Factors associated with higher oxytocin requirements in labor

Objective: To identify clinical characteristics associated with high maximum oxytocin doses in women who achieve complete cervical dilation.

Methods: A retrospective nested case-control study was performed within a cohort of all term women at a single center between 2004 and 2008 who reached the second stage of labor. Cases were defined as women who had a maximum oxytocin dose during labor >20?mu/min, while women in the control group had a maximum oxytocin dose during labor of ≤20?mu/min. Exclusion criteria included no oxytocin administration during labor, multiple gestations, major fetal anomalies, nonvertex presentation, and prior cesarean delivery. Multiple maternal, fetal, and labor factors were evaluated with univariable analysis and multivariable logistic regression.

Results: Maximum oxytocin doses >20?mu/min were administered to 108 women (3.6%), while 2864 women received doses ≤20?mu/min. Factors associated with higher maximum oxytocin dose after adjusting for relevant confounders included maternal diabetes, birthweight >4000?g, intrapartum fever, administration of magnesium, and induction of labor.

Conclusions: Few women who achieve complete cervical dilation require high doses of oxytocin. We identified maternal, fetal and labor factors that characterize this group of parturients.     

失效模式与效应分析在三级医院标本检验前质量管理中应用研究

目的 应用失效模式与效应分析理论(failure mode and effects analysis, FMEA)提高三级医院细菌培养标本检验前的质量管理。方法 成立院级失效模式与效应分析小组,对标本检验前质量控制中存在的失效模式进行风险评估,通过FMEA分析法确定5项影响质量的失效因子为高风险因子,制定改进措施,比较FMEA实施前后风险优先指数值(risk priority number,RPN)及标本不合格率。 结果 FMEA实施后,标本检验前质量管理5项失效模式的RPN值均显著下降;标本不合格率由0.085%降低到0.046%。 结论 将FMEA应用于标本采集与收送流程质量控制的各个环节,可以有效地提高标本检验前合格率,确保检验分析质量,提高医院风险管理水平。     

Examining practical nursing experiences to discover ways in which to retain and invigorate the remaining functions of the elderly with a demented and complex disability in nursing homes

Aim

The bedridden elderly with moderate‐to‐severe dementia account for a large proportion of the residents in nursing homes and form a specialized group requiring customized care in order to encourage their remaining functions, which determine the quality of their residual life. The purpose of this study was to search for ways to invigorate and foster the remaining functions of this complex‐disability group, based on practical nursing strategies in nursing homes.

Methods

The qualitative thematic analysis was done by conducting in‐depth interviews with 29 nurses working at 11 different nursing homes in South Korea.

Results

This study proposed four main themes and 19 sub themes as keys for providing specialized nursing care to the elderly with physical and cognitive disabilities. The main themes encourage the residents' remaining functions: (i) accurate identification of an elderly resident's physical, cognitive, and behavioral baseline is necessary in order to determine their functional levels; (ii) nurses provide meticulous management to support the remaining functions in order to prevent further deterioration; (iii) optimized know‐how, based on accumulated experience and knowledge, is reflected in nursing strategies that maximize the effects of nursing interventions; and (iv) steady compliance with nursing guidelines and standards in nursing homes creates the best therapeutic environment and brings unexpected positive changes in the elderly's status.

Conclusion

A practical nursing strategy to target the group with a demented and complex disability in nursing homes was developed through thematic analysis of the empirical knowledge of nurses. The findings provide new insights for developing specialized nursing interventions and practical nursing models in long‐term care facilities.     

延续护理干预对改善行PCI术后老年患者自我管理行为的效果评价

目的：分析延续护理对行老年PCI术后患者自我管理行为的影响 方法：将2016年1月-2016年6月收治的108例行PCI术后老年患者随机编号分组,对照组（n=54）给予患者常规出院指导和随访;观察组（n=54）实施延续护理模式,将健康教育、电话随访、门诊随访、来院授课、定期复查等护理工作延续到家庭中。应用冠心病自我管理量表评估随访期间的延续护理效果。结果：实施延续护理后,2组患者出院后6个月实验室检查结果均有统计学意义,P值<0.05,空腹血糖（mmol/L）、总胆固醇（mmol/L）、甘油三酯（mmol/L）、低密度脂蛋白（mmol/L）、高密度脂蛋白（mmol/L）分别是：5.535±0.558;3.738±1.090;1.106±0.837;1.634±0.607;1.498±0.700;差异均有统计学意义,T值分别为4.928;4.390;2.083;8.859;-4.599。2组患者出院后3个月、6个月自我管理行为均有统计学意义,P值<0.01,其自我管理总分、不良嗜好、日常生活、症状、疾病知识、治疗依从性、急救、情绪认知管理得分分别是：97.981±10.450、97.944±10.543;15.481±2.305、15.519±2.247;16.222±3.225、16.148±3.201;12.926±2.641、12.963±2.599;19.593±3.595、19.630±3.599;7.704±1.513、7.778±1.526;10.778±1.930、10.815±1.854;15.278±2.825、15.093±3.030;T值分别是：-4.329、-6.360;-3.498、-5.101;-3.444、-3.420;-1.635、-4.594;-4.296、-6.504;0.799、-1.496;0.374、-4.165;-3.046、-4.010。结论：延续护理能提高老年PCI术后患者的自我管理行为,减少心血管不良事件的发生,提高患者的生存质量。     

Non-pharmacological management of phantom limb pain in lower limb amputation: a systematic review

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation.

Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation.

Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles.

Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias.

Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation.     

达芬奇机器人辅助下经双侧腋窝和乳晕入路甲状腺手术体位的护理体会(附83例报告)

目的：探讨达芬奇机器人经双侧腋窝和乳晕途径(bilateral axillo-breast approach, BABA)入路实施甲状腺手术时体位的摆放护理,以保障手术顺利进行。方法：2015 年5 月至2016 年12月我院运用达芬奇机器人手术系统完成机器人BABA 入路甲状腺手术共83例。本研究总结分析了病人手术体位的安置、术后并发症发生及相关护理因素。83例患者均采取头高脚低仰卧位(与地面约呈15-30°),肩部略垫高,患者乳房下方安置一条弹力绑带,固定于手术床旁,将患者双侧乳房向上推高,最大限度地减小术者的手术盲区,扩大手术视野。结果：83例均顺利完成达芬奇机器人BABA 入路甲状腺手术,无一例出现因体位不当、护理失误而引起的并发症。患者满意度为100%。结论：达芬奇机器人BABA入路甲状腺手术术中合理放置体位可保障手术安全顺利进行,并可有效预防术后并发症的发生。     

以护士为核心的新型疼痛管理模式在临床应用研究

目的：探讨以护士为核心的新型疼痛管理模式,为术后患者疼痛的管理提供科学的经验。方法：选择2016年5月至2017年4月在我院行胸、腹微创手术的患者,共212名。随机分为干预组106例,对照组106例。对照组按常规方式进行术后疼痛管理;干预组由护士进行常规疼痛管理外,同时参与患者自控式镇痛(PCA)泵的管理。结果：各研究组中没有明显药物不良反应发生。干预组停泵率明显低于对照组。在胸部手术后行静脉镇痛的患者中干预组的镇痛效果优于对照组;其他治疗组间的镇痛效果比较虽无差异,但干预组的额外用药量却显著降低。研究证明通过以护士为核心,多学科协作的疼痛管理,使自控式镇痛泵得到了充分应用,额外镇痛药物的用药量明显减少。结论：以护士为核心的多学科协作管理模式在术后镇痛管理中具有很大的优势,起到了重要的作用。