Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

Exploration and Research on the Integrated Development of“Internet Plus Medical Treatment”

Objective To analyze the development of“internet plus medical treatment”and to explore advantages.Methods The literature of“internet plus medical treatment”was systematically combed and analyzed.Results and Conclusion After exploring the status quo of“internet plus hospitals”,smart pharmacy and web-assisted health management in China,we find that there are some problems in the medical service at present,such as the imperfect laws and regulations,the hidden dangers of information security and the obstacles of medical insurance payment.Therefore,we propose that the development of web-assisted medical service should be led by the government and relevant policies must be improved.Then,self-regulation should be strengthened,and industry standards should be enhanced.Three suggestions are made to improve medical insurance payment and benefit both hospitals and patients,which can provide reference for promoting the development of“internet plus medical treatment”in China.

Evaluation of the Clinical Efficacy of Qingqiao Capsule (清窍胶囊) in Treating Patients with Secretory Otitis Media

Objective： To observe the clinical efficacy of Qingqiao Capsule （清窍胶囊, QQC） in treating patients with secretory otitis media （SOM）. Methods： A total of 90 patients were randomly assigned into the treated group （n：45） and the control group （n=45）. Patients in the treated group were administrated with QQC, 5 capsules each time, 3 times a day for totally 10-14 days, and those in the control group were given per os cefaclor capsules 0.5g each time for adult, 3 times a day, or 20mg/（kg·d） for children, for 10-14 days. The therapeutic efficacy of treatment on the patients was observed and compared after treatment and followed up for 3-6 months. Results： （1） The clinical efficacy in the treated group was superior to that in the control group with significant statistical difference （P〈0.01）; （2） Comparison of the efficacies in patients of three different TCM syndrome types （the external pathogenic wind invasion caused auditory orifice stuffiness type, the Gan-Dan damp-heat steaming up auditory orifice type and the Pi-deficiency dysfunction induced dirty dampness blocking ear type） showed no statistically significant difference（P〉0.05）; （3） The vanishing rate and time needed of the main symptoms and signs in the treated group were superior to those in the control group on ear muffle, tinnitus, hearing impairment, hydrotypanum, pure tone threshold and abnormal tongue figure, and the difference was statistically significant （P〈0.05 or P〈0.01）, only those of earache, otopiesis and abnornal pulse figure were insignificantly different between the two groups （P〉0.05）. Conclusion： QQC is an effective Chinese composite medicine on patients with SOM, and shows no obvious adverse reaction.

Clinical Characteristics of 42 SARS Patients and Their Treatment of Integrative Chinese and Western Medicine

Objective:To understand the clinical manifestation of severe acute respiratory syndrome (SARS) and explore its effective treatment with integrative Chinese and western medicine (ICWM). Methods:The data of patients, whose diagnosis of SARS had been confirmed were summarized and analyzed, and clinical observation was conducted when the patients were treated with ICWM. Results:In the early stage of the 42 patients, the symptoms revealed were fever in 100% of SARS patients, headache in 92. 9%, aversion to cold in 76. 2%, chest stuffiness in 76. 2% , cough in 73. 8% and myalgia in 88.1%; pulmonary lesion involves >3 lobes in 42. 9%, 2 lobes in 47. 6% and 1 lobe in 9. 5%; 61. 9% of them showed liver function abnormality (increase of ALT or AST), 47. 6% showed elevated myocardial enzyme (CK or CK-MB) , 0. 48% showed an inclination of renal function (higher of BUN or Cr); in their T lymphocyte subsets, 91. 2% (31/34 patients) had lowered CD3 and 76. 5% (26/34 patients) lowered CD4/CD8 ratio. In the mid-late stage, the symptoms were lassitude and weakness in 85. 7%, scare in 81. 0%, short of breath or chest stuffiness in 71. 4%, loss of appetite in 64. 3%;light dark tongue proper in 52. 4%, yellow and white tongue coating in 45. 2%, and yellow thick coating on the middle-root part of the tongue in 21. 4%. Most of them were asymptomatic when discharged from hospital, with 92. 8% of their pulmonary lesion, according to chest film, completely absorbed and liver function, myocardial enzyme and renal function all normalized. However, of the 30 patients who had CD3 reexamination, 70% of the CD3 showed lower than normal range and 36. 7% showed their CD4/CD8 inclined to lower margin, follow-up should be done for these patients. Of the 42 patients, who received western medicine (WM) alone in the early stage and ICWM in the mid-late stage, 10 were severe cases and 3 critical cases, but none of them died. The mean defervescent time was 3. 52±0. 85 days, the time for complete absorption of pulmonary lesion judged by chest X-ray film was 26. 82±5. 98 days, and the mean hospitalization time was 33. 60±4. 37 days. Conclusion:The manifestation of SARS is multifarious, showing that there were damage in multiple organs. The T lymphocyte count percentage and its subsets, CD3 and CD4 /CD8 ratio, are valuable for early diagnosis and follow-up in the rehabilitation stage. Majority of the patients could be clinically cured. Combined treatment of WM and TCM according to syndrome differentiation and psychiatric intervention are beneficial to remit partial symptoms and promote rehabilitation.

