Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review

ObjectivesEmergency department (ED) attendance is common among people with dementia and increases toward the end of life. The aim was to systematically review factors associated with ED attendance among people with dementia approaching the end of life.DesignSystematic search of 6 databases (MEDLINE, EMBASE, ASSIA, CINAHL, PsycINFO, and Web of Science) and gray literature. Quantitative studies of any design were eligible. Newcastle-Ottawa Scales and Cochrane risk-of-bias tools assessed study quality. Extracted data were reported narratively, using a theoretical model. Factors were synthesized based on strength of evidence using vote counting (PROSPERO registration: CRD42020193271).Setting and ParticipantsAdults with dementia of any subtype and severity, in the last year of life, or in receipt of services indicative of nearness to end of life.MeasurementsThe primary outcome was ED attendance, defined as attending a medical facility that provides 24-hour access to emergency care, with full resuscitation resources.ResultsAfter de-duplication, 18,204 titles and abstracts were screened, 367 were selected for full-text review and 23 studies were included. There was high-strength evidence that ethnic minority groups, increasing number of comorbidities, neuropsychiatric symptoms, previous hospital transfers, and rural living were positively associated with ED attendance, whereas higher socioeconomic position, being unmarried, and living in a care home were negatively associated with ED attendance. There was moderate-strength evidence that being a woman and receiving palliative care were negatively associated with ED attendance. There was only low-strength evidence for factors associated with repeat ED attendance.Conclusions and ImplicationsThe review highlights characteristics that could help identify patients at risk of ED attendance near the end of life and potential service-related factors to reduce risks. Better understanding of the mechanisms by which residential facilities and palliative care are associated with reduced ED attendance is needed.     

硫酸镁注射液治疗婴幼儿喘息性疾病的分析

调查分析我院门诊、急诊患儿硫酸镁注射液的应用情况，为临床合理用药和儿科安全用药提供参考依据。对2017年11月门急诊含硫酸镁电子处方进行回顾性分析，内容包括年龄、用法用量、临床诊断、联合用药，使用天数等。共计204例患儿使用硫酸镁注射液，年龄在6个月至1岁之间的患儿最多，共72例，占比35.29%。67.65%的患儿使用剂量是30~50 mg·kg-1·d-1。临床诊断分别为急性喘息性支气管炎（32.35%）、肺炎（29.41%）、支气管炎（23.53%）等。在治疗方案中，硫酸镁常和糖皮质激素合用，其中有58.82%和醋酸甲泼尼龙合用，55.88%和布地奈德合用。目前硫酸镁在婴幼儿喘息性疾病的应用尚无统一、权威标准，可能存在用药风险。临床用药应加以重视、规范管理，保证用药安全。本研究结果对儿科合理使用硫酸镁注射液有参考价值。     

超声心动图诊断左冠状动脉右房瘘5例

【】目的:分析左冠状动脉右房瘘的彩色多普勒超声心动图特征,探讨超声心动图对诊断左冠状动脉右房瘘的价值。方法：应用超声心动图的二维图像、彩色显像和频谱多普勒观察左冠状动脉右房瘘的解剖异常及心腔内异常高速血流。结果：超声心动图均可见解剖异常的左冠状动脉显著扩张,走行迂曲,全程追踪显示瘘管,并于心腔内可见异常双期连续高速分流频谱,与冠状动脉造影及手术结果相符。结论：超声心动图对左冠状动脉右房瘘的诊断有很高直观性及实用性价值     

布地奈德联合沙丁胺醇氧驱动治疗喘憋性肺炎痰堵的临床护理观察

目的通过布地奈德混悬液联合硫酸沙丁胺醇溶液经氧驱动雾化吸入辅助治疗喘憋性肺炎，观察喘憋性肺炎痰堵患儿的临床护理疗效。方法80例喘憋肺炎患儿随机分为两组，观察组和对照组各40例，两组患儿均常规给予抗病毒、止咳化痰、吸氧、镇静等常规治疗与护理；观察组在此基础上给予布地奈德混悬液联合沙丁胺醇溶液氧驱动雾化吸入治疗，并进行仔细的临床观察，予以综合护理措施，观察临床护理效果。结果通过仔细观察和有针对性的护理，两组患儿有效率差异有显著意义（P〈0．05），未见不良反应和并发症。结论布地奈德混悬液联合沙丁胺醇溶液经氧驱动雾化吸入辅助治疗，结合临床观察和综合护理，可有效解除喘憋性肺炎患儿的痰堵，缓解临床症状，缩短病程，提高治愈率。     

