BACKGROUND Stroke frequently results in oropharyngeal dysfunction(OD),leading to difficulties in swallowing and eating,as well as triggering negative emotions,malnutrition,and aspiration pneumonia,which can be detrime...BACKGROUND Stroke frequently results in oropharyngeal dysfunction(OD),leading to difficulties in swallowing and eating,as well as triggering negative emotions,malnutrition,and aspiration pneumonia,which can be detrimental to patients.However,routine nursing interventions often fail to address these issues adequately.Systemic and psychological interventions can improve dysphagia symptoms,relieve negative emotions,and improve quality of life.However,there are few clinical reports of systemic interventions combined with psychological interventions for stroke patients with OD.AIM To explore the effects of combining systemic and psychological interventions in stroke patients with OD.METHODS This retrospective study included 90 stroke patients with OD,admitted to the Second Affiliated Hospital of Qiqihar Medical College(January 2022–December 2023),who were divided into two groups:regular and coalition.Swallowing function grading(using a water swallow test),swallowing function[using the standardized swallowing assessment(SSA)],negative emotions[using the selfrating anxiety scale(SAS)and self-rating depression scale(SDS)],and quality of life(SWAL-QOL)were compared between groups before and after the intervention;aspiration pneumonia incidence was recorded.RESULTS Post-intervention,the coalition group had a greater number of patients with grade 1 swallowing function compared to the regular group,while the number of patients with grade 5 swallowing function was lower than that in the regular group(P<0.05).Post-intervention,the SSA,SAS,and SDS scores of both groups decreased,with a more significant decrease observed in the coalition group(P<0.05).Additionally,the total SWAL-QOL score in both groups increased,with a more significant increase observed in the coalition group(P<0.05).During the intervention period,the total incidence of aspiration and aspiration pneumonia in the coalition group was lower than that in the control group(4.44%vs 20.00%;P<0.05).CONCLUSION Systemic intervention combined with psychological intervention can improve dysphagia symptoms,alleviate negative emotions,enhance quality of life,and reduce the incidence of aspiration pneumonia in patients with OD.展开更多
Background Delays in first case on-time starts(FCOTS)can lead to inefficiencies in the operating room(OR),dissatisfaction among patients with their providers and staff,and increased facility costs.While the literature...Background Delays in first case on-time starts(FCOTS)can lead to inefficiencies in the operating room(OR),dissatisfaction among patients with their providers and staff,and increased facility costs.While the literature has established standards for improving main OR efficiency,further research is needed in labour and delivery(L&D)units.Therefore,we aimed to identify the barriers to ontime case starts in L&D ORs and to develop interventions to reduce OR case delays.Methods This quality improvement study was conducted at a safety-net hospital,where the average FCOTS was 12%before our initiative.Starting in November 2022,a multidisciplinary team was formed,including representatives from quality,obstetrics,anaesthesiology,nursing and scheduling.We developed failure modes and effects analysis,process mapping and interventions using the Institute for Healthcare Improvement Model for Improvement,testing them through rapid Plan-Do-StudyAct cycles.We used Montgomery rules with statistical process control charts to measure statistically significant changes in both outcome and process measures.Results Contributors to the delays at the patient,provider and systems levels were identified.Interventions targeting structure,process,team members and patient engagement were implemented from December 2022 through December 2023.A 41%increase in the average percentage of on-time first cases compared with the baseline(12%)was observed,based on data collected from August 2022 through November 2022 to postintervention(53%),and this improvement was sustained for 4 months.Additionally,a 69%decrease in the average case delay in minutes from baseline(178 min)was noted 6 months after project initiation(55 min).Conclusions Interventions at the patient,provider and systems levels were identified and implemented,effectively increasing OR on-time case starts on L&D.These can be used in other L&D units to improve FCOTS.展开更多
基金Supported by Qiqihar City Science and Technology Plan Joint Guidance Project,No.LSFGG-2022085.
文摘BACKGROUND Stroke frequently results in oropharyngeal dysfunction(OD),leading to difficulties in swallowing and eating,as well as triggering negative emotions,malnutrition,and aspiration pneumonia,which can be detrimental to patients.However,routine nursing interventions often fail to address these issues adequately.Systemic and psychological interventions can improve dysphagia symptoms,relieve negative emotions,and improve quality of life.However,there are few clinical reports of systemic interventions combined with psychological interventions for stroke patients with OD.AIM To explore the effects of combining systemic and psychological interventions in stroke patients with OD.METHODS This retrospective study included 90 stroke patients with OD,admitted to the Second Affiliated Hospital of Qiqihar Medical College(January 2022–December 2023),who were divided into two groups:regular and coalition.Swallowing function grading(using a water swallow test),swallowing function[using the standardized swallowing assessment(SSA)],negative emotions[using the selfrating anxiety scale(SAS)and self-rating depression scale(SDS)],and quality of life(SWAL-QOL)were compared between groups before and after the intervention;aspiration pneumonia incidence was recorded.RESULTS Post-intervention,the coalition group had a greater number of patients with grade 1 swallowing function compared to the regular group,while the number of patients with grade 5 swallowing function was lower than that in the regular group(P<0.05).Post-intervention,the SSA,SAS,and SDS scores of both groups decreased,with a more significant decrease observed in the coalition group(P<0.05).Additionally,the total SWAL-QOL score in both groups increased,with a more significant increase observed in the coalition group(P<0.05).During the intervention period,the total incidence of aspiration and aspiration pneumonia in the coalition group was lower than that in the control group(4.44%vs 20.00%;P<0.05).CONCLUSION Systemic intervention combined with psychological intervention can improve dysphagia symptoms,alleviate negative emotions,enhance quality of life,and reduce the incidence of aspiration pneumonia in patients with OD.
文摘Background Delays in first case on-time starts(FCOTS)can lead to inefficiencies in the operating room(OR),dissatisfaction among patients with their providers and staff,and increased facility costs.While the literature has established standards for improving main OR efficiency,further research is needed in labour and delivery(L&D)units.Therefore,we aimed to identify the barriers to ontime case starts in L&D ORs and to develop interventions to reduce OR case delays.Methods This quality improvement study was conducted at a safety-net hospital,where the average FCOTS was 12%before our initiative.Starting in November 2022,a multidisciplinary team was formed,including representatives from quality,obstetrics,anaesthesiology,nursing and scheduling.We developed failure modes and effects analysis,process mapping and interventions using the Institute for Healthcare Improvement Model for Improvement,testing them through rapid Plan-Do-StudyAct cycles.We used Montgomery rules with statistical process control charts to measure statistically significant changes in both outcome and process measures.Results Contributors to the delays at the patient,provider and systems levels were identified.Interventions targeting structure,process,team members and patient engagement were implemented from December 2022 through December 2023.A 41%increase in the average percentage of on-time first cases compared with the baseline(12%)was observed,based on data collected from August 2022 through November 2022 to postintervention(53%),and this improvement was sustained for 4 months.Additionally,a 69%decrease in the average case delay in minutes from baseline(178 min)was noted 6 months after project initiation(55 min).Conclusions Interventions at the patient,provider and systems levels were identified and implemented,effectively increasing OR on-time case starts on L&D.These can be used in other L&D units to improve FCOTS.
