ICU病人非计划性拔管的原因分析与护理防范

为提高ICU插管病人的护理质量 ,分析非计划性拔管的原因 ,并提出进行相关知识的培训 ,有效固定导管 ,合理使用镇静剂及肢体约束等防范措施。     

The Role of Patient–Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako,Mali: A Qualitative Study

Mounting evidence in sub-Saharan Africa suggests poor patient-provider communication (PPC) negatively impacts patient engagement (retention in care and adherence to medication) in antiretroviral therapy (ART) programs. In Bamako, Mali, where 36% of ART patients are lost to follow-up within 12 months of initiating treatment, we aimed to define features of positive PPC according to patient values and explore the mechanisms by which these features may sustain engagement and re-engagement according to patient and provider experiences. We conducted 33 in-depth interviews and 7 focus groups with 69 patients and 17 providers in five ART clinics. Regarding sustaining engagement, participants highlighted “establishing rapport” as a foundational feature of effective PPC, but also described how “responding to emotional needs”, “eliciting patient conflicts and perspective” and “partnering to mitigate conflicts” functioned to address barriers to engagement and increase connectedness to care. Patients who had disengaged felt that “communicating reacceptance” may have prompted them re-engage sooner and that tailored “partnering to mitigate conflicts” would be more effective in sustaining re-engagement than the standard adherence education providers typically offer. Optimizing provider skills related to these key PPC features may help maximize ART patient engagement, ultimately improving health outcomes and decreasing HIV transmission in sub-Saharan Africa.     

Audiovisual aids in primary healthcare settings’ waiting rooms. A systematic review

Background: Health promotion is part of GPs' commitments. Some waiting rooms have therefore been implemented with audiovisual aids (posters, pamphlets or screens) for health promotion purposes. Few studies have assessed the effect of audiovisual aids in primary care.

Objectives: To identify, describe and appraise studies that have investigated the effects of audiovisual aids on health promotion in primary healthcare waiting rooms. To determine which factors influence this impact through literature review.

Methods: Systematic review. Two independent researchers using predefined keywords searched databases. Additional publications were extracted from the reference lists of the selected articles. The selection of the articles was performed on the title and abstract, followed by complete reading and assessment. Bias and level of evidence were analysed.

Results: A total of 909 articles were collected. Most of them were not in primary care settings. Fourteen peer-reviewed articles fully meeting inclusion criteria were included and analysed. Good quality studies were scarce. Eight of these articles using videos or slideshows on TV screens or tablets indicated effects: three of them were significant on patient knowledge with acceptable evidence and three on health behaviour on surrogate endpoints. Audiovisual aids seem to be used or noticed by patients and can induce conversations with physicians. The relevant factors that might influence these effects (duration of exposure, conception quality, theme, target population and time spent in the waiting room) are insufficiently investigated.

Conclusion: Audiovisual aids broadcasting messages using screens (TVs, computers, tablets, and smartphones with Bluetooth^® pairing) probably enhance patients’ knowledge. A change in health behaviour remains controversial.     

Progression of periodontitis in a sample of regular and irregular compliers under maintenance therapy: a 3-year follow-up study

Background: To our knowledge, prospective studies (matched for sex, smoking, and diabetes) that investigated the influence of compliance in the progression of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs were not previously reported. Methods: A total of 58 regular complier (RC) and 58 erratic complier (EC) individuals were recruited from a prospective cohort with 238 patients under PMT and matched by sex, diabetes, and smoking habits. A full‐mouth periodontal examination that included bleeding on probing (BOP), probing depths (PDs), clinical attachment levels, and number of teeth were determined at all PMT visits during a 3‐year interval. The influence of variables of interest was tested through multivariate logistic regression. Results: The progression of periodontitis and tooth loss was significantly lower among RC compared to EC patients. A higher progression of periodontitis was observed among EC patients who smoked. The final logistic model for the progression of periodontitis in the RC group included smoking (odds ratio [OR]: 4.2) and >30% of sites with BOP (OR: 2.8), and the final logistic model for the progression of periodontitis in the EC group included smoking (OR: 7.3), >30% of sites with BOP (OR: 3.2), PDs of 4 to 6 mm in 10% of sites (OR: 3.5), diabetes (OR: 1.9), and number of lost teeth (OR: 3.1). Conclusions: RC patients presented a lower progression of periodontitis and tooth loss compared to EC patients. This result highlighted the influence of the pattern of compliance in maintaining a good periodontal status. Moreover, important risk variables such as smoking and diabetes influenced the periodontal status and should be considered when determining the risk profile and interval time for PMT visits.     

Oral cancer awareness for the general practitioner: new approaches to patient care

In Australia, oral cancer accounts for approximately 2-3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses.     

The role of dentist, practice and patient factors in the provision of dental services

OBJECTIVES: Service provision varies by dentist, practice and patient factors. However, limited subsets of these potential influences on service rates have been explored. More comprehensive models could improve our understanding of the factors influencing the pattern of care delivered. The aim of this study was to examine variation in dental services by dentist (treatment choice, practice beliefs, preferences for patients, demographics), practice (type, location, size and volume of practice) and patient (visit, demographic, oral health and socio-economic) characteristics. METHODS: A random sample of Australian dentists was surveyed in 1997-98 (response rate=60.3%). Private general practitioners (n=345) provided dentist and practice data, and service provision and patient variables were collected from a log of a typical clinical day (n=4,115 patients). Multivariate negative binomial regression models were fitted for diagnostic, preventive, restorative, extraction and prosthodontic services. RESULTS: Significant dentist factors included (P<0.05; RR=rate ratio): lower diagnostic rates (RR=0.78) for dentists with stronger practice beliefs for giving information about cost and treatment options; preventive rates were lower (RR=0.74) for male dentists and higher (RR=1.48) for younger dentists aged 20-29 years; restorative rates were higher (RR=1.27) for dentists that rated patient preferences more highly in treatment choice and in the dentist age group 30-39 years (RR=1.25); extraction rates were lower (RR=0.61) for dentists with stronger preferences for patients that would adhere with treatment but higher (RR=1.57) for dentists with stronger preferences for sociable patients; and prosthodontic rates were lower (RR=0.38) for dentists with stronger preferences for adaptable patients who were willing to cooperate when expected to do so. Practice factors included: higher preventive (RR=1.28) and prosthodontic rates (RR=2.07) in solo practice; higher preventive (RR=1.34) but lower prosthodontic rates (RR=0.42) in capital cities; lower diagnostic (RR=0.82) and extraction rates (RR=0.55) in practices with fewer other dentists; higher diagnostic (RR=1.33) and extraction (RR=1.62) rates but lower restorative rates (RR=0.84) in practices with lower patient visits per year. Patient factors included: lower preventive (RR=0.76) but higher extraction rates (RR=1.45) for emergency visits; lower extraction rates (RR=0.60) for the insured; higher diagnostic rates (RR=1.17) for new patients; higher restorative (RR=1.31) but lower prosthodontic rates (RR=0.46) for patients with decayed teeth; higher prosthodontic rates (RR=2.14) for those with dentures; and lower preventive (RR=0.66), but higher extraction (RR=2.22) and prosthodontic rates (RR=1.82) for patients from lower socio-economic status areas. CONCLUSIONS: Dental service rates were influenced by large number of small effects from a wide range of dentist, practice and patient factors. Socio-economic and geographic barriers may need broad policy innovations to be addressed, but factors such as insurance and visit type have the potential to be altered to achieve better service outcomes and there is scope for research into clinical outcomes to improve the knowledge upon which treatment decisions are based.     

The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis

Purpose

The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of implants required to support a maxillary overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.