新型局部封闭在神经外科静脉外渗的观察

目的探讨新型局部封闭在神经外科静脉外渗的观察。方法将90例静脉外渗的患者按顺序单双号分为对照组45例和观察组45例,对照组采用50%硫酸镁湿热敷,观察组采用蜘蛛网同心圆型局部封闭法。比较两组护理结果。结果观察组局部封闭4h红、热、痛明显减轻45例,次日红、肿、热、痛全部消退45例。对照组采用50%硫酸镁湿热敷当日红、肿、热、痛消退不明显45例,次日肿部分消退,红、热、疼痛减轻40例,第3日红、肿、热、痛较次日减轻38例,1周后完全消退45例。两组比较,对照组耗材多,即大量硫酸镁及大量无菌纱布,而且病程长,患者承受的痛苦时间长,影响肢体或身体移动,在生活上不方便。而观察组只操作一次,用时短,耗材少,患者承受病痛的过程短,也不影响身体或肢体移动。结论新型局部封闭在神经外科静脉外渗中效果显著。     

应用百克瑞治疗药物渗漏性皮肤坏死临床护理体会

目的探讨百克瑞杀菌纱布用于药物渗漏性皮肤坏死的临床疗效及护理。方法针对我院2009年2月～2012年12月发生的32例药物外渗中5例4级典型药物渗漏性损伤患者,在彻底清创及常规换药的基础上,局部敷以百克瑞复合溶葡萄球菌酶杀菌纱布,观察治疗结果,创面分泌物细菌培养。结果 5例患者创面经连续三天换药后可见周围红肿减轻,渗出物明显减少,继续换药后溃疡周边可见新鲜肉芽组织生长,溃疡逐渐愈合,未发生创面感染情况。结论百克瑞杀菌纱布具有较强的广谱杀菌能力,能祛除坏死组织,促进肉芽组织生长,表皮组织再生,是一种比较安全的创面用药,适用于发生药物渗漏性损伤的治疗。     

VSD负压吸引技术治疗老年糖尿病慢性难愈合创面的护理体会

目的探讨负压封闭引流(VSD)技术治疗老年人糖尿病慢性难愈合创面的护理。方法通过对3例特殊老年患者采用VSD技术治疗慢性难愈合创面进行心理护理、糖尿病药物及饮食及体位护理,持续负压封闭引流,密切护理观察等。结果 1例老年患者创面植皮后愈合;2例无植皮自行愈合。结论 VSD治疗糖尿病慢性难愈合创面的护理过程中,可刺激局部肉芽组织的增生,在持续负压引流作用下使创面与外界隔离,大大减少污染的机会,还可吸净创面的坏死组织和渗液,保证创面的干燥。另外,减轻了换药时的痛苦和对创面的刺激,避免各种并发症,对缩短创面愈合时间具有重要的意义。     

湿润烫伤膏治愈皮肤坏死1例

新生儿皮肤薄嫩，静脉滴注高营养液易引发外渗导致皮肤坏死。本文介绍一种用湿润烫伤膏治疗皮肤坏死的方法。     

多黄酸粘多糖乳膏治疗静脉炎的临床研究

目的探讨多黄酸粘多糖乳膏外涂治疗静脉炎的临床研究。方法将46例发生静脉炎的患者随机分为实验组和对照组各23例,实验组多黄酸粘多糖乳膏外涂3天,对照组采用50%硫酸镁溶液湿敷3天。结果实验组在治疗后效果优于对照组(P<0.01)。结论多黄酸粘多糖乳膏外涂治疗静脉炎具有推广价值。     

37例新生儿脓胞疮护理体会

目的总结新生儿脓胞疮的护理经验,探讨新生儿脓疱疮的护理方法。方法对患儿家属进行心理护理,做好患儿生命体征、感染的监控,做好消毒隔离、控制感染、对症治疗及皮肤护理,防止交叉感染等科学护理。结果 37例新生儿脓疱疮患儿全部治愈,无1例出现并发症,治愈率达100%。结论积极与家属沟通,宣教正确的育儿知识、卫生常识及皮肤护理等相关知识,对患儿进行有效科学的护理,对护理新生儿脓疱疮具有积极的指导作用。     

曲安奈德注射液封闭治疗肱骨外上髁炎的护理体会

目的观察曲安奈德注射液痛点封闭治疗70例肱骨外上髁炎的疗效。方法取曲安奈德注射液20 mg与20%的盐酸利多卡因0.5 ml混合摇匀后，作痛点周围的浸润注射。结果肱骨外上髁炎可明显提高治愈率。结论曲安奈德注射液封闭治疗肱骨外上髁炎，并配合相应的护理方法，效果更好。     