手术室存在的护理风险因素分析及安全管理措施的效果评价

目的：探讨手术室存在的护理风险因素及安全管理措施的效果。方法将2010年11月~2013年12月于我院手术室接受手术治疗的120例患者根据管理方法不同分为对照组与观察组各60例。观察组采用安全管理，对照组未采用安全管理。比较两组患者手术室护理风险因素发生率及护理质量。结果对照组器械因素、手术室感染因素、院内感染因素、技术因素及管理因素分别为10.00%、3.33%、6.67%、3.33%及8.33%，显著高于观察组的1.67%、0、1.67%、0及3.33%，P＜0.05；观察组护理差错率、护理纠纷率、护理满意度及护理质控评分分别为1.67%、1.67%、96.67%及（99.02±10.11）分，对照组分别为5.00%、6.67%、86.67%及（92.18±9.05）分，差异有统计学意义（P＜0.05）。结论手术室存在的护理风险因素众多，应采取必要的安全管理措施，降低护理风险发生率。     

Kliniske erfaringer ved behandling af bulimia ved hjaelp af gruppeterapi

Peterson B, Ammitzbdl M. Kliniske erfaringer ved behandling af bulimia ved hjrelp af gruppeterapi.

The number of patients needing treatment for Bulimia has increased sharply during recent years. At KAS Stolpegård, DK-2820 Gentofte, a treatment program was established during the summer of 1986 offering this group of patients long-term group-therapy in a semi-closed group. The group therapy is based on the principles of Psychodynamics and System Theory. The article reviews the experience derived from this group treatment.     

手术室的职业危害自我防护及自我保健

目的研究手术室护士的自我保健的重要性以及手术室带来的职业危害。方法组织研究小组,采用查阅资料的方法包括书籍和计算机网络中查找,同时采取回顾性分析的方法,通过对手术室带来的危害分析的基础上,提出几点建设性意见,进而得出手术室护士自我保健的重要性。结果术室护士主要有生物因素,化学因素,物理因素及心理因素,针对四大因素提出有效的防治和预防措施。结论手术室护士的自我保健意识非常重要,树立正确的观念,有利于自身的身心健康,同时,使工作效率提高,给患者带来更快捷的服务。     

预先演示法在手术室教学中的应用效果

目的探讨预先演示法在手术室教学中的应用效果。方法将120名手术室实习护生随机分成两组，每组60名，观察组采用预先演示法，对照组采用传统教学法，比较两种方法对护生出科理论与操作考核．成绩的影响。结果观察组护生理论与操作考核成绩85分以上分别占83．3％，75．0％；优于对照组的58．3％，50．0％，差异有统计学意义（P〈0．01）。结论预先演示法在提高护生的应变能力、操作能力及综合运用知识能力方面均优于传统教学法。     

节能经济型手术室管理初探

节能经济型手术室建设首先考虑的是安全、可靠、实用方便,既洁污分明,又分区合理;既符合医院感染控制管理原则,又遵循全过程和全面控制原则;既要减少交叉感染,又要节约使用空间和运营费用。     

急诊观察室患者流行病学分析及对策

目的总结分析急诊观察室患者流行病学特点及临床疗效,为临床急诊治疗提供指导。方法以2007年1月-2010年12月收治的247 312例急诊观察室患者为研究对象,按年龄、性别、地域分布、疾病种类、发病时间、好转率、收入院百分率、死亡率等因素进行流行病学分析。结果各年度患者人数呈增加趋势,2010年减缓;城镇患者占91.5%;20～40岁患者占45.9%,40～60岁患者占27.2%,>60岁占21.3%;疾病种类分布中呼吸系统占42.4%,心血管疾病患者数量呈升高趋势,以老年人为主,中毒患者呈下降趋势。全年6、7、8月份因发热、上呼吸道感染患者较多,总数增加明显,其次11、12、1月份因慢性支气管炎急发患者较多,总数也有升高趋势;白天工作时间患者数量占66.2%;平均每天就诊人次为169.4人次,节假双休日平均每天就诊人次为191.1人次(P<0.01);各年度好转率呈升高趋势,收入院百分率无显著变化,死亡率无显著区别。结论近年急诊观察室患者以呼吸系统疾病为主,好转率呈升高趋势,但心血管疾病数量呈升高且有年轻化趋势,值得重视。