老年眼科患者的护理安全隐患分析及预防对策(附74例)

目的?探讨老年眼科患者护理安全隐患及相应预防对策.方法?选取老年白内障住院手术患者140例,随机分为2组,对照组66例,观察组74例,2组患者有可比性.分析老年眼科患者存在的护理安全隐患.对照组患者采取常规护理,观察组患者在对照组基础上给予针对安全隐患的全面护理.对2组患者安全问题发生情况以及护理满意度进行统计和比较.结果?老年眼科患者主要存在的安全隐患包括摔伤碰伤、错用药品、慢性疾病引起猝死、术眼错误或感染、人工晶体突出或术眼出血.经过针对性的护理后观察组患者安全问题发生情况明显低于对照组,观察组约有91.89%的患者未发生安全问题,明显高于对照组56.06%的比例;约有59.46%和93.24%的观察组患者对护理感到非常满意,明显高于对照组39.39%和83.33%的比例.上述比较两组差异有统计学意义(P<0.05).结论?安全护理在老年眼科患者中进行推广应用是十分必要的,在日常工作中,护理人员应对患者安全风险进行恰当评估,将危险因素消灭于萌芽中,保证患者的安全,提高护理质量,融洽护患关系.     

Treatment of impaired perfusion in septic shock

Severe sepsis and septic shock are relatively common problems in intensive care. The mortality in septic shock is still high, and the main causes of death are multiple organ failure and refractory hypotension. Impaired tissue perfusion due to hypovolemia, disturbed vasoregulation and myocardial dysfunction contribute to the multiple organ dysfunction. Treatment of hemodynamics in septic shock consists of appropriate fluid therapy guided by invasive monitoring combined with vasoactive drugs aiming to correct hypotension and inappropriately low cardiac output. The drug of choice for low vascular resistance is norepinephrine, while insufficient myocardial contractility is commonly treated with dobutamine. The use of norepinephrine seems to be associated with better prognosis as compared to results from the use of dopamine or epinephrine. In septic shock, vasopressin levels are low, and therefore, vasopressin has been advocated as a vasopressor. Its effectiveness and safety have not yet been documented, and so far it is regarded as an experimental treatment. Recent data support the use of corticosteroid, at least in some of the patients with septic shock. Also, activated protein C, a drug with anti-inflammatory and antithrombotic properties, decreases mortality in patients with septic shock.     

床旁电子支气管镜吸痰灌洗治疗机械通气患者的护理配合

目的探讨机械通气病人床旁电子支气管镜灌洗治疗的护理配合方法。方法对78名接受抗感染、对症支持治疗及气管常规护理的机械通气患者,配合使用床旁电子支气管镜吸痰灌洗治疗,观察临床疗效,总结护理经验。结果 78例患者经吸痰灌洗治疗后,呼吸困难症状均不同程度缓解。结论床旁电子支气管镜吸痰灌洗是辅助临床治疗,改善机械通气患者气道阻塞的一种简便有效的治疗手段,术中的护理配合对改善临床症状及预后至关重要。     

The frequency of and reasons for acute hospital transfers of older nursing home residents

The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR).     

Care farms as a space of wellbeing for people with a learning disability in the United Kingdom

People with a learning disability in the UK are increasingly choosing to spend their time on ‘care farms’ but there is limited research examining these spaces from their perspective. A qualitative research design was used to ask eighteen of these clients how care farms contributed to their health and wellbeing.For these participants care farms can be understood, using Fleuret and Atkinson's (2007) framework, as a ‘space of wellbeing’ and as a positive and life-enhancing space.Positive language was used by participants to describe the farms contrasting with ne gative language describing other spaces and activities. Farms were identified as contributing positively to mental and social wellbeing.     

内镜下置入幽门支架治疗进展期胃窦癌胃出口梗阻疗效观察

背景：胃出口梗阻（GOO）是进展期胃癌的常见并发症，此类患者手术切除机会较低，生存期短，生活质量差。目的：评价内镜下置入幽门支架对进展期胃窦癌合并GOO的姑息治疗作用。方法：2012年1月～2013年5月宝山区中西医结合医院32例表现为不能进食或进食后呕吐，经上消化道造影证实存在G00并接受内镜下置入幽门支架治疗的进展期胃窦癌患者纳入研究。治疗前后以GOO记分系统（GOOSS）和焦虑自评量表（SAS）、抑郁自评量表（SDS）评价患者的梗阻情况和心理状态，观察术后并发症发生情况。结果：32例患者均成功置入支架且膨胀良好，术后1周和4周GOOSS评分较术前明显增高，SAS、SDS评分较术前明显降低，差异均有统计学意义（P〈0．05）。1例患者发生支架移位，2例发生支架阻塞，未见穿孔和明显出血病例。结论：对于不能手术的进展期胃窦癌合并G00，内镜下置入幽门支架是一种微创、安全、有效的姑息治疗方法，可缓解梗阻症状，改善患者的焦虑、抑郁倾向。     

Cardiovascular Disease and Homelessness

Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.     

The extent,variability, and attitudes towards volunteering among undergraduate nursing students: Implications for pedagogy in nurse education

In the aftermath of the Francis Report nurses are being called to account for an apparent lack of care and compassion, leading to debate around pedagogy in nurse education. Absent from this debate is a consideration of student volunteering within undergraduate nursing programmes and its potential to promote student nurses self-esteem and to enhance the development of critical thinking skills. The aim of this study was therefore to understand the extent of and attitudes towards volunteering among nursing students. A mixed methods approach using a specifically developed questionnaire, followed by in-depth interviews to ascertain extent, variability, and attitudes towards volunteering revealed low levels of volunteering among nursing students. Limited time, limited access, and lack of academic support were cited as reasons. Nevertheless, students displayed positive attitudes towards volunteering. While volunteering has been shown to impact upon students abilities to think critically, to develop personal values and respond to the needs of others, volunteering within the UK undergraduate nursing programme considered here is neither structured nor formalized. Nurse educators should pay attention to the positive benefits of volunteering for nursing students and consider ways in which volunteering might be incorporated into the curriculum.