儿童和青少年癌症患者终末期真实体验与需求的Meta整合

目的 对儿童和青少年癌症患者终末期真实体验与需求的质性研究结果进行整合,为更好地开展安宁疗护实践提供参考。方法系统检索中英文数据库关于儿童和青少年癌症患者终末期真实体验与需求的质性研究,检索时限从建库至2023年4月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价,采用汇集整合法进行Meta整合。结果共纳入8篇研究,质量等级均为B级。提炼出40个研究结果,将相似结果归纳组合形成 7个新的类别,并整合为3个结果：遭受身心痛苦体验;积极应对疾病,经历正面心理体验及自身成长;对正常生活的渴望,希望得到社会支持。结论儿童和青少年癌症患者终末期经历消极和积极体验,其需求有年龄差异性。医护人员需重视儿童和青少年癌症患者终末期体验和需求,提供心理疏导和必要支持,提升其终末期生活质量。     

女性终末期肾病患者疾病体验质性研究的Meta整合

目的 系统整合女性终末期肾病患者疾病体验，为医护人员优化过渡期护理，改善患者生活质量提供参考。 方法 计算机检索PsycINFO、PubMed、Embase、CINAHL和中国知网、中国生物医学文献数据库、万方数据库，收集关于女性终末期肾病患者疾病体验的质性研究，检索时限为建库至2022年12月。运用JBI质性研究质量评价标准评价纳入文献的质量，采用汇集性整合方法对结果进行整合。 结果 共纳入8篇文献，提炼出28个完好明确的研究结果，将相似结果归纳为8个新的类别，并综合成3个整合结果：过渡期疾病体验、女性角色功能受损、妊娠风险决策。 结论 医护人员应重视女性终末期肾病患者疾病体验，优化过渡期护理，提升患者角色适应水平，改善育龄期患者妊娠决策辅助，最终提升患者长期生活质量。     

慢性肾脏病患者饮食管理体验质性研究的Meta整合

目的 深入了解慢性肾脏病患者饮食管理过程的真实体验，以期为慢性肾脏病患者展开针对性的饮食干预提供依据。方法 检索PubMed、Web of Science、EBSCO、ScienceDirect及中国知网、万方数据库、中国生物医学文献数据库等数据库从建库至2020年2月慢性肾脏病患者饮食管理相关的质性研究。根据澳大利亚JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价，采用汇集性整合的方法进行整合。结果 共纳入15篇文献，提炼63个结果，归纳形成9个类别，整合出3个结果，即慢性肾脏病饮食对患者造成的影响（疾病造成的饮食相关症状困扰、情感体验，生活限制和文化冲突）、应对方式（积极应对和消极应对）、需求（需要知识与技能、需要专业人员支持、需要家庭与朋友支持）。结论 慢性肾脏病饮食对患者身心、生活、社交等多方面造成一定影响，医务工作人员在患者饮食管理过程中应该重视患者的应对方式，情感体验与不同需求，针对患者需求，给予患者指导与帮助，以树立患者饮食管理信念，引导患者积极应对，提高慢性肾脏病饮食管理的有效性。     

心脏骤停幸存者真实体验质性研究的Meta整合

目的总结心脏骤停幸存者的真实体验,为有针对性地提供心脏骤停急救护理提供参考。方法计算机检索PubMed、Embase、Web of Science、The Cochrane Library、CINAHL、中国知网、维普数据库和万方数据库,搜集有关心脏骤停幸存者真实体验的质性研究。检索时限为建库至2020年8月。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合的方法进行结果整合。结果共纳入11篇文献,梳理出59个研究结果。经归纳提练为面临多重转变与挑战的身心感受、通过更新自我认知实现生活重建、渴求并感恩外界的支持与帮助3个整合结果及所属9个类别21个结果。结论心脏骤停幸存者存在多方面的心理社会问题与需求,医护人员应加以重视,予以针对性干预,帮助其重建社会生活,提高生活质量。     

肿瘤患者味觉改变体验及应对质性研究的Meta整合

目的 系统评价肿瘤患者味觉改变体验及应对的质性研究,为制订针对性干预方案提供参考。 方法 计算机检索PubMed、CINAHL、Web of Science、Embase、Scopus、ProQuest、中国知网、万方数据等数据库中有关肿瘤患者味觉改变体验及应对的质性研究,检索时限为建库至2022年4月。采用JBI循证卫生保健中心的质性研究质量评价标准进行文献质量评价,采取汇集性整合方法整合研究结果。 结果 纳入14篇文献,提炼出69个主题,归纳成5个类别,综合形成味觉改变体验的复杂多变、多元化的管理策略2个整合结果。 结论 肿瘤患者味觉改变复杂多变,负面影响患者的生活。护士应关注肿瘤患者味觉改变体验,给予持续、动态评估,加强健康教育,协助患者提高症状管理自我效能,提升味觉改变管理能力。     

我国护士作为第二受害者体验及支持需求的Meta整合

目的系统评价我国护士作为第二受害者的体验。方法检索PubMed、Web of Science、EMbase、Psyc INFO、Science Direct, CINAHL,中国知网、维普、万方、中国生物医学文献数据库从建库至2018年12月31日收录的相关质性研究。采用JBI循证卫生保健中心(2011)质性研究质量评价标准和质性研究资料提取工具(QARI Data Extraction Tools)进行文献质量评价和资料提取,使用汇集性整合方法进行结果整合。使用CERQual定性系统评价证据分级工具评价整合结果信度。结果共纳入13项研究,提取47个研究结果,归纳8个新的类别,得到3个整合结果:护士经历患者安全事件后表现出典型的第二受害者综合征(信度评级高级),护士缺乏应对患者安全事件不良影响的能力(信度评级中级),护士经历患者安全事件后得到的支持不足(信度评级中级)。结论我国护士作为第二受害者应对患者安全事件不良影响的能力不足,缺乏可靠支持体系。管理者应提高第二受害者认知,逐步开展相关教育培训,建立组织支持体系,促进护士身心健康和职业幸福。     

国内肾移植术后患者心理体验的质性Meta整合

目的系统评价肾移植患者术后心理体验。方法计算机检索数据库中国知网、万方数据库、维普数据库、中国生物医学文献数据库,搜索关于肾移植患者术后真实体验的质性研究,检索时限从建库至2018年5月。进行文献质量评价后,采用Meta整合方法对研究结果进行归纳、诠释。结果共纳入8篇文献,提炼出52个结果、6个类别和3个整合结果,分别为肾移植术后患者消极心理、肾移植术后患者对未来与生命的心理感受、肾移植术后患者的自身健康需求与期望。结论医护人员应充分了解肾移植术后患者心理体验,做好针对性心理干预,引导患者调整认知和行为方式,提高患者的术后生活质量,并且增强患者对未来生活的心理资本。     

成年癌症患者生育力保存决策体验质性研究的Meta整合

目的 系统整合癌症患者生育力保存决策体验的质性研究,为辅助癌症患者做决策及改进现有决策支持体系提供循证依据。方法 计算机检索PubMed、EMbase、The Cochrane Library、CINAHL、Web of Science、PsycINFO、Scopus、中国知网、万方数据库、维普数据库关于癌症患者生育力保存决策的质性研究,检索时限为建库至2022年8月。采用JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,采用Meta整合中汇集性整合方法对结果进行整合。结果 共纳入18篇文献,提炼出67个研究结果,将相似结果归纳成7个新的类别,并综合成3个整合结果：对生育力保存风险-收益的艰难权衡,紧迫决策下复杂的心理变化过程,决策过程的干扰。结论 医护人员及相关卫生机构应重视癌症患者生育力保存决策的心理体验和信息需求,优化决策程序、开发决策辅助方案,促进患者尽快完成决策。     

中国养老机构老年人入住体验质性研究的Meta整合

目的总结养老机构老年人的入住体验,为提高老年人的生活质量提供科学依据。方法检索CNKI、维普期刊网、万方服务平台、中国生物医学数据库、PubMed、Cochrane Library、Embase,收集从建库至2020年9月发表的关于老年人养老机构入住体验的质性研究文献。采用澳大利亚JBI卫生保健中心质性研究质量评价标准(2017)评价文献及Meta整合方法对结果进行整合。结果经筛选最后共纳入10篇中文文献,2篇英文文献。提炼81个研究结果,相近结果经归纳组合后形成11个新类属,将其综合而成4个整合结果(基本需求获得的满足感,存在多种不适应感,对自身健康状况担忧,存在经济困扰)。结论老年人养老机构入住体验喜忧并存,既满足于日常照护、基础健康维护等正性体验,也存在情感关怀、医疗照护感知不足等负性体验。需家庭、机构、社会、政府共同努力应对,提高养老机构老年人正性入住体验。     

