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The decision-making process for senior cancer patients: treatment allocation of older women with operable breast cancer in the UK

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Cancer Biology & Medicine 2015年第4期12卷 308-315页

作者： Jenna L.Morgan Paul Richards Osama Zaman sue ward Karen Collins Thompson Robinson Kwok-Leung Cheung Riccardo A.Audisio Malcolm W.Reed Lynda Wyld on behalf of the Bridging the Age Gap in Breast Cancer Trial Management Team Academic Unit of Surgical Oncology University of Sheffield Medical School Health Economics and Decision Science School for Health and Related Research University of Sheffield Center for Health and Social Care Research Sheffield Hallam University Collegiate Crescent Department of Cardiovascular Sciences University of Leicester School of Medicine University of Nottingham Royal Derby Hospital Center Department of Surgery University of Liverpool St Helens Teaching Hospital Brighton and Sussex Medical School University of Sussex

Objective: Up to 40% of women over 70 years with primary operable breast cancer in the UK are treated with primary endocrine therapy(PET) as an alternative to surgery. A variety of factors are important in determining treatment for older breast cancer patients. This study aimed to identify the patient and tumor factors associated with treatment allocation in this ***: Prospectively collected data on treatment received(surgery vs. PET) were analysed with multivariable logistic regression using the variables age, modified Charlson Comorbidity Index(CCI), activities of daily living(ADL) score, Mini-Mental State Examination(MMSE) score, HER2 status, tumour size, grade and nodal status. Results: Data were available for 1,122 cancers in 1,098 patients recruited between February 2013 and June 2015 from 51 UK hospitals. About 78% of the population were treated surgically, with the remainder being treated with PET. Increasing patient age at diagnosis, increasing CCI score, large tumor size(5 cm or more) and dependence in one or more ADL categories were all strongly associated with non-surgical treatment(P<0.05).Conclusion: Increasing comorbidity, large tumor size and reduced functional ability are associated with reduced likelihood of surgical treatment of breast cancer in older patients. However, age itself remains a significant factor for non-surgical treatment; reinforcing the need for evidence-based guidelines.

关键词： Frail elderly breast neoplasms decision-making

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Knock out Fall Incidence

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Journal of Health Science 2014年第9期2卷 405-427页

作者： Magdalene Ng Kim Choo Juweita Bte Arba'in Heng Lili Joline NurJannah Zhong Tan sue Ching Mardielene Cunanan Mercado Nur Amelia Binte Azman Jayanthi d/o Sivam Pillay Israel Jimenez Bernal Connie Besas Oepulango Chong Lai Ling Ang Shin Yuh ward 53C Department of Internal Medicine Singapore General Hospital 169608 Republic of Singapore ward 77H Department of Haematology Singapore General Hospital 169608 Republic of Singapore Nursing Division Singapore General Hospital 169608 Republic of Singapore Nursing Quality Department Singapore General Hospital 169608 Republic of Singapore

Fall is an event in which a person unintentionally descends onto the floor. It may lead to physical injuries, psychological harm and/or financial loses. Over the last three Financial Years 2009-201 l, there had been increasing fall incident rate at the unit level, Department of Internal Medicine and Haematology. The hospital fall performance target was set at 〈 one fall per 1000 patient days. Hence, there was a pressing need for improvement with an emphasis of focused analysis to prevent fall. The aim of the study was to reduce fall incidents by at least 50% at W53C and W77H in Financial Year 2012. The baseline fall incident data was collected from February 2011 to March 2012 for both wards. A total number of 33 falls with a median of 2.5 and 1.1 falls per 1000 patient days respectively were collected. The verification of root causes to fall incidences was identified in Pareto Chart. The 3 root causes were： Delayed elimination round, underestimated patients＇ risk for falls and lack of care coordination among team members. The solution implementations were： Cessation ofhardcopy of elimination chart and daily assessment of patient＇s fall risk using modified Morse Fall Scale was changed from paper to electronic. Conducting root cause analysis post fall and sharing near miss incidences were another two implementations to draw the learning points from the incidents to prevent the similar occurrence. Reallocation of staffassignment without increasing manpower to ensure better care coordination was the 5th solution. With the above stated multi-factorial interventions, a significant fall incidence rate was achieved. It had achieved 7% more than the target set for the project.

关键词： Falls patient safety quality improvement.

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护理安全管理模式对提高急诊科护理质量及满意度的影响

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中国医药科学 2017年第15期7卷 147-150页

作者：钟素雯杨莉瑕梁瑞清梁素娥刘英广东省博罗县人民医院急诊科广东博罗516100

目的探讨护理安全管理模式对提高急诊科护理质量及满意度的影响。方法采取自身对照方式2015年1月~2016年6月期间我院急诊科日间护理采用护理风险安全管理模式法(实施后),2013年1月~2014年12月采用传统护理管理方法(实施前),科室自行制... 详细信息

目的探讨护理安全管理模式对提高急诊科护理质量及满意度的影响。方法采取自身对照方式2015年1月~2016年6月期间我院急诊科日间护理采用护理风险安全管理模式法(实施后),2013年1月~2014年12月采用传统护理管理方法(实施前),科室自行制定调查问卷,观察实施前后护理投诉、护理纠纷发生情况,并对护理满意度、基础护理、消毒隔离、病房管理等护理质量进行评价。结果实施安全管理模式后护理投诉明显低于实施前,而护理满意度明显高于实施安全管理模式前,差异有统计学意义(P<0.05);实施安全管理模式后基础护理、消毒隔离、病房管理及护理综合质量评分明显高于实施安全管理前,且比较差异均有统计学意义(P<0.05);实施安全管理模式后不良事件发生率明显低于实施安全管理前,且比较差异均有统计学意义(P<0.05)。结论急诊科应用护理安全管理模式可有效提升患者的满意率,提高日间护理的安全质量。

关键词：急诊科安全管理护理质量护理纠纷护理投诉

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