接纳与承诺疗法对尿流改道腹壁造口术患者创伤后成长的影响

目的探讨接纳与承诺疗法对膀胱癌尿流改道腹壁造口术患者创伤后成长的影响。方法根据住院时间将膀胱癌尿流改道腹壁造口术患者分为对照组42例和观察组44例。对照组住院期间行接纳与承诺疗法干预3次,同时行常规健康教育和出院随访;观察组在对照组基础上,于出院后2～3个月对患者行接纳与承诺疗法干预3～4次。采用简体中文版创伤后成长评定量表测评患者干预前、出院时、出院2个月、出院3个月、出院6个月的创伤后成长状况。结果出院时、出院后2个月两组创伤后成长评分比较,差异无统计学意义(均P0.05),出院后3、6个月时两组创伤后成长评分比较,差异有统计学意义(均P0.01)。结论对膀胱癌尿流改道腹壁造口术患者出院后行接纳与承诺疗法干预,为患者提供院外延续性护理方案,可有效提升其创伤后成长水平,利于其身心康复。     

中青年脑卒中住院患者戒烟行为影响因素的质性研究

目的了解中青年脑卒中患者在不同戒烟行为阶段的影响因素,为戒烟干预提供参考。方法以行为转变理论为基础,采用质性研究中行为事件访谈法对12例中青年脑卒中住院患者进行访谈,使用Colaizzi内容分析法分析资料。结果提炼出两个主题群,分别是戒烟行为的促进因素和阻碍因素。结论不同戒烟行为阶段中青年脑卒中患者戒烟行为的影响因素不同,需根据患者的戒烟意愿和行为特点,采取相应的戒烟干预措施,以提高戒烟成功率。     

家庭尊严干预对乳腺癌患者照顾者的影响

目的 探讨家庭尊严干预对乳腺癌患者照顾者照顾感受、创伤后成长及照顾能力的影响.方法 将220名乳腺癌患者照顾者随机分为观察组和对照组各110人.对照组给予常规干预,观察组在此基础上实施家庭尊严干预.两组出院时及出院后3个月分别采用照顾者负担量表、创伤后成长评定量表及中文版照顾者能力量表进行调查.结果 观察组照顾负担显著低于对照组,创伤后成长及照顾能力评分显著高于对照组(均P＜0.01).结论 家庭尊严干预能有效降低乳腺癌患者照顾者的照顾负担,提升其创伤后成长水平及照顾能力.     

脑卒中患者跌倒恐惧变化轨迹及影响因素分析

目的 分析脑卒中患者跌倒恐惧变化轨迹及影响因素,为制订针对性的护理措施缓解脑卒中患者跌倒恐惧提供参考。 方法 便利选择神经内科住院的223例脑卒中患者,采用一般资料调查表、简易版国际跌倒效能感量表、医院焦虑抑郁量表于患者出院当天进行调查,并于出院后1、3、6个月追踪患者的跌倒恐惧程度。采用潜变量增长模型识别跌倒恐惧变化轨迹的潜在类别,logistic回归分析其影响因素。 结果 跌倒恐惧变化轨迹可分为跌倒恐惧缓慢下降组（50%）、持续跌倒恐惧组（28%）、跌倒恐惧快速下降组（22%）。logistic回归分析结果显示,性别、职业、日常生活活动能力、近6个月跌倒史、步行能力、焦虑、抑郁影响跌倒恐惧的轨迹类别（均P＜0.05）。 结论 脑卒中患者跌倒恐惧分为3种不同的变化轨迹,其跌倒恐惧存在群体异质性,应基于患者跌倒恐惧变化轨迹的同质群体,有针对性地进行评估和干预。     

微信群同伴教育对喉癌术后患者疾病感知和创伤后成长的影响

目的探讨微信群同伴教育对喉癌术后患者疾病感知和创伤后成长的影响。方法将喉癌术后患者93例采用随机数字表法分为对照组47例和观察组46例。对照组采用常规健康教育和随访,观察组在对照组的基础上接受出院后持续6个月的微信群同伴教育干预。评价并比较两组入院时、出院后1个月、3个月及6个月的疾病感知和创伤后成长水平。结果两组出院后1个月、3个月和6个月时,疾病感知总分及创伤后成长总分干预效应、时间效应及交互效应有统计学意义(P0.05,P0.01)。结论微信群同伴教育有利于喉癌术后患者方便获得来自同伴的支持,从而提高其疾病感知和创伤后成长水平。     

脑卒中并发症体验教学提高房颤患者服用华法林依从性

目的 探讨脑卒中并发症体验教学对房颤患者服用华法林依从性的影响.方法 将口服华法林的122例房颤患者按病区分为干预组63例和对照组59例.对照组采用常规教育方式,干预组在此基础上实施脑卒中并发症体验教学.干预3、6个月后评价效果.结果 干预组出院后3个月和6个月服药依从性评分显著高于对照组(P<0.05,P<0.01).出院后6个月对照组2例发生脑卒中;干预组未发生.结论 实施脑卒中并发症体验教学有助于提高房颤患者服用华法林依从性,可能有助于降低房颤并发脑卒中的发生.     

