外科病区护理不良事件原因分析及对策

外科病区护理不良事件与护理质量、患者安全、护理管理等密切相关,已引起广泛关注。因此,分析不良事件产生的原因以及探讨其防范对策,对于护理工作具有重大意义。本研究选取本院外科病区2015年1月至2016年12月发生的68例护理不良事件进行分析,结果表明非计划拔管、跌倒/坠床、给药错误为高发事件;重症监护室、胸心外科、普外科为高发科室;观察不到位、评估不足、沟通不良为主要原因;白班、大夜班为发生不良事件的主要时段;低年资、低职称为主要涉事人员;未造成后果事件为主要事件。因此,护理不良事件的预防需要提高护士的专业服务能力,落实核心制度、合理配置护士人力资源,加强管理等措施减少护理不良事件的发生。     

普外科护理不安全因素分析及干预对策

目的:分析普外科护理不安全因素,探讨干预对策。方法:回顾性分析医院2014年1月~2014年12月的护理不良事件发生情况,探讨干预对策。结果:2014年度共发生护理不良事件66例,其中,护理操作不规范28例,发生率为42.5%,法律意识缺乏导致医疗纠纷10例,发生率为15.1%,与患者发生争论9例,发生率为13.6%,护理记录不规范16例,发生率为24.3%,排班不合理3例,发生率为4.5%。结论:护理操作不规范、护理记录不规范为普外科护理中常见的不安全因素,通过因素分析,制定相应对策,提升护理质量。     

细节管理在儿科护理管理中的应用

目的:评价细节管理在儿科护理管理中的应用效果。方法:于2014年1月开始实施细节管理,对比2013年1月~10月与2014年1月~10月护理质量评分与不良事件发生情况、家属满意率。结果:2013年1月~10月,护理不良事件发生率2.64%高于2014年1月~10月0.63%,2014年1月~10月家属满意、基础护理质量评分、病区管理评分、危重症护理质量评分高于2013年1月~10月,差异具有统计学意义(P0.05)。结论:于儿科中实施细节护理管理有助于全面提高护理质量,降低护理不良事件发生风险,获得家属好评。     

布地奈德雾化吸入联合系统护理干预治疗儿童哮喘急性发作

为了探讨布地奈德雾化吸入联合系统护理干预治疗儿童哮喘急性发作的临床效果,本研究选取2016年2月至2017年12月在我院治疗的哮喘急性发作患儿84例,采用随机数字表法将患儿随机分为观察组(n=44)和对照组(n=40),均给予地奈德雾化吸入,其中对照组给予常规护理,观察组在对照组基础上增加系统护理干预,观察两组治疗疗效、临床症状消失时间、治疗依从性、肺功能等。研究结果表明观察组治疗疗效优于对照组(p<0.05),其治疗总有效率为93.18%;观察组和对照组喘息、咳嗽和肺部哮鸣音消失时间比较差异无统计学意义(p>0.05);观察组治疗后用力肺活量(FVC)、第一秒用力呼气容积(FEV1)和呼气流量峰值(PEF)分别为(3.30±1.03) L、(2.70±0.81) L和(6.10±0.90) L/s,明显高于对照组(p<0.05);观察组治疗依从性好的比例为86.36%,明显高于对照组(p<0.05);观察组和对照组治疗期间未发生不良反应。研究结果初步说明布地奈德雾化吸入联合系统护理干预治疗儿童哮喘急性发作能提高治疗效果,同时提高患儿治疗依从性。     