Nursing perspective of expert consensus for diagnosis and treatment of colorectal cancer with integrated traditional Chinese and Western medicine

As one of the most common malignant tumors in the world,colorectal cancer(CRC)is accompanied by a variety of symptoms in the process of disease development and treatment,which seriously affect the functional state and quality of life of patients.In China,comprehensive intervention measures of traditional Chinese medicine(TCM)play an indispensable role in the treatment and rehabilitation of CRC.In order to further standardize and improve the treatment and management of CRC by medical staff,the Chinese Association of Integrative Medicine issued the“Expert Consensus for Diagnosis and Treatment of Colorectal Cancer with Integrated Traditional Chinese and Western Medicine”in August 2021.This paper interprets this consensus in detail from the perspective of nursing,focusing on the common understanding of the pathogenesis of CRC,TCM diagnosis and syndrome differentiation,integrated traditional Chinese and Western medicine nursing,TCM characteristic therapies,etc.,with a view to deepening the understanding and practical application of the consensus among clinical doctors and nurses and improving the level of diagnosis,treatment,and nursing of CRC.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Practical Insights from Case Studies of Community Medical and Nursing Integrated Services in Britain, the United States, and the Netherlands

The Chinese government has issued a series of policies to promote the development of community medical and nursing integrated services.Since the development of these services involves the transition of medical and health services from public spaces to private spaces,the home has become a critical factor in service provision.It is therefore essential to consider the concept of home and the sense of at-homeness in the research and practice of community medical and nursing integrated services in China to avoid prioritizing"others"over"self-being."Through an analysis of three cases from Britain,the United States,and the Netherlands,this article demonstrates that a sense of control and social connection are key components of the elderly’s sense of at-homeness.Community medical and nursing integrated services should not only enable the elderly to maintain their sense of self-control but also assist in building a supportive social network.

新医科“融合人才”理念下护理学课程体系构建与教学改革探索

围绕新医科“融合人才”理念,整合课程资源,构建融合型课程体系,转变教学范式,创新教育教学模式,以期培养一批能够运用交叉学科知识解决护理问题的高水平高素质融合型护理人才。

