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Anesthetic Depth Monitoring Decreased the Incidence of Postoperative Delirium Assessed in Nursing Delirium Screening Scale in Elective Non-Cardiac Surgical Patients Receiving Intravenous Patient-Controlled Analgesia 麻醉深度监测降低选择性非心脏手术患者接受静脉自控镇痛后谵妄发生率的护理谵妄筛查量表
Pub Date : 2022-07-07 DOI: 10.33140/jnh.07.03.08
Background To identify the impact of processed electroencephalogram (pEEG)-guided anesthesia on postoperative delirium (POD) assessed by NuDESC, postoperative analgesic requirements, and the incidence of postoperative nausea/vomiting (PONV) in the elective non-cardiac surgical patients with intravenous patient-controlled analgesia (IVPCA) in the wards. Methods In this retrospective observational study, the anesthesiologists were free to use M-Entropy™, an pEEG device, to monitor the depth of anesthesia intraoperatively during the period (September 2015 ~ February 2018). Acute pain service team assessed the analgesic/side effects of IVPCA and POD at least twice daily for 3 days postoperatively. POD was screened by Nursing Delirium Screening Scale (NuDESC) (0-10). Pain severity was measured by an 11-point verbal numerical rating scale (0–10). Results A total of 1178 patients (≧60 years) were enrolled and divided to Entropy (749 patients) vs. non-Entropy group (429 patients). Multivariate logistic analysis showed that age (≧70), surgical types (non-joint), intraoperative highest minimum alveolar concentration (MAC) (<0.9MAC) and the POD incidence were independent predictors for group differences (multiple odds ratio and 95% confidence interval: 5.99, 4.34-8.29; 2.01, 1.49-2.72; 6.84, 4.38-10.67; 0.09, 0.04-0.19). The POD incidence in Entropy group (2.2%, 17 patients) was significantly lower than that in non-Entropy group (6.7%, 29 patients) (p <0.001). However, pEEG-guided anesthesia did not affect the phenomenological characteristics of POD. In addition, intraoperative pEEG-guided anesthesia did not reduce total morphine dose of IVPCA, the incidence of PONV and pain severity. Conclusions Processed EEG-guided anesthesia decreased POD incidence assessed in NuDESC in IVPCA patients undergoing elective non-cardiac surgery returning to the common ward. In addition, it did not reduce postoperative pain severity, postoperative analgesic requirements and PONV incidence. More researches are needed to investigate the effects of pEEG-guided anesthesia on POD and other postoperative conditions.
背景:探讨经处理脑电图(pEEG)引导麻醉对病房内选择性非心脏手术患者静脉自控镇痛(IVPCA)术后谵妄(POD)、术后镇痛需求及术后恶心/呕吐(PONV)发生率的影响。方法在回顾性观察研究中,麻醉医师于2015年9月~ 2018年2月期间自由使用pEEG装置M-Entropy™监测术中麻醉深度。急性疼痛服务小组评估IVPCA和POD的镇痛/副作用,每天至少两次,持续3天。采用护理谵妄筛查量表(NuDESC)(0-10分)对POD进行筛查。疼痛严重程度采用11分口头数字评定量表(0-10)。结果共纳入患者1178例(≥60岁),分为熵组(749例)和非熵组(429例)。多因素logistic分析显示,年龄(≧70)、手术类型(非关节)、术中肺泡最高最小浓度(MAC) (<0.9MAC)和POD发生率是组间差异的独立预测因素(多重优势比和95%可信区间:5.99,4.34-8.29;2.01, 1.49 - -2.72;6.84, 4.38 - -10.67;0.09, 0.04 - -0.19)。熵组POD发生率(2.2%,17例)显著低于非熵组(6.7%,29例)(p <0.001)。然而,peeg引导麻醉不影响POD的现象学特征。此外,术中peeg引导麻醉并没有降低IVPCA的吗啡总剂量、PONV发生率和疼痛严重程度。结论经过处理的脑电图引导麻醉降低了nudeesc评估的IVPCA选择性非心脏手术患者返回普通病房的POD发生率。此外,它没有降低术后疼痛严重程度、术后镇痛需求和PONV发生率。peeg引导麻醉对POD及术后其他情况的影响有待进一步研究。
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引用次数: 0
YOGA AND HOLISTIC HEALTH 瑜伽与整体健康
Pub Date : 2022-04-20 DOI: 10.33140/jnh.07.02.04
Yoga is an ancient art based on a harmonizing system of complete equilibrium of body, mind, and spirit. The link to yoga is asana. Holistic health is an approach to life, rather than focusing on illness or a specific part of the body. The holistic health approach considers the whole person and how he or she interacts with his or her environment. It emphasizes physical, mental, social, spiritual, and, intellectual. Yoga means union, so yoga is the union of the mind emotions, and the body. Holistic wellness is significant between physical health and mental health. Yoga is a holistic science, it seeks to build a lifestyle that values calmness, harmony, and positive thinking. Multiple-way yoga approach helps towards the health and well-being of humans. India ‘s invaluable gift is yoga. Many research finding concludes yoga play in holistic care.