ICU患者亲属对ICU日记使用感受质性研究的Meta整合

目的 系统评价ICU患者亲属使用ICU日记感受的质性研究,为开展危重症患者亲属人文关怀提供依据。方法 检索PubMed、Web of Science、Embase、Science Direct、AACN及中国知网、万方数据、维普网中相关的质性研究,检索时间均为建库至2019年5月,采用2017版澳大利亚循证卫生保健中心质性研究质量评价标准进行文献评价,采取汇集性整合方法进行Meta整合。结果 共纳入7项研究,提炼29个研究结果,归纳形成10个新类别,得出3个整合结果:亲属自身感受(信息和情感需求得到满足,少数反对);亲属与患者间的互动(维持交流,存在压力);亲属对医护人员的态度(人性化护理和信任感)。结论 早期提供ICU日记可以有效满足亲属对信息的需求,提供情感支持。未来可结合我国国情探索有效干预方法,加强人文关怀。     

Quality of life and daily hemodialysis

Preliminary findings indicate that daily hemodialysis positively impacts patients' energy/fatigue and other uremic and intradialytic symptoms. In addition to improvements in perceived symptoms, improvements in patients' perceived physical and psychosocial functioning have been reported. These findings have come from small series of patients, however, and may reflect an increased attention effect. Confirmation of preliminary findings and identification of changes in other quality of life outcomes await an adequately powered randomized clinical trial. Sleep quality, sexual functioning, and cognitive functioning are quality of life dimensions that may be impacted by daily hemodialysis but about which there is limited information in the preliminary data that exist. Understanding relationships among different levels of quality of life outcomes associated with daily hemodialysis requires consideration of emotional and psychological variables such as burden, depression, and satisfaction with care that may intervene between treatment and the quality of life outcomes that patients report. Deriving health utilities relevant to patient experience on different daily hemodialysis therapies, analyzing longitudinal quality of life outcomes reported by patients on daily hemodialysis, and investigating the effectiveness of daily hemodialysis for specific patient subgroups are research agendas that can provide information needed to facilitate treatment decision making in which quality of life has an important role.     

Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients

The prevalence, severity, and clinical significance of physical and emotional symptoms in patients who are on maintenance hemodialysis remain incompletely characterized. This study sought to assess symptoms and their relationship to quality of life and depression. The recently developed Dialysis Symptom Index was used to assess the presence and the severity of 30 symptoms. The Illness Effects Questionnaire and Beck Depression Inventory were used to evaluate quality of life and depression, respectively. Correlations among symptom burden, symptom severity, quality of life, and depression were assessed using Spearman correlation coefficient. A total of 162 patients from three dialysis units were enrolled. Mean age was 62 y, 48% were black, 62% were men, and 48% had diabetes. The median number of symptoms was 9.0 (interquartile range 6 to 13). Dry skin, fatigue, itching, and bone/joint pain each were reported by > or =50% of patients. Seven additional symptoms were reported by >33% of patients. Sixteen individual symptoms were described as being more than "somewhat bothersome." Overall symptom burden and severity each were correlated directly with impaired quality of life and depression. In multivariable analyses adjusting for demographic and clinical variables including depression, associations between symptoms and quality of life remained robust. Physical and emotional symptoms are prevalent, can be severe, and are correlated directly with impaired quality of life and depression in maintenance hemodialysis patients. Incorporating a standard assessment of symptoms into the care provided to maintenance hemodialysis patients may provide a means to improve quality of life in this patient population.     

综合护理模式应用与改善血液透析患者生活质量的临床分析

目的：探讨综合护理干预对血液透析患者生活质量的影响。方法将我院2012年10月~2013年10月需要进行血液透析的200例患者作为研究对象,随机分为对照组和观察组。对照组患者进行常规的血液透析护理,观察组患者在此基础上给予综合护理干预。使用SF-36生活质量量表对两组患者进行干预后评分。结果观察组患者发生高血钾症等急性疾病的发生率显著降低,患者在情感得分、健康指数、一般感情指数和生活满意度等方面的评分明显高于对照组,两组差异有统计学意义（P＜0.05）。结论综合护理干预能够有效维持血液透析患者的生活质量,值得临床推广。     

Association of decreased quality of life and erectile dysfunction in hemodialysis patients

BACKGROUND: Quality of life in hemodialysis patients has been associated with treatment outcomes. We explored the impact of erectile dysfunction on quality of life in a cohort of hemodialysis subjects. METHODS: A random sample of 302 Philadelphia area hemodialysis (HD) subjects was enrolled using a cross-sectional design. Subjects completed a self-administered questionnaire including items on sexual function, past medical history, and quality of life. Linear regression (accounting for sampling design by weighted estimation methods) was used to examine the associations between various measures of quality of life (the dependent variables) and erectile dysfunction (ED) and other variables (the predictor variables). RESULTS: We found the emotional domains of the SF-36, a multi-purpose, short-form health survey with 36 questions, to be more profoundly associated with ED than the physical domains. Using the physical and mental components of the SF-12, a new 12-item short form health survey as predictors of ED, only the mental composite score (MCS) was statistically significant after adjusting for age and diabetes (P = 0.008). Subjects with ED had significantly lower quality of life mean scores. In particular, ED was associated with poorer social interaction (mean score difference, -10.3, adjusted P < 0.001), decreased emotional well-being (-12.9, adjusted P = 0.005), more role limitations due to emotional problems (-22.9, adjusted P = 0.01), and poorer social function (-17.8, P = 0.001). CONCLUSION: Recent advances in therapies for ED warrant that the diagnosis and treatment of erectile dysfunction be included in the global health assessment by the nephrologists and primary care providers of patients with renal insufficiency, as it may improve the quality of life of patients.     

Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical,Psychological, and Social Sequelae

Women with metastatic breast cancer face a wide range of medical, practical, and emotional challenges that impact their quality of life. Research to date, however, has not focused on the quality‐of‐life concerns of metastatic breast cancer patients with significant distress. The present study examined a range of concerns among distressed metastatic breast cancer patients, including physical and emotional distress, social functioning, and existential issues. Forty‐four distressed women with metastatic breast cancer wrote their deepest thoughts and feelings regarding their illness. These essays were thematically analyzed for effects of the illness on quality of life. Three themes were identified in patients' essays. First, metastatic breast cancer and its treatment may result in a number of quality‐of‐life concerns, including physical symptom burden, emotional distress, body image disturbance, and disrupted daily activities. Second, social constraints on disclosure of cancer‐related concerns may exacerbate patients' distress. Third, many women experience a heightened awareness of life's brevity and search for meaning in their cancer experience. Results highlight a range of quality‐of‐life concerns following a metastatic breast cancer diagnosis and suggest that addressing social constraints on cancer‐related disclosure and the search for meaning may improve patients' psychological adjustment.     

Economic, Social, and Psychological Factors Associated With Health-Related Quality of Life of Chronic Hemodialysis Patients in Northern Taiwan: A Multicenter Study

This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 ± 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health ( P  < 0.05), and so was increased frequency of social activities with social functioning ( P  <  0.05). The more worries, the stronger the inverse associations with social functioning ( P  < 0.05) and mental health ( P  < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions ( P  < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients.     

Effect of kidney transplantation on quality of life measures

Assessing the quality of life should be an essential part of the long-term results of surgery, particularly for those procedures that may influence a patient's lifestyle and body image. Eliminating the need for dependence on chronic hemodialysis, kidney transplantation improves the patient's autonomy but exposes them to the side-effects of immunosuppression and the constant threat of rejection. The purpose of this study was to compare the quality of life of patients on the waiting list for a kidney transplantation to that of those already transplanted at our Center to quantify carefully the impact of this therapy on the patient's physical, emotional, and social well-being. Computer analysis of the data collected from self-administered questionnaires revealed that the vast majority of successfully transplanted patients experience a significant improvement in almost all the areas investigated compared with the pretransplant group. In addition, we tried to use the questionnaire to predict which type of patient will adjust more fully to the impact of a kidney transplantation and which will probably need posttransplant psychological care and social support. Aside from clinical factors such as the time spent on hemodialysis before transplantation, the gender, the age, as well as the source of the organ (living vs. cadaver donor) seem to play a role in the final outcome of a successful kidney transplantation.     