烧伤浸浴室的安全管理

大面积烧伤治疗后期常遗留部分散在创面,此时,大部分创面已基本愈合,同时新生皮肤比较脆弱,受轻微外力即可导致新生皮肤磨损或水泡形成,水泡破裂形成的创面常常迁延不愈[1]。烧伤浸浴治疗是我国独创的一种行之有效的烧伤治疗方法,因其能有效清除创面坏死物下方残存的大量渗出物,减轻换药时给患者带来的痛苦[2]。我院于2014年12月始陆续收治了多名大面积烧伤康复期患者。     

硼酸洗液联合安普贴治疗胺碘酮所致静脉炎的临床疗效

目的：探讨硼酸洗液联合安普贴治疗胺碘酮所致静脉炎的临床疗效。方法选取我院2010－2013年收治的胺碘酮静脉给药所致静脉炎患者100例,随机将其等分为两组,对照组患者用50%硫酸镁浸湿无菌纱布,湿敷病变部位并用电磁波谱治疗器（TDP）照射;观察组患者先用硼酸洗液湿敷,后用安普贴粘帖于病变部位。两组患者均连续治疗3 d,并评估疗效。结果观察组患者治疗总有效率明显高于对照组,两组比较差异有统计学意义（P＜0.05）。结论硼酸洗液联合安普贴治疗胺碘酮所致静脉炎疗效明显。     

湿润烧伤膏治疗胺碘酮静脉炎的效果分析

目的探讨湿润烧伤膏治疗胺碘酮所致静脉炎的临床疗效。方法 80例患者均为我院2012年3月至2013年5月收治的胺碘酮静脉给药所致静脉炎患者,随机等分为两组。对照组用50%硫酸镁浸湿无菌纱布,湿敷病变部位;观察组用湿润烧伤膏外敷病变部位。两组均连续治疗3 d并评估疗效。结果观察组治疗总有效率(97.5%)明显高于对照组(67.5%),两组比较差异有统计学意义(P<0.01)。结论外敷湿润烧伤膏治疗胺碘酮所致静脉炎疗效明显。     

硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响

目的研究硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响。方法选取自2010年1月～2011年12月在本院接受治疗的脑卒中偏瘫患者127例,随机分为两组,在相同常规治疗的前提下,治疗组患者静滴硫酸镁及口服乙哌立松,而对照组应用安慰剂进行治疗,进行临床对比。结果两组患者治疗后,治疗组的肌张力情况、运动功能情况明显好于对照组,p<0.05有统计学意义。结论硫酸镁及乙哌立松结合强化训练对脑卒中偏瘫肢体的影响十分明显。     

低分子肝素联合丹参注射液治疗早发型重度子前期效果评估

目的探讨低分子肝素与丹参注射液联合用药对早发型子前期(重度)的治疗效果。方法选取我院2008年10月至2012年10月诊断为重度子前期的患者共124例(孕龄在25～34周),随机平均分为四组,每组31例。第一组患者使用常规硫酸镁治疗,第二组患者使用硫酸镁加丹参注射液治疗,第三组患者使用硫酸镁加低分子肝素治疗,第四组患者使用硫酸镁、低分子肝素以及丹参注射液三种药物联合治疗,对比各组相关治疗结果的差异。结果第四组患者的孕龄延长时间和羊水量明显增加,脐动脉S/D值下降,新生儿体重明显增加,新生儿窒息率明显下降,与另外三组比较,差异有统计学意义(P<0.05)。同时第四组患者胎盘的重量有所增加,与第一组比较,差异有统计学意义(P<0.05),与另外两组比较差异无统计学意义。结论联合使用低分子肝素和丹参注射液在早发型的重度子前期治疗效果明显。     

硫酸镁联合缬沙坦与拉贝洛尔对妊娠高血压患者白血病抑制因子、同型半胱氨酸水平的影响

目的探讨硫酸镁联合缬沙坦、拉贝洛尔对妊娠高血压患者白血病抑制因子(LIF)、同型半胱氨酸(Hcy)水平的影响。方法选取2016年4月至2017年5月成武县人民医院收治的82例妊娠高血压患者作为研究对象,随机分为对照组与观察组,各41例。对照组应用硫酸镁治疗,观察组在对照组基础上联合缬沙坦及拉贝洛尔治疗,比较两组的治疗结果。结果两组治疗前舒张压、收缩压、24h尿蛋白定量水平比较,差异无统计学意义(P>0.05);治疗后,观察组张压、收缩压、24 h尿蛋白定量水平低于对照组,差异有统计学意义(P<0.05);两组治疗前LIF、Hcy水平比较,差异无统计学意义(P>0.05);观察组治疗后LIF水平高于对照组,Hcy水平低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为12.19%,与对照组7.32%比较,差异无统计学意义(P>0.05)。结论硫酸镁联合缬沙坦、拉贝洛尔治疗妊娠高血压安全有效,可改善患者血压水平,调节血清LIF、Hcy水平,且不会增加不良反应。     

