赞比亚卢萨卡的患者、护理人员和提供者对腰椎穿刺的接受程度(2515)

摘要目的:探讨赞比亚患者/护理人员和服务提供者对腰椎穿刺(LP)的接受程度。

背景:根据赞比亚的社会人口统计指数，脑膜炎死亡率高得不成比例。我们调查了卢萨卡脑膜炎护理的障碍。低脂蛋白摄取是一个障碍，但对低脂蛋白的可接受性知之甚少。

设计/方法:对大学教学医院(UTH)的脑膜炎患者或其护理人员(n=25)、医生(n=8)和护士(n=8)进行了面对面和电话录音访谈。患者/护理人员访谈涉及脑膜炎治疗、对脑膜炎的理解和生物医学护理。提供者访谈的重点是脑膜炎患者的护理和住院患者的护理挑战。采用框架方法进行分析。

结果:患者/护理人员知道LP从背部收集液体，但无法描述手术的好处。他们认为LP是一种与死亡相关的危险手术，必须不惜一切代价避免。同意LP的护理人员通常认识一些LP幸存者。LP同意意味着接受患者死亡的责任，尽管如果死亡被视为“上帝的意志”，这种责任会减轻。妻子们认为她们缺乏同意LP的能力，并顺从于大家庭，这延误了护理。

医生和护士认识到社区对LP的理解较差，但指出了床边咨询的多重障碍，包括竞争性的临床需求、有限的患者/护理人员教育和语言。有限的咨询并没有克服强烈的负面LP观点，因为护理人员在同意后往往仍然存在误解，而LP拒绝后有时会立即出院。同意通常在患者发病晚期获得，通常在开始使用经验性抗生素几天后获得。在解释结果时，通常不考虑之前的抗生素治疗。

结论:低LP的吸收反映了患者/护理人员的疑虑，对潜在不良结果的指责，以及无效的床边教育。为了提高LP在赞比亚的接受度和效用，还需要解决患者、提供者和社区的问题。

披露:埃拉弗罗斯博士没什么可透露的。Bwalya Chiti没有什么可透露的。Godfrey Muchanga没有什么可透露的。Mwangala Mwale没有什么可透露的。Nachizya Namukanga没有什么可透露的。Birbeck博士作为美国神经学协会(American Neurological Association)的官员或董事会成员，获得了500- 4,999美元的个人报酬。伯贝克博士的直系亲属因担任各种案件的专家证人而获得了10,000- 49,999美元的个人报酬。Birbeck博士所在的机构得到了NIH的研究支持。Birbeck博士的直系亲属所在的机构获得了RSNA的研究支持。Birbeck博士作为NIH FIC的顾问委员会获得了500- 4,999美元的个人报酬。 Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to AAN interests or activities. Dr. Chomba has nothing to disclose. Anchindika Mugala has nothing to disclose. Dr. Kvalsund has nothing to disclose. Izukanje Sikazwe, 7923 has received personal compensation for serving as an employee of Centre for Infectious Disease Research in Zambia. Izukanje Sikazwe, 7923 has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MSD. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities. The institution of Peter Winch has received research support from Bill and Melinda Gates Foundation.