关于Wards三角区的探讨

目的研究Wards三角区骨密度值的临床意义。方法采用美国HologicDelphiA双能X线骨密度仪测定385名20～80岁志愿者(男230例,女155例)左股骨骨密度及113例左右股骨骨密度,观察Wards三角区的变化规律及临床特点。结果①有40.4%～55.8%的青年人Wards三角区的具体位置计算机很难确定,Wards三角区大部分与解剖部位不相对应;②由计算机自动定位的Wards三角区小方块位置取样误差比较大;③Wards三角区骨密度值的精确度误差和变异系数百分比最大;④腿的位置旋转过度或旋转不足都能引起骨密度的变化;⑤正常人双腿骨密度值无显著性差异。结论Wards三角区骨密度值不能用于诊断或随访。

Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses'caring ability

Objective： To understand the effect of humanistic nursing care model wards in Children Caring Ward School （CCWS） on the nurses＇ caring ability. Methods： Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory （CAI） before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses＇ caring ability. Results： The nurses＇ caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered （p 〈 0.05）. Conclusions： The humanistic nursing care model wards in CCWS has a positive effect on the nurses＇ caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients＇ satisfaction.

Development of a Scale to Evaluate the Depressive State among Elderly Patients in General Wards

This study aims to develop a scale to evaluate depressive states among elderly patients in general wards, and verify the reliability and validity of the scale. Based on the results of interviews with nurses, we developed a draft of a scale comprised of 48 questions (NDE48). The Geriatric Depression Scale short version (GDS15), and the Zung Self-rating Depression Scale (SDS) were administered to 54 elderly patients. Two groups of nurses completed the NDE48 on different days. After performing an explanatory factor analysis, the NDE48 was simplified to a 16 question item scale (NDE16), comprising three factors. The correlation coefficient between GDS15 and NDE16 was 0.41 (p = 0.00191), and between SDS and NDE16 was 0.30 (p = 0.02633). Alpha coefficient of the total score of NDE16 was 0.88. For inter-rater reliability, the correlation coefficient was 0.57 (p = 0.00005). The findings suggest that the NDE16 will be highly useful when nurses evaluate depressive states among elderly inpatients.

Caring Behaviour of Nurses in Orthopaedic Wards of Selected Health Institutions as Perceived by Patients

Nurses are trained to provide hands-on care to patients in a variety of settings, which include physical care which can range from total care to helping a patient prevent illness. The health of a patient can significantly improve when they (patients) perceive caring nursing behaviours and are satisfied with the quality of care been received from their care giver. The aim of this study was to determine the caring behaviour of nurses as perceived by patients admitted to orthopaedic ward in some selected hospitals in Osogbo, Osun state, Nigeria. A descriptive comparative design was used. Convenient sample technique was used to select 616 respondents consisting of male and female patients admitted to orthopaedic wards of selected hospitals. The questionnaire on Caring Behaviour Assessment scale was adapted from CBI. The most highly ranked perceived nurses’ behaviour by patients rated “satisfactory” was the general perception of the patients and rendering of basic needs. The findings also revealed that patients rated nurses behaviour (care-giving) with respect to human needs assistance, the provision of safe environment, assisting in psychological care and giving physical comfort as average. Lastly, findings also revealed that patients rated perceived nurses behaviour (care-giving) as “not satisfactory” with regards to meeting their communication needs, nutritional needs and individualized care. In conclusion, care giving is an important branch of nursing and it depicts the quality of care received by a patient which in turn is capable of aiding speedy recovery.

Temporal-spatial Distribution of Various Types of Crime in the Special Wards of Tokyo

Based on the official criminal data released by the Tokyo Metropolitan Police Department in 2019,this paper discusses the temporal-spatial distribution of various types of crimes in the special wards of Tokyo.The results show that:(1)The times of high and low incidence of different types of crime differ significantly.Although vicious crime and violent crime present no obvious monthly distribution,property crime clearly differs between the first and second half of a calendar year.(2)The month before the new year sees a surge in most types of crime.(3)Vicious crime peaks in the hours between night and early morning.Violent crime and property crime correlate positively with the frequency of human interaction and peak in the morning and evening commuting hours.(4)The spatial distribution of crime resembles the concentric circles of the three rings of the special wards of Tokyo,with a central high-incidence area,a center-peripheral low-incidence area,and a marginal high-incidence area.In addition,the center sees more personal crime than the periphery,whereas property crimes show the opposite trend.(5)A spatial autocorrelation analysis shows that the special wards of Tokyo may be grouped into the“high-high”and“low-low”agglomeration modes of different types of crime,with marked differences between the various types of crime.The crime can be divided into three types:central agglomeration,double central agglomeration,and decentralized agglomeration.

