Cognitive Screening Before the Medicare Annual Wellness Visit

Dementia is a devastating illness with increasing prevalence, possibly due to the pervasiveness of untreated modifiable risk factors. While early identification and treatment can improve outcomes, few standardized screening protocols exist. Primary care is uniquely positioned to implement such a screening program. This quality improvement (QI) project implemented dementia screenings in the primary care setting to identify cognitive decline for patients ≥ 60 years old. Statistically significant differences were found in the screening rates between the baseline and implementation groups. Implementing a standardized dementia screening within the primary care setting resulted in improved identification of patients with cognitive changes.     

Effectiveness of a nurse-led personalized patient engagement program to promote type 2 diabetes self-management: A randomized controlled trial

PHEinAction® is a theory-based nurse-led patient engagement intervention developed among an Italian older adult population with various chronic diseases to facilitate cognitive, emotional, and behavioral processes in promoting individuals' active roles. This study aims to adapt and evaluate the effectiveness of PHEinAction® on diabetes self-management (DSM) among Turkish type 2 diabetes mellitus patients. First, the generic content of the intervention was customized for diabetes management and adapted for the Turkish population, including back-forward translation and expert panel evaluation; then, a randomized controlled trial was conducted with 51 adult diabetes patients randomly assigned to intervention or the control group receiving the usual care. The intervention consisted of two in-person sessions of 4-week intervals, a telephone consultation, and home-based written exercises, which involved personalized care activities addressing individuals' engagement levels and covering the cognitive, emotional, and behavioral aspects. The scores for treatment adherence, self-efficacy, and patient engagement had significantly improved with a large size effect in the intervention group at the fourth-week follow-up compared with the control group. Findings suggest that the nurse-led personalized patient engagement program could effectively promote DSM.     

The impact of routine cognitive screening by using the clock drawing task in the evaluation of elderly patients in the emergency department

The prevalence of cognitive impairment, as reflected by failure to correctly perform a clock drawing task, in elderly Emergency Department (ED) patients was assessed. Additionally, we evaluated whether primary care provider notification of cognitive impairment spurred further cognitive evaluation. The clock drawing task was administered to a convenience sample of 100 elderly, English-speaking subjects presenting for reasons other than altered mentation at a community hospital ED. Primary care providers were contacted regarding abnormal clock drawing task results immediately and again after 2 months to determine if there was further evaluation of cognition. Of the 100 subjects enrolled, 30% were unable to correctly complete the clock drawing task, but only 8 had further evaluation of their cognitive abilities, resulting in four new diagnoses of dementia. Subjects who drew incorrect clocks (54%; 16/30) were more likely to be reevaluated in the ED within 2 months than those who drew correct clocks (29%; 20/70; p < 0.02). Cognitive screening of elderly ED patients with the clock drawing task identified a substantial number with unsuspected abnormal cognition. Further evaluation by their primary care physicians in follow-up was disappointing.     

Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial

AIM: This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care. BACKGROUND: Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care. METHODS: A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention. RESULTS: Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment. CONCLUSION: The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.     

护理人员在营养风险筛查中的作用

营养风险筛查是临床营养支持治疗的基础。护理人员在营养风险筛查中应扮演重要角色。应建立护士主导的多学科营养支持小组,实现住院患者营养筛查与干预的常规化。对存在营养风险的患者,通过营养支持治疗可改善患者临床结局和成本效果比。     

Use of Preoperative Hypnosis to Reduce Postoperative Pain and Anesthesia-Related Side Effects

The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis.     

Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects

The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis.     

认知适应训练在严重精神障碍患者中的应用进展

认知适应训练能绕开严重精神障碍患者的认知缺陷，利用个性化的补偿策略和环境支持发展患者的适应性行为，提高其社会功能、服药依从性、生活质量和预后等。近年来，国外精神科护士主导的认知适应训练经过可行性探索，不断改进研究方法，已发展为较成熟的护理干预模式，并作为常规护理融入精神科病房临床实践。该文对认知适应训练在严重精神障碍患者中的研究现状、干预内容、干预效果进行综述，从4个方面提出在国内精神科病房和社区开展认知适应训练的建议，以期为国内开展认知适应训练的研究和临床实践提供借鉴。     

内分泌治疗对乳腺癌患者主客观认知功能影响的系统评价

目的 系统评价内分泌治疗对乳腺癌患者主客观认知功能的影响。方法 计算机检索The Cochrane Library、Medline、Embase、CINAHL、PubMed、Web of Science、中国生物医学文献数据库、万方、维普和中国知网期刊数据库建库至2021年10月31日的文献,根据纳入和排除标进行文献筛选、资料提取和质量评价,最后对纳入的文献进行总结分析。结果 共纳入11篇文献,结果显示,内分泌治疗对乳腺癌患者主客观认知功能影响的评定宜采用联合测试,客观认知表现以记忆力受损最为广泛,主客观认知功能影响的相关性较弱。结论 内分泌治疗对乳腺癌患者认知功能的影响结果尚待进一步统一,提示需关注乳腺癌患者远期认知功能损伤,开展更多高质量研究,进一步验证分析。     

健康教育对已婚妇女早期宫颈癌筛查的效果分析

目的:了解已婚妇女对宫颈癌早期筛查认知情况,为正确开展宫颈癌早期筛查患者的健康教育提供依据。方法:对在我院妇产科门诊就诊接受宫颈癌筛查的患者同时进行宫颈癌相关知识宣传教育,应用自行设计的问卷评估干预效果。结果:已婚妇女对宫颈癌筛查认知程度较低。干预后患者宫颈癌相关性知识综合掌握情况和愿意接受官颈癌筛查的患者明显提高。结论:开展多元素、多种形式的官颈癌筛查,有利于提高已婚妇女对宫颈癌筛查重要性的认识和宫颈癌筛查率,对早发现和早治疗宫颈癌具有重要意义。     

认知干预改善阿尔茨海默病患者认知功能障碍及生活质量的效果研究

目的探讨认知干预改善阿尔茨海默病患者认知功能障碍及生活质量的效果。方法选取160例阿尔茨海默病患者按照随机数字法分为实验组与对照组,各80例。对照组采用常规护理干预,实验组在对照组基础上采用认知干预,比较2组患者生存质量、认知功能、运动功能及生活独立率。结果干预3个月、6个月后,2组患者各生存质量指标得分较干预前均有不同程度提高,差异有统计学意义(P0.05),且实验组各指标显著优于对照组,差异有统计学意义(P0.05)。干预后,实验组认知功能及运动功能显著优于对照组,差异有统计学意义(P0.05)。实验组患者的独立率显著优于对照组,差异有统计学意义(P0.05)。结论认知干预能帮助阿尔茨海默病患者延缓病症的进一步发展,控制临床症状,减少对他人的依赖,降低肢体废用程度,提高运动功能,有效改善患者的认知功能障碍及生活质量。     

改善轻度认知障碍患者认知功能的护理干预效果研究

目的探讨护理干预对改善轻度认知障碍患者认知功能的效果。方法选取30例轻度认知障碍患者作为研究对象,指导其接受护理干预与健康管理,分别于干预前、末次干预后、干预后3周评价干预效果。结果干预后不同时间点测量的认知功能、知识、行为问卷得分均高于干预前,态度问卷得分低于干预前,差异均具有统计学意义(P<0.01或P<0.05);末次干预后和干预后3周患者的得分差异无统计学意义(P>0.05)。结论护理干预能够提高患者的认知功能、轻度认知障碍知识水平、态度和行为,对患者需进行持续性的护理干预。     

Postoperative pain: strategy for improving patient experiences

BACKGROUND: Many patients continue to suffer moderate pain following surgery. Much of this may be unnecessary and could be alleviated with careful strategic pain management. It appears that the knowledge and attitudes of both health care professionals and patients are pivotal to patients' pain experiences. AIM: This paper reports the introduction and evaluation of a nurse-led intervention to improve pain management after surgery. METHODS: The study design was experimental (pretest-post-test), comparing patients' pain scores in a control and an intervention hospital over time. The control hospital was included to assess if temporal effects reduced pain scores during the study period. A convenience patient sample was used, and patients' pain scores were measured in two phases (n = 800). Baseline data were compared with subsequent data collected after the introduction of the nurse-led intervention. The intervention included education for nurses in the form of short pain courses, introduction of regular pain assessment and profiling of pain at hospital level. RESULTS: Introduction of the nurse-led intervention reduced patients' pain scores. This reduction, in the order of 0.73 cm (7.3%) on a visual analogue scale (0-10 cm), was statistically significant for day of surgery and 2 days postsurgery (P < 0.05) in the intervention hospital. A reduction was not seen in the control hospital. CONCLUSION: Improvements in pain management can be made by embracing basic pain management principles.     

社区老年人轻度认知障碍患病率及其生活质量的调查

目的了解金华市社区老年人轻度认知障碍患病情况及其生活质量,以期为社区干预提供依据。方法 2011年1-6月采用蒙特利尔认知功能量表(montreal cognitive assessment scale,MoCA)、日常生活能力量表(activities of daily living scale,ADL)和一般资料问卷对随机抽取的金华市916名社区老年人进行轻度认知障碍筛查,对筛查得到的154例患者采用老年性痴呆生活质量量表(quality of life in Alzheimer’s disease,QOL-AD)进行生活质量调查。结果金华市社区老年轻度认知障碍患病率为17.2%。Logistic回归显示:较高文化程度、参加社交活动、喝茶、良好睡眠以及学习是老年轻度认知障碍的预防因素,而高龄是危险因素。多元线性回归显示,经济状况、认知功能和日常活动能力是影响患者生活质量的重要因素。结论金华市社区老年人轻度认知障碍的患病率较高,影响老年人的身心健康和生活质量,应采取积极措施帮助患者提高生活质量。     

