加强护理员规范化管理 提高病员满意度

随着医疗卫生事业的发展、人口老龄化进程的加速,医院病员增加,临床护士的数量不能满足病员增长的需要,生活护理员（简称护工）应势而生,弥补了护理人力的不足。为提高病员满意度,淮安市第一人民医院对护工进行规范化管理,收到了预期的效果。     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

中药熏蒸联合人工泪液治疗干眼症的临床观察及对患者视觉相关生命质量的影响

目的:探究中药熏蒸联合人工泪液治疗干眼症的临床疗效,分析其对患者视觉相关生命质量的影响。方法:选取2014年11月至2016年12月北京市健宫医院收治的干眼症患者72例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组36例(72只患眼),对照组给予人工泪液治疗,观察组在对照组的基础上联合中药熏蒸治疗,2周为1个疗程,2组均连续治疗2个疗程。统计2组临床疗效;比较2组患者治疗前后主要中医症状积分、泪液分泌量、泪膜破裂时间;采用美国国家眼科研究所视觉相关生命质量量表(NEI-VFQ-25)评价并比较2组患者治疗前后视觉相关生命质量。结果:治疗后观察组总有效率为90. 28%,较对照组的63. 89%显著升高(P 0. 01);与治疗前比较,治疗后2组患者患眼疲劳感、干涩感、异物感及烧灼感等症状积分均显著降低,且观察组显著低于对照组(P 0. 01);与治疗前比较,治疗2周后至治疗4周后2组泪液分泌量呈逐渐升高趋势(P 0. 01),泪膜破裂时间呈逐渐延长趋势(P 0. 05),且治疗后2组间差异有统计学意义(P 0. 05或P 0. 01);与治疗前比较,治疗后2组患眼一般健康状况、活动障碍及视力障碍评分均显著升高(P 0. 01),且观察组显著高于对照组(P 0. 01)。结论:中药熏蒸联合人工泪液治疗干眼症可有效缓解患眼临床症状,促进患眼泪液分泌并增强泪膜稳定性,同时还可显著改善患眼视觉相关生命质量,疗效显著优于人工泪液单用。     

高血压并发脑梗死患者血压控制与自我管理行为、生活方式的相关性及护理对策

目的 探讨高血压并发脑梗死患者自我管理行为和生活方式与血压控制的相关性,并讨论相关的护理对策.方法 分层抽样选取高血压并发脑梗死患者268例,设计调查表调查所有患者自我管理行为和生活方式,分析其对血压控制的影响,分析其护理对策.结果 年轻、文化程度高、生活水平高、自我管理能力强、蔬菜摄人量充足、食盐和烟酒摄入量少以及适度进行体育锻炼的受调查者血压控制情况更好.年长、自我管理能力差、盐摄入量高均不利于血压的控制.结论 有效的自我管理和良好的生活方式可以很好地控制高血压并发脑梗死患者的血压,改善患者预后和生活质量.     

Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes

Aim: To examine the effects of life review on daily activities, social participation, outlook on life, and perceptions of living in a nursing home measured by life satisfaction and quality of life in older adults. Method: The study design was a two-phase quasi-experimental pre-post-tests including development and testing of a life review protocol. Nine residents, age ≥65, participated in a life review group once weekly for 6 weeks. Outcomes were analyzed using the Life Satisfaction Index-Z (LSI-Z) and pre-post surveys. Results: LSI-Z scores improved post-intervention and survey outcomes indicated participation in activities of daily living (ADLs), socialization, outlook on life, and living in a nursing home perceptions improved for all participants. Conclusion: The study demonstrates the effectiveness of a life review protocol to improve ADLs, social participation, and enhancing perceptions of outlook on life and living in a nursing home enhancing QOL and life satisfaction for older adult nursing home residents.     

Assessing care-givers’ satisfaction with child immunisation services in Zambia: Evidence from a national survey

AimThe main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants.MethodsThis study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction.ResultsFindings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services.ConclusionThese findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation.