基于授权原理的综合性护理干预对2型糖尿病患者用药依从性及自我效能的影响

目的:探讨基于授权原理的综合性护理干预对2型糖尿病患者用药依从性及自我效能的影响。方法:选取2017年2月至2019年4月就诊于河北北方学院附属第一医院内分泌门诊的初诊2型糖尿病患者120例,按照随机数字表法分为观察组(n=60)与对照组(n=60),对照组使用传统护理干预,观察组给予基于授权原理的综合性护理干预。比较两组用药依从性、干预前后糖尿病代谢指标、自我护理行为、自我效能、生存质量。结果:观察组用药依从优良率(93.33%)高于对照组(80.00%,P0.05);观察组干预后3,6个月空腹血糖(fasting blood glucose,FPG)、餐后2h血糖(2h postprandia lblood glucose,2hPG)、糖化血红蛋白(glycated hemoglobin,HbA1c)均低于对照组(P0.05);观察组干预后1,3,6个月自我护理行为量表(Summary of Diabetes Self-Care Activities,SDSCA)评分均高于对照组(P0.05);观察组干预后1,3,6个月自我效能量表(Diabetes Self Efficacy Scale,DSES)评分均高于对照组(P0.05);观察组干预后1,3,6个月WHO生存质量评估简表(World Health Organization Quality of Life-Brief Version,WHOQOL-BREF)评分均高于对照组(P0.05)。结论:基于授权原理的综合性护理干预可以提升2型糖尿病患者的用药依从性,改善糖尿病代谢指标,提升患者自我护理能力、自我效能和生存质量。     

糖尿病患者授权能力与自护行为的相关性研究

目的探讨糖尿病患者授权能力与自护行为的相关性。方法采用糖尿病授权简化量表(diabetes empowermentscale-short form,DES-SF)和糖尿病自护行为量表以方便抽样法对杭州地区5所三级甲等医院175名住院糖尿病患者的授权能力和自护行为做现况调查。结果糖尿病患者授权水平总分处于中、高水平者86.8%;自护行为中用药管理得分最高,其次为饮食管理、足部护理;饮食管理、足部护理、自护总分与授权得分呈正相关(P<0.05)。结论医护人员应加强糖尿病患者自护行为的授权教育,以提高患者的自我管理能力,防止和减少并发症的发生。     

2型糖尿病患者自我效能影响因素分析

目的探讨影响2型糖尿病患者自我效能的因素。方法于南京市某三级甲等医院门诊用便利抽样方法抽取435例个案管理2型糖尿病患者,用中文版糖尿病管理自我效能量表进行患者自我效能的测量。采用单因素分析影响自我效能的因素、将有统计学意义的因素运用线性回归分析。结果435例初次进入个案管理的2型糖尿病患者自我效能得分为（132．28±38．66）分．63．9％处于中等水平;多元逐步回归显示：糖尿病教育、并发症种类、文化程度为2型糖尿病患者自我效能的影响因素。结论初次进入个案管理的2型糖尿病患者自我效能有待改善;需加强文化程度较低患者的自我管理教育,尤其在糖尿病患病早期,提高患者对疾病的重视程度,改善自我效能,减少糖尿病并发症的发生,减轻患者的生理、心理、经济负担。     

2型糖尿病患者授权能力及影响因素调查

目的 调查2型糖尿病患者的授权能力现状并分析其影响因素.方法 采用一般情况调查表、糖尿病授权简化量表、糖尿病管理自我效能量表及糖尿病态度量表,选取302例2型糖尿病患者的授权能力进行调查,并分析影响因素.结果 2型糖尿病患者授权简化量表得分为（31.91±5.40）分,均分为（4.02±0.71）,患者在减轻疾病带来的压力、克服自我管理过程中所遇的困难及制定个体化行为干预计划方面能力相对较差;多元逐步回归分析结果显示,患者授权能力的影响因素有自我效能（β=0.568,P=0.000）、糖尿病教育（β=0.128,P=0.007）.结论 加强对2型糖尿病患者的糖尿病教育管理,增进自我效能,以提高其授权能力.     

个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用

目的:探讨个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用效果。方法:将2016年10月1日～2018年8月31日收治的104例肺癌PICC置管化疗患者按照入院顺序分为观察组和对照组各52例,对照组实施常规护理,观察组在常规护理基础上给予个案管理的延伸护理服务;比较两组自护能力评分、导管相关性血流感染发生率、护理满意度、干预前后自我效能评分[采用中文版癌症自我管理效能量表(SUPPH)]。结果:观察组自护信心、自护依从性、导管维护能力、异常情况处置评分高于对照组(P0.01);观察组导管相关性血流感染发生率低于对照组(P0.05),护理满意度高于对照组(P0.05);干预后,两组自我决策、自我减压、正性态度评分高于干预前(P0.05),且观察组高于对照组(P0.05)。结论:在延伸护理服务中采取个案按理方案有利于提高肺癌PICC置管患者化疗间歇期自护能力,降低导管相关性血流感染发生率,提高患者自我效能,且护理满意度高。     

