危重新生儿压疮高危因素分析及护理对策

目的探讨危重新生儿压疮发生的高危因素,并总结相应有效的预防护理对策。方法对人住NICU的危重新生儿压疮高危因素进行分析评估,采取相应的预防对策。结果发生压疮12例,压疮发生率0．76％。结论针对引发新生儿压疮的各类危险因素进行相应的预防护理,对于降低压疮的发生具有重要意义。     

Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey

BackgroundSafety culture is significant in the complex intensive care environment, where the consequences of human error can be catastrophic. Research within Australian intensive care units has been limited and little is understood about the safety culture of intensive care units in Queensland.AimThe aim was to evaluate and compare safety culture in the intensive care units of two metropolitan tertiary hospitals in Queensland.MethodA cross-sectional survey, Safety Attitudes Questionnaire, was administered to all medical, nursing and allied health professionals in the research sites (A and B) during January and February 2016. Data were collated into six safety culture domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Comparison was made using t-tests and between demographic groups using generalising estimating equations.ResultsIn total, 206 surveys were returned from 522 staff (39.5% response rate). The majority of respondents were nurses (80.6%). Site B scored all domains of the safety attitudes questionnaire significantly higher than Site A (p < 0.001). The scores for both site A and B were significantly higher in all domains (p < 0.001) than a previous Australian study conducted in 2013. Both sites returned low scores in the stress recognition domain. Medical staff perceived the teamwork climate as more positive than nursing staff (mean difference 16.6 [Wald χ² = 10383.8, p < 0.001]). Allied health professionals reported poorer perceptions of working conditions than medical staff (mean difference 7.8 [Wald χ² = 775.4, p < 0.001]).ConclusionDespite similar governance and external structures, differences were found in safety culture between the two research sites. This finding emphasises the importance of local, unit-level assessment of safety culture and planning of improvement strategies. This study adds to the evidence and implications for critical care clinical practice that these interventions need to be unit focused, supported by management and multidisciplinary in approach.     

Status and cost analysis of antimicrobial treatment of terminally ill patients with hematological malignancy in an acute hospital

ObjectiveTerminally ill patients with hematological malignancy tend to be treated aggressively. We aimed to clarify the status and costs of antimicrobial treatment of patients dying with hematological malignancies.MethodsThis retrospective study was conducted in a Japanese acute hospital between September 2010 and August 2015. A total of 141 patients who stayed for 14 days or longer and died in the hospital were investigated.ResultsThe median patient age was 67 years (range, 22–93). Most patients were treated with antibacterial, antifungal, and antiviral agents (98%, 75%, and 27% of the patients, respectively) in the last 14 days of their lives. The frequency of antibiotics used in the last 7 days did not differ from that of the week before.The median cost of antimicrobials was 245,000 JPY (2227 USD), which reflected 16% of the total medical costs spent over the last 14 days. A subgroup analysis of the patients according to care policy (aggressive care policy (A) and palliative care policy (P), respectively) showed that the total medical cost in group P in the last 7 days decreased from that of the preceding week; however, the cost of antimicrobials did not lessen even in the last 7 days.ConclusionsMost patients dying with hematological malignancy were treated with a broad spectrum of antimicrobials. It appeared to be difficult to reduce, let alone discontinue antimicrobial treatment even in patients treated according to the palliative care policy. The optimal use of antibiotics for hematological patients in their end-of-life should be discussed.     

重性精神病患者封闭式住院治疗期间心理需求分析

目的了解封闭式管理重性精神病患者住院治疗期间心理需求。方法采用便利抽样法,2017年3月—2018年3月选取四川省精神卫生中心封闭式管理的81例重性精神病患者为研究对象,采用自行设计的重症精神病患者心理需求调查问卷进行调查,调查患者自知力、住院治疗自我归因、希望解决的问题等心理需求状况,分析患者心理需求的影响因素。结果81例患者中33.33%(27/81)的患者认为自己患病,对于本次住院治疗39.51%(32/81)的患者归因于自己性格原因,归因于情感问题占17.28%(14/81);心理需求中,希望有家人的陪伴和探视占79.01%(64/81),有心理治疗需求占62.96%(51/81);最想解决的问题中,35.80%(29/81)的患者希望治好疾病,需要提高自信心的患者只占4.94%(4/81)。不同疾病诊断的患者在希望家人陪伴和探视的需求中差异有统计学意义(P<0.05)。不同性别患者在自身疾病相关知识的需求中差异有统计学意义(P<0.05)。不同文化程度的患者对提升压力应对能力需求的差异有统计学意义(P<0.05)。结论封闭式管理重性精神病患者住院治疗期间有较多心理需求,不同性别、文化程度、疾病诊断患者的需求不同,要有针对性地提供心理干预及护理,促进患者尽快康复。     

肺结核并自发性气胸的临床特征及治疗

目的探讨肺结核合并自发性气胸的临床及治疗。方法对360例肺结核合并自发性气胸的临床表现和治疗方法进行回顾性分析。结果肺结核并气胸的临床特征是症状重、呼吸困难多见(26例,74.7%)、呼吸衰竭发生率高(217例,60.3%)、胸腔闭式引流率高(283例,78.6%)、多肋间插管率高(59例,16.4%),55例(15.3%)患者进行了纤维支气管镜介入治疗,共治愈356例,治愈率98.9%,肺复张时间平均6.5d。结论肺结核并自发性气胸病情危重者多,及时有效的排气减压预后良好,辅以纤支镜介入治疗可提高疗效。     

Comparison between standard Vs. Escalated dose venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19: A two centers,observational study

IntroductionThe risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill patients with COVID-19. Thus, this study aims to compare the effectiveness and safety of standard versus escalated dose pharmacological venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19.MethodsA two-center retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the intensive care unit (ICU) at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or Unfractionated heparin 5000 Units three times daily were grouped under the “standard dose VTE prophylaxis and patients who received higher than the standard dose but not as treatment dose were grouped under ”escalated VTE prophylaxis dose“. The primary outcome was the occurance of thrombotic events, and the secondary outcomes were bleeding, mortality, and other ICU-related complications.ResultsA total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). In patients who received escalated dose pharmacological VTE prophylaxis, any case of thrombosis and VTE were similar between the two groups (OR 1.22;95 %CI 0.52–2.86; P = 0.64 and OR 0.75; 95% CI 0.16–3.38; P = 0.70 respectively). However, the odds of minor bleeding was higher in patients who received escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08–10.61; P = 0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95 %CI0.79–1.73; P = 0.43 and HR 1.08;95 %CI 0.76–1.53; P = 0.83, respectively).ConclusionEscalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous evidence regarding the optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.