强化护理干预有利于提高肝硬化肝性脑病患者治疗效果、改善患者生存质量

为探讨强化护理干预在肝硬化肝性脑病患者治疗中的应用效果及对护理满意度的影响,本研究选取我院2014年1月至2016年1月收治的80例肝硬化肝性脑病患者,采用随机数字表法分为强化组和对照组各40例,两组患者均给予相同的基础治疗方案,强化组患者治疗期间给予强化的护理干预,对照组仅给予常规护理指导,对比两组的临床治疗效果、护理满意度。结果显示,治疗前,两组患者的丙氨酸氨基转移酶(alanine aminotransferase, ALT)、血清白蛋白(serum albumin, ALB)、总胆红素(total bilirubin, TBIL)、血氨(NH3)差异不具有统计学意义(p>0.05);治疗1周后,强化组的ALT、TBIL、NH3测定值均低于对照组(p<0.05),ALB高于对照组(p<0.05);治疗1周后,强化组的躯体健康、心理障碍、社会功能、物质生活四个维度评分均高于对照组(p<0.05);强化组护理非常满意72.50%、满意22.50%、一般5.00%、不满意0.00%,对照组非常满意50.00%、满意20.00%、一般17.50%、不满意2.50%,两组比较差异具有统计学意义(p<0.05)。本研究初步表明,强化护理干预应用于肝硬化肝性脑病患者的治疗中有利于提高临床治疗效果、改善患者的生存质量、提高护理满意度。     

综合护理干预对百草枯中毒患者hs-CRP、IL-10、ASL、ALT水平影响

为分析综合护理干预对百草枯中毒患者临床治疗预后的效果,本研究选取2015年5月至2016年12月我院收治的百草枯中毒患者92例,根据护理方法不同分为对照组和观察组。对照组患者采用常规护理模式进行干预,观察组患者采用综合护理模式进行干预,分析两组患者护理后的效果。研究发现,观察组患者治愈率、7 d存活率和30 d存活率高于对照组,口腔黏膜愈合时间、住院时间短于对照组(p<0.05)。干预前,两组患者hs-CRP、IL-10、ASL、ALT水平比较无统计学差异(p>0.05)。干预后,观察组患者hs-CRP、IL-10、ASL、ALT水平低于对照组(p<0.05)。干预前,两组患者焦虑、抑郁评分比较无统计学差异(p>0.05)。干预后,观察组患者焦虑、抑郁评分低于对照组(p<0.05)。本研究的结果说明,百草枯中毒患者采用综合护理干预可加快患者口腔黏膜愈合时间,提高治愈率、存活率,改善患者心理状况,值得临床推广及进一步规范研究。     

康复护理干预有助于颅脑外伤术后偏瘫患者的恢复

为探讨基于康复教育护理团队实施康复护理对颅脑外伤术后偏瘫患者生活能力及神经功能恢复的影响,本研究选取96例颅脑外伤术后偏瘫患者,随机分为对照组与观察组各48例,对照组采用常规护理,观察组应用基于康复教育护理团队的康复护理。通过比较两组干预前后日常生活能力评分(ADL)、Fugl-Meyer运动功能量表(FMA)评分及美国国立卫生院神经功能缺损评分(NIHSS)的变化,采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评定干预前后患者心理状态的变化,并统计两组护理期间并发症发生率。研究发现,干预8周,两组轻度依赖、中度依赖所占比例上升,重度依赖、完全依赖所占比例下降,观察组轻度依赖所占比例高于对照组,完全依赖所占比例高于对照组(p<0.05);干预8周,两组FMA表感觉、运动功能、关节活动度、疼痛、平衡等维度评分均上升,观察组各维度评分上升幅度高于对照组(p<0.05),两组NIHSS评分、SAS评分、SDS评分均降低,观察组上述量表评分低于对照组(p<0.05)。观察组护理期间并发症发生率略低于对照组,但比较差异无统计学意义(p<0.05)。本研究证实,对颅脑外伤术后偏瘫患者采用基于康复教育护理团队的康复护理模式可改善患者日常生活能力、运动功能及神经功能,纠正患者不良情绪。     

改良剖宫产后评分法联合护理干预对剖宫产术后再次妊娠的临床效果分析

为了探究改良评分法联合护理干预对剖宫产术后再次妊娠孕妇的临床效果,本研究选取200例剖宫产术后再次妊娠孕妇,随机分为两组:对照组给予改良评分法联合常规干预,观察组为改良评分法联合护理干预。统计分析两组孕妇抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)的评分情况、孕妇术后并发症,新生儿并发症和康复情况。研究结果显示,与常规干预组相比,改良评分法联合护理干预可明显降低剖宫产术后再次妊娠孕妇的SDS(p<0.05)和SAS评分(p<0.05),降低孕妇术后并发症(p<0.05)和新生儿并发症的发生率(p<0.05),以及增加孕妇术后的康复有效率(p<0.05)。本研究初步表明,改良评分法联合护理干预可明显改善剖宫产术后再次妊娠孕妇的临床效果,值得妇产科临床推广和运用。     

