Group Work With Individuals With Chronic Cancer

This article discusses the value and importance of support groups for people living with chronic cancer. It is a primer for the professional mental health practitioner interested in leading a support group. Group formation, screening, open versus closed groups, size, co-facilitation, duration and phases-beginning, middle and end will be discussed. Leadership, structure, and group dynamics are explained using case examples to highlight the issues. The effect of the deterioration and death of group members on both the facilitators and the group's members will be explored. The paper ends with a discussion of counter-transference, stress, self-care and resiliency.     

Coping With Illness-Related Stress Among Urban Children With Asthma

The effect of problem-focused and avoidant coping on social withdrawal was investigated among a sample of 31 urban children with asthma experiencing varied levels of illness-related stress. Two main and two moderating effects were examined. Neither problem-focused nor avoidant coping was significantly associated with withdrawal when the child's asthma symptoms and stressors were controlled. However, a pattern emerged in analyses of the interaction between coping and stress level. Higher levels of both problem-focused and avoidant coping were associated with lower levels of social withdrawal, but only for children with low levels of asthma-related stress.     

Transition Readiness for Talking With Providers in Urban Youth With Asthma: Associations With Medication Management*

Purpose

Teen readiness assessments may provide a developmental indicator of the transfer of responsibility for health self-management from caregivers to teens. Among urban adolescents with asthma, we aimed to describe teen readiness for talking with providers and identify how readiness relates to responsibility for asthma management, medication beliefs, and clinical outcomes.

Families' Experiences With End-of-Life Care in Nursing Homes and Associations With Dying Peacefully With Dementia

Objectives

To examine family caregivers' experiences with end-of-life care for nursing home residents with dementia and associations with the residents dying peacefully.

化疗联合安罗替尼对三阴性乳腺癌患者的预后研究

目的 探讨化疗联合安罗替尼对三阴性乳腺癌患者的预后及用药安全性.方法 选取2016年1月—2019年1月我院确诊为三阴性乳腺癌的100例患者作为研究对象,随机分为研究组和对照组.对照组纳入研究后给予单纯化疗,研究组加用安罗替尼,对比研究组和对照组治疗前、治疗6个月及治疗12个月血清PRL及BSP;两组治疗后药物安全性情...     

左乙拉西坦联合舍曲林对癫痫伴抑郁的效果

目的探讨左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁患者的疗效。方法我院60例2017年1月-2018年12月癫痫伴抑郁患者。随机分组,对照组采取左乙拉西坦500 mg每日两次治疗,试验组则采取左乙拉西坦联合盐酸舍曲林治疗,比较两组效果和不良反应。结果试验组的癫痫每个月发作的次数显著低于对照组,汉密尔顿抑郁量表-17评分显著低于对照组,认知功能MMSE评分以及癫痫患者生活质量量表QOLIE-31评分显著高于对照组,疗效高于对照组,且药物开始发挥作用的时间早于对照组,P<0.05。两组患者安全性方面无显著差异,P>0.05。结论左乙拉西坦联合盐酸舍曲林对癫痫伴抑郁的治疗作用确切,可有效控制癫痫,改善抑郁,且联合用药起效快,可有效改善认知功能以及癫痫患者生活质量,联用未增加不良反应,药物有良好的安全性。     

与国际标准接轨与现行制度融汇—医院质量管理采用ISO9000标准的几个问题

与国际标准接轨,是新世纪医院质量管理新动向。医院追求高质量,必须采用高标准。ISO国际标准是发达国家质量管理经验的结晶,提出建立质量管理体系是重大贡献,医院应积极采用。但应考虑自己的总体条件,做好思想发动,选好咨询公司,讲究实际效果。     

Association of Pisa Syndrome With Mortality in Patients With Parkinson's Disease

ObjectivesIn Parkinson's disease, Pisa syndrom (PS) has been associated with disease stage and severity, combined treatment with levodopa and dopamine agonists, gait disorders, and comorbidities. Some forms of PS are potentially reversible; nevertheless, little is known about the impact of this syndrome on survival.DesignProspective study with a median follow-up of 2 years.Setting and participantsPatients with Parkinson's disease, age 65 years and older (N = 189), attending a geriatric day hospital.MeasurementsAccording to established criteria, PS was diagnosed in the presence of at least 10° lateral flexion of the trunk reducible by passive mobilization or supine positioning. Cox regression was adopted to assess the association of PS with all-cause mortality.ResultsPS was diagnosed in 40 patients (21%); over the follow-up, 21 (11%) subjects died. In Cox regression, PS was associated with higher mortality [hazard ratio (HR) 4.10; 95% confidence interval (CI) = 1.36-12.38], after adjusting; other variables associated with mortality were age (HR = 1.19, 95% CI = 1.08-1.32), beta blockers (HR = 4.35, 95% CI = 1.23-15.39), and albumin levels (HR = 0.05, 95% CI = 0.01-0.33). The association of PS with mortality remained significant also after adjusting for variables associated with this syndrome (HR = 4.04, 95% CI = 1.33-12.25).Conclusions/ImplicationsPS represents a risk factor for earlier mortality in Parkinson's disease; further studies are needed to ascertain the underlying causes and whether treatment of this condition might improve survival.     

Factors and Outcomes Associated With Dysphagia in Hospitalized Persons With Dementia

ObjectivesDysphagia is prevalent in older adults with dementia, particularly in the acute care setting. The objective of this study was to use an innovative approach to extract a more representative sample of patients with dysphagia from the electronic health record (EHR) to determine patient characteristics, hospital practices, and outcomes associated with dysphagia in hospitalized persons with dementia.DesignA retrospective study of hospitalized adults (aged ≥65 years) with dementia was conducted in 7 hospitals across the greater New York metropolitan area.Setting and ParticipantsData were obtained from the inpatient EHR with the following inclusion criteria: age ≥65 years; admitted to one of 7 health system hospitals between January 1, 2019, and December 31, 2019; and documented past medical diagnosis of dementia (based on International Classification of Diseases, Ninth Revision).MethodsA diagnosis of dysphagia was defined as nurse documentation of a positive bedside swallow screening, nurse documentation of “difficulty swallowing” as reason for not performing bedside swallow screening, and physician documentation of a dysphagia diagnosis.ResultsOf adults with dementia (N = 8637), the average age was 84.5 years, 61.6% were female, and 18.1% were Black and 9.3% Hispanic. Dysphagia was identified in 41.8% (n = 3610). In multivariable models, dysphagia was associated with invasive mechanical ventilation [odds ratio (OR) 4.53, 95% CI 3.55-5.78], delirium (OR 1.53, 95% CI 1.40-1.68), increased length of stay (B = 3.29, 95% CI 2.98-3.60), and mortality (OR 4.44, 95% CI 3.54-5.55).Conclusions and ImplicationsGiven its high prevalence, underrecognition, and associated poor outcomes, improving large-scale dysphagia identification can impact clinical care and advance research in hospitalized persons with dementia.     

心脏瓣膜病变与顽固性房颤行瓣膜置换术联合射频消融术

目的研究探讨瓣膜置换术联合射频消融术在心脏瓣膜病变与顽固性房颤中的应用效果。方法选取我院2016年7月-2018年10月期间收治的心脏瓣膜病变合并顽固性房颤患者40例作为研究对象,随机分为两组后给予不同手术方案进行治疗,其中研究组行瓣膜置换术联合射频消融术治疗,对比组行瓣膜置换术治疗,统计记录两组患者术中情况与手术治疗有效率,并进行对比。结果研究组患者手术治疗有效率高于对比组患者,其术中情况均优于对比组患者,P<0.05。结论瓣膜置换术联合射频消融术应用在心脏瓣膜病变合并房颤的临床治疗中,能有效改善患者心功能,加快患者后期康复效率。     

Factors Associated With Family Caregiver Burden of Home-Dwelling Patients With Advanced Dementia

ObjectivesTo realize patients’ preferences for home death, this study aimed to identify factors associated with family caregiver burden of home-dwelling patients with advanced dementia and examine its relationship with end-of-life care treatment decisions.DesignA prospective cohort study.Setting and ParticipantsPatient-family caregiver dyads enrolled in a home-based palliative care program for patients with advanced dementia, with family caregiver burden assessed using the Zarit Burden Interview (ZBI) on enrolment, were included.MethodsIndependent variables included sociodemographic data, patients’ clinical phase, symptom severity, quality of life, informal paid help availability, and community resources utilized. Dependent variable was continuous ZBI scores and ZBI scores dichotomized into <24 and ≥24 for predicting depression risk. Place of death and interventions received 2 weeks before death were also collected. Data were analyzed using multivariate linear and logistic regression.ResultsFrom October 2014 to December 2020, a total of 377 family caregivers were assessed with ZBI. Median score was 25 (IQR 15-36), and 54.4% of them were at risk of depression. Younger family caregivers had higher ZBI scores (β = ?0.22, 95% CI –0.38, ?0.07), with the depression risk doubling for family caregivers aged <60 years (OR 2.13, 95% CI 1.33, 3.43). Absence of informal paid help also increased the ZBI scores (β = ?9.04, 95% CI –14.86, ?3.22) and depression risk (OR 2.50, 95% CI 1.03, 6.09). In addition, caregivers’ ZBI scores increased with patients’ neuropsychiatric symptom severity (β = 0.49, 95% CI 0.08, 0.89), and caregivers of clinically unstable patients had a higher depression risk (OR 1.80, 95% CI 1.03, 3.12). Baseline caregiver burden was not associated with treatment decisions made at the end of life.Conclusions and ImplicationsYounger family caregivers caring for clinically unstable patients with severe neuropsychiatric symptoms experienced greater burden without informal paid help. For end-of-life care at home in advanced dementia to be tenable, relevant national agencies and stakeholders are recommended to work collectively to support family caregivers holistically.