乳腺癌患者PICC护理质量敏感性指标的建立与实施

目的探讨乳腺癌患者PICC护理质量敏感性指标的建立与实施效果。方法将实施PICC护理质量敏感性指标前(2014年)行PICC置管的203例患者作为对照组,实施后(2015年)231例患者作为研究组。对照组实施常规护理,研究组采用自行研制的PICC护理质量敏感性指标监测管理,比较实施前后PICC相关并发症发生率、PICC专科护理质量及患者满意率。结果实施前后患者PICC相关并发症发生率、PICC维护护理质量评分比较,差异有统计学意义(P0.05,P0.01);实施后患者对护理工作满意率明显提高。结论建立并实施PICC专科护理质量敏感性指标监测与控制,能有效降低PICC相关并发症发生率,提高PICC专科护理质量,提高患者满意率。     

妊娠合并脊髓损伤的孕期康复及产科处理(附4例报告)

目的 探讨妊娠合并脊髓损伤的孕期康复及处理.方法 总结在我院检查并分娩的4例妊娠合并脊髓损伤者的临床资料,对所有患者治疗前进行Barthel指数评分、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分,结合文献讨论其孕期康复、分娩及产后管理.结果 4例妊娠合并脊髓损伤病例,均为初次妊娠,年龄27～33岁,分娩孕周为35+周～38周,脊髓损伤平段T8-T10,4例孕期均有尿失禁、便秘,2例孕期轻中度贫血,1例合并胎儿生长受限,1例合并妊娠期糖尿病.3例胎膜早破,2例早产.3例全麻下行子宫下段剖宫产术,1例产钳助产分娩.4例新生儿1min Apgar评分均为10分,体重2 350～3 350 g.经过孕期系统康复训练Barthel指数、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分的各项指标有明显改善.结论 妊娠合并脊髓损伤患者孕期应坚持心理疏导及康复训练,在多学科团队,特别是产科医生与康复医学科、麻醉科医师的密切协作下,通常有良好的妊娠结局;但要警惕早产、自主神经反射异常的风险.     

双环钢丝捆扎技术联合关节置换对转子间骨折患者快速康复的临床观察

目的  探讨交叉双环钢丝捆扎技术联合关节置换术治疗高龄股骨转子间粉碎骨折的临床疗效。方法选取本院2013～2014年行人工关节置换结合钢丝捆扎治疗转子间骨折（Evans-Jensen分型：Ⅲ型、Ⅵ型）病例进行回顾性分析,其中15例采用双环钢丝捆扎加人工关节置换术,19例采用普通环形钢丝捆扎加人工关节置换术。两组分别比较住院时间、首次行走时间、术前术后记录每日睡眠时间、每日饮食量、精神状态、髋关节Harris评分、血红蛋白、白蛋白、电解质、是否有关节脱位、呼吸及泌尿系统炎症等疾病,并进行对比分析。结果  采用交叉双环钢丝捆扎组与采用普通钢丝捆扎组比较,前者术后下床时间、住院天数及术后首月髋关节Harris评分优于后者（P <0.05）,两者血液指标出院前后无明显差异（P >0.05）,但前者恢复速度较后者更快（P <0.05）,两组术后第3个月、第6个月及1年髋关节Harris功能评分差异无统计学意义（P >0.05）。结论  交叉双环钢丝捆扎加人工关节置换术能促进患者术后快速康复,减少住院时间,提高患髋近期功能,在患者术后快速恢复方面有积极作用。

     

Preferences for symmetry in faces change across the menstrual cycle

Symmetry in human male faces may be a cue to heritable fitness benefits and is found attractive. Preferences for facial masculinity, another proposed marker of genetic quality, have been found to vary in ways that may maximise evolutionary relevant benefits and masculinity is found to be of increased attractiveness at peak fertility across the menstrual cycle. Here we show that women prefer more symmetric faces at peak fertility (Study 1) and that such shifting preferences may be potentially strategic preferences as we found them to occur only for judgements concerning short-term relations and when women already had a partner (Study 2). Such preferences potentially indicate a strategy that maximises the quality of extra-pair/short-term partners or a quality dependent response to hormones. Such strategic preferences for symmetry may support the role of symmetry in signalling potential good-gene benefits.     

Disentangling physician sex and physician communication style: their effects on patient satisfaction in a virtual medical visit

OBJECTIVE: The present study aimed to investigate the effect of physician sex and physician communication style on patient satisfaction. In real medical visits, physician sex and physician communication style are confounded variables. By using the virtual medical visit paradigm, we were able to disentangle the two variables and study their separate and/or joint effects on patient satisfaction. METHOD: In an experimental design, analogue patients (167 students) interacted with a computer-generated virtual physician on a computer screen. The patients' satisfaction during the visit was assessed. RESULTS: Depending on the sex composition of the dyad, physician communication style affected analogue patients' satisfaction differently. For instance, in male-male dyads, physician communication style did not affect the patients' satisfaction, whereas in female-female dyads, analogue patients were more satisfied when the physician adopted a caring as opposed to a non-caring communication style. CONCLUSION: Sex of the physician and sex of the patient moderate how different physician communication styles affect patient satisfaction. In particular, a female-sex role congruent communication style leads to higher patient satisfaction when women see a female physician. PRACTICE IMPLICATIONS: Physician communication training cannot be one size fits all. Rather female and male physicians should obtain different training and they need to be made aware of the fact that female and male patients harbor different expectations toward them.     

On the importance of nonverbal communication in the physician-patient interaction

OBJECTIVE: The goal of this paper is to show that nonverbal aspects in the physician-patient interaction play an important role. Interpersonal judgment relies mostly on nonverbal and appearance cues of the social interaction partner. This is also true for the physician-patient interaction. Moreover, physicians and patients tend to mirror some of their nonverbal behavior and complement each other on other aspects of their nonverbal behavior. Nonverbal cues emitted by the patient can contain important information for the doctor to use for treatment and diagnosis decisions. CONCLUSION: The way the physician behaves nonverbally affects patient outcomes, such as, for instance, patient satisfaction. Affilliative nonverbal behavior (e.g., eye gaze and proximity) of the physician is related to higher patient satisfaction. However, how different physician nonverbal behaviors are related to patient satisfaction also depends on personal attributes of the physician such as gender, for instance. PRACTICE IMPLICATIONS: Physician training could profit from incorporating knowledge about physician and patient nonverbal behavior.     

Pain drawings and concepts of pain among patients with "half-body" complaints

OBJECTIVE: To explore main features of pain drawings and concepts about illness in patients seeking help for "half-body" complaints at two primary health care centres in different parts of Sweden. METHODS: A qualitative study of pain-drawings and tape-recorded semi-structured interviews analysed by qualitative methods in 20 patients (4 men, 16 women, aged 37-68 years) from five health centers. Three of them were native Swedes and 17 were foreign-born. RESULTS: All complained of pain in a left (three-fourth) or right (one-fourth) body-half, mainly in front. Some had general pain with a "worse side". Many said they had pain only on the "edges" and outlined the margins on the side of pain, but excluded the "face". Posterior drawings often received a line in the middle dividing the body in lateral halves. Pain was referred to as a "growing" thing - ("It") - that could spread ("jump") to the other side, grow and eventually paralyse them. "It" was believed as caused by body imbalance, natural factors or supernatural forces. CONCLUSION: "Half-body" pain was an expression that in main was used by middle-aged patients to denote an initially superficial and frontal one-sided pain that could spread and become dangerous to their health. PRACTICE IMPLICATIONS: Patients with half-body complaints should be taken seriously and met with respect by doctors and other health care personnel, particularly in cross-cultural consultations.