类风湿关节炎患者生活质量影响因素的路径分析

目的探讨疲劳、功能障碍、自我效能、社会支持对类风湿关节炎患者生活质量的影响及作用机制,为改善患者生活质量提供依据。方法采用多维疲劳量表、健康评定量表残疾指数、关节炎自我效能量表、社会支持量表、简明健康状况调查表对207例类风湿关节炎患者进行调查,根据Wilson-Cleary健康相关生活质量模式和相关性分析结果提出假设,使用AMOS软件进行结构方程模型分析。结果自我效能对生活质量有直接正向效应(路径系数为0.356),并通过疲劳、功能障碍对生活质量产生间接影响(路径系数为0.310);疲劳对生活质量有直接负向效应(路径系数为-0.321),又通过功能障碍间接影响生活质量(路径系数为-0.136);功能障碍对生活质量有直接负向效应(路径系数为-0.274);社会支持通过疲劳间接影响生活质量(路径系数为0.080)。结论提高类风湿关节炎患者的自我效能,改善疲劳,预防和减缓功能障碍,增加社会支持可提高其生活质量。     

临床护理路径在86例急性心肌梗死患者中的应用效果分析

目的：探讨临床护理路径在急性心肌梗死患者中的应用效果,为今后临床实践提供参考和借鉴。方法选取2012年1月—2013年1月期间该院收治的86例急性心肌梗死患者为研究对象,根据护理方式的不同分为两组,对照组患者给予临床常规护理,观察组患者给予临床护理路径护理,比较两组患者的护理效果。结果观察组患者的护理满意度明显高于对照组患者(P<0.05);观察组患者的住院时间、并发症的发生情况明显低于对照组患者(P<0.05),差异具有统计学意义。结论临床护理路径在急性心肌梗死患者中的应用效果比较好,能够提高患者的生活质量,缩短住院时间,减少并发症的发生,提高护理满意度,值得在临床实践中广泛的应用和推广。     

涡阳县人民医院实施胆囊结石腹腔镜胆囊切除术临床路径效果分析

目的 评价胆囊结石腹腔镜胆囊切除术临床路径的临床应用效果.方法 将涡阳县人民医院2013年3月至2014年11月实施临床路径管理的259例胆囊结石腹腔镜胆囊切除术患者纳为路径组,未实施临床路径管理的256例胆囊结石腹腔镜胆囊切除术患者纳为对照组,对两组患者的平均住院天数、手术前住院天数、住院费用、药品费用、检查费用、药品费用比例、术后并发症率和患者满意度等指标进行比较评价.结果 路径组平均住院天数为(5.3±1.6)d,手术前住院天数为(1.2±0.4)d,与对照组比较,差异有统计学意义(P<0.05);路径组较对照组的住院费用和检查费增加,药品费用减少,差异有统计学意义(P<0.05).术后随访,路径组患者满意度高于对照组,差异有统计学意义(P<0.05);两组术后并发症差异无统计学意义(P>0.05).结论 胆囊结石腹腔镜胆囊切除术临床路径的实施可以有效缩短住院时间,降低治疗费用,减轻患者经济负担,提高患者满意度,对提升医院社会和经济效益有着积极意义.     

急救护理路径在急性心肌梗死患者抢救中的应用效果观察

【】目的：探讨急救护理路径在急性心肌梗死患者抢救中的应用效果。方法：选择2015年12月～2017年2月间到我院急诊科就诊的急性心肌梗死的患者共112例,所有患者均行经皮冠状动脉介入治疗(PCI),按照随机原则分为两组,对照组56例患者采取常规护理干预,观察组56例患者按照急救护理路径进行护理,比较两组患者抢救效果。结果：观察组患者分诊评估时间、静脉通道构建时间、进出急诊室时间、球囊扩张时间、住院时间均明显短于对照组患者(P＜0.05),急性心肌梗死复发率、再行PCI手术率、死亡率均明显低于对照组患者(P＜0.05),护理总满意度明显高于对照组患者(P＜0.05)。结论：急性心肌梗死患者抢救过程中应用急救护理路径能够有效缩短各急救环节时间,提高抢救成功率,提高患者护理满意度,建议临床推广应用。     

Integrative modeling of multi‐platform genomic data under the framework of mediation analysis

Given the availability of genomic data, there have been emerging interests in integrating multi‐platform data. Here, we propose to model genetics (single nucleotide polymorphism (SNP)), epigenetics (DNA methylation), and gene expression data as a biological process to delineate phenotypic traits under the framework of causal mediation modeling. We propose a regression model for the joint effect of SNPs, methylation, gene expression, and their nonlinear interactions on the outcome and develop a variance component score test for any arbitrary set of regression coefficients. The test statistic under the null follows a mixture of chi‐square distributions, which can be approximated using a characteristic function inversion method or a perturbation procedure. We construct tests for candidate models determined by different combinations of SNPs, DNA methylation, gene expression, and interactions and further propose an omnibus test to accommodate different models. We then study three path‐specific effects: the direct effect of SNPs on the outcome, the effect mediated through expression, and the effect through methylation. We characterize correspondences between the three path‐specific effects and coefficients in the regression model, which are influenced by causal relations among SNPs, DNA methylation, and gene expression. We illustrate the utility of our method in two genomic studies and numerical simulation studies. Copyright © 2014 John Wiley & Sons, Ltd.     

