Get With the Guidelines-Stroke与急性中风或过渡性缺血性发作住院患者的护理持续改善有关
Lee H Schwamm1, Gregg C Fonarow, Mathew J Reeves
1Massachusetts General Hospital, Boston, MA 02114, USA. lschwamm@partners.org
Circulation
|December 17, 2008
概括
参与"与指导方针相处-中风"计划显著改善了对中风护理指导方针的遵守. 这项质量改进计划使所有参与医院的中风治疗得到了更好的改善.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 对于中风和短暂性缺血性发作 (TIA) 治疗,遵守基于证据的指导方针仍然是不理想的.
- 需要评估旨在改善在中风护理中遵守指南的干预措施.
研究的目的:
- 确定是否参与"了解指导方针-中风"计划与更好地遵守中风护理指导方针有关.
主要方法:
- 一个前性的,非随机的,国家质量改进计划,涉及790家美国医院从2003年至2007年.
- 在322,847名患有缺血性中风或TIA的患者中,测量了7个绩效指标和一个复合指标的遵守.
- 使用通用估计方程来分析与随时间推移的坚持改善相关的因素.
主要成果:
- 从基线到第5年,参与Get With the Guidelines-Stroke与所有7个个体和复合依从度的显著改善有关.
- 具体的改善包括增加静脉血栓抑制剂的使用,早期和出院的抗血栓剂,DVT预防,心房动抗凝药,脂质治疗和戒烟.
- 多变量分析表明,满足护理机会的几率每年增加1.18倍,独立于世俗趋势.
结论:
- 参与Get With the Guidelines-Stroke计划导致了对所有中风性能指标的遵守率增加.
- 在所有医院中,无论大小,地理位置或教学地位如何,都观察到中风护理的显著改善.
相关概念视频
Coronary Artery Disease V: Interprofessional Care
450
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
450
Acute Coronary Syndrome IV: Interprofessional Care
525
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
525
Atherosclerosis IV: Nursing Management
621
Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
621
Stroke: Introduction and Types
69
A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
69
Ischemic Stroke l: Introduction
53
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
53
Ischemic Stroke ll: Pathophysiology
68
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
68


