Objective:Nurse-led virtual outpatient clinics are now a familiar component of healthcare delivery across many disciplines,including cancer care,or thopedics,rheumatology,and gastroenterology.However,establishing a nu...Objective:Nurse-led virtual outpatient clinics are now a familiar component of healthcare delivery across many disciplines,including cancer care,or thopedics,rheumatology,and gastroenterology.However,establishing a nurse-led vir tual clinic is challenging for nursing management,par ticularly regarding resources.We aimed to investigate nursing practices and processes and patient experiences in relation to vir tual outpatient clinics.Methods:This was a cross-sectional,descriptive study using mixed data collection methods.Patients(n=324)from 4 specialist clinics completed the Virtual Clinics Patient Satisfaction Questionnaire(VCSQ)survey.Five Nurse Specialists participated in a focus group interview.Results:Most participants(86.3%)reported being satisfied/very satisfied with the virtual clinics,particularly those that were nurse-led.Nurse specialists identified electronic health records(EHRs)and additional IT and administrative support as important for efficiency and effectiveness of the clinics.Conclusions:Nurse-led virtual clinics can be an effective and efficient way to provide care to patients.Nurse managers need to ensure supportive structures are in place,for example,dedicated administrators,IT support and infrastructure,education/training,and relevant policies/procedures.The success of nurse-led virtual services requires key infrastructure to support nursing staff and sustain this service.展开更多
BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery...BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery speed and quality of life.Effective prevention of anxiety and depression in elderly patients has become an urgent problem.AIM To investigate the trajectory of anxiety and depression levels in elderly patients after LIF,and the influencing factors.METHODS Random sampling was used to select 239 elderly patients who underwent LIF from January 2020 to December 2024 in Shenzhen Pingle Orthopedic Hospital.General information and surgery-related indices were recorded,and participants completed measures of psychological status,lumbar spine dysfunction,and quality of life.A latent class growth model was used to analyze the post-LIF trajectory of anxiety and depression levels,and unordered multi-categorical logistic regression was used to analyze the influencing factors.RESULTS Three trajectories of change in anxiety level were identified:Increasing anxiety(n=26,10.88%),decreasing anxiety(n=27,11.30%),and stable anxiety(n=186,77.82%).Likewise,three trajectories of change in depression level were identified:Increasing depression(n=30,12.55%),decreasing depression(n=26,10.88%),and stable depression(n=183,76.57%).Regression analysis showed that having no partner,female sex,elevated Oswestry dysfunction index(ODI)scores,and reduced 36-Item Short Form Health Survey scores all contributed to increased anxiety levels,whereas female sex,postoperative opioid use,and elevated ODI scores all contributed to increased depression levels.CONCLUSION During clinical observation,combining factors to predict anxiety and depression in post-LIF elderly patients enables timely intervention,quickens recovery,and enhances quality of life.展开更多
Objective:To explore the impact of evidence-based predictive nursing intervention on psychological stress and physiological indicator stability of elderly cataract patients during the perioperative period(1 day before...Objective:To explore the impact of evidence-based predictive nursing intervention on psychological stress and physiological indicator stability of elderly cataract patients during the perioperative period(1 day before surgery to 1 day after surgery),and to provide a basis for optimizing clinical nursing plans for elderly cataract surgery.Methods:A retrospective selection of 90 elderly patients(aged≥60 years)who underwent cataract surgery in the Ophthalmology Department of our hospital from August 2024 to December 2024 was conducted.They were divided into an observation group(n=45)and a control group(n=45)using a random number table method.The control group received routine nursing for cataract surgery,while the observation group implemented evidence-based predictive nursing intervention(including the establishment of a multidisciplinary evidence-based team,hierarchical psychological intervention,perioperative environment optimization,intraoperative personalized cooperation,and video-based health education).Psychological stress indicators[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),General Self-Efficacy Scale(GSES)]on the 1st day before surgery and 1st day after surgery,and fluctuations of physiological indicators[Heart Rate(HR),Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP)]on the 1st day before surgery and during surgery were compared between the two groups.Results:Before intervention,there were no statistically significant differences in SAS,SDS,GSES scores,HR,SBP,or DBP between the two groups(p>0.05);after