瑜伽是一门古老的艺术,它建立在身体、思想和精神完全平衡的和谐系统的基础上。与瑜伽有关的是体式。整体健康是一种生活方式,而不是专注于疾病或身体的特定部位。整体健康方法考虑到整个人以及他或她如何与他或她的环境相互作用。它强调身体、心理、社会、精神和智力。瑜伽意味着合一,所以瑜伽是心灵、情感和身体的合一。整体健康在身体健康和心理健康之间具有重要意义。瑜伽是一门整体科学,它寻求建立一种重视平静、和谐和积极思考的生活方式。多路瑜伽方法有助于人类的健康和福祉。印度的宝贵礼物是瑜伽。许多研究发现,瑜伽在整体护理中发挥作用。
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引用次数: 0
Nursing Telemedicine and Multipliers Training During the SARS-CoV-2 Pandemic – An Experience Report SARS-CoV-2大流行期间护理远程医疗和乘员培训经验报告
Pub Date : 2022-04-20 DOI: 10.33140/jnh.07.02.05
The worldwide pandemic due to SARS-CoV 2 demanded an exponential increase in intensive care. The deficit between the training of professionals specialized in intensive care and the increase of ICUs exposed the need to expand specialized action in the care of critically ill patients. In this scenario, a tele-ICU project was implemented in two philanthropic hospitals in the metropolitan region of Rio Grande do Sul. Objective: The purpose of this article is to report on the experience in implementing telemedicine among nurses and training multipliers during the pandemic resulting from COVID-19. Materials & methods: The nursing telemedicine occurred weekly and lasted around 30 to 50 minutes, focusing on developing the professional in the evaluation of the critically ill patient, electing priorities, as well as in the management and education of the technical team for key elements on the patient's status and the care to be provided. The training of professionals was based on a training matrix developed together with the nursing leadership, listing the main demands for each unit. Results/Discussion: Making the trained professional a multiplier brings responsibility and engagement in replicating the knowledge and, concomitantly, in changing the institutional culture. By developing and implementing the tele-ICU project, it was possible to notice an improvement in the quality of care, reflected in the indicators and the nurses' assessment, as the discussions matured. Furthermore, it was possible to emphasize with the management team the importance of continuing education with a managed matrix to develop critical sense and continuous quality of care even despite the completion of the project.
由于SARS-CoV - 2引起的全球大流行要求重症监护的指数级增加。重症监护专业人员的培训与重症监护病房的增加之间的差距暴露了扩大重症患者护理专业行动的必要性。在这种情况下,在南里奥格兰德州大都会区的两家慈善医院实施了远程icu项目。目的:报告2019冠状病毒病(COVID-19)大流行期间护士实施远程医疗和培训乘员的经验。材料与方法:护理远程医疗每周进行一次,持续时间约为30 - 50分钟,重点培养专业人员对危重患者的评估,选择优先事项,以及对技术团队的管理和教育,了解患者状况和提供的护理的关键要素。专业人员的培训是基于与护理领导一起制定的培训矩阵,列出了每个单位的主要需求。结果/讨论:使受过培训的专业人员成为倍增器,带来了复制知识的责任和参与,同时也改变了制度文化。通过制定和实施远程icu项目,随着讨论的成熟,有可能注意到护理质量的改善,这反映在指标和护士的评估中。此外,有可能向管理小组强调继续教育的重要性,以管理矩阵培养批判性意识和持续的护理质量,即使在项目完成之后。
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引用次数: 0
Protocol of Conservative Treatment of Persistent Edema after Rhinoplasty 鼻整形术后持续性水肿的保守治疗方案
Pub Date : 2022-04-18 DOI: 10.33140/jnh.07.02.02
Due to the great popularity and relative availability of surgical methods for correcting appearance, rhinoplasty steadily occupies a leading position among all types of plastic surgeries, while remaining difficult both in technical terms and in terms of the rehabilitation period. Often, edema after even sparing closed rhinoplasty using modern surgical methods, including piezotome, persists for a year or more, provoking the formation of fibrous tissue, which prompts the patient and the surgeon to revision surgery. With the increase in the number of repeated interventions on the tissues of the nose, the question arose of how to avoid certain complications, which, perhaps, will provide a predictable final result of the operation. Based on 3 years of experience with such patients, we have developed a protocol for the treatment of postoperative edema, which we actively use in our work both with patients after primary rhinoplasty and after repeated surgeries. Keywords: rehabilitation after rhinoplasty, rhinoplasty, treatment of surgical complications, postoperative edema, soft tissue edema, LLLT, neodymium laser.