Minimum nurse staffing ratios for nursing homes

The authors explored minimum nurse staffing ratios for nursing homes using production function simulations. Minimum levels of registered nurse hours per resident day were 0.31, 1.83, and 3.3 at 50%, 75%, and 90% levels of quality respectively. These results suggest that efficiency-oriented minimum nurse staffing points exist, and could be used to inform policymakers and nursing home administrators on better resource allocation and health care delivery.     

Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care

The results of analyses of the 2002 and 2004 National Sample Surveys of RNs and the 2004 National Sample of CNOs document the widespread perception that the shortage of nurses is a major problem for the overall quality of patient care in hospitals. In the eyes of the majority of hospital RNs and CNOs surveyed, care processes involving communication, timely response to pages and telephone calls, delays in patient discharges, and the time patients had to wait for tests and procedures were all affected negatively by the nursing shortage. These results are not encouraging.     

护理干预在耐药肺结核患者中的应用效果

目的探讨护理干预在耐药肺结核患者中应用效果。方法将我院收治的60例耐药肺结核患者随机分为对照组和观察组,对照组30例给予常规护理,观察组30例在常规护理的基础上给予护理干预,比较两组患者的临床效果。结果观察组患者抑郁、焦虑症状发生率为36.7%,对照组患者抑郁、焦虑症状发生率为76.7%,对照组高于观察组（P〈0.05）,观察组患者满意度高于对照组,且观察组住院时间少于对照组（P〈0.05）。结论对耐药肺结核患者进行护理干预,能有效提高治疗效果。     

QUANTIFYING THE IMPACTS OF LIMITED SUPPLY: THE CASE OF NURSING HOMES

This article develops a new estimation method that accounts for excess demand and the unobserved component of product quality. We apply our method to study the Wisconsin nursing home market in 1999 and find that nearly 20% of elderly qualified for Medicaid were rationed out. However, our counterfactual experiment shows that the net welfare gain of fulfilling all nursing home demands may be small, because the welfare gain could be largely offset by the increase in Medicaid expenditures. We also find that a 1% increase in quality would crowd out 3.2% Medicaid patients in binding nursing homes.     

The direct medical costs of Huntington’s disease by stage. A retrospective commercial and Medicaid claims data analysis

Abstract

Objective:

This study quantified the direct healthcare costs and major cost drivers among patients with Huntington’s disease (HD), by disease stage in commercial and Medicaid databases.

Methods:

This retrospective database analysis used healthcare utilization/cost data for HD patients (ICD-9-CM 333.4) from Thomson Reuters’ MarketScan Commercial and Medicaid 2002–2009 databases. Patients were classified by disease stage (Early/Middle/Late) by a hierarchical assessment of markers of disease severity, confirmed by literature review and key opinion leader input. Costs were measured over the follow-up time of each patient with total costs per patient per stage annualized using a patient-year cost approach.

Results:

Among 1272 HD patients, the mean age was similar in commercial (752 patients) and Medicaid (520 patients) populations (48.5 years (SD?=?13.3) and 49.3 years (SD?=?17.2), respectively). Commercial patients were evenly distributed by stage (30.5%/35.5%/34.0%; Early/Middle/Late). However, most (74.0%) Medicaid HD patients were classified as Late stage. The mean total annualized cost per patient increased by stage (commercial: $4947 (SD?=?$6040)–$22,582 (SD?=?$39,028); Medicaid: $3257 (SD?=?$5670)–$37,495 (SD?=?$27,111). Outpatient costs were the primary healthcare cost component. The vast majority (73.8%) of Medicaid Late stage patients received nursing home care and the majority (54.6%) of Medicaid Late stage costs were associated with nursing home care. In comparison, only 40.6% of commercial Late stage patients received nursing home care, which contributed to only 4.6% of commercial Late stage costs.

Conclusions:

The annual direct economic burden of HD is substantial and increased with disease progression. More late stage Medicaid HD patients were in nursing homes and for a longer time than their commercial counterparts, reflected by their higher costs (suggesting greater disease severity). Key limitations include the classification of patients into a single stage, as well as a lack of visibility into full long-term care/nursing home-related costs for commercial patients.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.