Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial

AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.

Electrical Stimulation in Addition to Passive Exercise Has a Small Effect on Spasticity and Range of Motion in Bedridden Elderly Patients: A Pilot Randomized Crossover Study

Purpose: Belt electrode skeletal muscle electrical stimulation (B-SES) can stimulate large portions of muscles including deep sites without localisation of the stimulation area. The purpose of this study is to investigate both immediate treatment effects of B-SES and long-term treatment effects of B-SES with passive exercise on range of motion (ROM) and muscle tone of lower extremities in bedridden elderly patients. Methods: Outcome measures before and after B-SES treatment alone (4 Hz, 20 min, both lower extremities) were examined for the immediate effect. Outcome measures were: ROM and Modified Ashworth scale (MAS) of hip flexion and adduction;knee flexion and extension;and knee joint distance at position of flexion abduction in hip (distance of knee). A randomized crossover trial was conducted to examine the long-term effect of adding B-SES to passive exercise on ROM and MAS. Results and Discussion: The immediate effect study had 18 patients. ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved after B-SES treatment. The long-term effect study had 11 patients. Friedman test revealed ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved during B-SES intervention but not control intervention. B-SES in addition to passive stretch has a more statistically significant effect on contracture and spasticity in large portions of the lower extremities of bedridden elderly patients than passive stretching alone. Conclusions: We consider B-SES a useful tool to improve the ROM in lower extremities of bedridden patients.

Treatment of Elderly Bedridden Patients with Removable Dentures to Promote Their Daily Physical Activities: A Case-Control Study

Bedridden patients remain in bed for various reasons, such as chronic illness, old age, and disability, and they cannot perform self-care activities completely or partially. The provision of care for bedridden patients is a major issue in the aging population. Effective rehabilitation is associated with several factors such as cooperation between the patient and the medical staff, selection of effective facilities, and the financial burden. The objective of this study was to evaluate the effect on the activities of daily living (ADL) of occlusion restoration using removable dentures in bedridden older people. This case-control study comprised 32 bedridden older patients who were divided into two groups as follows: denture (n = 18) and no-denture (n = 14). No rehabilitation was provided to any of the patients. The patients were evaluated 3 months after placing the denture, and the ADLs were compared between the two groups. Of the 18 bedridden patients who received removable dentures, 55.6% demonstrated improvements in the ADLs, and the effects persisted for at least 3 months. No improvement in the ADL was observed in the no-denture group. The results of this study suggested that adequate occlusal support can improve the ADL of the elderly. Thus, it is important to take care of oral health early in life in order to maintain oral health, which could help prevent the decrease in the ADL during the later stages of life.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Quantitative electroencephalography in predicting on outcome of awakening in long-term unconscious patients after severe traumatic brain injury

Objective To explore quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening. Methods All cases were divided into two groups(the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidneypancreas transplantation vs those with combined en bloc ' liver-pancreas transplantation

Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Long-Term Patient-Aspect Outcomes of the Single-Port Laparoscopic Cholecystectomy

Background: Single port laparoscopic cholecystectomy (SPLC) is a widely performed advanced technique in laparoscopic surgery which has many benefits compare to conventional three port laparoscopic cholecystectomy (TPLC). The purpose of this study was to compare the patients’ satisfaction of SPLC and TPLC after one year of operation by using questionnaire which not only objective factors such as results of operation and hospital days but also subjective factor such as social and cosmetic quality of life. Materials and Methods: This study analyzed the data of 74 patients (SPLC = 42, TPLC = 32) who underwent the laparoscopic cholecystectomy between March and July 2013. The patients were asked to complete a patient-assessment questionnaire measuring the postoperative social and cosmetic quality-of-life values at the 12-month mark. Results: Statistically significant differences in the age, sex distribution, and body mass index are absent between the two groups. All the average scores of the different parameters of the social-activity aspect—satisfaction with physical condition, limitation of nutrition, stamina, postoperative pain level, returning to social life, impairment of social life, degree of complications, and cost-effectiveness of the surgery—are not statistically significant in both groups. Alternatively, all the results of the cosmetic aspect—scar influence on charms (p p = 0.015), and patient’s score of scars (p < 0.001)—show statistically significant differences. Conclusion: The SPLC is a safe and an attractive approach regarding the patients of this study. It offers a more effective cosmetic result that may be conveyed by a greater patient satisfaction.