Potential drug–drug interactions in pediatric wards of Gondar University Hospital,Ethiopia:A cross sectional study

Objective: To determine the prevalence, level of severity of potential drug–drug interactions(PDDIs) and the associated factors for PDDIs in hospitalized pediatric patients of Gondar University Hospital.Methods: A retrospective cross-sectional study was conducted for a period of 3 months from March to May 2014 in pediatric wards of Gondar University Hospital. Systematic random sampling technique was used to select charts from all pediatric patients' charts with every 7th interval to get sample size of 384. Univariate and multivariate analysis were performed to compute crude odds ratio and adjusted odds ratio respectively. Statistical significance was set at P value < 0.05.Results: A total of 176(45.8%) patients had at least one PDDI. A total of 393 PDDIs,which were comprised of 283 types of interacting combinations, were identified. Of the total of 393 PDDIs, most were of moderate severity [201(51%)] followed by minor [152(39%)] and major severity [40(10%)]. The most common interacting pairs of major severity were gentamicin + furosemide(6), cotrimoxazole + methotrexate(4) and phenytoin + artemether(4). The occurrence of PDDIs was significantly associated with age and polypharmacy.Conclusions: The study showed that most of the interactions had moderate severity followed by minor severity. Age and polypharmacy were found to show statistically significant association with the occurrence of PDDIs. Due to sensitive nature of pediatrics population, close monitoring is recommended for the detection and management of PDDIs to prevent its negative consequences.

Economic efficiency of radiology wards using data envelopment analysis: Case study of Iran

Background: In evaluating the activities and performance of radiology units, the main aim of applying feasible scientific methods is to use technological and human resources optimally. One of the suitable scientific methods in this field is determining the technical, economic, and allocative efficacy of these centers. We aimed to assess the economic efficiency of radiology units of hospitals affiliated to Shiraz University of Medical Sciences, southern Iran. Methods: In this descriptive-analytical cross-sectional study, the technical, economical, and allocative efficiency of 27 radiology units of public hospitals was assessed using data envelopment analysis. The input oriented envelopment form with the assumption of the varied outputs with respect to the scale was used. Related forms were filled using the existing information in the archives of radiology centers. Input variables in this study were the number of radiology devices, the number of expert personnel, the number of technicians, equipment maintenance and depreciation costs, and the salaries of the experts and technician. Output variables included the number of admitted patients and the number of photographic film. Then, data were analyzed using the DEAP software for calculating the various forms of efficiency. Results: The mean scores of economic, technical, and allocative efficiencies of radiology units were 0.749, 0.880, and 0.852, respectively. The final score of economical efficiency was lower than the technical and allocative efficiency scores. Only 15% of radiology units were economically efficient. Conclusion: Economical efficiency can be attained when resources are used in the best possible way and not wasted. Therefore, a combination of inputs that comprise the lowest costs should be selected.

Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

Development of a Scale to Evaluate Depressive States among Elderly Patients in General Wards —Verification of the Contents to Improve the Accuracy of the Scale

Purpose: This study aims to verify the validity of the contents of the Nurse Administered Depression Scale for Elderly Inpatients16 (NDE16) using the Delphi approach in order to further improve the accuracy of the NDE16, a scale for rating potential depressive states in elderly inpatients through the observations reported by nurses. Methods: Participants were nurses working in general wards for longer than 3 years and who expressed consent to the study participation. Data were collected using the Delphi method (3 times). Responses are scored from 1 to 5 (3 - 5 points as positive) using the Likert method. The standard criteria for inclusion in the further evaluation are “mean ≥ 3.0”, “standard deviation < 1.0”, “median ≥ 3.0”, and “IQR ≤ 1.0”. Items that meet all the criteria at the third survey are employed as question items in the final questionnaire. Results: The respondents were 139 females, 10 males, and 1 unknown, aged 25 to 65. The collection rates of the three surveys were 75% to 82%. Based on the results of the first survey, wordings of 9 questions were modified. Since Question 13 “Queries are not really responded to.” did not meet the criteria (IQR = 2) at the third survey, we excluded this question and named the revised scale NDE15. Discussion: The reason why Question 13 did not meet the criteria could be due to the difficulty in distinguishing “Expressing thought suppression” from the state of cognitive decline in dementia. Further studies are needed to determine cutoff points.

