叙事医学视域下的“病为本，工为标”

“病为本, 工为标”是中医对医疗活动中医患的主从关系的论述, 强调患者的地位及医患配合的重要性, 这与叙事医学理论构建中的“主体间性”理念有着相似之处。文章旨在通过对“病为本, 工为标”进行阐释, 结合叙事医学原理钩沉, 尤其侧重对主客间性进行挖掘, 拓展其现代价值, 为中国叙事医学发展助力。     

基于络病理论从芳香通络疗法论治冠状动脉微循环障碍

近年来,随着冠脉介入诊疗技术的普及,冠状动脉微循环障碍（CMD）的检出率逐步升高,CMD已成为远期心血管事件的独立预测因子。络病理论认为CMD病位在络,病机为心络瘀阻、心络郁滞/虚滞和心络绌急,通络成为其基本的治法治则。芳香类药物可直接入络搜邪,芳香通络疗法较单纯活血通络法疗效更佳。故而从络病理论、芳香通络疗法的立法依据等方面,对芳香通络疗法治疗CMD进行论述。     

浮针治疗梨状肌综合征的疗效观察

目的:观察浮针在梨状肌综合征的临床应用效果。方法:本研究回顾性分析2017年7月1日—2018年6月30日宁波市中医院80例急性发病的梨状肌综合征患者,其中40例对照组患者采用常规药物及物理治疗,40例观察组患者在上述基础上以解剖列车理论为指导进行浮针治疗。两组患者均完成了随访。比较两组治疗后疼痛(VAS评分)、患髋关节Harris评分、患者满意度。结果:治疗前两组患者一般资料、疼痛VAS评分、患髋关节Harris评分差异无统计学意义(P0.05);治疗后两组患者疼痛VAS评分均较治疗前下降,观察组患者疼痛(VAS)评分治疗后24 h(6.5±0.5)分、7 d(3.4±0.5)分、14 d(2.1±0.3)分,较对照组术后24 h(7.9±0.6)分、7 d(5.2±0.5)分、14 d(3.6±0.5)明显下降(P0.05);治疗后两组患者髋关节Harris评分均较治疗前上升,观察组患者髋关节(Harris)评分治疗后24 h(55.6±1.1)分、7 d(68.5±1.8)、14 d(80.3±1.7)分,较对照组术后24 h(43.7±1.2)分、7 d(54.6±1.3)、14 d(63.0±1.4)分明显上升(P0.05);患者满意度观察组(92.5%)较对照组(72.5%)增加,差异有统计学意义(P0.05)。结论:合理运用浮针治疗,疼痛感触明显减轻、功能和患者的满意度显著提高。     

童年期居住环境卫生对农村居民中老年期慢性病患病的影响研究

目的探讨童年期居住环境卫生对农村居民中老年期慢性病患病的影响, 并检验童年期健康状况在其中的中介效应。方法基于中国健康与养老追踪调查2018年最新调查和2014年生命历程调查共同访问的12 506名农村居民数据, 运用χ2检验、秩和检验、logistic回归分析模型、倾向评分加权法、负二项回归模型和KHB分析法进行分析。结果调整其他混杂因素后, 相比童年期居住环境卫生较好的农村居民, 童年居住环境卫生较差的中老年农村居民患哮喘风险提高23.7%(OR=1.237, 95%CI:1.060～1.445), 患肝脏疾病、肾脏疾病和消化系统疾病的风险增加16.4%(OR=1.164, 95%CI:1.006～1.347)、22.4%(OR=1.224, 95%CI:1.083～1.383)和19.6%(OR=1.196, 95%CI:1.103～1.296), 患血脂异常和心脏病的可能性上升了26.6%(OR=1.266, 95%CI:1.153～1.390)和13.6%(OR=1.136, 95%CI:1.031～1.253)。负二项回归模型分析结果显示, 童年居住环境卫生较差的中老年农村...     

