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Application of Six Sigma management in reducing the misdiagnosis rate of acute abdomen pre-examination in emergency department 六西格玛管理在降低急诊科急腹症预检误诊率中的应用
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20190819-02355
Hongyan Zan, Xianping Xie, Xiaomei Tan, Hong Yuan
Objective To explore the effect of the Six Sigma management in reducing the pre-examination and triage error rate of emergency acute abdominal diseases. Methods Data of 367 misdiagnosed patients in Emergency Department of Shanxi Bethune Hospital from January to June 2018 were collected. Six Sigma management method was applied to the management of emergency acute abdomen triage. After analyzing the causes of errors, improvement measures were formulated and implemented.A total of 118 patients who were triaged from September 2018 to February 2019 were taken as the intervention group to evaluate the effect. Results After the implementation of Six Sigma management, the errors of acute abdomen diagnosis were significantly reduced from 9.92%(367/3 698) to 2.80%(118/4 219), and there was a significant difference before and after the implementation (χ2 value was 174.082, P < 0.05). Conclusions The application of Six Sigma management method can effectively reduce the misdiagnosis rate of emergency acute abdomen triage and realize standardized management of acute abdomen triage, which has the value of popularization and application. Key words: Six Sigma theory; Acute abdominal diseases; Emergency pre-examination and triage; Error rate
目的探讨六西格玛管理在降低急腹症预检及分诊错误率中的作用。方法收集2018年1 - 6月山西白求恩医院急诊科367例误诊患者的资料。采用六西格玛管理方法对急腹症分诊进行管理。在分析误差产生的原因后,制定并实施了改进措施。以2018年9月至2019年2月分诊的118例患者为干预组,评价干预效果。结果实施六西格玛管理后,急腹症诊断错误率由9.92%(367/3 698)显著降低至2.80%(118/4 219),实施前后差异有统计学意义(χ2值为174.082,P < 0.05)。结论应用六西格玛管理方法可有效降低急诊急腹症分诊的误诊率,实现急腹症分诊的规范化管理,具有推广应用价值。关键词:六西格玛理论;急性腹部疾病;紧急预检和分诊;出错率
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引用次数: 0
A qualitative research on fatigue cognition and coping experience in elderly patients with chronic obstructive pulmonary disease 老年慢性阻塞性肺疾病患者疲劳认知及应对经验的定性研究
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20190508-01271
Zhenxia Zhang, Hongyan Shao
Objective To investigate the cognition and coping experience of fatigue in elderly patients with chronic obstructive pulmonary disease (COPD), so as to provide basis and research basis for the preparation of fatigue intervention measures for elderly patients with COPD. Methods Qualitative research interview was used to conduct face-to-face and in-depth communication with 12 elderly patients with COPD under the guidance of pre-prepared interview outline. The 7-step Colaizzi analysis method was used to analyze the transcript of the interview and extract the theme and representative statements. Results Fatigue cognition could be summarized into five themes:fatigue symptoms were often accompanied by drowsiness, fatigue, anxiety, poor sleep, memory loss and other symptoms; there was no definite time point for the appearance of fatigue symptoms; breathing difficulties, limited activities, mental and psychological disorders and deficient social support were the main causes of fatigue; family accidents, seasonal variation, the occurrence of complications and relapses of the malady were the aggravating factors of fatigue symptoms; fatigue affects the patient′s ability to move, social circle and life motivation. Coping experiences could be summarized into three themes: strengthen self-management and ask for help; take the initiative to learn and improve the level of self-care; emotional disorder, negative response. Conclusions There are obvious fatigue symptoms in elderly patients with COPD. Affected by many factors, such as disease factors, self-perceived burden level, family support and social support level, most patients have insufficient fatigue cognition and lack of coping ability. Medical staff should fully understand the fatigue cognition and coping experience of such patients and implement effective intervention programs to improve the coping ability of patients. Key words: Aged; Pulmonary disease, chronic obstructive; Fatigue cognition; Coping experience; Qualitative research
