Patient assessment

患者评估
  • 文章类型: Journal Article
    背景:痛经,或月经疼痛,是一种主观体验,并且只能通过患者报告的结果进行评估。这些仪器应该是可靠的,有效和响应。
    目的:确定并严格评估用于痛经的特定患者报告结局指标的测量特性的现有证据。
    方法:使用PRISMA声明报告本系统综述。搜索的数据库是PubMed,Scopus,CINAHL,WebofScience,ScienceDirect和GoogleScholar(2021年4月;2023年2月更新)。原始研究与主要数据收集,对报告一种或多种痛经相关患者报告结局指标的心理测量特性的语言和出版日期没有限制。文献检索,选择研究,数据提取和偏倚风险评估由两名评审员独立进行,并遵循COSMIN指南.
    结果:这篇综述分析了30项研究,评估了19项患者报告的结局指标.仪器在测量结构和测量特性方面有所不同(有效性,可靠性和响应性)。研究的方法学质量和患者报告的结局指标的证据质量是可变的。在报告患者报告结果指标发展的13项研究中,大多数方法质量不足,总体评级不足或不一致。
    结论:痛经症状干扰(DSI)量表是唯一已确定的患者报告的结局指标,由于其足够的评级以及中等质量的证据,具有推荐的潜力。未来的研究应进一步评估现有患者报告的结果指标的测量特性,或根据COSMIN方法开发新的患者报告结局指标。
    不适用,因为这是一个系统的审查。
    背景:PROSPERO协议:CRD42021244410。2021年4月22日注册。
    BACKGROUND: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive.
    OBJECTIVE: To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea.
    METHODS: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines.
    RESULTS: Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent.
    CONCLUSIONS: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology.
    UNASSIGNED: Not applicable as this is a systematic review.
    BACKGROUND: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021.
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  • 文章类型: Journal Article
    类风湿关节炎(RA)患者患心血管疾病(CVD)的风险增加。识别有风险的患者对于启动预防性护理和相应地定制治疗至关重要。尽管国际指南建议所有RA患者进行CVD风险评估,利率仍然是次优的。本综述的目的是绘制用于在常规护理中对RA患者进行CVD风险评估的策略。确定谁提供CVD风险评估,并确定使用了哪些综合措施。使用了JoannaBriggs研究所的方法指南。在电子和灰色文献数据库中进行了文献检索,审判登记处,医疗结算所,和专业风湿病组织。调查结果是以叙述方式综合的。共纳入12项研究。本综述中报告的策略使用了各种基于系统的干预措施来支持RA患者的CVD风险评估。以不同的方式运作,采用两种方法:(A)多学科合作,(二)教育。在使用中引用了各种综合措施,有和没有RA调整。这篇综述的结果表明,尽管文献中引用了几种支持RA患者CVD风险评估的策略,有有限的证据表明标准化模式已应用于常规护理.此外,缺乏大量证据来绘制卫生保健专业人员如何在实践中进行心血管疾病风险评估。需要进行研究,以确定医疗保健专业人员在常规护理中评估其RA患者的CVD风险程度。关键点•使用数量有限的基于系统的干预措施来支持RA患者的CVD风险评估。•多学科团队协作,和教育用于实施干预措施,以支持医疗保健专业人员在实践中进行CVD风险评估。•需要确定医疗保健专业人员对RA患者的CVD风险评估的程度。
    Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.
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  • 文章类型: Journal Article
    背景:全面的患者评估对于安全的患者护理至关重要。护士的患者评估框架通常仅限于已经改变生命体征并有恶化风险的患者。或特定的风险或身体系统,如跌倒,压力伤和格拉斯哥昏迷评分。全面和结构化的循证护理评估框架,考虑整个患者并超越生命体征,特定风险和单一系统在住院设置中不常规使用,但对于确定患者恶化的早期风险很重要.