Effect of blood gas analysis in patients with bed rest and blood sampling through the dorsal artery:A meta-analysis

Objective:To systematic evaluation by the dorsalis pedis artery puncture for bed patients blood gas analysis of application effect of impact.Methods:A randomized controlled trial of the effect of arterial blood extraction on blood gas analysis in PubMed,CNKI,Wanfang database and VIP database.After selecting the literature,extracting the data and evaluating the quality of the literature.Meta- analysis was carried out by RevMan 5.3 software.Results:Twelve randomized controlled trials were included and 1696 patients were enrolled.After meta-analysis,the arterial puncture can effectively improve the success of arterial puncture in patients with bed [Z = 5.78,95%CI(1.90,3.66),P<0.001],reduce the occurrence of hematoma [Z = 4.27,95%CI(0.19,0.54),P<0.001],reduce the mistaken into the vein [Z = 4.60,95%CI(0.08,0.36),P<0.001],reduce cyanosis [Z = 2.84,95%CI(0.23,0.81),P<0.008],the difference was statistically significant.Conclusion:Dorsalis pedis artery puncture can improve the success rate of blood gas analysis in bedridden patients,reduce the incidence of hematoma and the incidence of venous leakage,and can be widely used in clinical practice.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

Study on the Effect of the Intervention on Traditional Chinese Medicine Negative Heel Shoes in Geriatric Orthopedics Patients

In the clinical practice of orthopedics,geriatric patients are prone to form and exhibit complex and diverse clinical complications during long-term bedridden treatment.This can result in poor survival rate and adverse final clinical outcomes.Hence,it is essential to select appropriate methods for nursing intervention and health-care support for long-term bedridden geriatric orthopedic patients.It is of great significance to support and guarantee patients to obtain the best clinical results.This article focuses on the topic of interventional health effects of traditional Chinese medicine negative-heeled shoes in orthopedic bedridden patients,and two specific aspects were selected for a brief explanation.

脑卒中卧床患者足部压力性损伤预防装置的设计与应用

目的观察脑卒中卧床患者足部压力性损伤预防装置的临床应用效果。方法选择2021年3月至2022年3月在杭州市第一人民医院重症监护病房(ICU)住院的(166例)脑卒中患者作为研究对象。采用定量研究中的实验设计,根据病区将患者分为对照组(ICU 4楼患者)和观察组(ICU 5楼患者),每组83例;护士也按照此法分组(观察组41名,对照组43名)。两组均进行常规治疗及预防压力性损伤护理,对照组采用海绵圈或现有的枕头减压,并采用丁字鞋内衬毛巾预防足下垂,观察组采用自行设计研发的卧床患者足部压力性损伤预防装置。观察两组患者足部压力性损伤和足下垂的发生率,以及患者使用足部压力性损伤预防装置的满意度和护士操作足部压力性损伤预防装置的满意度。结果观察组足部压力性损伤和足下垂发生率均明显低于对照组〔足部压力性损伤:3.61%(3/83)比8.43%(7/83);足下垂发生率:9.64%(8/83)比16.87%(14/83),均P<0.05〕;观察组患者满意度明显高于对照组〔91.6%(76/83)比79.5%(66/83),P<0.05〕;护士满意度较对照组升高〔95.1%(39/41)比86.0%(37/43)〕,但差异无统计学意义(P>0.05)。结论足部压力性损伤预防装置适用于脑卒中重症卧床患者,可有效地降低压力性损伤及足下垂的发生率,提高患者和操作人员的满意度,值得在临床上推广使用。

1例高龄长期卧床男性患者并发紫色尿袋综合征的护理体会

本文总结1例高龄长期卧床男性患者并发紫色尿袋综合征(PUBS)的护理经验。PUBS的发生与尿路感染有关,护理人员应加强导管维护和相关尿路感染护理,同时给予饮食指导、便秘管理和心理护理,改善患者便秘症状,缓解负性情绪,提高治疗依从性,加快患者康复。

卧床患者便携式护理服优化设计

通过广泛市场调研和深入实地走访,全方位分析卧床患者对于服装各部位功能的实际需求。在充分调研的基础上,致力于针对便携式护理服进行创新性设计。从面料的精心挑选、结构的合理规划到工艺的细致打磨全面展开优化分析。着重增加舒适度与便捷性设计,力求最大程度满足患者对服用舒适性的渴望,以及护理人员操作的便捷性需求。优化后的设计方案在舒适性、功能性与便携性方面均有显著提升,不仅能够切实改善患者的生活品质,使该群体感受到更多关怀与温暖,而且极大地方便了护理人员,使其日常工作更加高效和轻松。这一设计为医养理疗行业的服装选择提供参考,同时也可供相关服装生产企业借鉴。

