ICU机械通气患者意外拔管的原因分析及对策

对2008年1月至2010年6月,在ICU发生意外拔管的16例气管插管病人的临床资料进行了总结分析。结果导致意外拔管的相关因素有:缺乏有效的固定、未使用镇静剂、未使用适当的肢体约束及护患沟通不良等。因此,对人工气道的患者应高度重视,重在预防,做到正确固定,充分沟通,适当镇静和肢体约束,是有效的护理措施。     

Assessing depression severity using the UK Quality and Outcomes Framework depression indicators: a systematic review

BackgroundDepression is a major cause of chronic ill-health and is managed in primary care. Indicators on depression severity assessment were introduced into the UK Quality and Outcomes Framework (QOF) in 2006 and 2009. QOF is a pay-for-performance scheme and indicators should have evidence to support their use; potential unintended consequences should also have been considered.AimTo review the effectiveness of routine assessment of depression severity using structured tools in primary care, and to determine the views of GPs and patients regarding their use.DesignSystematic review.MethodStudies were identified by searching electronic databases; study selection, data abstraction, and quality assessment were carried out by one reviewer, with checks from other authors and GRADE (grading of recommendations, assessment, development and evaluation) tables completed for included effectiveness studies.ResultsEight studies met the eligibility criteria. There was very low-quality evidence that assessing severity in a structured way at diagnosis using a validated tool led to interventions that were appropriate to the severity of depression. Patients and GPs had different perceptions of the assessment of depression at diagnosis, with patients being more positive. GPs highlighted unintended consequences. There was low-quality evidence that structured assessment at follow-up led to increased rates of remission and response, but changes to management were not seen. Patients used this assessment to measure their own response to treatment.ConclusionAny estimate of the effect of structured assessment of depression severity in UK general practice is uncertain. GPs consider routine use of questionnaires as incentivised by the QOF has unintended consequences, which could adversely affect patient care.     

Physicians’ comprehension of the German Patients’ Rights Act: A cross-sectional study

ObjectiveThe German Patients' Rights Act (PRA), promulgated on February 25, 2013, was created to enhance transparency of patients' rights. This prospective study aimed to objectively measure physicians' comprehension of the PRA.MethodsWe generated a controlled study design, developing a questionnaire consisting of six case scenarios with 4–7 dichotomous items each. The survey concluded with seven 5-point-Likert scale questions, dealing with the PRA’s effects. Physicians teaching at the Westfälische Wilhelms-Universität (WWU) Münster served as the intervention group, and medical students from WWU Münster at the beginning of their clinical education formed the control group. Physicians were surveyed in November 2015; students were surveyed in February 2016.ResultsA total 56 completed surveys of physicians and 134 of students were analyzed. Of a total 33 points, on average physicians answered 21.04 (95% confidence interval (CI) 20.43–21.64) items correctly, a significantly higher result than students' 19.74 (95% CI 19.31–20.17) points (p < 0.001; Hedges' g = 0.53). Estimations of the PRA’s effects were ambiguous. Students agreed with the PRA’s supporting effect more often than physicians (p < 0.001) whereas physicians felt increased uncertainty arising from the PRA.ConclusionComprehension of the PRA increases significantly over the course of medical work experience; however, this comprehension is limited among medical experts. The PRA leads to ambiguity and uncertainty in the medical decision-making process.     

The Impact of Nonalcoholic Fatty Liver Disease in Primary Care: A Population Health Perspective

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide, with rising rates in parallel to those of obesity, type 2 diabetes, and metabolic syndrome. NAFLD encompasses a wide spectrum of pathology from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis, which are linked to poor outcomes. Studies confirm a significant amount of undiagnosed NAFLD and related fibrosis within the community, increasing the overall burden of the disease. NAFLD appears to be more prevalent in certain populations, such as those with type 2 diabetes and metabolic syndrome. Early detection and lifestyle modifications, including weight loss and regular exercise, have been shown to improve outcomes. Adverse cardiovascular events are a key contributor to NAFLD-associated morbidity and mortality, and efforts to minimize their occurrence are essential. A targeted and algorithmic approach using noninvasive diagnostic techniques is promptly required to identify and risk-stratify patients with NAFLD. Patients at low risk of progression to NASH and advanced fibrosis can be managed in the primary care setting, while those at high risk of disease progression should be referred to hepatology specialists for surveillance and treatment. This review summarizes the key data of NAFLD's impact within primary care populations and proposes a potential algorithmic approach to identifying and managing such patients.