突发性耳聋循证护理的文献研究与护理方法初探

目的本组通过循证护理的方法检索突发性耳聋护理方面的现代文献,初步分析突发性耳聋的临床护理,根据文献研究结果与临床专业知识、经验和患者的需求相结合,探索突发性耳聋患者的护理模式,使突发性耳聋的护理活动有证可循,从而提高对突发性耳聋患者的护理质量。方法以"突发性耳聋and护理"、"突聋and护理"为关键词,检索维普资源系统、中国期刊网、中国生物医学文献数据库从建库起至2011年07月关于突发性耳聋护理的相关文献,对文献进行Jadad评价和分析。结果检索出相关文献304篇,根据文献纳入标准和排除标准,仅有17篇文献被纳入进行本次研究,所纳入的17篇文献Jadad评分均<4,属于低质量文献。结论根据文献结果,应从心理护理、治疗护理、生活及出院护理等探索突发性耳聋的循证护理模式,后续研究应采用多中心、大规模、随机、双盲对照的前瞻性临床研究加以验证,以总结出疗效确切、特色明显的突发性耳聋临床护理模式。     

Value‐based medicine,a compass to guide healthcare decisions in the COVID‐19 aftermath

The ongoing COVID‐19 pandemics has claimed hundreds of thousands of lives among the elderly, the patients with chronic conditions and among underserved communities and people in social distress. In addition, the measures that succeeded in containing the epidemic created a profound economic crisis, which real dimension is still unclear. It is clear, however, that most healthcare systems were unprepared. Years of cost containments had eroded the ability of the healthcare sector to cope with the surge in cases. This editorial contends that rebuilding the healthcare systems will require forward thinking, a data‐driven approach and avoidance of reactive decision making. The editorial proposes the Value Based Medicine approach as a way to avoid the errors of the past and to align decision making in healthcare with patient health and quality of life (Value). This is an approach that is gaining traction in several systems. It needs a built‐in capability to collect and analyse outcome and costing data. Today the necessary informatic and computational capabilities are widely available.     

基层医院开展高血压患者家庭自测血压的临床研究

目的 探讨基层医院开展高血压患者家庭自测血压的临床意义.方法 300例高血压患者患者被随机分为实验组和对照组.对照组给予门诊测量血压(OBP)实验组先自我测量(HBP)再给予门诊测量.观察血压测量对病情的影响.结果 半年后的结果显示,实验组HBP和OBP组内比较无显著性差异(P>0.05),实验,组和对照组OBP和并发症率,比较有显著性差异(t=4.197,P<0.05;x2=15.940,P<0.05).结论 HBP能更准确的反映血压值,从而为临床治疗提供更为科学的临床参考,值得在基层医院推广.     

社区组织对艾滋病病毒感染者与病人的服务效果分析

目的：分析社区组织为艾滋病病毒感染者和病人（ people Living with HIV/AIDS,PLHA）提供服务的效果,为政府购买其服务提供依据。方法选取一基层社区组织,通过现有资料收集、关键人物访谈、专项调查等对社区组织为PLHA提供服务的过程、效果和经济指标进行比较分析。结果该社区组织2012年和2013年服务的PLHA人数、检测治疗指标均达到国家要求,超过全国和四川省的平均水平;病毒抑制达到较高水平;机会性感染发生、病死率均维持较低水平,且低于我国其他地区;服务的人均成本下降超过30％。结论该社区组织为PLHA提供服务的成效明显;社区组织为PLHA提供服务具有较多优势;社区组织应加强自身建设以更好为PLHA提供服务;各地政府和相关部门要加强对社区组织参与艾滋病防治工作的支持。     

Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia

Persistent infection with HPV 16 and 18 has been causally associated with the development of cervical cancer and its precursor lesions as well as with other carcinomas and their precursors, e.g. some vulvar and vaginal cancers. Furthermore HPV 6 and 11 are responsible for anogenital condylomata acuminata in more than 90% of cases. With the recently developed prophylactic bivalent (HPV 16 and 18) and quadrivalent (HPV 6, 11, 16 and 18) vaccines, it is possible to prevent infection of the cervical epithelium and other squamous epithelia, the development of premalignant lesions and, in the case of the quadrivalent vaccine, the development of condylomata acuminata. The following paper represents a summary of the full-text version of the German evidence-based Guidelines, including all evidence-based recommendations regarding the safety as well as the efficacy of the vaccines in preventing CIN, VIN/VaIN, genital warts and other HPV-associated lesions.     