目的了解老年慢性阻塞性肺疾病(COPD)患者对疲劳的认知和应对经验,为老年COPD患者疲劳干预措施的制定提供依据和研究依据。方法采用质性研究访谈法,在事先编写的访谈提纲指导下,对12例老年COPD患者进行面对面深入交流。采用Colaizzi七步分析法对访谈笔录进行分析,提取访谈主题和代表性陈述。结果疲劳认知可归纳为五大主题:疲劳症状常伴有嗜睡、疲劳、焦虑、睡眠差、记忆力减退等症状;疲劳症状的出现没有明确的时间点;呼吸困难、活动受限、精神和心理障碍以及缺乏社会支持是疲劳的主要原因;家庭意外事故、季节变化、并发症的发生和疾病的复发是疲劳症状的加重因素;疲劳会影响患者的活动能力、社交圈和生活动机。应对经验可以归纳为三个主题:加强自我管理,寻求帮助;主动学习,提高自理水平;情绪障碍,消极反应。结论老年COPD患者存在明显的疲劳症状。受疾病因素、自我感知负担水平、家庭支持和社会支持水平等多种因素的影响,大多数患者存在疲劳认知不足和应对能力不足。医务人员应充分了解该类患者的疲劳认知和应对经验,实施有效的干预方案,提高患者的应对能力。关键词:老年;慢性阻塞性肺病;疲劳认知;应对经验;定性研究
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引用次数: 0
Effect of acupoint massage combined with high frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life 穴位按摩联合高频重复经颅磁刺激对脑卒中后抑郁及生活质量的影响
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20190905-02528
Wang Shuiyu, Si Aibing, Manas K Dan, W. Xuemei
Objective To investigate the effects of acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life. Methods A total of 169 patients with post-stroke depression who were admitted to the Department of Neurological Intensive Care Unit of Zhengzhou University First Affiliated Hospital from June 2017 to June 2019 were selected as the research subjects. The patients were divided into observation group (85 cases) and control group (84 cases) by random number table method. The control group was treated with high frequency repetitive transcranial magnetic stimulation, and the observation group was treated with high frequency repetitive transcranial magnetic stimulation combined with acupoint massage, high frequency repetitive transcranial magnetic stimulation 5 times a week, 28 minutes each time, 8 weeks of intervention, acupoint massage once a day, 1-2 minutes each acupoint, 8 weeks of intervention. The state of depression and the improvement of quality of life were observed, and the adverse reactions were recorded. Results The total effective rate of depressive symptoms improvement in the observation group was 83.53% (71/85), which was higher than that of the control group 70.24% (59/84), the difference was statistically significant (χ2 value was 4.204, P 0.05). Conclusions Acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation has a effective in the treatment of post-stroke depression, which can significantly improve the depression status and quality of life. Key words: Acupoint massage; High frequency repetitive transcranial magnetic needling; Stroke; Depression; Quality of life
目的探讨穴位按摩联合高频重复经颅磁刺激对脑卒中后抑郁及生活质量的影响。方法选取2017年6月至2019年6月郑州大学第一附属医院神经内科重症监护室收治的脑卒中后抑郁症患者169例作为研究对象。采用随机数字表法分为观察组(85例)和对照组(84例)。对照组采用高频重复经颅磁刺激治疗,观察组采用高频重复经颅磁刺激联合穴位按摩治疗,高频重复经颅磁刺激每周5次,每次28分钟,干预8周,穴位按摩每天1次,每个穴位1-2分钟,干预8周。观察两组患者抑郁状态及生活质量改善情况,并记录不良反应。结果观察组抑郁症状总有效率为83.53%(71/85),高于对照组70.24%(59/84),差异有统计学意义(χ2值为4.204,p0.05)。结论穴位按摩联合高频重复经颅磁刺激治疗脑卒中后抑郁有效,可显著改善抑郁状态和生活质量。关键词:穴位按摩;高频重复经颅磁针;中风;抑郁症;生活质量
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引用次数: 1
Effect of rewarming and homeostasis of groin-mediated forced-air warming system in patients with hypothermia after cardiopulmonary bypass 腹股沟介导的强制空气加热系统对体外循环后低温患者再温和体内平衡的影响
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20190524-01443
Yanmei Liu, Yang‐hui Xu, Jiahai Shi, Jinfeng Wang