医养结合服务的有效模式及其实现机制研究——基于陕西省汉阴县鸿济医养中心的案例分析

医养结合是优化老年健康和养老服务供给的重要举措。如何实现医养结合的真正落地和可持续发展,是在多年试点后进一步推进医养结合发展中需要优先解答的关键问题。文章对陕西省汉阴县鸿济医养中心的服务模式进行了总结,并借鉴社会-生态系统适应性理论,剖析了鸿济医养中心作为一家民营医院如何推动县域医养结合服务优质高效和可持续运行的实现机制。研究发现:汉阴县鸿济医养中心通过“从民办民营到公办民营”的成长路径,形成了以民营医院转型为驱动、服务延伸为抓手、从机构逐步走向居家社区的医养结合发展模式。该模式破解了医养结合服务中存在的服务连续性、可持续性不足等问题,有效满足了老年人的医养结合需求,其有效运行的关键在于能够主动适应环境变迁,把握时机、顺势而为,实现了医养结合从外部需求压力向内在发展动力的转变。与此同时,政府的支持和引导也增强了该模式的稳定性和可持续发展能力。因此,应通过激活医疗机构提供医养结合服务的内生性动力、发挥民营医疗机构的作用、强化政府的支持和引导等措施,推进我国医养结合服务健康、高质量发展。研究结果不仅为县域层次推进医养结合服务发展提供了借鉴,也为破解民营医院的发展困境提供了一种新思路。

医教协同视域下护理专业群“岗课赛证”融合育人的现实困境与改革路径

护理专业群“岗课赛证”融合育人是培养高素质护理人才的有效途径。当前,护理专业群“岗课赛证”融合育人还存在院校联动不够、证书不够科学规范、监管不够严格等诸多困难和问题。深入推进“岗课赛证”融合育人,必须大力推进医教协同,切实加强课岗契合、课证融合、课赛结合、质控配合、评价综合、手段复合。

智能化导诊信息系统在儿童专科医院的构建及应用

目的:构建智能化导诊信息系统,并评价该系统在儿童专科医院门诊工作中的应用效果,为提升就诊质量及效率提供参考。方法:建立规则引擎,采用信息化方法根据患儿主诉、症状和体征进行预检分诊,系统自动决策推荐就诊科室或专业,同时对接院内多个子系统,形成门诊就诊全链条的信息化导诊系统。选取北京市某三级甲等儿童医院2022年10月1日至2023年6月30日就诊患儿为对照组,采用传统的预检分诊及就诊流程;选取2023年7月1日至2024年3月31日就诊患儿为实验组,采用智能化导诊信息系统进行就诊。比较两组患儿的就诊质量,患儿及家长和门诊在岗护士对该系统的使用评价。结果:与智能化导诊信息系统应用前比较,应用后门诊退号率及投诉率有所降低(P<0.05),预检分诊准确率和满意度均有显著提升(P<0.05);患儿及家长对该系统使用的体验感、指导性、便捷性、准确性及全面性5个维度的评价得分均>4.93分,门诊在岗护士评价得分>4.13分。结论:应用智能化导诊信息系统可有效降低门诊退号率及投诉率,提升预检分诊准确率及患者满意度,有利于优化门诊就诊流程及提高护理服务质量。

医联体背景下护理专科联盟的建设与思考

目的在医联体背景下建立护理专科联盟,探讨护理专科联盟建设的成效。方法2022年11月1日通过问卷星以南京医科大学附属淮安第一医院为护理专科联盟理事长单位的14个护理联盟发放调查问卷。比较实施前后各护理专科联盟单位护理专科联盟实施成效及护理专科联盟护理质量督查情况。结果实施后,护理专科联盟单位的护理管理能力、护士理论考核、护士操作考核、实境考核、护理人员职业认同感、患者满意度评分均高于实施前,差异有统计学意义(P<0.05)。实施后,护理专科联盟分级护理质量、急救药品物品质量、消毒隔离质量评分均高于实施前,差异有统计学意义(P<0.05)。结论成立护理专科联盟是优质护理资源下沉的新思路,有利于提升护理专科联盟的护理管理水平,护士的核心能力,提高基层护理服务质量,提升基层患者就医的获得感。