intervention,the SAS score(33.62±5.72)and SDS score(32.14±4.86)of the observation group on the 1st day after surgery were significantly lower than those of the control group[(41.05±5.56),(43.59±4.75)],and the GSES score(31.15±3.28)was significantly higher than that of the control group(24.84±3.52)(all p<0.05);during surgery,the fluctuations of HR(74.0±6.0)beats/min,SBP(127.0±15.8)mmHg,and DBP(75.0±5.9)mmHg in the observation group were significantly smaller than those in the control group(all p<0.05).Conclusion:Evidence-based predictive nursing intervention can effectively alleviate anxiety and depression in elderly cataract patients during the perioperative period,improve self-efficacy,stabilize intraoperative physiological status,and enhance surgical cooperation,which is worthy of clinical promotion.展开更多
Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January...Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January 2024 to May 2025 were prospectively included and randomly divided into a furosemide monotherapy group(20 cases),a spironolactone monotherapy group(20 cases),and a combination therapy group(20 cases).The intervention period is 28 days,and the main observation indicators include 24-hour urine output,changes in abdominal circumference,weight loss,serum electrolyte levels,renal function indicators,and incidence of adverse reactions.All study subjects received standardized dietary management and sodium restriction intervention(daily sodium intake<5 g).Result:The total effective rate(significant+effective)of the combination therapy group in reducing ascites was 95%(19/20),significantly higher than the 75%(15/20)of the furosemide group and the 70%(14/20)of the spironolactone group(p<0.01).On the 28th day of treatment,the mean urine output in the combination group was 2450±210 mL/d,which was higher than that in the monotherapy group(1850±195 mL/d in the furosemide group);Spironolactone group 1560±180 mL/d.The blood sodium levels of the three groups were maintained at 135-140 mmol/L,but the incidence of hypokalemia in the combination group(10%)was significantly lower than that in the furosemide group(35%).Conclusion:The combination of furosemide and spironolactone has a synergistic effect in the treatment of ascites in cirrhosis,with a 39.2%increase in diuretic effect and a reduction in the risk of electrolyte imbalance;Individualized dose adjustment combined with strict sodium restriction is the core strategy to ensure treatment safety.展开更多
AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).MET...AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).METHODS:This is a cross-sectional study.Thepatients underwent basic ophthalmic examinations,axiallength measurement,wide-field fundus photography,andaccommodation function testing.Behavioral habits datawere collected using a self-administered questionnaire,andvisual symptoms were assessed with the Quality of Vision(QoV)questionnaire.Postoperative satisfaction was alsorecorded.RESULTS:Totally 410 subjects[820 eyes,160males(39.02%)and 250 females(60.98%)]who hadundergone SMILE or FS-LASIK 5y ago were enrolled.Themean(standard deviation,SD)age of all patients was29.83y(6.69).The mean(SD)preoperative manifest SEwas-5.80(2.04)diopters(D;range:-0.88 to-13.75).Patient satisfaction at 5y after undergoing SMILE or FSLASIKwas 91.70%.Patients were categorized into twogroups:dissatisfied group and satisfied group.Significantdifferences were observed between the two groups in termsof age(P=0.012),sex(P=0.021),preoperative degreeof myopia(P=0.049),postoperative visual symptoms(frequency,P=0.043;severity,P<0.001;bothersome,P=0.018),difficulty driving at night(P=0.001),andaccommodative amplitude(AMP,P=0.020).Multivariateanalysis confirmed that female sex(P=0.024),severityof visual symptoms(P=0.009),and difficulty driving atnight(P=0.006)were significantly associated with lowersatisfaction.The dissatisfied group showed higher rates ofstarbursts,double or multiple images,and high myopia,but lower age.The frequency,severity,and bothersome ofdistortion exhibited decreased with increasing age.CONCLUSION:Patient satisfaction 5y after SMILEand FS-LASIK is high and stable.Difficulty driving at night,sex,and severity of visual symptoms are important factorsinfluencing patient satisfaction.Special attention should bepaid to younger highly myopic female patients,particularlythose with starbursts and double or multiple images.It is crucial to monitor postoperative visual outcomesand provide patients with comprehensive preoperativecounseling to enhance long-term satisfaction.展开更多
BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship ...BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.展开更多
We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on pa...We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
Neurodegenerative disorders represent an increasingly pertinent public health crisis.As a greater proportion of the population ages,neurodegenerative disorders and other diseases of aging place undue burdens on patien...Neurodegenerative disorders represent an increasingly pertinent public health crisis.As a greater proportion of the population ages,neurodegenerative disorders and other diseases of aging place undue burdens on patients,caregivers,and healthcare workers.Alzheimer’s disease(AD)and Parkinson’s disease represent the two most common neurodegenerative disorders in the population,affecting over 65 million people,worldwide.展开更多
Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value ...Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.展开更多
BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptio...Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptions of empathy,patient satisfaction,and the quality of recovery in elderly patients undergoing postoperative care for lower extremity fractures under spinal anesthesia.Methods:In the present cross-sectional study,138 elderly patients who underwent surgery for lower extremity fracture and spinal anesthesia were selected for inclusion in the study.The questionnaire included demographic characteristics,the Jefferson Scale of Patient Perception of Physician Empathy,the Patient Satisfaction Scale,and the Postoperative Quality of Recovery Score.Multivariate regression was performed to evaluate the associations between patient-reported factors and satisfaction.Results:The overall average scores for patient perception of empathy,quality of recovery,and patient satisfaction were 20.30(1.18),110.11(8.26),and 156.86(5.44),respectively.There was a statistically significant positive correlation between patient quality of recovery and patient perception of empathy and patient satisfaction(p<0.01).Conclusions:This finding could also inform policymaking and the development of guidelines aimed at improving the quality of healthcare delivery.This study encouraged healthcare organizations and institutions to foster empathy in healthcare interactions,which may positively impact patient satisfaction and subsequent recovery outcomes,and patient-centered care.展开更多
This study aims to reveal the prototypical argumentative patterns employed in situations where patient distrust arises in China.Based on the quantitative analysis of data from a general social survey,we focus on a dis...This study aims to reveal the prototypical argumentative patterns employed in situations where patient distrust arises in China.Based on the quantitative analysis of data from a general social survey,we focus on a distinctive phenomenon that while a majority of Chinese respondents trust the medical profession as a whole,significant distrust exists toward doctors'skills and ethics,particularly among older,urban,and higher income populations.Qualtatively,we employ Generalized Argumentation Theory to analyze Chinese clinical dialogues,identifying three kinds of prototypical argumentative patterns in situations of patient distrust.Methodologically,this article shows the value of combining statistical analysis with goal-oriented Generalized Argumentation research to reconcile the tricky trust phenomenon of Chinese doctor-patient communication.展开更多
Background/objective Patients often expect antibiotics for self-limiting diseases,pressuring providers to prescribe antibiotics unnecessarily.These expectations also contribute to the unsafe practice of taking antibio...Background/objective Patients often expect antibiotics for self-limiting diseases,pressuring providers to prescribe antibiotics unnecessarily.These expectations also contribute to the unsafe practice of taking antibiotics without a prescription(non-prescription use),such as pills retained from prior prescriptions or antibiotics from non-medical sources.Previous work shows that non-prescription use is due to strong,widely held misconceptions regarding the curative power of antibiotics.To reduce unnecessary use of antibiotics,we developed and pilot-tested a patient-focused,bilingual(English and Spanish)educational tool with patient and provider stakeholder input.The tool,a trifold brochure,included information on safe antibiotic use,potential antibiotic harms and symptom management with over-the-counter medications.Design Using a qualitative design,we conducted a two-phase study to(1)develop a provider–patient communication tool and(2)pilot-test the tool in primary care clinics.Development of the tool involved patient advisory board meetings and healthcare professional(HCP)focus groups.Pilot-testing of the tool was done through semistructured interviews of randomly recruited patients from primary clinic waiting rooms and their providers.Setting Publicly funded safety net primary care clinics in Texas.Participants Patients(n=18)and HCPs(nurses,medical assistants,pharmacists,nurse practitioners and physicians)(n=14)from participating clinics.Result Themes were extracted from the qualitative data.Main themes from the development phase highlighted the need to create a simple tool to make it clear that antibiotics are not used to treat viral infections,pain or allergies and that using antibiotics without consulting a medical professional is not safe.During pilot-testing,providers noted the tool helped adjust patients’antibiotic expectations.Providers felt that the tool gave them credibility in scenarios where antibiotics were not indicated.Patients felt that the tool provided alternatives to antibiotics for symptom relief.Patients and providers found the tool useful in supporting patient–provider communication around antibiotic use.Conclusions A stakeholder-driven,patient-focused educational tool addressing inappropriate antibiotic use facilitated patient–provider communication around antibiotic usage and helped manage patients’antibiotic expectations.Embedding this tool into a community-facing intervention may reduce use of antibiotics without a prescription.展开更多
Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by in...Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by integrating literature analysis,clinical practice research,and multidisciplinary experts’consensus.Focusing on the differentiated needs of patients,the study proposes a dual-track management framework of‘precise diagnosis and treatment standard’and‘humanistic care practice’,and innovatively designs a multidisciplinary collaborative mechanism,an information-based follow-up platform,and a social support network.Through the role of‘care consultant’,the programme connects the medical team with the individual needs of patients,strengthens treatment compliance and improves the quality of life,and provides a theoretical basis and practical reference for the optimization of the whole management mode of lymphoma patients.展开更多
Objective:To evaluate the practical application effect of nursing risk management in preventing falls among inpatients,and to provide a reference for optimizing clinical safety management strategies for inpatients.Met...Objective:To evaluate the practical application effect of nursing risk management in preventing falls among inpatients,and to provide a reference for optimizing clinical safety management strategies for inpatients.Methods:A total of 428 inpatients in our hospital from January 2021 to December 2023 were selected as the research objects.They were divided into a control group(218 cases)and a study group(210 cases)according to the nursing management method.The control group received routine fall prevention nursing,while the study group implemented systematic nursing risk management.The fall rate and post-fall injury rate during hospitalization were compared between the two groups.Results:The fall rate of the study group was significantly lower than that of the control group,and the difference was statistically significant(p<0.05).Conclusion:Nursing risk management can effectively reduce the fall rate and post-fall injury rate of inpatients through systematic risk identification,targeted intervention and continuous quality improvement.It also improves patients’awareness of fall prevention and nursing satisfaction,and promotes the improvement of nurses’risk management ability,which has important clinical promotion value.展开更多
To the editor:Using drugs off-label in paediatric patients(age:0-18 years)has drawn increasing attention worldwide.Off-label use of drugs implies using drugs beyond the scope of their approved market authorisation(eg,...To the editor:Using drugs off-label in paediatric patients(age:0-18 years)has drawn increasing attention worldwide.Off-label use of drugs implies using drugs beyond the scope of their approved market authorisation(eg,patient age,indication,dosage and route of administration).Previous literature reported that the prevalence of off-label drug use ranged from36.3%to 97.0%among paediatric patients worldwide.展开更多
BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,ma...BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
基金supported by Nursing and Midwifery Practice Development Unit(NMPDU),Dublin South,Kildare,and Wicklow,Nurses preparedness for end of life conversations(No.P210537)。
文摘Objective:Nurse-led virtual outpatient clinics are now a familiar component of healthcare delivery across many disciplines,including cancer care,or thopedics,rheumatology,and gastroenterology.However,establishing a nurse-led vir tual clinic is challenging for nursing management,par ticularly regarding resources.We aimed to investigate nursing practices and processes and patient experiences in relation to vir tual outpatient clinics.Methods:This was a cross-sectional,descriptive study using mixed data collection methods.Patients(n=324)from 4 specialist clinics completed the Virtual Clinics Patient Satisfaction Questionnaire(VCSQ)survey.Five Nurse Specialists participated in a focus group interview.Results:Most participants(86.3%)reported being satisfied/very satisfied with the virtual clinics,particularly those that were nurse-led.Nurse specialists identified electronic health records(EHRs)and additional IT and administrative support as important for efficiency and effectiveness of the clinics.Conclusions:Nurse-led virtual clinics can be an effective and efficient way to provide care to patients.Nurse managers need to ensure supportive structures are in place,for example,dedicated administrators,IT support and infrastructure,education/training,and relevant policies/procedures.The success of nurse-led virtual services requires key infrastructure to support nursing staff and sustain this service.