由于整形手术的普及和相对可用性,鼻整形手术在所有整形手术中一直占据领先地位,但在技术和康复周期方面仍然存在困难。通常情况下,即使使用现代手术方法(包括压组术)进行闭合性鼻成形术后,水肿也会持续一年或更长时间,引起纤维组织的形成,这促使患者和外科医生进行翻修手术。随着对鼻子组织的重复干预次数的增加,如何避免某些并发症的问题出现了,这些并发症可能会提供一个可预测的手术最终结果。根据3年的治疗经验,我们制定了一套治疗术后水肿的方案,并积极应用于初次鼻整形术后和多次手术后的患者。关键词:隆鼻术后康复,隆鼻,手术并发症处理,术后水肿,软组织水肿,LLLT,钕激光。
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引用次数: 0
Water handling, sanitation, and hygienic practices and its association with under-five childhood diarrhea among households of Kirkos sub city, Addis Ababa, Ethiopia 埃塞俄比亚亚的斯亚贝巴Kirkos分城家庭的水处理、环境卫生和个人卫生习惯及其与五岁以下儿童腹泻的关系
Pub Date : 2022-04-18 DOI: 10.33140/jnh.07.02.01
Background: Diarrheal disease is the second leading cause of death in children under five years old. It is more than 90% is due to poor sanitation, poor hygiene, and unsafe drinking water. This research is aiming to assess the water handling, sanitation and hygiene practices of mothers/caregivers and its association with under-five childhood diarrhea in Addis Ababa. Methods: A community-based cross sectional study was conducted from April – May, 2016 to selected eligible mothers/caregivers. Data was used Epi Info 3.5.1 software and SPSS V.20 for further analysis. Binary Logistic regression analysis was used to determine COR and 95% CI. Variables with p-value <0.20 in the bivariate analysis were entered in to multivariate analysis. Result: The overall prevalence was 13.6% with 95% CI (10.4-16.9) which was associated with household income level [AOR: 7.21, 95% CI (1.49, 34.92)], water storage duration [AOR: 5.10, 95% CI (1.47, 17.62)], hand washing facility [AOR: 5.70, 95% CI (1.01, 32.247)], maternal history of diarrhea [AOR: 8.03, 95% CI (1.32, 48.67)] and presence of uncollected garbage in the compound [AOR: 3.42, 95% CI (1.38, 8.49)]. Conclusion: The two-week period under five diarrhea was relatively high and lower income level, storing water for more than a week, lack of hand washing facility, uncollected garbage in the compound, and mother/caregiver history of diarrhea were variables associated with the occurrence of diarrhea.