成人非胰岛素依赖型糖尿病患者自我效能与自护行为的相关性研究

目的明确成人非胰岛素依赖型糖尿病患者自我效能和自护行为水平,并检测两者间关系.方法采用糖尿病自我效能量表和糖尿病自护行为量表,以方便抽样法调查成人非胰岛素依赖型糖尿病130例.结果①成人非胰岛素依赖型糖尿病患者的自我效能与自护行为均不够理想;②成人非胰岛素依赖型糖尿病患者的自我效能与自护行为呈高度正相关(r均＞0.7).结论在设计和实施护理干预措施时,应重视提高患者自我效能,从而更有效地改善患者的自护行为.     

授权原理与多阶段改变理论相结合的教育模式对老年糖尿病患者饮食自我管理的影响

目的探讨授权原理与多阶段改变理论相结合的教育模式与传统的糖尿病教育模式对老年2型糖尿病患者饮食行为的影响。方法将118例老年2型糖尿病患者随机分成两组,对照组采用常规的教育方法;干预组采用授权原理与多阶段改变理论相结合的教育方法。比较两组患者糖尿病授权简化量表(C-DES-SF)、糖尿病自护行为量表(SDSCA)及糖尿病自我效能量表(DSES)得分及饮食行为改变阶段频数。结果干预组患者,C-DES-SF,SDSCA,DSES得分较对照组明显提高(P0.05)。结论运用授权原理与多阶段改变理论相结合的教育模式,能帮助老年糖尿病患者提高授权能力及饮食自我管理水平。     

中文版糖尿病自护行为量表的信度和效度研究

目的 考察中文版糖尿病自护行为量表(SDSCA)的信度和效度,为我国2型糖尿病患者,自护行为评估提供有效、简便的工具.方法 翻译国外的糖尿病自护行为量表(SDSCA),形成中文版SDSCA,采用随机抽样方法,从内分泌门诊中选取20例2型糖尿病患者,进行中文版糖尿病自护行为量表的重测信度、量表内部一致性和结构效度研究.结果 中文版SDSCA各维度重测信度在0.763～1.000;量表各维度条目间相关系数,具体饮食最低(0.104),其余各维度条目间呈中度至高度相关0.555～0.933;主成分分析共抽取4个因子,解释变异量的67.483%.结论 中文版SDSCA的信效度理想,适合于2型糖尿病患者自护行为评价.

Abstract：

Objective To test the reliability and validity of the Chinese version Diabetea Self-Care Behavior(SDSCA)Questionnaire,and thus to provide an effective and convenient way of self-care behavior assessment for patients with type 2 diabetes.Methods The questionnaire based on the translation of SDSCA wag used in 20 cases of type 2 diabetes patients,in order to analyze the retest rehability,internal consistency and scale construct validity. Results The retest reliability of each dimension wag between 0.763 to 1.000;the scale correlation coeflicients between items in specific diet dimension Wag lowest(0.104),and the others were moderate to high degree of correlation between 0.555～0.933;exploratory factor analysis extracted 4 components,and the percentage of variance explained was 67.483% .Conclusions Chinese version SDSCA has a good reliability and validity,and is good for evaluating the self-care activities in type 2 diabetes patients.     

护士主导的个案管理模式对2型糖尿病患者自护行为及授权能力的影响

目的 探讨以护士为主导的个案管理模式对于2型糖尿病患者的效果评价.方法 选择2016年4-9月在社区招募的2型糖尿病患者共88例,按照随机数字表法分为观察组和对照组,各44例.对照组由糖尿病专科护士对2型糖尿病患者进行12周的常规健康教育.观察组患者则采用12周的以护士为主导的个案管理模式进行干预.比较2组患者自护行为及授权能力.结果 观察组糖尿病自护行为量表各维度得分明显高于对照组(P<0.05);观察组糖尿病授权简化量表总得分高于对照组(P<0.001).结论12周的护士为主导的症状个案管理模式可以降低2型糖尿病患者血糖值,增强其自护行为,同时提高了相应的授权能力.     

授权教育对提高糖尿病患者自我效能感的探索

目的探索授权教育对提高糖尿病患者自我效能感的效果。方法对86例糖尿病患者采用"个体化教育+小组讨论"授权教育实施自我管理教育,按照授权教育的5个步骤,为患者制订自我管理教育计划,进行疾病知识、自我技能与情绪的管理,在患者干预前及干预后3月,评价患者的糖尿病控制自我效能、自护行为的变化,检测血糖控制代谢指标。结果干预后3月,患者的糖尿病控制自我效能、自护行为与干预前相比,差异有统计学意义;血糖控制代谢指标与干预前相比,差异有统计学意义。结论授权教育可有效提高糖尿病患者的自我效能感,促进行为改变,提高自我管理能力,从而控制血糖水平。     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

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.