胃癌患者Sox2蛋白和CTHRC-1蛋白的表达与肿瘤发展密切相关

本研究选取病理科收集的自2016年1月至2016年12月的90例术后胃癌组织标本(胃癌组)、45例癌旁组织标本(对照组),采用免疫组化染色法检测两组标本中的Y框蛋白(Sox2)、胶原三股螺旋重叠蛋白-1表达,并分析其与肿瘤TNM分期、淋巴结转移、浸润深度、分化程度的关系,采用Spearman秩相关检验检测两种蛋白的相互关系,试图探讨胃癌患者癌组织中性别决定区Y框蛋白(Sox2)、胶原三股螺旋重叠蛋白-1(CTHRC-1)的表达及其相关性。研究结果表明:胃癌组的Sox2蛋白阳性表达率63.33%显著低于对照组的93.33%(p<0.05),胃癌组的CTHRC-1蛋白阳性表达率78.89%显著高于对照组的24.44%(p<0.05);胃癌组的Sox2蛋白阳性表达与胃癌的分化程度、发生淋巴结转移具有相关性(p<0.05);胃癌组的CTHRC-1蛋白阳性表达与胃癌的淋巴结转移、TNM分期、肿瘤浸润深度具有显著的相关性(p<0.05);胃癌组的Sox2蛋白与CTHRC-1蛋白呈显著的负相关表达(Spearman相关系数r=-0.322, p=0.002<0.05)。本研究的初步结论表明:胃癌组织中Sox2蛋白低表达和CTHRC-1蛋白高表达,并且与肿瘤发展密切相关,且二者表达呈负相关。     

认知行为干预对颅脑肿瘤患者术后情绪及认知的影响

为了揭示认知行为干预对颅脑肿瘤患者术后情绪及认知的影响,选取大理学院附属医院2014年5月至2016年5月收治的颅脑肿瘤患者80例,依据随机数字表法将这些患者分为常规护理干预组(n=40)和认知行为干预组(n=40)两组,对两组患者的焦虑抑郁情绪、疼痛感、应激性溃疡发生情况、依从性及护理满意度进行统计分析。分析显示,认知行为干预组患者的焦虑评分和抑郁评分均显著低于常规护理干预组(p0.05);认知行为干预组患者的VAS评分和应激性溃疡发生率(10.0%)也显著低于常规护理干预组22.5%(9/40)(p0.05);认知行为干预组患者的依从性、护理满意度均显著高于常规护理干预组(p0.05)。本研究表明,颅脑肿瘤术后患者深受焦虑抑郁情绪影响,认知行为干预较常规护理干预在患者焦虑抑郁情绪、疼痛感、应激性溃疡发生情况、依从性及护理满意度等方面具有更好的护理效果。     

Cognitive functioning of female nurses during the night shift: The impact of age,clock time,time awake and subjective sleepiness

ABSTRACT

Decline in cognitive functioning in the workplace is a major concern for health care systems. Understanding factors associated with nighttime functioning is imperative for instituting organizational risk management policies and developing personalized countermeasures. The present study aims to identify individual factors associated with cognitive functioning during the night shift of hospital nurses working on irregular rotating-shift schedules. Ninety-two female nurses were recruited from 17 wards in two general hospitals, using convenience sampling by clusters. Inclusion criteria were working at least 28 h a week (75% of full time) and one night shift per week. Exclusion criteria were pregnancy, diagnosed sleep disorders or medical conditions that may affect sleep and/or function. Cognitive performance was measured during the middle (03:00 h) and at the end (07:00 h) of the night shift using the Digit Symbol Substitution Task (DSST) and the Letter Cancellation Task (LCT) over two night shifts. Subjective sleepiness was assessed by the Karolinska Sleepiness Scale (KSS) at the same time points. All participants completed a sociodemographic questionnaire, the Munich ChronoType Questionnaire for Shift-Workers (MCTQShift) and the Pittsburgh Sleep Quality Index (PSQI). Sleep duration 24 h before the night shift and time awake since last sleep opportunity were monitored by actigraphy. Univariate repeated measures ANOVA found main effects for clock time (p<0.001), age (p<0.05), time awake (p<0.05) and sleepiness (p<0.01) for DSST correct responses; main effects for clock time (p<0.001) and sleepiness (p<0.001) for LCT capacity; and main effects for clock time (p<0.001) and age (p<0.01) for LCT omission errors. All factors remained significant in a mixed-model analysis for DSST. Cognitive performance among hospital nurses is low during the middle of the night shift and increases at the end of the shift; decreased functioning is associated with increased subjective sleepiness, older age and prolonged time awake. Identifying factors contributing to performance during the night shift may provide a basis for the development of risk management policies and preventative interventions.     