预防老年卧床患者压力性损伤的体位改变证据总结

目的系统检索、评价并汇总预防老年卧床患者压力性损伤(PI)的体位改变相关证据。方法根据“6S”模型进行计算机检索,检索数据库包括BMJ最佳临床实践、UpToDate临床顾问、全球协作指南网、英国国家卫生与临床优化研究所、苏格兰校际指南网、JBI EBP、Cochrane图书馆等网站中,所有关于预防老年卧床患者PI的临床实践指南、临床决策、推荐实践、证据总结、系统评价、meta分析、专家共识,检索时限为建库至2023年5月31日,进行方法学质量评价后,对证据进行提取、分类和汇总。结果共纳入12篇证据,包括2篇指南、7篇系统评价、3篇证据总结。从风险评估、间隔时间、角度和姿势、辅助和指导4个方面汇总了12个证据主题,40条最佳证据。结论护理人员应遵循最佳证据,规范老年卧床患者的体位改变管理,预防PI的发生。

一种卧床患者靠枕的设计与应用

卧床患者多采用后背垫物体、抬高床头位置等方法来获取半卧位姿势。但现有方法存在执行力不足、角度估计错误、意识不强、遗忘、舒适度下降、易引起压疮和吸入性肺炎等缺点。为了解决现有卧床患者进食体位摆放方法的不足之处,桐乡市中医医院老年医学科团队特设计了一种卧床患者靠枕,用于卧床患者进食时或其他要求半卧位时使用,并获得了国家实用新型专利(专利号:ZL 202122859891.4)。使用时将该装置靠枕放在平坦的床上,靠枕背面紧靠床头用于支撑,防止滑动。患者放于靠置槽内,头部置于第1靠置槽内,肩背部置于第2靠置槽内,腰腹部置于第3靠置槽内,双手放置在靠枕两侧的扶手位置。卧床患者靠枕使用方法简单易学、方便、经济实用、省时省力,而且方便监督检查,能减少误吸、压疮等并发症的发生,进而减轻患方经济负担,改善生活质量,提高患者和家属的满意度,值得在临床推广使用。

基于女性卧床患者的功能性服装改良设计

为了满足女性卧床患者日常生活的舒适性需求,针对目前卧床患者在服装穿脱便捷性、护理便捷性、穿着舒适性3个维度设计并发放问卷,根据调查问卷结果设计了一款采用对称两片式可拆卸结构的女性功能性卧床病服,实现了女性功能性卧床病服的快速穿脱性和护理便捷性。结合主观评价实验与客观服装压力模拟实验,对改良病服的工效性进行分析,结果表明:针对前胸、臀部、裆部改良的病服结构设计与舒适性相较于普通病服更符合卧床病人的功能性需求,且改良病服的服装压力均在舒适范围之内,可为提高卧床病服的功能性设计提供参考。

改良型护理裤对留置尿管卧床患者舒适度的影响

目的评估改良型护理裤对留置尿管卧床患者舒适度的影响。方法选取2022年7月至12月福州市第八医院需要进行导尿及留置导尿的124例卧床病患作为研究对象,采用随机数字表法将其分为观察组和对照组,每组各62例。对照组采用院内统一普通病员裤,观察组采用改良型留置导尿管患者专用护理裤。比较两组的舒适度情况、配合度情况,对比两组尿管固定不良事件(尿管折叠、尿管污染、尿液外渗、牵拉脱管)及皮肤、黏膜受压情况(尿道黏膜红肿、大腿处压迹)。结果观察组穿戴改良护理裤1周后舒适度评分高于对照组,差异有统计学意义(P<0.05);观察组穿戴改良护理裤1周后护理配合度评估结果优于对照组,差异有统计学意义(P<0.05);观察组佩戴尿管期间尿管固定不良事件和皮肤、黏膜受压情况发生率低于对照组,差异有统计学意义(P<0.05)。结论针对导尿及留置导尿期间的卧床患者,应用改良型护理裤有利于提高患者的舒适度,增强患者临床护理操作的配合度,同时有利于减少导尿及留置导尿期间不良反应的发生,对于导尿及留置导尿期间的卧床患者具有重要意义,适宜在临床护理实践中推广应用。