系统认知治疗技术在精神分裂症患者临床心理护理中的应用效果

目的探讨系统认知治疗技术在精神分裂症患者临床心理护理中的应用效果。方法 2014年6月至2015年6月,便利抽样法选择在上海市浦东新区精神卫生中心治疗的30例新入院的精神分裂症患者为研究对象。患者在常规心理护理的基础上采用认知治疗技术进行护理。在人院初及治疗8周时,采用护士用住院患者观察量表(nurses'observation scale for inpatient evaluation,NOSIE)对其进行评定,分析其治疗效果。结果干预后8周时,患者的NOSIE总分高于入院时,差异有统计学意义(P0.05),且干预8周时,积极因素中的社会兴趣因子和个人整洁因子评分均高于入院时,差异均有统计学意义(均P0.05);消极因素中的激惹、精神病表现因子评分均低于入院时,差异均有统计学意义(均P0.05)。结论精神科临床心理护理中结合运用系统认知治疗技术,可增强心理护理的作用,协同达到心理护理预期的目标,值得推广。     

Effectiveness of nurse-led clinics in the early discharge period after percutaneous coronary intervention: A systematic review

BackgroundReadmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes.ObjectiveThe aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention.Review method usedA systematic review of randomised and quasi-randomised controlled trials was undertaken.Data sourcesThe databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest.Review methodsDatabases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool.ResultsOf 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time.ConclusionsThis review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.     

运动疗法对乳腺癌患者癌症相关认知障碍干预效果的研究进展

认知障碍是乳腺癌患者治疗后的不良反应之一,但缺乏明确的干预策略,而运动作为可能改善认知的干预措施,其效果仍需要大量的研究证实。本文通过分析乳腺癌患者癌症相关认知障碍的现状,并总结比较抗阻训练、有氧运动、补充运动疗法、多模式运动对乳腺癌患者认知功能的影响及患者生化指标的改变,为临床相关研究及为患者开展更合理的运动干预提供参考。     

功能性近红外光谱应用于脑认知领域的可视化分析

目的：对功能性近红外光谱技术应用于脑认知相关研究的现状、热点及前沿行可视化分析。方法：检索Web of Science（WOS）数据库2012年1月1日～2022年12月31日功能性近红外光谱技术应用于脑认知研究的文献,使用CiteSpace 5.7软件进行可视化分析。结果：最终纳入文献1685篇,文献年发表量呈增长趋势。Ann-Christine Ehlis是发文最多的作者（36篇）,美国是发文量最多的国家（480篇）,德国图宾根大学是发文量最多的机构（47篇）,发文机构间合作较密切。研究热点集中于认知障碍及儿童脑发育障碍等认知疾病的神经机制研究、认知水平测量及认知疾病治疗评价等方面。结论：功能性近红外光谱技术在脑认知领域的应用处于发展阶段,国内机构应继续强化合作,近年研究开始结合多模态检测数据,研究者可进一步将多模态大数据结合人工智能建立各类认知疾病的认知评估、疗效评价等模型,实现脑认知疾病的客观化精准医疗。     

认知护理干预对抑郁症病人认识障碍影响的研究

[目的]观察认知护理干预对抑郁症病人认识障碍的影响。[方法]选择58例抑郁症病人,随机分为实验组(28例)和对照组(30例),对两组病人进行健康教育并给予常规治疗护理,实验组加用认知护理干预。4周后对两组病人用汉密顿抑郁量表(HAMD)评定,计算其中认识障碍因子分。[结果]实验组4周后的HAMD中认识障碍因子分明显低于对照组(P<0.01)。[结论]认知护理干预可明显改善抑郁症病人的认识障碍。     

Computerized mental health assessment in integrative health clinics: a cross-sectional study using structured interview

Computerized mental health assessment is gaining popularity. It enables the standardization of assessment of clinical problems, increases the capacity to collect sensitive or confidential information, facilitates personal assessment at one's own pace, and offers rapid screening of mental health status. The use of computer technology to conduct mental health assessment was an initiative proposed for two nurse-led integrative health clinics affiliated to a University in Hong Kong. It was intended to provide an efficient screening for depression, anxiety, alcohol abuse, and problem gambling common in the primary health-care settings to facilitate early intervention. This study was conducted to assess the effectiveness of using a computerized health assessment kiosk to perform mental health assessment. The assessment items were derived from an abbreviated World Health Organization Mental Disorders Checklist and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Pathological Gambling. The study involved an opportunity sample of 31 subjects who volunteered to complete the computerized mental health assessment during their waiting time in the clinics. The results showed that most subjects had positive feelings about using a computer to perform a mental health assessment and had increased understanding of their mental health. Suggestions made to improve computerized mental health assessments included touch screen, voice instructions, and enlarged print font size.