Pharmacotherapy for Adverse Events Reduces the Length of Hospital Stay in Patients Admitted to Otolaryngology Ward: A Single Arm Intervention Study

Background

To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events.

Methods

A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events.

Results

Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4%) experienced adverse events of grade ≥2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3–4, respectively. Medical intervention lowered the incidence of grade ≥2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260–2.259, P<0.001). A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay.

Conclusion

Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events.     

比伐卢定联合替罗非班在高血栓负荷拟行PPCI治疗的急性ST段抬高型心肌梗死患者中的应用价值

目的:探讨替罗非班与比伐卢定联合治疗在高血栓负荷拟行直接经皮冠状动脉介入(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者中的应用价值。方法:选取我院于2018年3月~2020年3月期间收治的127例高血栓负荷拟行PPCI治疗的STEMI患者。将所有患者按照入院顺序,单号分为对照组(替罗非班治疗),双号分为观察组(比伐卢定联合替罗非班治疗),分别为63例和64例。对比两组术后24 h、术后30 d支架内血栓事件、30 d内的出血事件发生率,对比两组心肌梗死溶栓试验(TIMI)血流分级变化、心功能及肌酸激酶同工酶(CKMB)峰值时间及CKMB峰值,记录两组术后不良心血管事件发生率及住院时间。结果:两组术后24 h、术后30 d均未发生支架内血栓事件,观察组30 d内的出血事件发生率较对照组低(P<0.05)。两组住院时间组间对比无明显差异(P>0.05)。两组术后1个月TIMI血流分级为Ⅲ级的占比高于术前同一分级,TIMI血流分级为0~Ⅰ级、Ⅱ级的占比低于术前同一分级(P<0.05)。观察组术后7 d左心室收缩末期内径(LVESD)、CKMB峰值小于对照组,左心室射血分数(LVEF)高于对照组,CKMB峰值时间短于对照组(P<0.05)。两组心血管不良事件总发生率对比无差异(P>0.05)。结论:比伐卢定联合替罗非班治疗高血栓负荷拟行PPCI的STEMI患者,可改善患者心功能,减少心肌损伤,改善TIMI血流分级,同时还可减少30 d内的出血事件发生率。     

不同剂量替罗非班联合冠脉介入治疗对非ST段抬高型急性冠脉综合征的疗效及安全性

目的:探讨不同剂量替罗非班联合冠脉介入治疗对非ST段抬高型急性冠脉综合征(Non ST-segment elevation acute coronary syndromes,NST-ACS)的疗效及安全性。方法:选择我院2014年10月至2016年6月收治的110例NST-ACS患者,根据随机数字表法,分为全剂量组及半剂量组。观察两组患者治疗前后的TIMI血流分级情况、术前及术后30 d的心功能、主要心血管事件及出血事件、住院费用及住院天数。结果:与术前相比,两组的TIMI 2级和3级血流分级显著降低;术后30 d两组患者的左室收缩末期容积(left ventricular end diastolic volume,LVEDV)、左室舒张末期容积(left ventricular end systolic volume,LVESV)均明显下降,而左室射血分数(left ventricular ejection fraction,LVEF)均明显上升,P均0.05;而术前、术后组间TIMI血流分级、LVEDV、LVESV及LVEF对比无统计学意义,两组的主要心血管事件及住院时间对比差异无统计学意义,P均0.05;而全剂量组组的出血事件及住院费用对比明显高于半剂量组,P0.05。结论:半剂量组的替罗非班联合冠脉介入治疗对NST-ACS疗效显著,且可降低患者的出血事件及住院费用,值得临床推广应用。     