基金Supported by the Scientific Research Projects of the Health System in Pingshan District,No.2023122.
文摘BACKGROUND Lumbar interbody fusion(LIF)is the primary treatment for lumbar degenerative diseases.Elderly patients are prone to anxiety and depression after undergoing surgery,which affects their postoperative recovery speed and quality of life.Effective prevention of anxiety and depression in elderly patients has become an urgent problem.AIM To investigate the trajectory of anxiety and depression levels in elderly patients after LIF,and the influencing factors.METHODS Random sampling was used to select 239 elderly patients who underwent LIF from January 2020 to December 2024 in Shenzhen Pingle Orthopedic Hospital.General information and surgery-related indices were recorded,and participants completed measures of psychological status,lumbar spine dysfunction,and quality of life.A latent class growth model was used to analyze the post-LIF trajectory of anxiety and depression levels,and unordered multi-categorical logistic regression was used to analyze the influencing factors.RESULTS Three trajectories of change in anxiety level were identified:Increasing anxiety(n=26,10.88%),decreasing anxiety(n=27,11.30%),and stable anxiety(n=186,77.82%).Likewise,three trajectories of change in depression level were identified:Increasing depression(n=30,12.55%),decreasing depression(n=26,10.88%),and stable depression(n=183,76.57%).Regression analysis showed that having no partner,female sex,elevated Oswestry dysfunction index(ODI)scores,and reduced 36-Item Short Form Health Survey scores all contributed to increased anxiety levels,whereas female sex,postoperative opioid use,and elevated ODI scores all contributed to increased depression levels.CONCLUSION During clinical observation,combining factors to predict anxiety and depression in post-LIF elderly patients enables timely intervention,quickens recovery,and enhances quality of life.
基金Hospital Quality Management Research Fund Project of China Medical Quality Management Association(Project No.:YLZG202511)。
文摘Objective:To explore the impact of evidence-based predictive nursing intervention on psychological stress and physiological indicator stability of elderly cataract patients during the perioperative period(1 day before surgery to 1 day after surgery),and to provide a basis for optimizing clinical nursing plans for elderly cataract surgery.Methods:A retrospective selection of 90 elderly patients(aged≥60 years)who underwent cataract surgery in the Ophthalmology Department of our hospital from August 2024 to December 2024 was conducted.They were divided into an observation group(n=45)and a control group(n=45)using a random number table method.The control group received routine nursing for cataract surgery,while the observation group implemented evidence-based predictive nursing intervention(including the establishment of a multidisciplinary evidence-based team,hierarchical psychological intervention,perioperative environment optimization,intraoperative personalized cooperation,and video-based health education).Psychological stress indicators[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),General Self-Efficacy Scale(GSES)]on the 1st day before surgery and 1st day after surgery,and fluctuations of physiological indicators[Heart Rate(HR),Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP)]on the 1st day before surgery and during surgery were compared between the two groups.Results:Before intervention,there were no statistically significant differences in SAS,SDS,GSES scores,HR,SBP,or DBP between the two groups(p>0.05);after intervention,the SAS score(33.62±5.72)and SDS score(32.14±4.86)of the observation group on the 1st day after surgery were significantly lower than those of the control group[(41.05±5.56),(43.59±4.75)],and the GSES score(31.15±3.28)was significantly higher than that of the control group(24.84±3.52)(all p<0.05);during surgery,the fluctuations of HR(74.0±6.0)beats/min,SBP(127.0±15.8)mmHg,and DBP(75.0±5.9)mmHg in the observation group were significantly smaller than those in the control group(all p<0.05).Conclusion:Evidence-based predictive nursing intervention can effectively alleviate anxiety and depression in elderly cataract patients during the perioperative period,improve self-efficacy,stabilize intraoperative physiological status,and enhance surgical cooperation,which is worthy of clinical promotion.