渐进性肌肉放松疗法对中青年缺血性脑卒中患者益处发现的影响

目的探讨渐进性肌肉放松疗法对中青年缺血性脑卒中患者益处发现水平的影响。方法按照住院时间将108例中青年缺血性脑卒中患者分为对照组和观察组各54例。对照组给予常规护理和随访,观察组在此基础上实施渐进性肌肉放松疗法,出院后通过微信随访指导。干预前及干预3个月后采用中文版益处发现评定量表评价干预效果。结果干预后,观察组益处发现总分及接受、家庭关系、世界观、个人成长、健康行为5个维度评分显著高于对照组(P0.05,P0.01)。结论渐进性肌肉放松疗法能有效改善中青年缺血性脑卒中患者益处发现水平,促进患者疾病康复。     

积极自我表露干预对中青年脑卒中患者照顾者获益感的影响

目的 探讨积极自我表露干预对中青年脑卒中患者照顾者获益感、照顾负担及生活质量的影响。方法 将78名中青年脑卒中患者的照顾者按照病区分为对照组和干预组各39名。对照组接受常规护理，干预组在对照组的基础上实施为期4周、共8次的积极自我表露干预。比较两组干预前，干预后即刻，干预后1个月、3个月的获益感、照顾负担、生活质量情况。结果 干预组、对照组各有36名照顾者完成研究。干预后即刻及干预后1个月，干预组照顾者获益感评分显著高于对照组（均P＜0.05）；干预后即刻及1个月、3个月干预组照顾负担评分显著低于对照组，生活质量评分显著高于对照组（均P＜0.05）。结论 积极自我表露干预可有效地提高中青年脑卒中患者照顾者获益感，减轻照顾负担，提高生活质量。     

Impact of intensive interventions on therapeutic compliance of patients with stroke and impaired glucose tolerance

目的 探讨强化护理干预对脑卒中并存糖耐量异常患者依从性的影响.方法 将210例脑卒中并存糖耐量异常患者随机分为观察组和对照组各105例.两组住院期间均接受相同的健康教育,但观察组接受护理人员的监督,确保干预措施的强化和落实.测评两组出院时依从性情况及出院后6个月的血糖.结果 观察组患者出院时治疗依从性显著高于对照组(均P＜0.01),出院后6个月血糖控制情况显著优于对照组(P＜0.01).结论 强化干预可提高脑卒中并存糖耐量异常患者治疗依从性,有利于血糖控制.     

意外创伤患者创伤后认知评价的质性研究

目的了解意外创伤患者创伤后认知评价状况及其心理体验变化过程。方法以目的抽样法抽取15例康复中后期的意外创伤患者,采用现象学研究方法,进行半结构式深入访谈,并对访谈资料进行录音、转录、分析,析取主题。结果提取威胁、接受、挑战、获益4个主题,14个亚主题。结论意外创伤患者创伤后经历对创伤的抗拒、恐惧、担忧到接受、面对进而获得成长的认知评价过程。提出需准确理解认知评价对遭遇创伤事件个体身心健康的作用,开展针对性干预,以促进患者身心康复。     

Methodological index for non-randomized studies (minors): development and validation of a new instrument

Background: Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. Methods: After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialities for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. Results: The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the κ-coefficient and good internal consistency by a high Cronbach's α-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. Conclusions: MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.     

Quantitative heel ultrasound in a population-based study in Italy and its relationship with fracture history: the ESOPO study

We assessed the clinical usefulness of quantitative ultrasound (QUS) in defining the prevalence rates of osteoporosis and osteopenia and their association with fractures of the forearm, vertebrae, and hip. The ESOPO study was conducted in 2001 and assessed a random sample of 11,011 women and 4,981 men, in 83 centers spread all over Italy. A large array of risk factors was investigated, and self-reported history of fractures was collected in a questionnaire. After the patient had undergone interview and a brief physical examination, QUS of the heel was performed, using the Achilles apparatus (GE-Lunar, Madison, USA). The prevalence rate of osteoporosis in women 40–79 years old was approximately 18.5%, while the rate of osteopenia was about 44.7%; in men 60–79 years of age the rates were 10% and 36%, respectively. A strong association with fractures was found for osteoporosis and osteopenia in both men and women, independently of all traditional risk factors, including age. These results confirm the suitability of US measurements as a tool for detecting individuals at risk of fractures.The authors wrote this article on behalf of the ESOPO Study Group     

儿科护士离职原因的质性研究

目的了解儿科护士离职的真正原因,为采取针对性措施稳定护士队伍提供参考。方法对14名从事儿科护理且自愿离职护士进行深度访谈,采用现象学分析法分析资料。结果儿科护士离职原因主要有3个主题:不能缓解的压力,包括不满意的工作环境、不完善的管理体系、不认可的工作性质和不稳定的专业思想;社会家庭的支持;获取外部工作的机会。结论儿科护士承受着来自各个方面的压力,护理管理者应关心员工的工作状态,使其更好地应对压力,减少离职行为。     