Nursing Care Management Strategies in Isolation Wards during the COVID-19 Outbreak

Coronavirus disease 2019 (COVID-19) is highly infectious and has spread worldwide. Medical staff may be exposed to the infection under circumstances of medical supply shortages and improper protection. How to better protect medical staff has become the focus of all walks of life. Therefore, during the COVID-19 outbreak, timely adjustments and optimization of nursing management strategies in isolation wards are important for improving care quality and reducing the infection of medical staff. Based on a literature review and clinical nursing management practices, this article summarizes the nursing management strategies in isolation wards during the COVID-19 outbreak, aiming to provide references for clinical nursing managers.

What Contributes to Satisfaction with Care for Family Caregivers of Terminal Cancer Patients Admitted to General Wards? A Qualitative Study

Satisfaction with care is an important indicator for family caregivers of patients with terminal cancer and is linked to the quality of life. Despite this, few studies have examined the aspects of satisfaction with care of family caregivers of inpatients with cancer in general wards. This qualitative study aimed to elucidate the elements of satisfaction with the care that inpatients with terminal cancer in general wards and their family caregivers receive from medical staff, as perceived by the family caregivers. Semi-structured interviews were conducted with 10 family caregivers of inpatients with terminal cancer. Participants were asked about the care received until then from medical staff, the features of satisfactory care, and the aspects of care they felt were unsatisfactory or could become satisfactory with improvement. The data were analyzed with the content analysis method and the six categories were extracted. For family caregivers of inpatients with terminal cancer in general wards, along with the care identified as important in palliative care, the methods of alleviating symptoms and explaining the patient’s condition were also important. The results highlight the importance of determining a patient-oriented approach and explanations together with each patient and family caregiver, based on an understanding of the long treatment process.

Relation between Family Functioning and Quality of Life among Family Caregivers of Patients with Terminal Cancer Hospitalized in General Wards

Caring for a patient with terminal cancer poses difficulties for family caregivers. Although families of patients with cancer have been classified by type, little is known about the relation between family functioning and quality of life (QOL) in family caregivers. This study aimed to develop a typology of family functioning in family caregivers of patients with terminal cancer and then examine the relation between the family functioning and QOL of family caregivers. From December 2013 to August 2014, fifty-one family caregivers of patients with terminal cancer were recruited at three hospitals in Tokyo, Japan. Perceptions of family functioning were assessed with the Family Relationship Index, and its three subscores were classified into three groups by cluster analysis. Caregivers’ QOL was measured with the Caregiver Quality of Life Index-Cancer. The average total FRI score among 51 caregivers was 8.5 (SD = 2.8). Family functioning was categorized into three clusters: supportive (n = 12), communicative (n = 30), or conflictive (n = 8). Their QOL was categorized into two groups: the communicative group, with relatively high confliction, showed high QOL comparable to the supportive group. Family functioning in the families of patients with terminal cancer hospitalized in general wards was not good. For improving the QOL of family caregivers, it may be important for the family members to express their feelings and distress if they have conflicts.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

颜值控——2020 WARDS十佳内饰

2020年6月25日,美国《Wards Auto》杂志公布了2020年十佳内饰榜单(2020 Wards 10 Best Interiors)。十佳内饰奖已进入第10个年头,8名评委用了两个多月时间对入选的32款车型从设计美学、用料、人体工程学、安全性、舒适性、价值、工艺以及信息娱乐系统用户体验性和创新性等方面进行了综合考量,最终10款车脱颖而出,入选2020年十佳内饰榜单。这些获奖车型的内饰个个都是精品,具有一流的颜值。下面就让我们一起来看看,究竟有哪些车型入选该名单。

术后患者自控镇痛:北京协和医院30年临床管理经验

术后疼痛严重影响患者的康复进程,从而导致住院时间延长,照护成本增加。合理应用患者自控镇痛装置可有效缓解围术期急性疼痛。北京协和医院于1994年引入患者自控镇痛技术,并于2004年成立了急性疼痛服务工作组,以麻醉医生为指导、手术室疼痛专科护士为基础,联合实施基于患者自控镇痛的全流程、规范化管理,并不断改进和创新工作方法,为术后疼痛管理的发展奠定了坚实基础。本文从临床工作重点、护理管理经验、疼痛治疗理念的推广与传播、新形势下急性疼痛服务模式的发展等方面对该项工作进行系统回顾与总结,以期为全面加强患者诊疗过程中的疼痛管理、提升患者围术期镇痛服务满意度提供有价值的参考。