1例腰椎间盘突出症患者的医护一体化中医护理查房

总结1例腰椎间盘突出患者的医护一体化中医护理查房实践经验。分析患者临床资料,由责任护士汇报病例,医生分析病情,医护联合对重点护理内容进行讨论,协同制定护理措施。通过医护一体化查房,医护之间专业互补,重建医、护、患三位一体的治疗和护理模式,达到实施整体护理的效果。

医院信息化建设在儿科门诊就医的发展与思考

基于国内医院信息化建设的现状和发展趋势,本文对加快信息化系统建设提出针对性建议,包括加强区域医联体地区间的协作、构建敏感指标预警及控制信息系统、深度整理及高效利用诊疗过程数据、拓展移动终端的信息化健康教育等。以期为医院信息化建设在儿科管理领域的进一步发展提供启示和参考,同时为医护管理者提供可靠的决策依据,从而提高医院护理质量与管理水平。

PBL联合医护一体化教学模式在助产专业临床实习中的应用

目的:探讨PBL联合医护一体化教学模式在助产专业教学中的应用。方法:选取本院2019年1月至2020年6月来我院产科实习的学生60名,随机数字表法分为试验组和对照组,每组30名。试验组采用PBL联合医护一体化教学模式,对照组进行传统教学。比较两组学生的理论和技能得分和教学模式的满意度及护理的软技能。结果:试验组理论和技能得分高于对照组(P<0.05)。试验组学生对教学模式满意度高于对照组(P<0.05)。教学前两组学生护理软技能各方面差异无统计学意义(P>0.05);教学后试验组学生护理软技能各方面均高于对照组(P<0.05)。结论:PBL联合医护一体化教学模式在助产专业临床实习中的应用效果较好,能显著提高学生对教学模式的满意度,提高学生护理的软技能。

基于医养结合模式的双心养护在老年冠心病患者中的应用价值

目的观察医养结合模式下双心养护对老年冠心病患者心功能、情绪状态的影响。方法收集2020年1月—2023年1月丰县人民医院老年冠心病患者80例进行前瞻性研究,随机数字表法分为观察组(n=40)与对照组(n=40),分别行基于医养结合模式的双心养护与常规护理。比较两组护理前后心功能指标、情绪状态、并发症情况及对不同模式护理的满意度。结果护理前心功能指标组间差异均无统计学意义(P>0.05),护理后观察组LVEF高于对照组,LVEDV、LVESV低于对照组(均P<0.05)。情绪状态方面,抑郁-焦虑-压力量表21(DASS-21)各项评分护理前组间比较无统计学差异(P>0.05),护理后均降低,观察组低于对照组(P<0.05)。观察组并发症发生率5.00%,低于对照组的20.00%(P<0.05);护理满意度比较,观察组(97.50%)高于对照组(80.00%)(P<0.05)。结论医养结合模式的双心养护,可改善老年冠心病患者心功能及情绪状态,并减少并发症。

医护一体化康复护理对老年糖尿病患者生活质量、血糖水平的影响效果观察

目的 研究老年糖尿病患者接受医护一体化康复护理的干预效果。方法 选取2021年8月—2022年8月泉州市第一医院收治的120例老年糖尿病患者作为研究对象,将其用随机数表法分为两组,对照组与观察组,各60例,分别采用常规护理、医护一体化康复护理,比较两组护理前后患者的生活质量与血糖水平变化情况。结果 两组护理8周后患者的生活质量评分均高于护理前,且观察组均高于对照组,差异有统计学意义(P<0.05);护理8周后两组患者的各项血糖值均小于护理前,且观察组均小于对照组,差异有统计学意义(P<0.05)。结论 对老年糖尿病患者实施医护一体化康复护理的干预效果显著,既可以降低患者的血糖水平,又可以提高其生活质量,综合优势显著。

