薄弱环节管理在肝胆外科护理工作中的应用

目的探讨薄弱环节管理对肝胆外科患者护理工作的影响.方法选择该院肝胆外科2011年1—7月收治的患者200例,按住院号尾数单双号分为观察组与对照组,对观察组患者加强薄弱环节管理;对照组患者实施常规护理;出院前分别派发放调查表100份,对患者进行满意度调查并统计基础护理质量合格率;对数据进行统计学分析.结果强化薄弱环节管理能对护理服务工作质量的提高起到明显的效用,不论是从病患者的病情恢复情况还是从患者的满意度来说都较前期有明显提高,同时多项考核得分记录也远高于其对照小组.结论?加强薄弱环节管理能够明显提高肝胆外科患者的护理质量,有利于减少护理风险,保障患者安全.     

Biochemical markers of bone remodeling: recent data of their applications in managing postmenopausal osteoporosis

The recent development of new biochemical markers has considerably improved the non invasive exploration of bone turnover. Currently, the most sensitive markers to access bone formation are osteocalcin, bone alkaline phosphatase and N-terminal propeptide of type I procollagen. Blood or urinary immunoassays of pyridinoline, deoxy-pyridinoline and terminal telopeptides type I of collagen are currently the best indices to evaluate the bone resorption. The principal application fields of biochemical markers in postmenopausal osteoporosis, in combination with the measurement of the bone mineral mass, are primarily the monitoring of anti-resorptive therapy response and prediction of bone loss and risk of fractures. In fact, treatment with anti-resorptive drugs is followed by rapid decrease of bone markers levels (3 months for the markers of resorption and 6 months for those of osteo-formation ), whereas the bone mineral density measurements requires at least two years to change significantly.     

Patient preferences for managing asthma: results from a discrete choice experiment

Effective control of asthma requires regular preventive medication. Poor medication adherence suggests that patient preferences for medications may differ from the concerns of the prescribing clinicians. This study investigated patient preferences for preventive medications across symptom control, daily activities, medication side-effects, convenience and costs, using a discrete choice experiment embedded in a randomized clinical trial involving patients with mild-moderate persistent asthma. The present data were collected after patients had received 6 weeks' treatment with one of two drugs. Three choice options were presented, to continue with the current drug, to change to an alternative, hypothetical drug, or to take no preventive medication. Analysis used random parameter multinomial logit. Most respondents chose to continue with their current drug in most choice situations but this tendency differed depending on which medication they had been allocated. Respondents valued their ability to participate in usual daily activities and sport, preferred minimal symptoms, and were less likely to choose drugs with side-effects. Cost was also significant, but other convenience attributes were not. Demographic characteristics did not improve the model fit. This study illustrates how discrete choice experiments may be embedded in a clinical trial to provide insights into patient preferences.     

Patient assessment in the diagnosis, prevention, and treatment of osteoporosis.

Assessment of the patient with osteoporosis includes history and physical examination, laboratory testing, and imaging studies. Information gathered during this assessment assists clinicians in targeting strategies to prevent fractures. The medical history should contain items such as personal and family history of fractures, lifestyle, intake of substances such as vitamin D, calcium, corticosteroids, and other medications. The physical examination can reveal relevant information such as height loss and risk of falls. Bone mineral density (BMD), most commonly determined by dual-energy x-ray absorptiometry, best predicts fracture risk in patients without previous fracture. BMD testing is most efficient in women over 65 years old but is also helpful for men and women with risk factors. Serial BMD tests can identify individuals losing bone mass, but clinicians should be aware of what constitutes a significant change. Laboratory testing can detect other risk factors and can provide clues to etiology. Selection of laboratory tests should be individualized, as there is no consensus regarding which tests are optimal. Biochemical markers of bone turnover have a potential role in fracture risk assessment and in gauging response to therapy, but are not widely used at present. Clinicians should be aware of problems with vitamin D measurement, including seasonal variation, variability among laboratories, and the desirable therapeutic range. Careful assessment of the osteoporotic patient is essential in developing a comprehensive plan that reduces fracture risk and improves quality of life.     

The forgotten dimensions in health education research

This paper evaluates the content focus of health education research as presented in the professional literature over a 6-year period (2000-2005). The majority of research (1365 papers) addresses the physical dimension of health (79%), while other health dimensions receive less attention. It is argued that the current content focus of research in health education fails to harmonize with the multidimensional, dynamic and functional nature of health as generally defined. The goal of health education, positive behavior change, also seems less reachable without a better understanding of how nonphysical dimensions of health influence wellness behaviors. At present, there exists an opportunity for health educators to move toward research agendas that more fully appreciate the interconnectedness of various dimensions of health and that evaluate them evenhandedly. Practical application of this approach will require a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships and new programs that seek to influence outcomes in a variety of dimensions.     

Pitfalls in managing falls

Falls are common in the elderly and one of the most common reasons for older people to seek medical help. To illustrate the diagnostic dilemmas of this common clinical problem, we present a case study of a woman with a history of recurrent falls.     

The forgotten players in ACO development: nursing homes

Given the history and dynamics of the Patient Protection and Affordable Care Act, nursing homes have been left out of the business of Accountable Care Organization (ACO) development and implementation over the last year. Only now are ACOs, hospitals, and physicians realizing that an effective ACO needs long-term care and rehabilitation as a key component to maximize shared savings in the ACO environment. This article discusses the history of ACO development, examines why nursing homes may have been left out, and explains why nursing homes are critical participants in ACO effectiveness. The article also discusses how nursing homes will need to position their businesses for ACO participation.