循证护理在社区流动人口结核病人用药问题的应用

目的探讨循证护理在社区流动人口结核病人用药问题中的应用,以提高病人的服药依从性。方法根据流动人口结核病患者的特点、服用抗结核药物应具备的知识,提出问题,检索中国医院数字图书馆、万方医学网及中国知网等数据库和手工检索有关医学期刊、专著,查找高质量的护理证据,并根据病人实际情况及循证证据制定针对性的护理干预措施。结果纳入相关文献资料证据表明:①大多数流动人口坚持治疗决心相对较差,与其对疾病的认知水平低,对知识的接受能力差,经济收入低下及无医疗保障有关;②肺结核治愈的关键是全程、规律服药,患者能否坚持规律用药,与其对肺结核病知识的了解程度有密切关系;③常用抗痨药物大都有不同程度的不良反应,药物副反应高是患者未能坚持疗程的主要原因之一;④服药依从性低可导致肺结核治疗的失败,使初治者产生耐药性,从而使初治者变为复治者,甚至不能治愈,成为社会的传染源[1]。综合文献信息并结合患者具体情况,全疗程实施有针对性的用药指导,循环互动式健康教育,患者遵医嘱按时复查、主动配合治疗等方面循证护理组均显著优于常规组。结论将循证护理应用到流动人口结核病人的用药指导中,可提高病人对抗痨药物的认知水平及药物不良反应的应对能力,更好地完成整个治疗疗程,从而提高流动人口结核病人的遵医行为。     

对社区流动人口结核病管理的循证评价

Objective To investigate management and treatment to tuberculosis(TB)of floating population in the community,and evaluate systematically,study the effect of TB control management,in order to provide reliable basis for developing the scientific and practical intervention programs specifically for the floating population,and also to further explore and update the governance strategy of the floating population of TB.Hethods The databases of CHKD,WANFANG MED ONLING and CNKI Etc,were searched and analyzed by computer,and related medical journals and monographs were studied by manual searching,getting the issued literature on the treatment,management,nursing intervention of floating population tuberculosis from 1998 to 2010.At the same time we used non-probability purposive sampling method and had on-site interviews after obtaining the interviewee informed of consent.Besults We retrieyed 137 documents that have been published meeting the inclusion criteria,by viewing the full text,9 docunents had been evaluated for the 1 evidence and 15 documents had been evaluated for the 2～3 finally.From the literature with the evaluation and interviews.it showed that:to use a variety ofeffective management measures include health promotion,providing incentives,cross-regional referral tracking,DOTS nanagemerit of patient,had achieved certain effects.But the floating population understood limitedly TB-related knowledge and free treatment policy and had mixed views,that the awareness of TB control is poor,residential instability,lack of effective contact,resulted in difficuhing in supervision and tracking of the floating population.The TB management to floating population patients should be strengthened.Condusion It is necessary to expand the free flow of patient treatment and the corresponding cost of subsidies,to carry out comprehensive and multi-fornKq of community knowledge on TB and the publicity on national TB control policy,to make efforts to improve community supervision OfTB,and carry out individual recycling interactive health education for improving the compliance of TB patient.     

肺结核疫情核查追踪对发现病人的影响

目的分析广州市海珠区肺结核病人的疫情追踪情况对肺结核病人发现的影响。方法选择2008年1月-2010年4月在结核病网络直报中,居住在广州市海珠区的肺结核病人核查追踪访视工作进行研究。结果广州市胸科医院第二门诊部对非结防机构网络直报本辖区肺结核患者实施全面追访,追踪到位率大幅增加,结核病人发现率逐年增加。结论肺结核的疫情追踪是发现病人的一个重要环节,规范非结防机构对肺结核病人的转诊工作,不断完善追踪访视技巧、方法,可以有效地提高结防机构对非结防机构网络直报病人的追踪效率,从而达到提高肺结核病人的发现率。     

引入循证方法对社区流动人口结核病患者的护理干预

目的 通过循证的方法为社区流动人口中结核病患者提供科学的护理干预,使管治效果达到常住人口水平.方法 确定护理问题为社区流动人口结核病患者管治问题,在中国期刊全文数据库中进行检索,以"流动人口/外来人口、结核、心理、健康教育"为关键词,检索到文献137篇.对试验进行评价、提取,分析干预措施的差异,计算结果.在获得访谈对象...     

社区流动人口结核病患者心理问题的循证护理

目的探讨应用循证医学的方法对社区流动人口肺结核患者的心理问题进行护理干预的效果。方法确定护理问题为社区流动人口肺结核患者的心理问题,在中国期刊全文数据库中进行检索,检索到文献187篇。对文献相关资料进行系统评价、提取分析并计算结果,得出有效的循证护理措施。设实验组173例,在常规护理基础上增加循证护理;对照组174例,按常规护理。结果实验组96％患者能按医嘱规律治疗和按时复查,治愈率达98％;对照组88％患者能按医嘱规律治疗,86％患者按时复查,治愈率为83％。两组比较差异有统计学意义（P均〈0．05）。结论通过循证证据对流动人口结核病患者进行心理护理,能提高患者对疾病的应对方式与服药依从性,从而提高临床疗效。     