    目的:本综述的目的是确定用于全面评估住院患者的护理评估工具或框架,并确定这些工具对患者和卫生服务结果的影响。
    方法:进行了范围界定文献综述。医学文献在线分析和检索系统(MEDLINE),护理和相关健康文献累积指数(CINAHL),ProQuest论文和论文,Embase和Scopus是搜索中使用的数据库。首次搜索于2021年8月进行,并于2022年11月重复。未设置日期参数。参与者,概念,上下文(PCC)框架用于指导研究问题的发展,并合并纳入和排除标准。遵循PRISMA-ScR清单项目,以确保使用方法上合理的清单。
    结果:纳入了评估六个护理评估框架的十项主要研究。在五个护理评估框架中,没有一个明确设计用于普通病房护理,而是急诊科或特定的患者群体,比如肿瘤学。四项研究报告了可靠性和/或有效性;两项报告了患者结果,四项报告了员工满意度。
    结论:缺乏用于普通住院病房的循证护理患者评估框架。现有的评估工具主要是针对特定的患者队列设计的,特定的身体系统或已经恶化的患者。
    为了患者安全,需要一个框架来实现在这种环境下对患者进行结构化评估的方法,评估的一致性,护理人员的支持和信心,以升级护理。常规的系统护理评估也可以帮助患者及时升级。
    结论:这项研究解决了什么问题?这项研究解决了缺乏用于住院患者的循证护理评估框架的问题。这样做的影响是,它强调了基于证据的需求,整个患者评估框架,供护士用于入住病房环境的患者。主要发现是什么?这篇综述发现了有限的综合性,用于普通病房住院地区的患者评估框架。那些确定的患者没有在这个患者队列中得到验证,并且针对的是已经恶化的患者。这项研究将在哪里以及对谁产生影响?这篇综述有可能影响未来的研究和患者护理。它强调,大多数研究都集中在对已经恶化的患者进行检测和升级护理的过程上。需要一个基于证据的常规护理评估框架,用于住院患者进入病房环境,以促进积极的患者预后并防止恶化。
    这篇综述有助于现有的护理患者评估框架知识,然而,它也突出了几个差距。目前,没有已知的,已验证,整体,整体用于普通病房住院设置的结构化护理患者评估框架。然而,使用此类评估框架的区域(如急诊科)已显示出积极的患者结果和工作人员可用性.住院病房患者将从常规中受益,在病情恶化发生之前,针对患者积极预后的结构化护理评估。
    BACKGROUND: A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence-based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration.
    OBJECTIVE: The aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes.
    METHODS: A scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA-ScR Checklist Item was followed to ensure a methodologically sound checklist was used.
    RESULTS: Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction.
    CONCLUSIONS: Evidence-based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient.
    UNASSIGNED: A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation.
    CONCLUSIONS: What problem did the study address? This study addresses the lack of evidence-based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence-based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment. What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating. Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence-based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration.
    UNASSIGNED: This review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.
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  • 文章类型: Journal Article
    本文将通过案例研究讨论外周动脉疾病(PAD)导致的慢性肢体缺血。患者同时诊断为转移意味着临床决策复杂,治疗方案有限。PAD是仅次于冠状动脉疾病和中风的动脉粥样硬化的第三大常见临床表现。尽管放射技术和生化筛查的进步为PAD患者提供了早期干预和提高生存率的潜力,对证据的审查表明,致力于更保守的方法,如运动疗法和健康促进,可以更可持续,慢性肢体缺血患者的长期获益。护患关系的治疗性质使护士成为鼓励改变生活方式和支持服务的路标的理想场所。患者的积极参与对于任何潜在的改变都是必要的,作为整体护理计划的一部分,应该个性化,确保患者的参与度和依从性。因此,应将重点放在可改变的风险因素的管理和预防上,护士的角色是确保成功不可或缺的一部分。
    This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient\'s concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse-patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse\'s role is an integral part to ensure success.