文摘Objective:This study aims to systematically evaluate the clinical efficacy and safety of diuretic therapy in patients with liver cirrhosis ascites.Method:60 patients with liver cirrhosis ascites diagnosed from January 2024 to May 2025 were prospectively included and randomly divided into a furosemide monotherapy group(20 cases),a spironolactone monotherapy group(20 cases),and a combination therapy group(20 cases).The intervention period is 28 days,and the main observation indicators include 24-hour urine output,changes in abdominal circumference,weight loss,serum electrolyte levels,renal function indicators,and incidence of adverse reactions.All study subjects received standardized dietary management and sodium restriction intervention(daily sodium intake<5 g).Result:The total effective rate(significant+effective)of the combination therapy group in reducing ascites was 95%(19/20),significantly higher than the 75%(15/20)of the furosemide group and the 70%(14/20)of the spironolactone group(p<0.01).On the 28th day of treatment,the mean urine output in the combination group was 2450±210 mL/d,which was higher than that in the monotherapy group(1850±195 mL/d in the furosemide group);Spironolactone group 1560±180 mL/d.The blood sodium levels of the three groups were maintained at 135-140 mmol/L,but the incidence of hypokalemia in the combination group(10%)was significantly lower than that in the furosemide group(35%).Conclusion:The combination of furosemide and spironolactone has a synergistic effect in the treatment of ascites in cirrhosis,with a 39.2%increase in diuretic effect and a reduction in the risk of electrolyte imbalance;Individualized dose adjustment combined with strict sodium restriction is the core strategy to ensure treatment safety.
基金Supported by Research and Transformation Application of Capital Clinical Diagnosis and Treatment Technology by Beijing Municipal Commission of Science and Technology(No.Z201100005520043).
文摘AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).METHODS:This is a cross-sectional study.Thepatients underwent basic ophthalmic examinations,axiallength measurement,wide-field fundus photography,andaccommodation function testing.Behavioral habits datawere collected using a self-administered questionnaire,andvisual symptoms were assessed with the Quality of Vision(QoV)questionnaire.Postoperative satisfaction was alsorecorded.RESULTS:Totally 410 subjects[820 eyes,160males(39.02%)and 250 females(60.98%)]who hadundergone SMILE or FS-LASIK 5y ago were enrolled.Themean(standard deviation,SD)age of all patients was29.83y(6.69).The mean(SD)preoperative manifest SEwas-5.80(2.04)diopters(D;range:-0.88 to-13.75).Patient satisfaction at 5y after undergoing SMILE or FSLASIKwas 91.70%.Patients were categorized into twogroups:dissatisfied group and satisfied group.Significantdifferences were observed between the two groups in termsof age(P=0.012),sex(P=0.021),preoperative degreeof myopia(P=0.049),postoperative visual symptoms(frequency,P=0.043;severity,P<0.001;bothersome,P=0.018),difficulty driving at night(P=0.001),andaccommodative amplitude(AMP,P=0.020).Multivariateanalysis confirmed that female sex(P=0.024),severityof visual symptoms(P=0.009),and difficulty driving atnight(P=0.006)were significantly associated with lowersatisfaction.The dissatisfied group showed higher rates ofstarbursts,double or multiple images,and high myopia,but lower age.The frequency,severity,and bothersome ofdistortion exhibited decreased with increasing age.CONCLUSION:Patient satisfaction 5y after SMILEand FS-LASIK is high and stable.Difficulty driving at night,sex,and severity of visual symptoms are important factorsinfluencing patient satisfaction.Special attention should bepaid to younger highly myopic female patients,particularlythose with starbursts and double or multiple images.It is crucial to monitor postoperative visual outcomesand provide patients with comprehensive preoperativecounseling to enhance long-term satisfaction.
文摘BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.
文摘We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
基金supported by the Canadian Institutes of Health Research(DFD-181599)the National Institutes of Health(T32AG058527)to RJB and R0190106435 to VM.