Leadership by collaboration: Nursing's bold new vision for academic-practice partnerships

In 2016 the American Association of Colleges of Nursing issued a report, Advancing Healthcare Transformation: A New Era for Academic Nursing that included recommendations for more fully integrating nursing education, research, and practice. The report calls for a paradigm shift in how nursing leaders in academia and practice work together and with other leaders in higher education and clinical practice. Only by doing so can we realize the full benefits of academic nursing in this new era in which integration and collaboration are essential to success. In this paper we: 1) examine how academic nursing can contribute to healthcare innovation across environments; 2) explore leadership skills for deans of nursing to advance the goals of academic nursing in collaboration with clinical nursing partners, other health professions and clinical service leaders, academic administrators, and community members; and, 3) consider how governance structures and policy initiatives can advance this work.     

临床路径管理实施过程中的障碍原因与处置对策研究

目的探讨临床路径管理实施过程中的障碍原因及处置对策。方法回顾性分析医院2013年8-12月进入临床路径管理的282例患者(病种为胆囊结石腹腔镜胆囊切除术、慢性鼻-鼻窦炎、2型糖尿病)的完整临床资料,按照是否顺利完成临床路径管理分为两组,观察组140例均顺利完成临床路径,对照组142例未顺利完成临床路径,统计分析临床路径实施障碍原因,总结处置对策。结果观察组患者年龄显著小于对照组,文化程度显著优于对照组,自费者显著高于对照组,2型糖尿病患者病程显著短于对照组,差异均具有统计学意义(均P<0.05);多因素分析显示,年龄大、文化程度低、医保就医及2型糖尿病病程长是临床路径管理实施障碍的原因,差异均具有统计学意义(均P<0.05)。结论针对年龄大、文化程度低、医保就医及2型糖尿病病程长等临床路径实施障碍原因,可加强健康教育、心理干预及康复指导,保证临床路径顺利实施。     

支气管平滑肌细胞中MK2 和MK3 过表达对细胞因子分泌的调节作用

目的:研究支气管平滑肌细胞中丝裂原活化蛋白激酶2/3(MK2/3)的过表达对细胞因子分泌的调节作用。方法:将野生型MK2和MK3腺病毒转染至人支气管平滑肌细胞中,Western blot实验检测MK2和MK3蛋白表达水平,确定转染腺病毒的最佳感染系数,检测热休克蛋白HSP27的磷酸化水平以及MK2和MK3过表达对MAPK和核因子(NF)-κB信号通路的影响。ELISA检测支气管平滑肌细胞分泌细胞因子的情况。结果:野生型MK2和MK3腺病毒转染至支气管平滑肌细胞的最佳感染系数为40,在支气管平滑肌细胞内有活性。MK2通过p38MAPK信号通路促进IL-6的分泌,抑制正常T细胞表达及趋化因子配体5(CCL5)的分泌,MK3通过NF-κB信号通路抑制RANTES/CCL5的分泌。结论:本研究揭示了MK2和MK3在支气管平滑肌细胞中通过不同的信号通路调节细胞因子的分泌,通过靶向MKs可调节支气管气道炎症反应。     

Comparison of Torque,Screw-in Force,and Shaping Ability of Glide Path Instruments in Continuous Rotation and Optimum Glide Path Motion

IntroductionThis study aimed to analyze torque/force generation and transportation in double-curved canals instrumented with 3 types of glide path files using optimum glide path (OGP) motion in comparison with continuous rotation.MethodsSixty simulated double-curved canals were prepared with #10/0.05 or #15/0.03 HyFlex EDM Glidepath files (Coltene/Whaledent, Altstätten, Switzerland) or a #13/0.04 prototype MANI Glidepath file (Tochigi, Japan) using OGP motion or continuous rotation (n = 10 each). Canals were sequentially prepared to 20 mm and 22 mm (full working length) using automated root canal instrumentation and a torque/force analyzing device. Transportation was calculated at 1–9 mm from the apex. Data were compared using 2-way analysis of variance followed by a post hoc simple main effect test with Bonferroni correction and a Kruskal-Wallis test (α = 5%).ResultsAll #10/0.05 instruments fractured. In the 22-mm preparation, the OGP motion resulted in lower clockwise torque and screw-in force than did continuous rotation (P < .05). In the 20-mm preparation, #15/0.03 instruments recorded a lower screw-in force for OGP motion than for continuous rotation (P < .05). Comparing the 2 preparation phases, OGP motion generated no significant differences; however, continuous rotation developed higher clockwise torque and screw-in force in the 22-mm preparation than in the 20-mm preparation (P < .05). There was no significant difference among the tested groups for transportation values.ConclusionsCompared with continuous rotation, OGP motion generated less screw-in force, lower clockwise torque, and similar transportation. The #15/0.03 HyFlex EDM instrument and the #13/0.04 prototype MANI instrument performed similarly well.