疾病严重程度评价量表的建立与应用研究

目的 探讨护理分级中疾病严重程度的量化评估方法.方法 在李玉乐等研究的分级护理标准要素指标的基础上,参考国外危重疾病严重程度评分工具,采用专家小组讨论法,形成了疾病严重程度评价量表初表;首先对200例住院患者进行测试,调整各项指标赋予的分值及护理级别确定范围,形成最终的量表;用量表对我院2095例住院患者进行评定,将评分结果与医嘱的护理级别、标准的护理级别进行对比分析,以验证量表的可靠性.结果 医嘱组、评分组均与标准组呈正相关,但评分组与标准组相关性较高.3种方法划分的护理级别比较,医嘱组与标准组比较,差异有统计学意义(P＜0.05);评分组与标准组比较,差异无统计学意义(P＞0.05).4个护理级别中,特级护理在3组中差异无统计学意义(P＞0.05);一级、二级、三级护理在3组中,医嘱组与标准组比较,差异有统计学意义(P＜0.05),评分组与标准组比较,差异无统计学意义(P＞0.05).结论 疾病严重程度评价量表可作为划分护理级别的客观依据,具有一定的临床意义.     

44所三级医院医疗护理员使用与管理现状调查

目的 对国内44所三级医院医疗护理员的使用与管理现状进行调查,为规范护理员行业管理、深化优质护理服务提供指导。方法 2021年4月—8月,采用便利抽样法,使用自行设计的医院医疗护理员管理现状调查表,对10个省、自治区、直辖市44所三级医院或对应的第三方服务机构医疗护理员管理部门负责人进行调查。结果 共调查24所三级甲等医院、20所三级乙等医院。当前医疗护理员管理机构主要为第三方服务机构（三级甲等为54.2%、三级乙等为60.0%）;培训分为岗前和岗中2个阶段,“互联网+”的培训方式并未被大多数三级医院采纳;接受岗中培训、考核的频率较低;医疗护理员在三级医院的评价方式主要由第三方管理机构进行;工作模式选择上,三级医院普通病区和ICU都倾向于1对1模式。结论 当前国内三级医院医疗护理员聘用和管理模式多样、资格认证待规范,培训、考核机制落实不到位,工作模式管理、评价体系有待进一步规范。因此,有必要加强医疗护理员聘用和管理,制订专业化的培训方案,建立清晰可及的工作制度和评价体系,深化优质护理服务,提高护理质量。     

全膝关节置换患者术前心理弹性现状及其影响因素分析

目的 探讨全膝关节置换患者术前心理弹性现状并分析其影响因素。方法 采用便利抽样法,选取2021年3月—7月在上海市某三级甲等医院关节外科住院的183例择期行全膝关节置换术的患者作为调查对象。基于心理弹性模型选定潜在影响变量,采用一般资料调查表、西安大略和麦克马斯特大学骨关节炎指数、康纳戴维森心理弹性量表、慢性病自我效能量表、希望指数量表、心理困扰量表、社会支持评定量表、医学应对方式问卷进行调查。采用多元线性回归进行心理弹性影响因素分析。结果 全膝关节置换患者术前心理弹性水平为（59.98±9.20）分。多元线性回归分析显示,患者文化程度（β=0.202,P<0.001）、自我效能（β=0.319,P<0.001）、希望（β=0.363,P<0.001）、屈服应对（β=-0.149,P=0.010）可影响全膝关节置换患者术前心理弹性,共解释68.20%的总变异。结论全膝关节置换患者术前心理弹性整体水平较低,临床实践中应重视健康教育与心理辅导,提高患者的自我效能和希望水平,避免消极应对方式,促进患者的手术预后。     

无痛人工流产术不良反应5 192例分析与处理

目的总结丙泊酚无痛人工流产术的不良反应及其处理。方法选择ASAⅠ～Ⅱ级自愿接受无痛人工流产术的受术者,按2.0～2.5 mg/kg静脉注射丙泊酚或合用利多卡因40～50 mg静脉注射,将2002年至2006年的5192例无痛人工流产术进行回顾性分析。结果所有受术者术中表情安静,镇痛有效率达100%,未出现1例人工流产术综合征,均能迅速苏醒,无1例延迟。受术者出现注射疼痛、肌阵挛、梦幻、呼吸暂停、恶心呕吐、呛咳、皮肤过敏等不良反应,依次为4065例(78.3%)、405例(7.8%)、2139例(41.2%)、322例(6.2%)、93例(1.8%)、166例(3.2%)、24例(0.5%)。结论丙泊酚用于人工流产术的镇痛效果确切,虽安全可靠,但要重视不良反应的处理和警惕意外的发生。     

全直肠系膜切除直肠癌根治术：附126例报告

目的 评价全直肠系膜切除在直肠癌根治术中的应用价值.方法 对近126例中下段直肠癌患者行全直肠系膜切除术的临床资料进行回顾性分析.结果 2例(1.6%)高龄患者死于术后肺部感染.术后发生吻合口瘘2例(1.6%),术后随访1～5年,2年局部复发率为4.0%,3年生存率为93.6%,5年生存率为85.4%.结论 只要合理选择手术适应证.直肠癌全直肠系膜切除术可降低局部复发率,不增加并发症.     

The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education

Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.     