文摘Neurodegenerative disorders represent an increasingly pertinent public health crisis.As a greater proportion of the population ages,neurodegenerative disorders and other diseases of aging place undue burdens on patients,caregivers,and healthcare workers.Alzheimer’s disease(AD)and Parkinson’s disease represent the two most common neurodegenerative disorders in the population,affecting over 65 million people,worldwide.
文摘Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
文摘Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptions of empathy,patient satisfaction,and the quality of recovery in elderly patients undergoing postoperative care for lower extremity fractures under spinal anesthesia.Methods:In the present cross-sectional study,138 elderly patients who underwent surgery for lower extremity fracture and spinal anesthesia were selected for inclusion in the study.The questionnaire included demographic characteristics,the Jefferson Scale of Patient Perception of Physician Empathy,the Patient Satisfaction Scale,and the Postoperative Quality of Recovery Score.Multivariate regression was performed to evaluate the associations between patient-reported factors and satisfaction.Results:The overall average scores for patient perception of empathy,quality of recovery,and patient satisfaction were 20.30(1.18),110.11(8.26),and 156.86(5.44),respectively.There was a statistically significant positive correlation between patient quality of recovery and patient perception of empathy and patient satisfaction(p<0.01).Conclusions:This finding could also inform policymaking and the development of guidelines aimed at improving the quality of healthcare delivery.This study encouraged healthcare organizations and institutions to foster empathy in healthcare interactions,which may positively impact patient satisfaction and subsequent recovery outcomes,and patient-centered care.
基金supported by the Fundamental Research Funds for the Chinese MOE Project of Key Research Institute of Humanities and Social Sciences at Universities(22JJD720022)the Central Universities of Jinan University(Grant No.23JNQMX55).
文摘This study aims to reveal the prototypical argumentative patterns employed in situations where patient distrust arises in China.Based on the quantitative analysis of data from a general social survey,we focus on a distinctive phenomenon that while a majority of Chinese respondents trust the medical profession as a whole,significant distrust exists toward doctors'skills and ethics,particularly among older,urban,and higher income populations.Qualtatively,we employ Generalized Argumentation Theory to analyze Chinese clinical dialogues,identifying three kinds of prototypical argumentative patterns in situations of patient distrust.Methodologically,this article shows the value of combining statistical analysis with goal-oriented Generalized Argumentation research to reconcile the tricky trust phenomenon of Chinese doctor-patient communication.
基金supported by grant number R01HS026901-01 from the Agency for Healthcare Research and Qualitysupported in part by the US Department of Veterans Affairs Health Services Research and Development Service(grant number CIN 13-413)at the Center for Innovations in Quality,Effectiveness and Safetysupported by the Department of Health and Human Services,Health Resources and Services Administration(grant number T32 HP1003).
文摘Background/objective Patients often expect antibiotics for self-limiting diseases,pressuring providers to prescribe antibiotics unnecessarily.These expectations also contribute to the unsafe practice of taking antibiotics without a prescription(non-prescription use),such as pills retained from prior prescriptions or antibiotics from non-medical sources.Previous work shows that non-prescription use is due to strong,widely held misconceptions regarding the curative power of antibiotics.To reduce unnecessary use of antibiotics,we developed and pilot-tested a patient-focused,bilingual(English and Spanish)educational tool with patient and provider stakeholder input.The tool,a trifold brochure,included information on safe antibiotic use,potential antibiotic harms and symptom management with over-the-counter medications.Design Using a qualitative design,we conducted a two-phase study to(1)develop a provider–patient communication tool and(2)pilot-test the tool in primary care clinics.Development of the tool involved patient advisory board meetings and healthcare professional(HCP)focus groups.Pilot-testing of the tool was done through semistructured interviews of randomly recruited patients from primary clinic waiting rooms and their providers.Setting Publicly funded safety net primary care clinics in Texas.Participants Patients(n=18)and HCPs(nurses,medical assistants,pharmacists,nurse practitioners and physicians)(n=14)from participating clinics.Result Themes were extracted from the qualitative data.Main themes from the development phase highlighted the need to create a simple tool to make it clear that antibiotics are not used to treat viral infections,pain or allergies and that using antibiotics without consulting a medical professional is not safe.During pilot-testing,providers noted the tool helped adjust patients’antibiotic expectations.Providers felt that the tool gave them credibility in scenarios where antibiotics were not indicated.Patients felt that the tool provided alternatives to antibiotics for symptom relief.Patients and providers found the tool useful in supporting patient–provider communication around antibiotic use.Conclusions A stakeholder-driven,patient-focused educational tool addressing inappropriate antibiotic use facilitated patient–provider communication around antibiotic usage and helped manage patients’antibiotic expectations.Embedding this tool into a community-facing intervention may reduce use of antibiotics without a prescription.