中国公众公共卫生安全素养量表的开发研究

目的开发公共卫生安全素养量表, 为我国公众的公共卫生安全素养测评提供适宜工具。方法通过理论构想、指标池构建、现场验证、题项缩减等步骤编制中国公共卫生安全素养初始量表, 转为"问卷星"电子问卷, 随机抽取4个省份共2 809名居民进行现场测试。利用经典测试理论(CTT)和项目反应理论(IRT)进行题项缩减。使用SPSS 23.0软件进行探索性因子分析(EFA)和单维性检验。使用R 4.1.1软件ltm和mirt包进行题项的心理测量学指标分析, 并绘制项目特征曲线(ICC)和信息函数曲线(IIC和TIF)。结果选用专家一致性系数最优的初始量表3, 共30个题项(B1～B30), 测试对象完成1个题项平均需9.8 s。根据CTT分析, 删除校正题项-总相关系数(CITC)<0.3及题项-维度相关系数(IDCC)<0.4的B2题项;删除CITC<0.3、IDCC<0.4及难度指数<0.2的B23题项;删除CITC<0.3及难度指数<0.2的B30题项。删除后量表总内部一致性信度(Cronbach’’sα)值为0.923。EFA提示删除14个因子载荷较小...     

Patients' and family members' perspectives on the benefits and working mechanisms of family nursing conversations in Dutch home healthcare

The aim of this study is to propose a model of the benefits and working mechanisms of family nursing conversations in home healthcare from the perspective of participating patients and their family members. Family nursing conversations in this study are intended to optimise family functioning, improve collaboration between family and professional caregivers and ultimately prevent or reduce overburden of family caregivers. In a qualitative grounded theory design, data were collected in 2017 using intensive interviewing with participants of family nursing conversations in home healthcare. A total of 26 participants (9 patients and 17 family members) from 11 families participated in a family nursing conversation and the study. Seven nurses who received extensive education in family nursing conversations conducted them as part of their daily practice. Interviews occurred 4–6 weeks after the family nursing conversation. The model that was constructed in close collaboration with the families consists of three parts. The first part outlines working mechanisms of the conversation itself according to participants, i.e. structured and open communication about the care situation and the presence of all of the people who are involved. The second part consists of the benefits that participants experienced during and immediately after the conversation – an increased sense of overview and improved contact among the people involved – and the related working mechanisms. The last part consists of benefits that emerged in the weeks after the conversation – reduced caregiver burden and improved quality of care – and the related working mechanisms. Insight into the benefits and working mechanisms of family nursing conversations may assist healthcare professionals in their application of the intervention and provides directions for outcomes and processes to include in future studies.     

综合护理干预对急性左心衰患者的影响

目的 探究基于自我调节理论的综合性护理干预对急性左心衰患者无创呼吸机治疗依从性的影响。方法 选取来我院就诊的急性左心衰患者83例,随机分成对照组41例和观察组42例。对照组采用常规护理模式,观察组采用基于自我调节理论的综合性护理。比较两组患者干预前后使用无创呼吸机依从性,比较干预后两组患者对无创呼吸机耐受情况、出院3个月后生活质量及干预过程中并发症发生率。结果 两组患者干预后,观察组依从性指数(85.18±4.13)高于对照组(80.45±3.68)(t=5.512,P=0.000);经干预后,观察组无创呼吸机耐受率(92.68%)与对照组(83.33%)无差异(χ2=1.711,P=0.190);两组患者出院3个月后,观察组在生活质量评分中社会功能(83.23±13.45,75.35±12.7,t=2.736,P=0.007)、情绪职能(74.31±13.64,65.34±8.45,t=3.611,P=0.001)、精神健康(76.38±10.24,68.23±11.53,t=3.402,P=0.001)方面分数高于对照组;干预期间,观察组并发症发生率(26.83%)低于对照组(59.52%)(χ2=9.029,P=0.002)。结论 基于自我调节理论的综合性护理干预能提高急性左心衰患者无创呼吸机治疗依从性,适当改善患者对无创呼吸机的耐受性,减轻并发症发生率,改善患者出院后生活质量。