四川省综合医院住院患者非计划拔管风险监控现状调查

目的了解四川省二级及以上综合医院住院患者非计划拔管风险监控管理现状,为建立和完善非计划拔管风险管理模式提供参考。方法采用自行设计的住院患者非计划拔管风险监控调查问卷,对四川省171所二级及以上综合医院进行调查。结果 161所(94.15%)医院开展非计划拔管风险监控,其中157所(97.52%)医院设置有监控机构,均有护理部参与;153所(89.47%)医院有对住院患者非计划拔管的风险评估,160所(93.57%)医院开展非计划拔管风险质量管理督查;10所(5.85%)医院未建立非计划拔管上报机制,36所(21.05%)医院发生非计划拔管后无预警机制,17所(9.94%)医院未开展非计划拔管事件追踪评价。结论四川省二级及以上综合医院开展住院患者非计划拔管风险监控管理相对较好,但在监控机构组成人员、管道监控范围、风险评估工具、风险督查、上报机制、预警机制、追踪评价机制等方面还需进一步完善,以保障非计划拔管管理质量,防范非计划拔管事件发生。     

持续质量改进在小儿气管插管非计划性拔管中的应用

目的 探讨小儿气管插管非计划性拔管的危险因素,采取针对性措施,以降低小儿气管插管非计划性拔管的发生率.方法 应用持续质量改进的方法,对小儿发生非计划性拔管的原因进行分析,确定改进目标,制订改进计划并实施,评价改进效果.结果 小儿气管插管非计划性拔管的发生率下降(P<0.01).结论 遵循质量持续改进原则实施管理,...     

Effects of Connective Tissue Massage on Pain in Primiparous Women After Cesarean Birth

Objective

To evaluate the efficacy of connective tissue massage to reduce postoperative pain in primiparous women on Postoperative Day 1 after unplanned cesarean birth.

Medicaid expansions,preconception insurance,and unintended pregnancy among new parents

ObjectiveTo assess the relationship between recent changes in Medicaid eligibility and preconception insurance coverage, pregnancy intention, health care use, and risk factors for poor birth outcomes among first‐time parents.Data SourceThis study used individual‐level data from the national Pregnancy Risk Assessment Monitoring System (2006‐2017), which surveys individuals who recently gave birth in the United States on their experiences before, during, and after pregnancy.Study DesignOutcomes included preconception insurance status, pregnancy intention, stress from bills, early prenatal care, and diagnoses of high blood pressure and diabetes. Outcomes were regressed on an index measuring Medicaid generosity, which captures the fraction of female‐identifying individuals who would be eligible for Medicaid based on state income eligibility thresholds, in each state and year.Data Collection/Extraction MethodsThe sample included all individuals aged 20‐44 with a first live birth in 2009‐2017.Principal FindingsAmong all first‐time parents, a 10‐percentage point (ppt) increase in Medicaid generosity was associated with a 0.7 ppt increase (P = 0.017) in any insurance coverage and a 1.5 ppt increase (P < 0.001) in Medicaid coverage in the month before pregnancy. We also observed significant increases in insurance coverage and early prenatal care and declines in stress from bills and unintended pregnancies among individuals with a high‐school degree or less.ConclusionsIncreasing Medicaid generosity for childless adults has the potential to improve insurance coverage in the critical period before pregnancy and help improve maternal outcomes among first‐time parents.     

“Planned” and “unplanned” pregnancy: Deconstructing experiences of conception

This paper seeks to explore women's experiences of conception, and to deconstruct the dichotomy between the terms “planned” and “unplanned” pregnancy. It draws on interviews with 19 primagravidae conducted as part of a wider qualitative study of women's experiences of pregnancy and childbirth. Although the concept of pregnancy intention is widely regarded as ambiguous, and by some immeasurable, this paper draws on interview data to develop four categories of pregnancy intention. The first category (the planned pregnancy) is unambiguous and reflects the type of planned approach currently advocated by health professionals. The second category (the laissez-faire pregnancy) reflects the experiences of women who stop using contraception but adopt a more relaxed approach to pregnancy planning. The third category (the recalcitrant pregnancy) is far more ambiguous and describes the experiences of those who want to be pregnant but for whom it would not be socially acceptable to plan a pregnancy. The final category (the accidental pregnancy) is unambiguous and deals with pregnancies that could be described as unexpected, and arising due to genuine contraceptive failure. This paper concludes by highlighting the significance of pregnancy intention for health policy, health research, and for the health care providers. The importance of adopting a subjective approach to improve our understanding of women's experiences of conception is also highlighted.     

Unsafe abortion: worldwide estimates for 2000

Unsafe abortion is preventable and yet remains a significant cause of maternal morbidity and mortality in much of the developing world. Over the last decade, the World Health Organization has developed a systematic approach to estimate the regional and global incidence of unsafe abortion. Estimates based on figures around the year 2000 indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies ended in an unsafe abortion, giving a ratio of one unsafe abortion to about seven live births. Almost all unsafe abortions take place in the developing world. In Latin America and the Caribbean, 3.7 million unsafe abortions are estimated to take place each year, with an abortion rate of 26 per 1000 women of reproductive age, almost one unsafe abortion to every three live births. Asia has the lowest unsafe abortion rate at 11 per 1000 women of reproductive age, but 10.5 million unsafe abortions take place there each year, almost one unsafe abortion to every seven live births. However, excluding East Asia, where most abortions are safe and accessible, the ratio for the rest of Asia is one unsafe abortion to five live births. In Africa, 4.2 million abortions are estimated to take place per year, with an unsafe abortion rate of 22 per 1000 women, or one unsafe abortion per seven live births. In contrast, there is one unsafe abortion per 25 live births in developed countries.     

Sexual behaviour and contraceptive use among unmarried, young women migrant workers in five cities in China

This paper reports the results of exploratory research on reproductive and sexual health knowledge and sexual behaviour of young, unmarried women who migrate to cities from rural areas for work, and their access to and needs in relation to family planning in Beijing, Guangzhou, Shanghai, Guiyang and Taiyuan, in China. Focus group discussions were conducted with 146 young women aged 16-25 and 58 in-depth interviews with key informants. Some of the young female migrant workers were sexually active and living with their boyfriends, most of whom expected to marry each other. Most of the women lacked basic information about reproduction and contraception, and did not know where or how to obtain contraception. There were social, psychological and economic barriers to accessing services. Only a small proportion of those who were unmarried were using contraception, so induced abortion was often the outcome of unprotected premarital sex. Pleasing male partners also played an important role in unprotected sex. The training, attitudes and approach of the entire family planning service system in relation to unmarried and young people in China, including this migrant population, needs to be reorientated so as to provide them with appropriate and adequate services.     

加速康复外科在腹腔镜胰十二指肠切除围手术期的渐进式应用

目的 探讨加速康复外科(ERAS)在腹腔镜胰十二指肠切除术(LPD)围手术期渐进式应用的临床效果.方法 前瞻性分析西安交通大学附属咸阳市中心医院肝胆外科2018年3月至2021年3月拟行LPD的112例患者临床资料.采用渐进式推行ERAS:所有病例经术前按标准严格排查,术前及术中均采用ERAS所要求的处理措施.手术过程...