案例教学法联合标准化病人在健康评估教学中的应用

目的探讨案例教学法联合标准化病人在健康评估教学中的应用方法及效果。方法采取方便取样法,选取2009级护理大专班两个班分别为试验组和对照组,试验组采用案例教学联合标准化病人教学法,对照组采用传统教学法,比较两组的教学效果,并调查试验组学生的教学反馈。结果理论考试中,病案分析题的成绩试验组高于对照组(P<0.01);操作考试成绩试验组高于对照组(P<0.01);多数学生对案例教学联合标准化病人教学法持肯定态度,认为此种方法可以提高自己多方面的能力,尤其是实践操作能力。结论案例联合标准化病人教学法在健康评估教学中运用,有利于提高学生的学习成绩、动手能力和综合素质,值得继续实践研究。     

Implementation of evidence‐based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence‐based practice: A qualitative study

The aim of the study was to explore how community nurses apply the best available evidence to their practice, and how they mentor student nurses to conceptualize and implement evidence‐based practice in community settings. In the UK, the expansion of health‐care provision in the community has supported the development of highly skilled community nurses. However, there is limited literature regarding the strategies used by community nurses to implement evidence‐based practice and mentor student nurses to conceptualize evidence‐based practice in community placements. An exploratory qualitative approach applying inductive reasoning to focus group data was used. As a result, nurses working for a community NHS Foundation Trust in South England with a mentor qualification were invited to participate in one of the seven focus groups, 33 nurses participated. Data were analyzed with thematic analysis. The themes discussed in this paper are: ‘our practice is evidence‐based’ as guidelines and policies provided structure, but occasionally stifled autonomous clinical decision‐making, and ‘time’ as a barrier and facilitator to mentoring student nurses in community settings. In conclusion, nurses need to develop the ability to incorporate patients' needs and wishes within evidence‐based care. Time was a facilitator for some community mentors, but protected time is required to complete the necessary practice documentation of student nurses.     

A new clinical complexity model for the Australian Refined Diagnosis Related Groups

BackgroundThe Australian Refined Diagnosis Related Groups (AR-DRG) underwent a major review in 2014 with changes implemented in Version 8.0 of the classification. The core to the changes was the development of a new methodology to estimate the Diagnosis Complexity Level (DCL) and to aggregate the complexity level of individual diagnoses to the complexity of an entire episode, resulting in an Episode Clinical Complexity Score (ECCS). This paper provides an overview of the new methodology and its application in Version 8.0.MethodThe AR-DRG V8.0 refinement project was overseen by a Classifications Clinical Advisory Group and a Diagnosis Related Groups (DRG) Technical Group. Admitted Patient Care National Minimum Dataset and the National Hospital Cost Data Collection were used for complexity modelling and analysis.ResultIn total, Version 8.0 comprised 807 DRGs, including 3 error DRGs. Of the 321 Adjacent DRGs (ADRGs) that had a split, 315 ADRGs used ECCS as the only splitting variable while the remaining 6 ADRGs used splitting variables other than ECCS: 2 used age and 4 used transfer.Discussion and conclusionA new episode clinical complexity (ECC) model was developed and introduced in AR-DRG V8.0, replacing the original model introduced in the 1990s. Clear AR-DRG structure principles were established for revising the system. The new complexity model is conceptually based and statistically derived, and results in an improved relationship with actual variations in resource use due to episode complexity.