背景:腹泻病是5岁以下儿童死亡的第二大原因。90%以上是由于卫生条件差、个人卫生差和饮用水不安全造成的。这项研究的目的是评估亚的斯亚贝巴母亲/照料者的水处理、环境卫生和个人卫生习惯及其与五岁以下儿童腹泻的关系。方法:2016年4 - 5月对符合条件的母亲/照顾者进行基于社区的横断面研究。数据采用Epi Info 3.5.1软件和SPSS V.20进行进一步分析。采用二元Logistic回归分析确定COR和95% CI。将双变量分析中p值<0.20的变量纳入多变量分析。结果:总患病率为13.6%,95% CI(10.4-16.9),与家庭收入水平[AOR: 7.21, 95% CI(1.49, 34.92)]、水储存时间[AOR: 5.10, 95% CI(1.47, 17.62)]、洗手设施[AOR: 5.70, 95% CI(1.01, 32.247)]、孕产妇腹泻史[AOR: 8.03, 95% CI(1.32, 48.67)]和院内未收集垃圾的存在[AOR: 3.42, 95% CI(1.38, 8.49)]有关。结论:5岁以下儿童2周腹泻发生率较高,且收入水平较低,积水1周以上、小区缺乏洗手设施、小区垃圾未收集、母亲/照顾者腹泻史是腹泻发生的相关变量。
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引用次数: 0
Efficacy of premarital genotype screening and counselling on knowledge toward Sickle Cell disease among university students in Dodoma Tanzania: uncotrolled quasi-experimental study 坦桑尼亚多马市大学生婚前基因型筛查与咨询对镰状细胞病知识的影响:非对照准实验研究
Pub Date : 2022-04-17 DOI: 10.1101/2022.04.11.22273743
A. Lumbe, S. Kibusi
Background: Tanzania is experiencing the increase burden of Sickle cell disease, with an estimate of 20.6% Sickle Cell carriers. There is no preventive measure has been put in this area by the government; a great focus has been directed in the diagnosis and management and national guideline emphasis on the care rather than prevention. Methods: A non-controlled quasi-experimental study conducted from June to September 2020 among 697 randomly recruited students from the University of Dodoma. Pre and post-test knowledge information were collected through structured self-administered questionnaires. Data analysed using SPSS v20. Simple and multiple linear analysis model used to test for significant association of variables at 95% CI, at p<0.05. The results were presented using tables and figures. Results: The mean knowledge score at pre-test was 0.009{+/-}1.014 which improved to 0.365{+/-}0.901 on the post-test, with a statistically significant difference (t=6.965, p<0.01). The results of linear regression showed that knowledge change was not statistically associated with other predictors (p>0.05) Conclusion : Health education demonstrated to be effective towards change in knowledge on sickle cell disease among University students.
背景:坦桑尼亚镰状细胞病负担正在增加,估计有20.6%的镰状细胞携带者。政府在这个地区没有采取任何预防措施;诊断和管理是一个很大的焦点,国家指南强调护理而不是预防。方法:于2020年6月至9月,随机抽取土耳其多多马大学697名学生进行非对照准实验研究。通过结构化的自我管理问卷收集测试前和测试后的知识信息。数据分析使用SPSS v20。结论:健康教育对大学生镰状细胞病知识的改变是有效的。
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引用次数: 0
Is there correlation between measured and console CTDIvol in multislice CT scanners? 多层CT扫描仪中测量的CTDIvol和控制台CTDIvol之间是否存在相关性?
Pub Date : 2022-01-21 DOI: 10.21203/rs.3.rs-1273535/v1
Allen Mhagama
This study investigated the relationship between measured and console volume computed tomography dose index (CTDIvol) in multislice CT scanners. The measured CTDI values were determined from kerma length product measured using pencil ionization chamber inserted in the holes of standard CT phantoms with diameters 16 and 32 cm, which respectively mimic adult head and body using the procedures recommended by International Electro-technical Commission. Significantly large deviations were observed between the measured and console CTDI vol values in multislice CT scanners
本研究探讨了多层螺旋CT扫描仪测量和控制台体积CT剂量指数(CTDIvol)之间的关系。根据国际电工委员会推荐的程序,将铅笔电离室插入直径为16和32 cm的标准CT模型孔中,分别模拟成人头部和身体,通过测量kerma长度乘积来测定CTDI值。在多层CT扫描仪中,观察到测量值和控制台CTDI vol值之间存在显著的大偏差
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引用次数: 0
Research on the Impact of Canceling Medicinemarkups on the Price Change of Medical Services 取消药品加价对医疗服务价格变动的影响研究
Pub Date : 2022-01-20 DOI: 10.33140/jnh.07.01.05
A new round of medical system reform in China since 2009 aims to solve the problems of "difficult to see doctors" and "expensive medical treatment". In the past few years, the cancellation of drug markups has been promoted to the whole country by local pilot projects as an important measure of medical reform. In this context, the price of medical services, as an important part of medical charges, will become the focus and difficulty of the future reform, which deserves the attention of the academic circles and practitioners. In this study, based on the policy feedback theory, this paper analyzes the interaction and mechanism between the two major medical reform policies: the cancellation of drug markups and the price adjustment of medical services, and puts forward suggestions for further reform and policy coordination in the future from the two dimensions of resource effect and interpretation effect.