Objective To investigate the rewarming effect of groin-mediated forced-air warming system in patients with hypothermia after cardiopulmonary bypass. Methods A total of 100 hypothermia patients after cardiopulmonary bypass were divided into observation group and control group with 50 cases each by random digits table method. Patients in control group received pelma-mediated forced-air warming system, observation group carried out groin-mediated forced-air warming system. The levels of bladder temperature, axillary temperature and lactate concentration were monitored at 10 min (T10), 30 min (T30), 60 min (T60), 90 min (T90) after rewarming in two groups, rewarming time and drainage volume at 90 min after rewarming between two groups was also compared. Results Bladder temperature in observation group were (34.44±0.98), (35.44±1.12), (36.71±1.16), (37.60±1.45) ℃ at T10, T30, T60, T90, axillary temperature were (34.30±1.85), (35.31±1.36), (36.38±1.57), (37.28±1.72) ℃, bladder temperature and axillary temperature in control group were (34.18±1.56), (36.91±1.61), (37.70±1.29), (37.40±1.10) ℃ and (34.45±1.03), (36.30±1.25), (37.70±1.23), (37.19±1.31) ℃, respectively. There was no significant difference in bladder temperature and axillary temperature at T10 and T90 (P>0.05), however, the bladder temperature and axillary temperature was significantly decreased in observation group compared to control group at T30 and T60 (t value was 5.309, 4.073, P 0.05), however, the lactate concentration was significantly decreased in observation group compared to control group at T60 and T90 (t value was 7.276, 8.640, P<0.01), in addition, there were crossover effect of time and grouping factor in lactate concentration (F value was 36.034, P<0.01). Drainage volume at 90 min after rewarming were (95.44±15.24) ml in observation group, (106.08±25.56) ml in control group, the difference was significant between two groups (t value was 2.528, P<0.05). Conclusions Groin-mediated forced-air warming system can effectively and uniformly rewarming the body temperature of patients with hypothermia after cardiopulmonary bypass and served as a potential rewarming strategy. Key words: Cardiopulmonary bypass; Forced-air rewarming; Bladder temperature; Axillary temperature
目的探讨腹股沟介导的强制空气加热系统对体外循环术后低温患者的复温效果。方法将100例体外循环术后低温患者采用随机数字表法分为观察组和对照组各50例。对照组采用盆腔介导的强制空气加热系统,观察组采用腹股沟介导的强制空气加热系统。监测两组患者复温后10 min (T10)、30 min (T30)、60 min (T60)、90 min (T90)膀胱温度、腋窝温度和乳酸浓度,比较两组患者复温后90 min的复温时间和引流量。结果观察组T10、T30、T60、T90时膀胱温度分别为(34.44±0.98)、(35.44±1.12)、(36.71±1.16)、(37.60±1.45)℃,腋窝温度分别为(34.30±1.85)、(35.31±1.36)、(36.38±1.57)、(37.28±1.72)℃,对照组膀胱温度和腋窝温度分别为(34.18±1.56)、(36.91±1.61)、(37.70±1.29)、(37.40±1.10)℃和(34.45±1.03)、(36.30±1.25)、(37.70±1.23)、(37.19±1.31)℃。T10、T90时膀胱温度、腋窝温度差异无统计学意义(P>0.05),但观察组T30、T60时膀胱温度、腋窝温度较对照组显著降低(t值分别为5.309、4.073,P 0.05),观察组T60、T90时乳酸浓度较对照组显著降低(t值分别为7.276、8.640,P<0.01);时间与分组因子对乳酸浓度有交叉影响(F值为36.034,P<0.01)。观察组患者复温后90min引流量为(95.44±15.24)ml,对照组为(106.08±25.56)ml,两组比较差异有统计学意义(t值为2.528,P<0.05)。结论腹股沟介导的空气强制升温系统能有效、均匀地对体外循环后低温患者进行体温复温,是一种有潜力的复温策略。关键词:体外循环;压力复温;膀胱温度;腋窝温度
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引用次数: 0
Effects of resilience and cognitive evaluation on quality of life of burn patients 恢复力和认知评价对烧伤患者生活质量的影响
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20191009-02821
Panpan Zhang, Shigeng Zhang, A. Zhang
