体验式教学在急危重症护理学中的应用

目的 探讨在急危重症护理学教学中开展体验式教学的效果.方法 将2008级护理专业本科学生65名分为2个团队,进行突发公共事件急救医疗服务体系体验性演练,并对演练全过程录像.演练结束后回放录像并反思,进行总结汇报,写出心得体会.实验课程结束后,发放调查表了解学生对体验式教学效果的评价.结果 90.6％以上的学生认为体验式教学对巩固理论知识,提高急救意识、急救技能、沟通能力、应变能力、团队协作能力等方面帮助较大或很大.结论 体验式教学有利于激发学生的学习积极性,培养其自主学习的能力及急救综合能力,有助于学生沟通交流、团结协作、人文关怀及应变能力等综合素质的培养.     

在"优质护理服务示范工程"活动中高职护理教育的实践

"优质护理服务示范工程"活动以"夯实基础护理,提供满意服务"为主题,以"息者满意、杜会满意、政府满意"为目标.面对新的主题和目标要求,培养优秀的高职护理人才,提供优质护理服务,是高职护理教育工作者面临的重大课题.专业教师需要认真学习,提高对"优质护理服务示范工程活动"的认识;明确职贵,加强基础护理的教学实践,为临床培养优秀的护理人才.     

护理干预对初产妇产后抑郁症的影响

目的探讨护理干预对预防初产妇产后抑郁的效果。方法将2008年8月至2009年8月产前检查及正常足月分娩的初产妇350例,随机分成干预组200例和对照组150例,对照组接受常规护理,干预组在常规护理的基础上,接受系统的护理干预。观察两组孕妇产后6周产后抑郁量表(EPDS)评分和产后抑郁症的发生率。结果干预组与对照组在孕28周基础EPDS评分比较差异无统计学意义(P>0.05),产后6周两组比较差异有统计学意义(P<0.05);产后6周干预组产后抑郁症的发生率为6.50%(13/200),对照组产后抑郁症的发生率为14.67%(22/150),两组差异有统计学意义(P<0.05)。结论对初产妇进行孕产期的护理干预,能有效地减轻其抑郁情绪,降低产后抑郁症的发生。     

Hot spotting surgical patients undergoing hepatopancreatic procedures

BackgroundThe burden of health care spending in the United States is a major concern, as health care costs have exponentially increased during the last three decades. The objective of the current study was to investigate the degree of cost-concentration among Medicare patients undergoing liver and pancreatic surgery.MethodsMedicare claims data from 2013 to 2015 were used to identify patients undergoing elective liver and pancreatic resections. Patients were divided into four groups: 1) non-complex pancreatic procedures; 2) complex pancreatic procedures; 3) non-complex liver procedures; and 4) complex liver procedures. Unadjusted price-standardized Medicare payments were calculated and payments were divided into quintiles. Patient-level factors associated with payments were analyzed by multivariable linear regression.ResultsA total of 17,125 patients were included in the study. Patients in the top quintile of spending accounted for over 40% of payments for all liver and pancreatic procedures. Patients with comorbidity scores ≥5, male sex, open surgical approach and a diagnosis of congestive heart failure were associated with higher costs.ConclusionPatients undergoing liver and pancreatic resections on the top 20% of payments were responsible for a disproportionate share of Medicare payments – over 40% of total expenditures. Overall hospital surgical volume was lower among the highest quintile of payments.     

Cost-utility analysis of genetic polymorphism universal screening in colorectal cancer prevention by detection of high-risk individuals

BackgroundIn the past 15 years numerous studies have been published on the involvement of low-penetrance susceptibility genes on the risk for developing colorectal cancer (CRC).AimTo perform an economic analysis of blood genetic testing in CRC screening in a population-based nationwide setting using polymorphisms in prostaglandin E₂ pathway genes as proof of concept.MethodsA cost-utility analysis was performed from a societal perspective in Portugal comparing two strategies: blood genetic testing by the age of 40 versus no genetic screening under different assumptions of the cost of genetic testing (€10 and €30) and expected risk (1.5 to 5-fold). The adopted threshold was set at €44,870 (USD 50,000). The primary outcome was the incremental cost-effectiveness ratio (ICER) for a base case scenario.ResultsPolymorphism genotyping provided cost-utility only under the assumption of a 5-fold increased risk in the general population, providing ICERs of €44,356 and €30,389 for €30 and €10 tests, respectively.ConclusionBlood genetic screening for colorectal cancer has cost-utility only under specific assumptions of increased CRC risk and conservative cost estimates. Future studies should focus on defining genetic profiles because single-gene approaches are very unlikely to be cost-effective considering their modest predictive value.     

高原与平原地区围产期保健相关因素分析

目的研究高原地区产妇孕期保健及产科干预措施与平原地区的差异,以期提高高原地区的产科质量。方法收集并总结2009年10月-2010年9月高原地区（高原组）及平原地区（平原组）住院分娩产妇667例的临床资料,将孕期保健、产科并发症、剖宫产率及围产儿出生等相关情况进行多因素分析。结果高原组产妇孕期定期产前检查率（10.34%）显著低于平原组（94.67%）,P〈0.01;妊娠期高血压病、羊水过少为高原组产科并发症前两位,发生率分别为13.34%和9.15%,显著高于平原组（P〈0.01）;高原组剖宫产率（20.54%）低于平原组（40.17%）,P〈0.01;高原组足月新生儿平均出生体质量（3 095.17±433.53）g低于平原组（3 487.32±468.89）g,P〈0.01;高原组新生儿窒息率（5.10%）、早期新生儿死亡率（0.75%）、足月低出生体重儿发生率（5.85%）均高于平原组,P〈0.05。结论普及妇幼卫生知识,加强孕产妇系统管理,积极防治产科并发症特别是妊娠期高血压和羊水过少,提高医疗技术及加大必要医疗设备投入,是提高高原地区产科质量的重要措施。     

Online hypospadias support group data analysis

Background

Although hypospadias is the most common malformation of the penis, this condition is virtually unknown to the general population. This lack of information may lead to psychological distress to both parents and patients. In this study the content of an Internet-based hypospadias support group is analyzed.

Materials and Methods

All comments and postings made by members of an online support group between 2001 and 2008 were analyzed. No personalized data were used for evaluation.

Results

At the end of 2008, the group consisted of 535 members. In the study period, 3050 postings were published. Major issues discussed in the group were (a) medical questions, exchange of medical knowledge, experience, and history; (b) psychological, ethical, and philosophical aspects; (c) practical questions and recommendations; (d) recommendations for surgeons; and (e) hypospadias in adults.

Conclusions

Online hypospadias support groups play an important role in how parents and patients cope with the condition. Surgeons dealing with hypospadias should be aware of the importance of Internet-based information in the field of hypospadias. They may benefit from the valuable feedback information from patients and parents to improve their practice and outcome.