2009年开始的中国新一轮医疗体制改革旨在解决“看病难”和“看病贵”的问题。近年来,取消药品加成作为医改的一项重要举措,已通过地方试点向全国推广。在此背景下,医疗服务价格作为医疗收费的重要组成部分,将成为未来改革的重点和难点,值得学术界和实践者关注。本研究基于政策反馈理论,分析了取消药品加成与医疗服务调价这两大医改政策之间的相互作用和机制,并从资源效应和解释效应两个维度对未来进一步改革和政策协调提出建议。
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引用次数: 0
Prebriefing in Nursing Simulation: Does the Use of Concept Mapping in The Prebriefing Process Impact Clinical Competence in Nursing Students? 护理模拟预简报:在预简报过程中使用概念图对护生临床能力有影响吗?
Pub Date : 2022-01-20 DOI: 10.33140/jnh.07.01.01
Background: The purpose of this study was to evaluate the impact of a concept map in the prebriefing on clinical competence of nursing students in a prelicensure associated degree nursing program. Methods: A prospective, quasi-experimental, comparative, post-test-only project was implemented using a concept map in the prebriefing process to evaluate the impact on clinical competence in nursing students in a prelicensure associated degree nursing program. Results: The evaluation of 115 nursing students enrolled in first-year nursing courses revealed no overall increase in clinical competence using a concept map in the prebriefing process. Although not captured, students stated they felt the concept map positively impacted their critical thinking during simulation. Conclusions: A concept map in the prebriefing process may impact the clinical competency of nursing students. Further evaluation is warranted to determine the impact of a concept map in the prebriefing process on clinical competence.
背景:本研究的目的是评估概念图在预简报中对护理预科护理专业学生临床能力的影响。方法:采用前瞻性、准实验性、比较性、后测试项目,采用概念图的方法,在预习过程中评估对护理学预科护理专业学生临床能力的影响。结果:采用概念图法对115名一年级护理专业学生的临床能力进行评估,结果显示,在预习过程中,临床能力没有全面提高。虽然没有被捕获,但学生们表示,他们觉得概念图在模拟过程中对他们的批判性思维有积极的影响。结论:预习过程中的概念图可能影响护生的临床胜任力。进一步的评估是必要的,以确定概念图的影响,在预习过程中的临床能力。
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引用次数: 0
Quality of Work-Life and its impact on Performance of Health Care Providers with Effect on Organizational Outcome: A Review of Contemporary Literatures 工作-生活质量及其对医疗服务提供者绩效的影响及对组织结果的影响:当代文献综述
Pub Date : 2022-01-20 DOI: 10.33140/jnh.07.01.04
QWL is a broad term and applicable in different fields including health care sector. With regular opening of new dimensions in health care delivery system, both in curative and diagnostic aspect, and associated increase in complexity in delivering adequate and quality care to the patients, proper and in time estimation of problem and immediate formulation of its solution is now an urgency, particularly in a developing country like India, which after globalization is a popular destination for health care tourism. Doctors and also other health care employees are heart of a health care provider unit and entire system is totally dependent on their performance. It is therefore, highly essential to frame a homogeneous policy to provide health care providers, doctors in particular, adequate scope to maintain their work life balance, to enjoy work satisfaction and conductive work environment and also to achieve career fulfilment and proper recognition which in tern is reflected in better organizational performance. This study deals with recent reviews in reputed journals to update recent developments in regard of changes in work place atmosphere and policy framing with its impact on doctors and other health care workers and also on organizational performance.
QWL是一个广泛的术语,适用于包括医疗保健部门在内的不同领域。随着医疗保健服务系统在治疗和诊断方面的新维度的定期开放,以及向患者提供充分和高质量护理的复杂性的增加,正确和及时地估计问题并立即制定解决方案现在迫在眉睫,特别是在像印度这样的发展中国家,在全球化之后,印度是一个受欢迎的医疗保健旅游目的地。医生和其他医疗保健人员是医疗保健提供者单位的核心,整个系统完全取决于他们的表现。因此,极为重要的是制定一项同质政策,为保健提供者,特别是医生提供足够的空间,以保持其工作与生活的平衡,享受工作满意度和有益的工作环境,并实现职业成就和适当的认可,从而反映在更好的组织绩效中。本研究涉及知名期刊最近的评论,以更新工作场所气氛和政策框架的变化及其对医生和其他卫生保健工作者以及组织绩效的影响方面的最新发展。
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引用次数: 2
期刊
Journal of Nursing &amp; Healthcare
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