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  • 文章类型: Journal Article
    衰弱是一种涉及脆弱性增加的综合征,通常是由于与年龄相关的多器官系统的生理储备和功能下降而发展而来的。导致对健康状况急性变化的反应能力受损。在初级保健和社区环境中与老年人一起工作的医疗保健提供者必须了解如何评估脆弱并确定适当的干预措施。本文报告了快速审查的结果,该审查研究了如何评估社区居住的老年人的虚弱状况以及使用了哪些干预措施来解决该人群的虚弱状况。
    Frailty is a syndrome involving increased vulnerability that usually develops from age-related decline in physiological reserves and function in multiple organ systems, resulting in an impaired ability to respond to acute changes in health conditions. It is imperative that healthcare providers who work with older adults in primary care and community settings understand how to assess frailty and can identify appropriate interventions. This article reports the results of a rapid review that examined how frailty is assessed in community-dwelling older adults and what interventions are used to address frailty in this population.
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  • 文章类型: Journal Article
    The purpose of this integrative review was to evaluate the literature from January 2013 to April 2020 and to explore critical care nurses\' perspectives of and intent to use recommended Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) patient assessment tools in adult critical care units. A literature search was performed with a total of 47 studies included in the final analysis for this review. The studies\' data were organized and further reduced based on The Reasoned Action Approach behavioral theory to reflect the extent to which a nurse plans to use a PADIS assessment tool. Extracted themes were related to behavioral beliefs in patient-centered care and critical thinking; normative beliefs about communication and prioritization; and control beliefs concerning autonomy and confidence. Contextualizing the international phenomenon of variation in PADIS assessment tool use by critical care nurses provides a deeper understanding of its complexity for use in the clinical setting.
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  • 文章类型: Journal Article
    NHS continuing healthcare is a package of care that is arranged and funded solely by the NHS where an individual has been found to have a \'primary health need\'. Individuals who may be eligible have a right to be assessed for NHS continuing healthcare, and this assessment is undertaken by healthcare professionals using a national framework. However, there is a lack of literature on continuing healthcare and its assessment process. The aim was to review the literature on undertaking and providing continuing healthcare in terms of workforce roles, education and training, and competencies. A literature search was undertaken to identify relevant literature on continuing healthcare. Primary searching of electronic internal databases and indices at the Royal College of Nursing and King\'s College London was used, alongside a further database search and hand searching. A narrative synthesis of the literature was used to synthesise the findings, and a thematic analysis was undertaken to identify themes from the literature. The literature search identified 100 articles, of which 84 were excluded because they did not meet the inclusion criteria or provided insufficient details in the abstract. A total of 18 articles were included and examined in detail. Four themes were identified in the literature: complexity of care in transitioning care from hospital to home; different care models; importance of education of healthcare professionals; and role of continuing healthcare. Healthcare professionals - including nurses - should receive further training in caring for older people, especially in relation to continuing healthcare. Since there is an increasing ageing population, there is an increasing requirement for continuing healthcare, and thus further research examining all aspects of this care is required.
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  • 文章类型: Journal Article
    OBJECTIVE: To describe what is currently known about nurses\' assessment decisions when providing care to patients at home or in their usual place of residence.
    METHODS: In August 2018, an integrative literature review using a systematic approach was conducted using specific search terms to search Informit, MEDLINE and Cumulative Index of Nursing and Allied Health Literature (CINAHL). The literature search was not limited by date, and included published papers or unpublished dissertations written between 1980 and 2018.
    RESULTS: In total 25 full papers were assessed for inclusion in this review; seven met the inclusion criteria. Three themes were identified from this review: i) nurse education and experience; ii) assessment informing decision-making and iii) knowing the patient.
    CONCLUSIONS: Nurses\' education, experience, abilities, prior learning, beliefs, attitudes and values are key factors in the delivery of home-based nursing care, and strongly influence how assessments, clinical judgements and decisions are made. Impact Statement: An understanding of home based nurses\' decisions and response to clinical deterioration is needed to inform Hospital in the Home nursing-specific curricula.
