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971.
目的 探讨个性化护理对风湿免疫科无痛病房患者疼痛的影响.方法 随机选取2011年3月一2014年10月中国医科大学附属第一医院风湿免疫科无痛病房收治的患者80例,分为观察组(n=40)和对照组(n=40).对照组患者进行常规护理,观察组患者进行个性化护理,然后对二组患者的疼痛程度和对护理工作的满意度进行统计分析.结果 组内比较,二组患者护理后的NRS评分均显著低于护理前(P＜0.05);组间比较,护理前二组患者的NRS评分之间差异无统计学意义(P＞0.05),护理后观察组患者的NRS评分显著低于对照组(P＜0.05);观察组患者中很满意21例,满意15例,对护理工作的满意度为90.0％(36/40);对照组患者中很满意14例,满意11例,对护理工作的满意度为62.5％(25/40).观察组患者对护理工作的满意度显著高于对照组(P＜0.05).结论 个性化护理能够有效缓解风湿免疫科无痛病房患者疼痛,同时显著提高对护理工作满意度. 相似文献
972.
Fahad Alqahtani Sami Aljohani Ali Hama Amin Mohammed Al-Hijji Oluseun O. Ali David R. Holmes Mohamad Alkhouli 《Mayo Clinic proceedings. Mayo Clinic》2018,93(5):607-617
Objective
To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR).Patients and Methods
Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs).Results
Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001).Conclusions
African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites. 相似文献973.
Paula Harding Angela Burge Kerrie Walter Bridget Shaw Carolyn Page Uyen Phan Desiree Terrill Susan Liew 《Physiotherapy》2018,104(1):98-106
Objective
To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists.Design and setting
A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015.Main outcome measures
The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding).Results
2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding.Conclusions
The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. 相似文献974.
975.
976.
Claudia Eliza Patrocinio de Oliveira Osvaldo Costa Moreira Zoila Marilú Carrión-Yagual Carlos Medina-Pérez José Antonio de Paz 《Archives of physical medicine and rehabilitation》2018,99(5):819-825
Objective
To compare the effects of classic progressive resistance training (PRT) versus eccentric strength-enhanced training (EST) on the performance of functional tests and different strength manifestations in the lower limb of people with multiple sclerosis (PwMS).Design
Experimental trial.Setting
Strength training program.Participants
PwMS (N=52; 19 men, 33 women) belonging to MS associations from the Castilla y León, Spain.Interventions
Participants were assigned to 1 of 2 groups: a control group that performed PRT or an experimental group that performed EST. In both groups, the knee extensor muscles were trained for 12 weeks.Main Outcome Measures
Before and after 12 weeks of training, maximal voluntary isometric contraction and 1 repetition maximum (1RM) of the knee extensors were evaluated, as were the Chair Stand Test (CST) and Timed 8-Foot Up and Go (TUG) functional tests.Results
No differences were found between the groups in the initial values for different tests. Intragroup comparisons found significant differences in CST (F=69.4; P<.001), TUG (F=40.0; P<.001), and 1RM (F=57.8; P<.001). For intergroup comparisons, EST presented better results than PRT in the CST (EST, 4.7%±2.8%; PRT, 1.9%±2.8%; F=13.1; P=.001) and TUG (EST, ?2.9±4.7; PRT, ?.41±5.6; F=5.6; P=.022).Conclusions
In PwMS, EST leads to improvements in 1RM, TUG, and CST that are similar to those of PRT. However, for patients who participated in this study, the EST seems to promote a better transfer of strength adaptations to the functional tests, which are closer to daily-living activities. 相似文献977.
Mattia Morri Paolo Chiari Cristiana Forni Antonella Orlandi Magli Domenica Gazineo Natalia Franchini Lorenzo Marconato Tiziana Giamboi Andrea Cotti 《Archives of physical medicine and rehabilitation》2018,99(5):893-899
Objective
To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture.Design
A prospective cohort study.Setting
The orthopedic and orthogeriatric departments of 2 regional hospitals.Participants
Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture.Main Outcome Measures
The level of autonomy at 4 months was assessed using the ADL scale.Results
The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014).Conclusions
Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy. 相似文献978.
Daniel K. White Zhichang Li Yuqing Zhang Adam R. Marmon Hiral Master Joseph Zeni Jingbo Niu Long Jiang Shu Zhang Jianhao Lin 《Archives of physical medicine and rehabilitation》2018,99(1):194-197
Objective
To describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States.Design
Observational.Setting
Community environment.Outcomes
Both groups adhered to the Osteoarthritis Research Society International (OARSI) protocols for the 6-minute walk and 30-second chair stand. We compared physical function prior to TKR and 6 months after using linear regression adjusted for covariates.Participants
Women (N=60) after TKR.Interventions
Not applicable.Results
Age and body mass index in the China group (n=30; 66y and 27.0kg/m2) were similar to those in the U.S. group (n=30; 65y and 29.6kg/m2). Before surgery, the China group walked 263 (95% confidence interval [CI], ?309 to ?219) less meters and had 10.2 (95% CI, ?11.8 to ?8.5) fewer chair stands than the U.S. group. At 6 months when compared with the U.S. group, the China group walked 38 more meters, but this difference did not reach statistical significance (95% CI, ?1.6 to 77.4), and had 3.1 (95% CI, ?4.4 to ?1.7) fewer chair stands. The China group had greater improvement in the 6-minute walk test than did the U.S. group (P<.001).Conclusions
Despite having worse physical function before TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands than did the U.S. group after surgery. 相似文献979.
980.