目的:探讨患者安全追踪日志在患者安全关键环节的应用效果.方法:根据患者安全的五大关键点,包括手术患者转运交接、查对落实、出入院流程、输血管理、特殊检查.每月组织专人负责进行追踪督查,并按照追踪的时间点形成追踪日志,通过逐项查找追踪日志中存在的薄弱点,对现有的护理流程进行改进和完善,以确保患者安全.结果:通过患者安全追踪日志,共总结出患者安全管理的薄弱点82个,各类患者安全关联环节执行的规范率(手术患者转运交接规范率、查对落实规范率、出入院流程规范率、输血管理规范率、特殊检查规范率)均显著提升,追踪实施前后两组有统计学差异,患者的满意度实施前后显著提升,实施前后有统计学差异,关键患者不良事件的发生率显著降低,实施前后违反查对和特殊检查有统计学差异.结论:患者安全追踪日志能够以患者为中心实现整个关键流程的还原,是追踪方法学在护理管理中的应用效果的体现,能够便于管理者查找出薄弱点,逐项完善,同时对追踪者个人也是全方面的提升,起到相互促进的作用.

目的 自行制作上肢功能锻炼测量器,并将其应用于康复科脑卒中后患侧上肢功能障碍患者中,观察其应用效果.方法 采用方便抽样法,选取2018年1月—12月在上海市某二级甲等医院康复科住院的60例脑卒中患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组各30例.对照组采用常规康复治疗及康复护理,观察组在对照组的基础上使用上肢功能锻炼测量器.在项目实施前、项目实施2周后,采用简式Fugl-Myer上肢运动功能评价量表(FMA)评定两组患者的上肢功能;采用Lovett分级的国际肌力评定法评定患者的患侧上肢肌力;采用改良Barthel指数(MBI)量表评定患者的日常生活自理能力;所得数据用统计软件SPSS 19.0进行统计分析.结果 治疗后,观察组的患侧上肢FMA评分、MBI评分均高于治疗前和对照组,差异有统计学意义(P<0.05);项目实施后,观察组的患侧上肢肌力优于对照组,差异有统计学意义(P<0.05).结论 使用自制上肢功能训练器能有效改善脑卒中后患者的患侧上肢功能,提高患侧上肢肌力和患者的日常生活自理能力.

为评估奥马珠单抗治疗儿童重度过敏性哮喘的有效性、安全性和经济性,检索国内外相关文献数据库和卫生技术评估组织官网,共纳入9篇文献,应用快速卫生技术评估方法进行评估.结果显示,对于儿童重度过敏性哮喘,奥马珠单抗治疗可显著降低患者哮喘急性重度发作的风险,缓解临床症状,减少控制用药剂量,同时不良反应发生率低,安全性好.但奥马珠单抗目前售价昂贵,与安慰剂或哮喘标准治疗相比不具有成本效果优势.

目的:探讨影响老年冠心病病人经皮冠状动脉介入治疗术(PCI)术后生活质量相关因素及护理对策.方法:应用西雅图心绞痛量表(SAQ)对200例老年冠心病PCI病人术后生活质量进行评价,对影响术后生活质量的相关因素行非条件logistic回归分析,并对其进行护理干预.结果:经非条件logistic回归分析显示,医疗方式为自费、学历为初中以下、术前有合并症及治疗依从性差,是影响老年冠心病PCI病人术后生活质量的独立危险因素(P<0.01),而合理饮食、服药依从性、规律适量运动、戒烟戒酒则为保护因素(P<0.01).经护理干预后,病人SAQ总评分及各维度评分均显著提高(P<0.01).结论:医疗方式为自费、学历初中以下、术前有合并症及治疗依从性差的老年冠心病病人PCI术后生活质量较低,应对该类病人加强护理干预,以提高其生活质量.

目的 分析老年科住院患者医院感染的因素,探讨预防与控制策略.方法 回顾性分析该院2015年6月-2016年6月老年科收治的住院患者临床资料,将其分为无医院感染、合并医院感染两组,针对影响感染的相关因素进行单因素分析和多元回归分析.结果 与无医院感染相比,40例合并医院感染患者通过实施单因素分析,得到糖尿病、肿瘤、营养不良、预防应用抗菌药物、住院时间、侵入性操作、使用糖皮质激素是引起医院感染的危险因素;实施多元回归分析显示导致医院感染的危险因素包括5个,分别是住院时间＞ 30d、侵入性操作、营养不良、糖尿病、使用预防应用抗菌药物等.结论 诱发老年科住院患者产生医院感染的因素较多,需要严格制定预防措施,降低医院感染率.

Objective To investigate the nursing efficacy of the whole health education on thyroid cancer patients using 131 I treatment after surgery. Methods Two hundred thyroid cancer cases using 131I treatment after surgery from Shanghai Tenth Peopleˊs Hospital,Tongji University were enrolled. They were divided equally into two groups(100 cases in each group)from February 2013 to December 2015. The control group(hospitalized from February 2013 to June 2014 )was given the traditional health education while the observation group (hospitalized from July 2014 to December 2015)was given the whole health education. Results Compared with the control group,the observation group showed better outcomes in the aspects of preparation of 131I treatment,compliance at each stage,mastering of radiation protection knowledge,management of complications and overall satisfaction(P < 0. 05). The incidence rate of complications in the observation group was also lower than that in the control group( P < 0. 05). Conclusion The implementation of whole health education in thyroid cancer patients using 131 I treatment after surgery will definitely improve the patient compliance and reduce the incidence of complications.

Objective To explore and compare the clinical significance of routine coagulation tests and thromboelastography(TEG)in as-sessment of blood coagulation status in patients with chronic renal diseases(CKD). Methods A total of 108 inpatients were enrolled and divided into 5 groups in accordance with the grading of renal dysfunction:CKD stages 1 - 2,CKD stage 3,CKD stage 4 and CKD stage 5 without hemodi-alysis,and CKD stage 5 with hemodialysis,their routine coagulation tests,TEG and estimated glomerular filtration rate(eGFR)were analyzed and compared respectively. Results ① There was no statistical difference found in TT,APTT,PT,INR,Fib and D - dimer among different groups ( P < 0. 05). ②Statistical differences were noted in R,K,MA,Angel and CI value among different groups( P > 0. 05). ③Correlation analysis of routine coagulation tests,TEG and eGFR demonstrated positive correlation among R,K and eGFR( P < 0. 05),while negative correlation was found between D - Dimer and eGFR( P < 0. 05). Conclusion TEG can be a choice of preference compared to routine coagulation tests for its higher sensitivity in monitoring status of blood coagulation. A combination of both tests may bring more clinical implications.