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    文章类型: Journal Article
    阳性和阴性综合征量表(PANSS)是用于测量精神分裂症症状严重程度的公认评估工具。研究人员和临床医生一直对PANSS的简短版本的开发感兴趣,该版本可以减轻患者和评估者的管理负担。作者全面概述了现有的PANSS简要措施,包括他们的优势和局限性,并讨论了一些可能的后续步骤。有两种可用的秤提供减少数量的原始PANSS项目:PANSS-14和PANSS-19;和两个较短的版本,包括六个项目:简短的PANSS和PANSS-6。PANSS-6已在既定试验中进行了相当广泛的测试,并且似乎显示出对变化的高度敏感性和既定的缓解截止定义。对于这些较短版本的PANSS,仍需要在新的抗精神病药物治疗试验中进行前瞻性测试。此外,他们需要补充采访指南,以及提供转换公式,将总分从简短的PANSS版本转换为PANSS-30。PANSS的两个简短版本本质上都旨在评估对抗精神病治疗的反应。未来的PANSS量表开发需要通过包括治疗敏感项目来解决治疗反应阳性症状的具体测量,以及特定疾病阶段的PANSS工具。
    The Positive and Negative Syndrome Scale (PANSS) is a well-established assessment tool for measuring symptom severity in schizophrenia. Researchers and clinicians have been interested in the development of a short version of the PANSS that could reduce the burden of its administration for patients and raters. The author presents a comprehensive overview of existing brief PANSS measures, including their strengths and limitations, and discusses some possible next steps. There are two available scales that offer a reduced number of original PANSS items: PANSS-14 and PANSS-19; and two shorter versions that include six items: Brief PANSS and PANSS-6. The PANSS-6 has been tested quite extensively in established trials and appears to demonstrate high sensitivity to change and an established cut off definition for remission. Prospective testing in new antipsychotic treatment trials is still required for these shorter versions of PANSS. In addition, they need to be supplemented with interview guides, as well as provide conversion formulas to translate total scores from the short PANSS versions to the PANSS-30. Both short versions of the PANSS are essentially designed to evaluate response to antipsychotic treatment. Future PANSS scale development needs to address specific measurement of treatment-responsive positive symptoms by including treatment-sensitive items, as well as illness-phase specific PANSS tools.
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  • 文章类型: Journal Article
    Availability of normative patient outcome data may assist in designing experiments and estimating sample sizes. The purpose of this review was to determine normative ranges for colonic transit time (CTT), Patient Assessment of Constipation-Symptoms (PAC-SYM), and Patient Assessment of Constipation-Quality of Life (PAC-QOL) in adults diagnosed with functional constipation per Rome III guidelines. Pooled estimates were derived from random-effects meta-analysis. Meta-regression was used to explore sources of heterogeneity among studies. A total of 24 studies (3786 patients) were included in the review. In 10 studies with 1119 patients, pooled CTT was 58 hours (95% confidence interval [CI]: 50-65 hours). Publication bias was not evident (Egger P = .51); heterogeneity was high (I2 = 92%, P < .001). In meta-regression, geographical location explained 57% of the between-study variance, with CTT significantly longer in studies conducted in Europe (71 hours) compared with Asia (49 hours) or the Americas (44 hours). In 9 studies with 2061 patients, pooled PAC-SYM was 1.70 (95% CI: 1.58-1.83). Publication bias was not evident (Egger P = .44). Heterogeneity was high (I2 = 90%, P < .001); however, no study or patient factor influenced PAC-SYM in meta-regression. In 12 studies with 1805 patients, pooled PAC-QOL was 1.97 (95% CI: 1.70-2.24). Publication bias was not evident (Egger P = .28); heterogeneity was high (I2 = 98%, P < .001). In meta-regression, age explained 52% of the between-study variance, with older age associated with lower PAC-QOL scores. Overall, in adults diagnosed with functional constipation per Rome III criteria, significant heterogeneity in CTT, PAC-SYM, and PAC-QOL exists among studies. Variability among studies may be explained by geography and patient factors.
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