Objective To understand the status of life quality, resilience and disability acceptance of burn patients, and to explore the impact of mental resilience and disability acceptance on the quality of life. Methods Connor-Davidson Resilience Scale (CD-RISC), Acceptance of Disability Scale (ADS) and Burn Specific Health Scale-Brief (BSHS-B) were used to carry out questionnaire survey for a total of 315 burned patients who were in rehabilitation phase. Results For burned patients, the total score of resilience was 57.12±14.34, the total score of disability acceptance was 78.20 ±9.99, and the total score of quality of life was 128.29 ±37.26. The correlation analysis showed that the total score of resilience was positively correlated with quality of life for burned patients (r value was 0.646, P<0.01); the total score of disability acceptance was positively correlated with the total score of quality of life for burned patients (r value was 0.846, P < 0.01). Multiple stepwise regression showed that the total score of disability acceptance, severity of burn, sleep state, ability and endurance of negative emotions were the main predictors of the quality of life for burned patients. Conclusions Great attention should be paid to the quality of life of burned patients, and psychological problems of high-risk patients should be found as soon as possible and reasonable intervention should be given to improve the resilience and disability acceptance of patients, so as to improve their quality of life. Key words: Burns; Quality of life; Resilience; Cognitive evaluation
目的了解烧伤患者的生活质量、心理弹性和残疾接受状况,探讨心理弹性和残疾接受对生活质量的影响。方法采用康诺-戴维森恢复力量表(CD-RISC)、残疾接受度量表(ADS)和烧伤特异性健康量表-简要表(BSHS-B)对315例处于康复期的烧伤患者进行问卷调查。结果烧伤患者恢复力总分为57.12±14.34分,残疾接受总分为78.20±9.99分,生活质量总分为128.29±37.26分。相关分析显示,烧伤患者心理弹性总分与生活质量呈正相关(r值为0.646,P<0.01);残障接受总分与烧伤患者生活质量总分呈正相关(r值为0.846,P < 0.01)。多元逐步回归分析结果显示,残障接受总分、烧伤严重程度、睡眠状态、负性情绪承受能力和承受能力是烧伤患者生活质量的主要预测因子。结论应高度重视烧伤患者的生活质量,尽早发现高危患者的心理问题,并给予合理干预,提高患者的适应能力和残疾接受度,从而提高患者的生活质量。关键词:烧伤;生活质量;弹性;认知评价
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引用次数: 1
Rare Genetic Dissorder: Crouzon Syndrome 罕见遗传疾病:克鲁宗综合征
Pub Date : 2020-04-01 DOI: 10.21088/ijpn.2347.7083.8120.6
G. Tomar
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引用次数: 0
Effectiveness of Structured Teaching Programme on Knowledge Regarding Artificial Nutrition for Terminally Ill Cancer Patients 癌症晚期患者人工营养知识结构化教学方案的有效性
Pub Date : 2020-04-01 DOI: 10.21088/ijpn.2347.7083.8120.3
Sharun Nv
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引用次数: 0
A Study to Assess the Effectiveness of Planned Teaching Programme on Knowledge Regarding Thermoregulation of Neonate Among Mothers in Selected Rural Areas 评价农村地区母亲新生儿体温调节知识计划教学方案效果的研究
Pub Date : 2020-04-01 DOI: 10.21088/ijpn.2347.7083.8120.1
Amol wasekar
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引用次数: 0
Buerger Allen Exercise and Skin Perfusion Pressure: The Significance in Compromised Peripheral Circulation 运动与皮肤灌注压:外周循环受损的意义
Pub Date : 2020-04-01 DOI: 10.21088/ijpn.2347.7083.8120.5
Shrikant K. Nair
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引用次数: 0
Application progress of implantable upper arm central venous access port 植入式上臂中心静脉通路的应用进展
Pub Date : 2020-04-01 DOI: 10.3760/CMA.J.CN211501-20190703-01858
Fei Liu, Yingxin Wang
Upper arm central venous access port refers to the port implanted through the peripheral vein of the upper arm by surgeon and peripherally inserted central catheter nurse cooperation. It can provide a new way for patients requiring long-term infusion therapy but it has not been widely used in China. This article introduces the targeted patients, operation process, maintenance and use, daily life notes, common complications and advantages of arm port, to provide reference for the wide application of arm port. Key words: Implantable venous access port; Upper arm; Vascular access; Specialist nurse; Progress
上臂中心静脉进入口是指通过上臂外周静脉植入的口,由外科医生与外周插入中心导管的护士合作。它可以为需要长期输液治疗的患者提供新的途径,但在国内尚未得到广泛应用。本文介绍了臂口术的目标患者、手术流程、维护与使用、日常生活注意事项、常见并发症及优点,为臂口术的广泛应用提供参考。关键词:植入式静脉通路;上臂;血管通路;专科护士;进步
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引用次数: 0
期刊
The Journal of practical nursing
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