提高紧急腹部手术 (EPOCH) 后生存率的国家质量改进计划的有效性:一个阶段性子集群随机试验
Carol J Peden1, Tim Stephens2, Graham Martin3
1Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Lancet (London, England)
|April 30, 2019
概括
紧急腹部手术的国家质量改善计划没有改善患者的生存率. 未来的倡议需要足够的时间和资源来有效实施和改善患者的结果.
科学领域:
- 改善外科手术的质量
- 患者安全
- 医疗服务研究
背景情况:
- 紧急腹部手术与患者的不良结果有关.
- 实施了国家质量改善计划,以引入旨在提高这些重症患者的生存率的护理途径.
研究的目的:
- 评估国家质量改善计划对接受紧急腹部手术的患者的生存率的有效性.
- 评估标准化护理途径对紧急整体手术患者结果的影响.
主要方法:
- 一个分阶集群随机试验,涉及40岁及以上的接受紧急腹部大手术的患者.
- 在85周的时间内从符合条件的英国国家卫生服务 (NHS) 医院收集的数据,医院随机顺序开始QI计划.
- 主要结果是90天死亡率,根据治疗意向进行分析.
主要成果:
- 在接受紧急腹部手术的患者中,QI计划没有显著的生存益处.
- 在QI组中,90天死亡率为16%,在常规治疗组中为16% (危险比率1.11,95%置信区间0.96-1.28).
- 总共包括93家NHS医院的15873名符合条件的患者.
结论:
- 实施的QI计划和护理途径没有改善紧急腹部手术的患者的存活率.
- 未来的QI计划必须确保有足够的时间和资源用于成功实施和改善患者护理.
- 可能需要进一步的研究来确定有效的策略来改善紧急整体手术的结果.
相关概念视频
Improving Translational Accuracy
14.1K
Base complementarity between the three base pairs of mRNA codon and the tRNA anticodon is not a failsafe mechanism. Inaccuracies can range from a single mismatch to no correct base pairing at all. The free energy difference between the correct and nearly correct base pairs can be as small as 3 kcal/ mol. With complementarity being the only proofreading step, the estimated error frequency would be one wrong amino acid in every 100 amino acids incorporated. However, error frequencies observed in...
14.1K
Improving Translational Accuracy
3.6K
3.6K
Wedges
1.7K
A wedge is a simple machine that serves various purposes, such as adjusting the elevation of structural or mechanical parts, providing stability for heavy objects, and splitting a body into two parts. This versatile tool can amplify an applied force, making it easier to manipulate large or heavy objects.
Consider using a wedge to lift a heavy slab. Here, the wedge functions by converting the applied force into a much larger force directed almost perpendicular to the initial force. This...
Consider using a wedge to lift a heavy slab. Here, the wedge functions by converting the applied force into a much larger force directed almost perpendicular to the initial force. This...
1.7K
National Nursing Organizations I
3.0K
Nursing organizations assume a significant role in consistently developing the nursing profession through education, research studies, establishing practice standards, and reforming health policies. Typically, nursing organizations operate at the regional, national, and international levels. For example, the International Council of Nurses (ICN) represents more than 28 million nurses worldwide. In contrast, the American Nurses Association (ANA) is a membership organization representing nurses...
3.0K
National Nursing Organizations II
2.0K
Nursing organizations play a vital role in representing nurses working in specialized clinical settings, such as the American Association of Critical-Care Nurses (AACN).
The AACN emphasizes a healthy work environment through six standards to achieve an optimal patient outcome. The standards are appropriate staffing, meaningful recognition, collaboration, authentic leadership, effective communication, and decision-making. In addition, AACN provides certification programs, webinars, journals, and...
The AACN emphasizes a healthy work environment through six standards to achieve an optimal patient outcome. The standards are appropriate staffing, meaningful recognition, collaboration, authentic leadership, effective communication, and decision-making. In addition, AACN provides certification programs, webinars, journals, and...
2.0K
Emerging Adulthood
653
Jeffrey Arnett's concept of emerging adulthood offers a framework to understand the unique developmental stage between adolescence and full-fledged adulthood, generally from ages 18 to 25. This period is marked by extensive exploration and shifts in identity, relationships, and career choices, a process known in psychology as role experimentation. Emerging adulthood reflects the evolving cultural expectations surrounding adulthood and the dynamic process of personal transformation during...
653