文摘Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by integrating literature analysis,clinical practice research,and multidisciplinary experts’consensus.Focusing on the differentiated needs of patients,the study proposes a dual-track management framework of‘precise diagnosis and treatment standard’and‘humanistic care practice’,and innovatively designs a multidisciplinary collaborative mechanism,an information-based follow-up platform,and a social support network.Through the role of‘care consultant’,the programme connects the medical team with the individual needs of patients,strengthens treatment compliance and improves the quality of life,and provides a theoretical basis and practical reference for the optimization of the whole management mode of lymphoma patients.
文摘Objective:To evaluate the practical application effect of nursing risk management in preventing falls among inpatients,and to provide a reference for optimizing clinical safety management strategies for inpatients.Methods:A total of 428 inpatients in our hospital from January 2021 to December 2023 were selected as the research objects.They were divided into a control group(218 cases)and a study group(210 cases)according to the nursing management method.The control group received routine fall prevention nursing,while the study group implemented systematic nursing risk management.The fall rate and post-fall injury rate during hospitalization were compared between the two groups.Results:The fall rate of the study group was significantly lower than that of the control group,and the difference was statistically significant(p<0.05).Conclusion:Nursing risk management can effectively reduce the fall rate and post-fall injury rate of inpatients through systematic risk identification,targeted intervention and continuous quality improvement.It also improves patients’awareness of fall prevention and nursing satisfaction,and promotes the improvement of nurses’risk management ability,which has important clinical promotion value.
基金supported by the National Natural Science Foundation of China (No.72374011).
文摘To the editor:Using drugs off-label in paediatric patients(age:0-18 years)has drawn increasing attention worldwide.Off-label use of drugs implies using drugs beyond the scope of their approved market authorisation(eg,patient age,indication,dosage and route of administration).Previous literature reported that the prevalence of off-label drug use ranged from36.3%to 97.0%among paediatric patients worldwide.
文摘BACKGROUND Non-ST-elevation myocardial infarction(NSTEMI)is a prevalent acute coronary syndrome among the elderly,a population often underrepresented in clinical trials.Frailty,a marker of physiologic vulnerability,may influence the risks and benefits of percutaneous coronary intervention(PCI)in these patients.AIM To evaluate the impact of frailty status on in-hospital outcomes among patients aged≥75 years with NSTEMI undergoing PCI.METHODS We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged≥75 years undergoing PCI.Patients were stratified into three frailty categories using the Hospital Frailty Risk Score.Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.RESULTS Among 456690 NSTEMI admissions,37.95%,50.71%,and 11.34%were categorized as low,intermediate,and high frailty,respectively.PCI use declined with increasing frailty(35.0%in low vs 7.5%in high;P<0.001).Adjusted mortality was lower with PCI across all frailty levels[odds ratios(OR):0.27(low),0.37(intermediate),0.43(high);all P<0.001].However,the mortality benefit was attenuated with increasing frailty(interaction OR:1.56 and 1.83 for intermediate and high vs low frailty;P<0.001).Frailty was independently associated with higher odds of complications,including acute kidney injury,respiratory failure,delirium,and bleeding.PCI was associated with shorter hospital stays in low(-0.90 days)but longer in the high-frail category(+2.47 days;P<0.001),and increasing frailty correlated with significantly higher hospital charges.CONCLUSION In elderly NSTEMI patients,PCI conferred a survival benefit across all frailty strata,although with a diminishing magnitude as frailty increased.Frailty correlated with increased complications and healthcare resource utilization.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