县域医共体急性上消化道出血医工交叉防治融合体系建设探索

基于县域医共体及一体化医疗信息系统,针对县域内发病率较高又严重威胁患者生命安全的急性上消化道出血(acuteuppergastrointestinalbleeding,AUGIB)疾病,构建一套以县域内三级综合医院为中心、联合下属医共体单位、以危重症AUGIB疾病患者为主要服务对象的院前、院内一体化预防救治体系,建立“基层智能化筛查识别-院前高危患者快速分级转诊-院内多学科联动快速救治绿色通道-恢复期智能化随访管理”的分级联动精准防治新体系。

低分子肝素联合医护一体化快速康复外科干预对结直肠癌术后下肢DVT的预防效果

目的探究低分子肝素(LMWH)联合医护一体化快速康复外科(ERAS)干预对结直肠癌(CRC)术后下肢深静脉血栓(DVT)的预防效果。方法回顾性收集2021年1月至2023年10月杭州市中医院CRC术后患者,根据干预方式分为联合干预组(LMWH联合ERAS)和对照组(LMWH)。本研究主要观察指标为下肢DVT的发生率。次要观察指标为干预前后凝血指标[D-二聚体(D-D)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(Fib)]变化;双侧腘静脉、髂外静脉和股静脉血流速度;术后肛门排气恢复时间、进食时间、下床活动时间和住院时间;术后并发症率和药物不良反应率。结果研究共纳入患者110例,联合干预组和对照组各55例。两组患者的基线资料、干预前凝血相关指标及下肢静脉血流速度差异无统计学意义(P>0.05);干预7 d和14 d后,两组患者的TT、PT、APTT和Fib均干预前较升高,D-D水平较干预前下降(P<0.05)。两组的TT、PT和APTT差异无统计学意义(P>0.05),但联合干预组D-D水平较对照组下降(P<0.05),Fib水平较对照组升高(P<0.05)。干预14 d后,联合干预组的双侧腘静脉、髂外静脉和股静脉血流速度高于对照组(P<0.05);DVT的发生率更低(1.82%vs.7.27%),但差异无统计学意义(P=0.363)。联合干预组的术后肛门排气恢复时间、进食时间、下床活动时间和住院时间较观察组缩短(P<0.05)。两组患者在术后并发症和LMWH不良反应的发生率上差异无统计学意义(P>0.05)。结论LMWH联合ERAS干预可以有效改善CRC术后患者高凝状态,提高下肢静脉血流速度,减少DVT发生率,促进术后康复,并具有较好的安全性。

医护治一体化康复模式在脑卒中气管切开患者肺康复中的应用

目的探讨医护治一体化康复模式在脑卒中气管切开患者肺康复中的应用效果。方法选取2021年7月1日至2022年6月31日康复医学科收治的脑卒中气管切开患者48例作为研究对象,其中2021年12月31日之前收治的24例作为对照组,之后收治的24例作为试验组。两组患者均给予康复医学科常规康复干预措施,试验组在此基础上进行医护治一体化康复模式管理,观察时间均为4周。两组患者在入院当天及护理干预4周后分别测定用力肺活量(FVC)、1秒用力呼气量(FEV1)、呼气峰值流速(PEF),膈肌厚度及移动度,比较两组患者护理干预4周后肺部感染发生率、抗菌药物使用时间、气管套管拔管率及出院时的满意度。结果两组患者护理干预4周后FVC、FEV1、PEF、膈肌厚度和膈肌平静呼吸移动度均大于入院当天,P<0.05或<0.01;且试验组护理干预4周后的FVC、FEV1、PEF、膈肌厚度和膈肌平静呼吸移动度均大于对照组,P<0.05。护理干预4周后,与对照组比较,试验组肺部感染发生率降低,P<0.05,抗菌药物使用时间缩短,P<0.01。试验组出院当天满意度(91.7%)高于对照组满意度(83.3%),但差异无统计学意义。结论医护治一体化康复模式能有效改善脑卒中气管切开患者的肺功能,降低肺部感染发生率,从而提高患者生活质量,康复干预效果满意,患者满意度高。