Urodynamically age-specific prevalence of urinary incontinence in women with urinary symptoms

AIMS: To determine the age-specific prevalence rates of different types of urinary incontinence in women with urinary symptoms using urodynamic studies (UDS). METHODS: One thousand five hundred women with urinary symptoms who underwent UDS in our department from January 1997 through December 1999 were enrolled. A detailed history, physical examination, and data of multi-channel UDS including uroflowmetry, filling and voiding cystometry, stress urethral pressure profile, and 20-minute pad test were obtained for each patient. The urodynamic findings of each patient were analyzed and correlated with age in decades. RESULTS: Of 1,500 women, 329 were excluded from analysis because they had undergone anti-incontinence surgery (n=27), had undergone treatment for cervical cancer (n=147), or were being followed-up after medication (n=155). Of the remaining 1,171 patients, 656 (56%) had genuine stress incontinence (GSI), 68 (5.8%) had detrusor instability (DI), 187 (16%) had mixed GSI/DI, 245 (20.9%) had either voiding or storing dysfunction without concomitant incontinence, and 15 (1.3%) had normal urodynamic findings. The 41-50- and 51-60-year age groups had the highest prevalence rates of urinary incontinence, accounting for 31% and 28% of GSI cases, 35% and 25% of DI cases, and 40% and 27% of mixed GSI/DI cases, respectively. The prevalence of GSI and mixed GSI/DI increased consistently with age, but the prevalence of DI decreased after age 66. Thus, the prevalence rates of GSI, DI, and mixed GSI/DI were 56%, 5.8%, and 16%, respectively, in women with urinary symptoms. CONCLUSIONS: Female urinary incontinence had a biogenic peak prevalence in the 41-50-year and 51-60-year age groups.     

单中心维持性血液透析患者透析现状调查分析

目的对单中心维持性血液透析（MHD）患者进行现状调查分析，为透析质量持续改进提供参考依据。方法选择南京军区福州总医院血液净化科412名MHD患者的临床资料进行回顾性分析。结果412例MHD患者中，高磷血症358人（86．99％），钙磷乘积大于55mga／dl。194人（47．15％），iPTH达标率为13．59％。首次透析使用血管通路为临时中心静脉留置导管者345人（83．74％），而以动静脉内瘘作为长期血管通路者395人（95．87％）。412例血红蛋白值为99．35±21．38g／L，其中女性95．50±23．66g／L，男性105．4±11．21g／L，两者均低于正常值（P〈0．05）；其中血红蛋白≥100g／L占46．8％，血红蛋白≥110g／L占26．70；乙型肝炎抗原标志物和丙型肝炎抗体的阳性率分别为14．08％和9．47％；尽管有服用降压药物，本组大于140／90mmHg的高血压患者仍有343人（83．25％），其中使用3种以上降压药物的为315人（76．45％）。全部患者中每周透析三次者仅为214人（51．94％），透析频次与医保种类密切相关，每周透析三次患者的构成比，省医保）市医保）居民医保）自费。结论本中心MHD患者中，仍有部分患者未能很好的控制血磷、PTH水平，贫血、高血压的发生率仍高且达标率低，而医保类型的报销额度一定程度上制约了透析充分性，透析质量有待持续改进。     

黄芪润肠丸治疗慢传输型便秘的临床与实验研究

为探索黄芪润肠丸治疗慢传输型便秘（STC）的机理,进行了临床与实验研究。结果显示,黄芪润肠丸（治疗组）治疗STC有效率达92．5％,优于西沙必利（对照组）（P〈0．05）。动物实验表明,小鼠排便颗粒数和炭末推进百分率治疗组均优于对照组和生理盐水组（空白组）;家兔结肠电波波幅和频率均高于正常组;治疗组小鼠结肠P物质（SP）和血管活性肠肽（VIP）物质含量均高于对照组。结果表明,由于黄芪润肠丸能通过提高结肠内SP和VIP物质含量,激活结肠电活动,加快结肠肠蠕动,故对STC有明显治疗作用。     

The use of fluoride cement: preliminary experimental study and clinical application

One of the most common complications of cemented prostheses is aseptic loosening of the implant, which is often due to mechanical breakdown at the bone-cement interface. To improve the characteristics of PMMA, the addition of fluoride has been proposed, which, without jeopardising its mechanical qualities, should provide better integration with the surrounding bone. An experimental study was performed in 4 sheep. A cylinder of cement (with and without fluoride) was inserted in the meta-epiphysis of the distal femur. A clinical study followed 7 patients. The cement with added fluoride was used as a filler after the curettage of a benign tumour located in the meta-epiphysis around the knee. Histological results in animals combined with long-term radiographic results in humans have shown the positive influence of fluoride in the cement, as it allows better integration of the cement with the surrounding bone.