晚期胃癌患者在化学治疗期间恐惧疾病进展的现状调查及护理策略探讨

目的 调查晚期胃癌患者在化学治疗(简称“化疗”)期间恐惧疾病进展(FoP)的现状,并探讨对应的护理策略。方法 选取2019年1月至2021年6月于徐州医科大学附属医院接受化疗的90例晚期胃癌患者作为研究对象。在采集患者相关临床资料的同时,采用恐惧疾病进展简易量表评估其FoP水平,采用焦虑自评量表和抑郁自评量表分别评估其焦虑和抑郁情绪,采用医学应对方式问卷评估其在应对疾病时产生的应对方式,并通过单因素分析和多因素Logistic回归分析调查晚期胃癌患者在化疗期间FoP的影响因素。结果 90例晚期胃癌患者在化疗期间的FoP-Q-SF评分为(28.48±4.21)分。单因素分析结果显示,年龄、家庭人均月收入、文化程度、自理程度、焦虑、抑郁和疾病应对方式不同的患者,其FoP-Q-SF评分相比差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,年龄≥60岁、焦虑和(或)抑郁、回避和屈服疾病应对方式均是导致晚期胃癌患者在化疗期间FoP的危险因素(P均<0.05),大学及以上、基本自理、面对疾病应对方式和家庭人均月收入≥5 000元均是保护因素(P均<0.05)。结论 文化程度高、自理程度高、积极应对疾病和家庭人均月收入高的患者FoP水平相对较低,年龄大、存在焦虑或抑郁情绪、消极应对疾病的患者在化疗期间更易出现高水平的FoP,临床应给予高水平FoP患者相应的干预措施。     

重症颅脑伤患者家属的应对方式及其影响因素

目的探讨重症颅脑伤患者家属的应对方式及其影响因素。方法按便利抽样法抽取某院2008年1月至2009年12月380例重症颅脑伤患者家属,采用自制的一般情况调查问卷及医学应对方式问卷（medical coping modes question-naire,MCMQ）对家属的一般情况及应对方式进行调查,并分析其影响因素。结果影响重症颅脑伤患者家属选择应对方式的因素有性别、职业、年龄、文化程度以及患者住院天数。结论了解重症颅脑伤患者家属的应对方式及其影响因素将有助于护理工作的开展。     

住院老年冠状动脉硬化性心脏病患者的疾病应对现状及对策

目的调查住院老年冠状动脉硬化性心脏病(简称冠心病)患者的疾病应对现状,分析其影响因素,以期为临床护理干预提供依据。方法 2014年12月至2015年3月,便利抽样法选取上海市10所三级甲等综合医院心内科住院冠心病患者181例为研究对象。采用一般资料问卷和医学应对方式问卷(medical coping style questionnaire,MCMQ)对其进行应对方式的调查。结果住院老年冠心病患者的面对与屈服维度的评分高于常模,差异均有统计学意义(均P0.05)。不同文化程度、职业以及平均月收入患者的面对维度评分差异均有统计学意义(均P0.05);不同居住地、病程以及伴发疾病患者的回避维度评分差异均有统计学意义(均P0.05);不同性别、职业、婚姻状况、文化程度以及伴发疾病患者的屈服维度评分差异均有统计学意义(均P0.05)。职业、平均月收入以及文化程度是面对维度评分的主要影响因素;有无伴发疾病、性别、婚姻状况和职业是屈服维度评分的主要影响因素;而居住地、有无伴发疾病和病程是回避维度评分的主要影响因素(均P0.05)。结论住院老年冠心病患者的疾病应对方式不良,护理人员应采取有针对性的个性化护理对策及干预,以引导其采取积极的疾病应对方式。     

肝移植受者应对方式现状及其相关因素的研究

目的探讨肝移植受者压力应对方式现状及相关因素。方法采用方便抽样方法,应用应对方式问卷对146例肝移植受者进行调查。结果解决问题、退避为肝移植受者主要的应对方式;采用"成熟型"、"混合型"和"不成熟型"应对方式的比例分别为59.59%、23.29%和17.12%;文化程度、民族、居住情况、术后参加工作情况及术后有无并发症是应对方式的相关因素(P0.05)。结论肝移植受者总体应对方式是成熟的;应加强对文化程度较低、少数民族、独居、术后未参加工作及术后发生并发症的受者应对方式的教育和指导,对提高其生存质量有重要意义。     

家属应对方式与内科急诊危重患者焦虑情绪的相关性研究

目的 调查内科急诊危重患者家属应对方式与患者焦虑情绪之间的相互关系.方法 2004年6月至2005年5月,对200名内科急诊危重患者的焦虑情绪以及家属应对方式进行调查,患者的焦虑状况测量应用状态焦虑量表,由护士和患者交谈后记录;家属的应对方式测量应用汪向东等编制的应对方式量表,采用问卷法了解,结合患者的情绪状况进行分析.结果 患者焦虑状况:200名患者用状态焦虑量表测量的平均得分为(48.09±7.84)分,高于国内常模(38.97±8.45)分,差异有统计学意义(P＜0.05).家属应对方式分析:以家属年龄、性别、文化程度、与患者关系作为自变量,家属应对方式为因变量,进行直线相关分析,应对方式差异无统计学意义(P＞0.05);从不同经济收入家庭中家属应对方式来看,月收入在2000元以下的家庭,其家属消极应对分最高(P＜0.05).家属的消极应对方式与患者的焦虑情绪呈显著正相关(P＜0.01).结论 在内科急诊危重患者的护理过程中,指导家属避免采取消极的应对方式,帮助患者减轻并消除焦虑情绪.     

