进行比较研究。结果　 6 94 6例被检人群中高血压患病率随年龄增加而增加 ,至 80岁以上有所下降 ,以 6 1～ 80岁组最高 ,为 2 1 9%。男性高于女性。比较高血压组与对照组年龄、性别构成、体重指数、血糖、血脂、吸烟史、高密度脂蛋白 (HDL) ,发现年龄、性别、体重指数、血糖、甘油三脂 (TG)在病例组和对照组间差异有统计学意义。而胆固醇、吸烟史、高密度脂蛋白两组差异无统计学意义。Logistic回归分析表明进入回归模型的研究因素有年龄、性别、BMI、血糖、HDL。其中年龄、性别、BMI、血糖、TG可能是高血压的危险因素 ,HDL是保护因素。结论　超重和肥胖、血糖升高、高甘油三脂血症是高血压病的危险因素     

淮南地区急性脑血管病患者的危险因素分析

[目的]探讨脑血管病的流行病学特征以及各种危险因素对不同类型卒中的影响,观察淮南地区人群脑血管病的发病特点.[方法]连续收集从2008年6月至2010年4月首次发病入院且资料完整的急性脑血管病患者773例,其中缺血性684例,出血性89例.分析卒中患者的发病年龄、分型特点及危险因素等.[结果]淮南地区773例首发卒中患者的平均发病年龄为(64.96±11.86)岁,其中出血性卒中组平均年龄显著低于缺血性卒中组(P＜0.001),男性卒中患者的平均发病年龄显著低于女性卒中患者(P＜0.01).缺血性卒中发病高峰年龄为60～79岁,出血性卒中发病高峰年龄为45～64岁,两者有显著性差异(p＜0.001).高血压是出血性和缺血性卒中的首要危险因素,其次为吸烟、饮酒、心脏病和糖尿病史.入院首次血压(收缩压和舒张压),出血性卒中组均显著高于缺血性卒中组(P ＜0.001).高血压史、吸烟史、饮酒史在出血性卒中组出现的频率均高于缺血性卒中组(P＜0.01、P＜0.05、P＜0.01).出血性卒中组血清高密度脂蛋白显著高于缺血性卒中(P＜0.001).本组患者就诊距发病时间＜24 h者出血性卒中约占75.0％～82.4％,缺血性卒中占48.8％～ 57.3％.[结论]淮南地区出血性卒中发病高峰年龄明显小于缺血性卒中,与国内多数报道一致;高血压是导致各类卒中的重要危险因素;血清高密度脂蛋白胆固醇增高、吸烟、饮酒与出血性卒中密切相关.     

静脉血栓性疾病112例临床分析

回顾112例静脉血栓性疾病(VTD)栓塞的部位,其中四肢深静脉53例,门静脉35例,肠系膜静脉12例,脾静脉4例,门静脉合并脾静脉5例,下腔静脉3例。重点分析了肺栓塞、肾静脉以外的112例VTD患者的临床特点,血栓形成的诱因,如恶性肿瘤、手术、外伤骨折、血管炎、妊娠、糖尿病、高血压病等,纠正危险因素和对高危患者给予适当的预防措施有助于防治VTD。     

偏头痛多种危险因素的分析

目的：研究偏头痛的危险因素。方法：用1：1配对对照的方法进行单因素分析,再用Mc Nemar‘s test公式计算卡方,求得P值,并计算相对危险度。结果：家族遗传史、过敏性疾病史,在病例组与对照间有非常 显著性;睡眠不足、夜间工作,病例组与对照组间有显著性差异。结论：家族遗传史、过敏性疾病史是偏头痛的危险因素。     

老年人跌倒的有关危险因素分析

目的调查和分析与老年人跌倒有关的危险因素.方法调查60岁及以上的老人415例,运用访谈、观察和查阅病历的方法收集资料,对各种因素进行单因素和多因素分析,并分析被筛选出的危险因素的相关特征.结果ADL和行走能力测定为“不能独自活动”和居住安排为“独居”是跌倒的危险因素.不能独自活动者多在家中跌倒,且跌倒多与身体因素有关,近一半的跌倒与环境因素有关.独居者的相关特征是高龄、寡(鳏)居、以及居家环境中危险因素较多.婚姻状况中的“寡(鳏)居”和智力测验中的“智力损害”为跌倒的危险因素,但未能进入logistic回归模型.结论“不能独自活动”和“独居”为跌倒的危险因素;“寡(鳏)居”和“智力损害”可能为跌倒的间接危险因素;环境危险因素是跌倒的重要因素.建议进一步研究某些因素,如高龄、寡(鳏)居、智力损害、某些慢性病、虚弱等,是否与老年人跌倒有更密切的关系.