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis

BACKGROUND: Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients. METHODS: Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method. RESULTS: Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about 10,000 dollars lower for home nocturnal hemodialysis (55,139 dollars +/- 7651 dollars for home nocturnal hemodialysis vs. 66,367 dollars +/- 17,502 dollars for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 +/- 0.23 vs. 0.53 +/- 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was 71,443 dollars/quality-adjusted life-year (QALY), while for in-center hemodialysis it was 125,845 dollars/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -45,932 dollars. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of 50,000 dollars. The net monetary benefit of home nocturnal hemodialysis ranged from 11,227 dollars to 35,669 dollars. CONCLUSION: Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.     

血液透析患者残余肾功能的保护

残余肾功能是影响透析患者生存率和生活质量的重要因素。在我国,血液透析是终末期肾病患者肾脏替代治疗的最主要方式,充分认识维持性血液透析患者残余肾功能的重要性,加强对其残余肾功能的保护,是肾脏病学家和患者共同关注的问题。本文对近年来关于残余肾功能对血液透析患者的临床意义、残余肾功能的保护措施等方面的研究进行论述,并重点对透析脱水调节和透析频率对残余肾功能影响的研究进行归纳总结,同时结合笔者临床经验阐述了血液透析容量控制与残余肾功能保护的关系,旨在加强临床医务工作者对保护血液透析患者残余肾功能的重视,并提供保护其残余肾功能的途径。     

Kidney Transplantation Does Not Increase the Level of Basic Hope or Life Satisfaction Compared With Hemodialysis in Patients With Chronic Kidney Disease

Introduction

Although renal replacement therapy can lead to improved health, it also can cause emotional disturbances in patients. It is believed that the success of renal replacement therapy hinges not only on medical parameters, but also on psychosocial factors, which is why modern medicine provides an ever-increasing role in the improvement of patients' quality of life.

Purpose

The purpose of this study was to compare the level of life satisfaction, purpose in life, and basic hope in patients who had received renal replacement due to chronic kidney disease. We also tested whether the specific type of renal replacement therapy and kidney function parameters were influential factors on the above variables.

Patients and methods

Sixty-one adult patients treated via renal replacement for chronic kidney disease took part in the study. Patients were divided into two groups: 31 hemodialysis patients (15 women and 16 men, ages 23–77 years, mean 51.19 years, SD 14.53 years) and 30 patients who had undergone kidney transplantation (14 women and 16 men, ages 22–69 years, mean 48.40 years, SD 12.64 years). The following research tools were used for analysis: Satisfaction With Life Scale (SWLS), Purpose in Life Test (PIL), and Basic Hope Inventory (BHI-12).

Results

There were no statistical differences in the level of satisfaction with life between hemodialysis patients and postkidney transplant patients. The results for the SWLS obtained from both groups fell within the normal range. The average SWLS for hemodialysis patients remained 20.61, SD = 5.79; for postkidney transplant patients, it was 22.57, SD = 5.16. The PIL level in the group of hemodialysis patients (101.5, SD = 15.64) was significantly lower than in the group of postkidney transplant patients (109.7, SD = 15.54). The average BHI-12 level was similar in both groups. The average BHI-12 result for hemodialysis patients was 29.00 (SD = 5.06), and for postkidney transplant patients 29.93 (SD = 3.55). The correlations between the psychological variables and selected biochemical parameters are worthy of particular attention. Among hemodialysis patients, there was an additional correlation between SWLS and hematocrit; whereas for postkidney transplant patients, there was an additional correlation of PIL and eGFR.

Conclusions

Our data show that satisfaction with life and basic hope do not increase in patients after renal replacement therapy. The form of renal replacement therapy (hemodialysis or kidney transplantation) does not change the above variables. Patients treated via renal replacement require specialized psychological support to improve the efficacy of renal replacement therapy.