Treatment with atorvastatin is associated with a better prognosis in chronic heart failure with systolic dysfunction: results from The Daunia Heart Failure Registry

Background

Few works have evaluated the effect of statins on left ventricular dysfunction in patients with chronic heart failure (CHF), by using tissue Doppler imaging (TDI). We therefore aimed to investigate whether atorvastatin treatment may influence prognosis and myocardial performance evaluated by TDI in subjects with CHF.

Methods

Five hundred thirty-two consecutive CHF outpatients enrolled in a local registry, the Daunia Heart Failure Registry, were prospectively analysed. 195 patients with CHF and left ventricular ejection fraction (LVEF) ≤40 %, either in treatment with atorvastatin (N: 114) or without statins (N: 81), underwent TDI examination. Adverse events were evaluated during follow-up.

Results

The atorvastatin group showed a lower incidence of adverse events (cardiac death: 0 % vs 7 %, p < 0.01), and better TDI performance (E/E’ 15 ± 5.7 vs 18 ± 8.3, p < 001) than controls. Ischaemic CHF patients in treatment with atorvastatin also showed a lower incidence of adverse events (death: 10 % vs 26 %, p < 0.05; sustained ventricular arrhythmias: 5 % vs 19 %, p < 0.05, cardiac death: 0 vs 8 %, p < 0.05) and better TDI performance (E/E’ ratio: 15.00 ± 5.68 vs 19.72 ± 9.14, p < 0.01; St: 353.70 ± 48.96 vs 303.33 ± 68.52 msec, p < 0.01) than controls. The association between atorvastatin and lower rates of cardiac death remained statistically significant even after correction in a multivariable analysis (RR 0.83, 95 % CI 0.71–0.96, p < 0.05 in CHF with LVEF ≤40 %; RR 0.77, 95 % CI 0.62–0.95, p < 0.05 in ischaemic CHF with LVEF ≤40 %).

Conclusions

Treatment with atorvastatin in outpatients with systolic CHF is associated with fewer cardiac deaths, and a better left ventricular performance, as assessed by TDI.     

复方金银花煎液湿热敷与夫西地酸乳膏联合治疗靶向药物所致皮疹的临床疗效

目的:分析复方金银花煎液湿热敷与夫西地酸乳膏联合治疗靶向药物所致皮疹的临床疗效。方法:选择2014年8月~2016年8月我院收治的靶向药物所致皮疹患者80例,参照抽签法分作对照组与观察组,每组各40例。对照组患者采用夫西地酸乳膏治疗,观察组患者采用复方金银花煎液湿热敷与夫西地酸乳膏治疗,比较两组治疗前后症候积分、生活质量评分的变化、临床疗效和不良反应的发生情况。结果:治疗后,观察组症候积分(6.87±1.25)分显著低于对照组(10.29±2.74)分(P0.05),生活质量评分(3.15±0.57)亦明显低于对照组(6.42±1.20)分(P0.05)。观察组临床有效率(95.00%)显著高于对照组(77.50%),差异有统计学意义(P0.05);两组不良反应的发生率比较差异均无统计学意义(P0.05)。结论:复方金银花湿热敷与夫西地酸乳膏联合治疗靶向药物所致皮疹的临床疗效确切,可有效缓解患者临床症状,提高生活质量。     

Safety and Efficacy of Apatinib Combined with Temozolomide in Advanced Melanoma Patients after Conventional Treatment Failure