疾病进展恐惧对青年淋巴瘤患者生育忧虑的影响研究

目的调查青年淋巴瘤患者生育忧虑现状并分析影响因素,探讨其生育忧虑和疾病进展恐惧之间的关系。方法采用便利抽样法选取2020年7月至2021年3月在郑州市两所三级甲等医院就诊的199例青年淋巴瘤患者为研究对象,采用一般资料调查表、癌症后生育忧虑量表以及疾病进展恐惧简化问卷对其进行调查。结果青年淋巴瘤患者生育忧虑得分为(57.89±9.80)分,年龄、生育意愿、文化程度和疾病进展恐惧是其生育忧虑的影响因素,可解释总变异水平的70.8%(均P0.01)。青年淋巴瘤患者的生育忧虑与疾病进展恐惧之间呈正相关(r=0.78,P0.01)结论青年淋巴瘤患者生育忧虑水平高,疾病进展恐惧会加剧其生育忧虑。护士应结合影响因素,通过信息支持与积极心理疗法等措施降低青年患者疾病进展恐惧水平,帮助其积极应对生育忧虑。     

育龄期乳腺癌患者生育忧虑现状及影响因素分析

目的调查分析育龄期乳腺癌患者生育忧虑现状及影响因素,为干预育龄期乳腺癌患者生育忧虑和全国性调查提供参考依据。方法使用一般资料调查表、中文版癌症后生育忧虑量表、社会支持评定问卷、SF-12健康量表对2018年1月—2020年1月长沙市3所三级甲等医院收治的306例育龄期乳腺癌患者进行横断面调查。结果育龄期乳腺癌患者生育忧虑总分为50.90±11.74分,多元线性逐步回归分析结果显示,婚姻状况、文化程度、术后时间、每月经济收入、化疗、放疗、与配偶的关系、职业、子女情况是育龄期乳腺癌患者生育忧虑的主要影响因素(P<0.05)。结论育龄期乳腺癌患者生育忧虑处于中等偏上水平,婚姻状况、文化程度、术后时间、每月经济收入、化疗、放疗、与配偶的关系、职业、子女情况是生育忧虑的影响因素,其中婚姻状况的影响最大。     

院前急救患者家属的应对方式及相关因素

目的探讨院前急救患者家属的应对方式，分析相关因素。方法选择2010年1月至6月收治的116例院前急救患者家属，采用自制的一般资料问卷及医学应对方式问卷对患者家属进行调查。结果病情危重的患者家属容易采取消极应对方式，女性家属应对方式趋于两极化，中年、有稳定职业／收入、文化程度较高的家属多采取积极应对方式。结论了解院前急救患者家属的应对方式及其影响因素，可开展针对性健康教育及心理疏导工作，从而帮助患者家属采取积极的应对方式。     

头颈部肿瘤患者放疗期间舒适程度的影响因素研究

目的调查头颈部肿瘤患者放疗过程中的舒适程度现状,并分析其影响因素。方法采用医学应对问卷、社会支持评定量表和头颈部肿瘤患者放疗舒适程度量表,调查我院363例行放疗的头颈部肿瘤患者。结果头颈部肿瘤患者放疗期间整体舒适程度得分为(61.65±9.43)。年龄、文化程度、家庭月收入、伴化疗、放疗次数、家属陪伴、合并高血压、合并糖尿病是影响头颈部肿瘤患者放疗舒适度的因素(P0.05)。社会支持与整体舒适程度呈正相关(P0.05),应对方式中屈服、逃避与整体舒适程度呈负相关(P0.05)。其中合并糖尿病、伴化疗、屈服应对、放疗次数是负向影响因素。结论护理工作中应加强文化程度低、无家属陪伴、放疗中后期、合并高血压、合并糖尿病及同时接受化疗的头颈部肿瘤患者放疗期间的舒适护理,应鼓励患者采取积极主动的应对方式,有效利用社会支持。     

腹腔镜子宫切除手术前心理分析及干预

探讨腹腔镜子宫切除患者手术前的心理状况及有效的护理干预.方法 采用自制的心理调查问卷量表,调查分析120例腹腔镜子宫切除患者的心理状况及可能的原因.结果 患者年龄≤48岁及文化程度越高,术前焦虑抑郁程度越重,不同年龄阶段,文化程度不同,不良心理反应存在显著性差异(P＜0.05).结论 护理人员应对存在不良心理反应的患者或在手术前给予心理干预及健康教育,以确保手术顺利,促进康复.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.