“针灸科嵌入式查房”管理模式提升临床医疗效能:以上海某二级医院糖尿病周围神经病变病种为例

目的 构建“针灸科嵌入式查房”模式,研究其对于提升糖尿病周围神经病变(DPN)诊治及预后的应用效果。方法 医院于2021年10月引入并实施“针灸科嵌入式查房”,开始改革针灸诊疗模式。实施前收集2019年10月至2021年10月我院内分泌科收治的DPN患者85例,实施后收集2021年10月至2023年6月我院内分泌科收治的DPN患者96例,共181例患者。对比改实施前后DPN患者医疗服务能力(平均住院日、平均住院费用、中医非药物治疗费用、中医非药物治疗率)、患者就医感受度(7 d满意度、30 d满意度)等相关质量安全指标。结果 与实施前相比,实施后平均住院日缩短,平均住院费用减少,平均中医非药物治疗费用增加,中医非药物治疗率提高(P <0.05)。实施后,内分泌科、针灸科的7 d满意度、30 d满意度均比实施前上升(P <0.05)。结论 实施“针灸科嵌入式查房”模式能够对该病种增强医疗服务能力,提升临床医疗效能,缩短住院时间,减少住院费用,提升患者就医感受。

基于物联网的多院区病区中央监护系统的建设实践

基于目前医院普通病区患者生命体征监测现状,设计开发了基于物联网的多院区病区中央监护系统,在病区床旁通过PDA扫码实现监护仪与患者绑定和解绑。病区中央监护系统与护理综合信息平台通过接口对接,患者生命体征定时发送到护理综合信息平台,实现了普通病区患者生命体征实时监测。通过基于物联网的多院区病区中央监护系统的应用,显著减少了护士工作量,提高了护士工作效率。

广东省三级综合医院优质护理服务评价指标的构建

目的构建广东省三级综合医院优质护理服务评价指标,为促进优质护理服务评价工作和规范优质护理服务提供参考。方法基于文献检索的基础上,应用头脑风暴法并借鉴国内已有的相关制度、标准和政策构建出评价指标条目池和问卷初稿;采用德尔菲法对评价指标进行两轮专家函询。结果两轮专家函询的回收率分别为80.00%和91.67%;权威程度系数均为0.93,医院部分Kendall协调系数W分别为0.128和0.116,病区部分分别为0.193、0.107,差异具有统计学意义(均P<0.001)。第2轮函询医院各指标的重要性均数为(4.43~5.00)分。第2轮函询病区各指标的重要性均数为(4.59~5.00)分。构建的广东省三级综合医院优质护理服务评价指标包括医院和病区两个部分,其中医院部分包括一级指标8项、二级指标22项、三级指标65项,病区部分包括一级指标9项、二级指标23项、三级指标50项。结论本研究编制的广东省三级综合医院优质护理服务评价指标具有较好的科学性和可靠性,有利于完善优质护理服务管理制度,引导优质护理服务健康发展。

以病房示教为主联合TBL教学法在眼科教学中的探索

目的眼科学是临床专业学生的必修内容,其内容专业性强、学时相对有限、教学难度大。在眼科教学过程中改进教学方法并提高教学效率已经成为眼科学教学研究的重要课题。方法选取2021年11月—2022年5月于中山大学附属第五医院眼科见习的79名中山大学临床医学系本科学生为研究对象。随机分为对照组和研究组,对照组39名,研究组40名。对照组授课方式为传统教学法,研究组授课采用以病房示教为主联合以团队为基础的教学法(team-based learning,TBL)。教学结束后进行理论及技能考试对教学效果进行评价,采用问卷调查的方法评估学生对教学模式的满意度。结果研究组病例分析成绩[(89.04±4.03)分]优于对照组[(80.29±4.51)分],差异有统计学意义(P<0.001);研究组理论成绩较对照组稍提高,差异无统计学意义(P>0.05)。教学满意度评价显示,研究组中对眼科疾病的整体认识、理论知识掌握程度及提高临床思维能力、拓宽知识面增强横向联系及纵向认知、提高眼科学专业学习兴趣、提升学习效率、提高沟通能力、提高团队合作精神的满意程度更高,差异有统计学意义(P<0.05)。结论病房示教为主联合TBL教学法的教学模式是眼科学临床教学方法改革的积极探索,可显著提高见习生对临床眼科疾病的识别及诊疗能力,加强眼科见习生对眼科疾病的掌握程度。