社区流动人口结核病患者心理问题的循证护理

目的探讨应用循证医学的方法对社区流动人口肺结核患者的心理问题进行护理干预的效果。方法确定护理问题为社区流动人口肺结核患者的心理问题,在中国期刊全文数据库中进行检索,检索到文献187篇。对文献相关资料进行系统评价、提取分析并计算结果,得出有效的循证护理措施。设实验组173例,在常规护理基础上增加循证护理;对照组174例,按常规护理。结果实验组96%患者能按医嘱规律治疗和按时复查,治愈率达98%;对照组88%患者能按医嘱规律治疗,86%患者按时复查,治愈率为83%。两组比较差异有统计学意义(P均0.05)。结论通过循证证据对流动人口结核病患者进行心理护理,能提高患者对疾病的应对方式与服药依从性,从而提高临床疗效。     

网络直报肺结核病人转诊追踪情况分析

目的分析近3年来,广州市海珠区非结防机构网络直报病人的转诊追踪及到位情况、结核病人的登记情况,掌握结核病控制工作动态,为制定适合海珠区实际的工作计划和指导相关工作提供依据。方法选2007～2009年非结防机构在结核病网络直报中,居住在广州市海珠区的肺结核病人转诊、追踪访视工作及追踪到位病人的诊断情况进行回顾性分析。结果 2007～2009年广州市海珠区非结防机构网络直报疑似及临床诊断肺结核病人数、转诊到位率、结防所追踪率、追踪到位率、总体到位率(转诊到位+追踪到位+其他到位)各率均较低。转诊到位率从2007年的14.82%到2009年的31.83%,追踪到位率从2007年的39.37%到2009年的72.41%,总体到位率从2007年的48.42%到2009年的87.81%,是一个很大的飞跃,但仍低于全市水平。结论肺结核疫情报告、核查追踪是检出结核病的重要环节。不断完善追踪访视技巧、方法,实施可行的健康教育,可以有效地提高结防机构对病人的追踪到位率及病人的发现率,控制结核病的传播。     

大鼠结核性胸膜炎模型和胸腔炎症免疫反应的研究

目的　探讨建立大鼠结核性胸膜炎模型的方法以及观察胸腔局部炎症免疫反应。方法　用标准人型结核分枝杆菌菌株H37Rv003mg注入50只Wistar大鼠胸腔内,并在注入后第1、2、3、5、7、10、15、20、30、60天分批处死实验动物。解剖胸腔,记录胸腔积液量,观察胸腔、胸膜和肺组织大体及镜下病理变化。检测胸腔积液中白细胞数及分类、总蛋白质(TP)、葡萄糖(GLU)和乳酸脱氢酶(LDH)的含量,测定可溶性细胞间黏附分子1(sICAM1)、转移生长因子β1(TGFβ1)和γ干扰素(IFNγ)的水平。另对10只大鼠胸腔内注入2ml生理盐水,10只注入2ml蛋白纯化衍生物(PPD)原液作为对照。结果　大鼠胸腔内注入结核分枝杆菌后15d内均有双侧胸腔积液,胸腔积液量于第5天最多(67±05)ml。胸腔积液白细胞数第1天最高(103×109/L),随时间而下降,第15天为34×109/L。细胞分类第1天中性粒细胞占优势(66%),以后淋巴细胞明显增多,第15天淋巴细胞占92%。TP为51~55g/L。葡萄糖从第1天的52mmol/L逐渐降低至第15天的28mmol/L。LDH在第1天为181μmol·s-1·L-1,此后随时间持续升高,第15天为289μmol·s-1·L-1。胸腔积液的生化指标符合结核性胸腔积液的特征。sICAM1水平早期升高,第7天后下降并低于第1天的水平。IFNγ水平第1天为412pg/ml,以后持续升高并维持     

结核病防治所的服务流程再造

目的以"业务流程再造"理论为依据,保障病人就诊过程安全、快捷。方法筹备阶段:调查分析,评估传统流程,环境的准备,护理人员的培训,流程制定;实施阶段:明确分工,管理者实时监督,提供让病人满意服务。结果新流程运行通畅,病人得到及时医疗服务,有效地减少患者在医院停留的时间。结论落实优化服务流程,为患者提供了优质的服务措施,同时,也提高了本所的护理服务质量、及患者满意度。     

对社区流动人口结核病管理的循证评价

Objective To investigate management and treatment to tuberculosis(TB)of floating population in the community,and evaluate systematically,study the effect of TB control management,in order to provide reliable basis for developing the scientific and practical intervention programs specifically for the floating population,and also to further explore and update the governance strategy of the floating population of TB.Hethods The databases of CHKD,WANFANG MED ONLING and CNKI Etc,were searched and analyzed by computer,and related medical journals and monographs were studied by manual searching,getting the issued literature on the treatment,management,nursing intervention of floating population tuberculosis from 1998 to 2010.At the same time we used non-probability purposive sampling method and had on-site interviews after obtaining the interviewee informed of consent.Besults We retrieyed 137 documents that have been published meeting the inclusion criteria,by viewing the full text,9 docunents had been evaluated for the 1 evidence and 15 documents had been evaluated for the 2～3 finally.From the literature with the evaluation and interviews.it showed that:to use a variety ofeffective management measures include health promotion,providing incentives,cross-regional referral tracking,DOTS nanagemerit of patient,had achieved certain effects.But the floating population understood limitedly TB-related knowledge and free treatment policy and had mixed views,that the awareness of TB control is poor,residential instability,lack of effective contact,resulted in difficuhing in supervision and tracking of the floating population.The TB management to floating population patients should be strengthened.Condusion It is necessary to expand the free flow of patient treatment and the corresponding cost of subsidies,to carry out comprehensive and multi-fornKq of community knowledge on TB and the publicity on national TB control policy,to make efforts to improve community supervision OfTB,and carry out individual recycling interactive health education for improving the compliance of TB patient.