OBJECTIVE: Asian melanoma patients, predominantly comprised of acral and mucosal subtypes, might not benefit from immunotherapy and targeted therapy as much as Caucasian patients. Novel treatment strategies are demanded after conventional treatment failure. This was a prospective, single-arm, and single-center dose escalation study to investigate the safety and preliminary efficacy of apatinib combined with temozolomide in heavily treated advanced melanoma patients. METHODS: Patients were sequentially admitted to four dose-escalating groups of apatinib and temozolomide (three cases in each group) using a traditional 3?+?3 dose escalation design method. RESULTS: Twelve patients were enrolled between December 2016 and August 2017. Most patients with an acral or mucosal primary origin progressed after immunotherapy or targeted therapy. Dose escalation had been completed without dose-limiting toxicity. Common adverse events included hypertension, hand-foot syndrome, proteinuria, neutropenia, nausea, and fatigue. All adverse events were grade 1 or 2, while the maximum tolerated dose was not reached. Up to January 2018, 1 patient achieved partial response, 9 experienced stable disease, and 2 exhibited progressive disease. The objective response rate and disease control rate were 8.3% and 83%, respectively. CONCLUSIONS: In conclusion, apatinib combined with temozolomide was well tolerated and has demonstrated efficacy in advanced melanoma patients.     

Comparison of long-term care in an acute care institution and in a long-term care institution

BACKGROUND: Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. METHODS: A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. RESULTS: In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p < 0.01) and underwent more tests (299 v. 79 laboratory units/year for each patient, p < 0.001) and radiographic examinations (64 v. 46 per 1000 patient-weeks, p < 0.05). At both institutions, 36% of the patients showed anthropometric and biochemical evidence of protein-calorie undernutrition; 28% at the acute care hospital and 27% at the long-term care hospital had low serum iron and low transferrin saturation, compatible with iron deficiency. The longitudinal study showed that there were more consultations (61 v. 37 per 1000 patient-weeks, p < 0.02) and fewer pressure ulcers (18 v. 34 per 1000 patient-weeks, p < 0.05) at the acute care hospital than at the long-term care facility; other measures did not differ. The cost per patient-year was $7580 higher at the acute care hospital, attributable to the higher cost of drugs ($42), the greater use of laboratory tests ($189) and, primarily, the higher cost of nursing ($7349). For patients requiring 3.00 nursing hours/day, the acute care hospital provided more hours than the long-term care facility (3.59 v. 3.03 hours), with a higher percentage of hours from professional nurses rather than auxiliary nurses or nursing aides (62% v. 28%). The nurse staffing pattern at the acute care hospital was characteristic of university-affiliated acute care hospitals. INTERPRETATION: The long-term care provided in the acute care hospital involved a more interventionist medical approach and greater use of professional nurses (at a significantly higher cost) but without any overall difference in the quality of care.     

Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?

doi: 10.1111/j.1741‐2358.2011.00554.x
Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Objective: To explore nursing home patients’ oral hygiene and their nurses’ assessments of barriers to improvement. Background: In nursing homes, nurses are responsible for patients’ oral hygiene. Materials and methods: This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. Results: More than 40% of patients had unacceptable oral hygiene. ‘More than 10 teeth’ gave OR = 2, 1 (p = 0.013) and ‘resist being helped’ OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients’ teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty‐one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. Conclusion: Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses’ education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.     

法舒地尔在急性ST段抬高型心肌梗死患者PCI术中疗效及安全性

目的:探讨法舒地尔在急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗术(PCI)中的疗效及安全性。方法:选择2014年1月至2016年1月间于我院就诊的急性ST段抬高型心肌梗死患者173例作为研究对象,随机将其分为观察组87例及对照组86例。对照组患者单纯行PCI治疗,观察组患者在PCI治疗过程中加用法舒地尔。对两组患者临床疗效、TIMI血流分级、左心功能指标及生化指标以及心血管不良事件进行考察与比较。结果:观察组患者治疗总有效率为90.80%,高于对照组的70.93%,P0.05。治疗前两组患者TIMI血流分级无显著差别(P0.05),治疗后两组患者TIMI血流3级患者较治疗前明显增多,且观察组TIMI血流3级患者明显多于对照组(P0.05)。观察组患者治疗后左心功能指标及生化指标均明显优于对照组(P0.05)。观察组患者心血管不良事件发生率仅为6.90%,远远低于对照组的45.35%,P0.05。结论:急性ST段抬高性心肌梗死患者在PCI术中使用法舒地尔具有良好的临床疗效及安全性,有利于患者心功能改善,值得临床推广应用。