Hormonal changes and their impact on cognition and mental health of ageing men

Demographic changes resulting in ageing of the world's population have major implications for health. As men grow older, circulating levels of the principal androgen or male sex hormone testosterone (T) decline, while the prevalence of ill-health increases. Observational studies in middle-aged and older men have shown associations between lower levels of T and poorer mental health in older men, including worse cognitive performance, dementia and presence of depressive symptoms. The role of T metabolites, the more potent androgen dihydrotestosterone (DHT) and the oestrogen receptor ligand estradiol (E2) in the pathophysiology of cognitive decline are unclear. Studies of men undergoing androgen deprivation therapy in the setting of prostate cancer have shown subtle detrimental effects of reduced T levels on cognitive performance. Randomised trials of T supplementation in older men have been limited in size and produced variable results, with some studies showing improvement in specific tests of cognitive function. Interventional data from trials of T therapy in men with dementia are limited. Lower levels of T have also been associated with depressive symptoms in older men. Some studies have reported an effect of T therapy to improve mood and depressive symptoms in men with low or low-normal T levels. T supplementation should be considered in men with a diagnosis of androgen deficiency. Beyond this clinical indication, further research is needed to establish the benefits of T supplementation in older men at risk of deteriorating cognition and mental health.     

Evaluation of the Food And Nutrient Database for Dietary Studies for use with a mobile telephone food record

The development of a mobile telephone food record (mpFR) in which image analysis and volume estimation data can be indexed with the Food and Nutrient Database for Dietary Studies (FNDDS) has the potential to improve the accuracy of dietary assessment. To validate the mpFR for use with adolescents, a convenience sample of adolescents, aged 11–18 years, was recruited to eat all meals and snacks in a controlled feeding environment over a 24-h period. Each food item matched a food code in the FNDDS 3.0. The objective of this analysis was to compare the measured energy and protein content of foods to the published values in the FNDDS. Duplicate plates of all meals and snacks were prepared, and samples of 20 foods were individually weighed, homogenized, freeze dried, and analyzed for energy with a bomb calorimeter and for protein with a Dumas nitrogen analyzer. Eleven of the twenty food items had energy values in the FNDDS within ±10% of the measured energy value. The measured energy and protein values from all foods correlated significantly with the energy (r = 0.981, P < 0.01) and protein (r = 0.911, P < 0.01) values in the FNDDS. These results support the use of the FNDDS with the mpFR.     

Imaging of aortoiliac arterial disease. Duplex ultrasound and MR angiography versus digital subtraction angiography

Purpose: To evaluate and compare the diagnostic accuracy of duplex ultrasound (US) and MR angiography (MRA) at 1.0 T in aortoiliac arterial disease using digital subtraction angiography (DSA) as the reference standard. In addition, a comparison of the 2D time-of flight (TOF) and 3D contrast-enhanced MRA (CE MRA) techniques was performed.Material and Methods: Prospectively, 39 patients with symptoms of lower-extremity arterial occlusive disease were examined using US, TOF MRA, CE MRA and DSA. Significant lesions (stenosis ≥50%) and occlusions were evaluated blindly for each method.Results: For all segments, the sensitivity for US, TOF MRA and CE MRA with regard to significant lesions was 0.72, 0.81 and 0.81, respectively, and the specificity for each was 0.97, 0.91 and 0.92, respectively. For significant lesions above the inguinal ligament the corresponding sensitivity was 0.84, 0.89 and 0.94 and the specificity 0.93, 0.82 and 0.73, respectively. The specificity was higher when the two MRA methods were combined. TOF MRA overgraded 7 segments as occluded. In most cases, the length of the occlusions was correctly determined on CE MRA, overestimated on TOF MRA and uncertain on US.Conclusion: Neither US nor MRA were sufficiently accurate to fully replace angiography. MRA was preferable to US as a non-invasive test when vascular intervention was contemplated. Although CE MRA was superior to TOF MRA, the most accurate results were achieved when the two methods were combined.     

Contrast-enhanced color Doppler ultrasonography in suspected parathyroid lesions

Purpose: To assess the usefulness of US contrast media in the evaluation of patients with primary hyperparathyroidism, with a nodule showing US features of a primary parathyroid lesion but lacking the color Doppler US appearance of a parathyroid mass.Material and Methods: Thirteen patients (7 female, 6 male; age range 51-79 years) were examined with US before and after administration of a stabilized galactose-based microbubble contrast agent. Ten patients underwent surgery and the final histological examination demonstrated parathyroid adenoma in 9 cases and a mesenchymal benign nodule in 1 case. Three nodules were proved to be of thyroid origin at fine-needle aspiration biopsy.Results and Conclusion: The use of a US contrast agent resulted in a diagnostic gain compared to unenhanced studies in 12/13 cases. Color Doppler findings characteristic of parathyroid lesions were observed in 7/13 cases, of thyroid nodules in 4/13 cases, and nonspecific patterns in 2/13 cases. Contrast-enhanced color Doppler US can be proposed in selected patients in whom unenhanced color Doppler provides uncertain findings. Its ideal application should be the evaluation of cervical lesions without detectable intranodular flow at unenhanced Doppler studies. In these cases, the contrast agent helps in visualizing typical color Doppler signals of the parathyroid lesions ("vascular pole" and "mixed pattern").