一例下肢皮肤感染引起的脓毒症伴多器官功能不全的个案护理

目的：总结脓毒症伴多器官功能不全患者的护理工作经验;方法：对我科住院的一例下肢皮肤感染引起的脓毒症伴多器官功能不全的患者,重点观察生命体征、尿量、意识变化等,准确的记录并计算出患者的出入量,关注患者实验室结果,观察其病情变化及用药情况,总结其护理工作;结果：经治疗及精细护理后,患者病情改善后出院;结论：脓毒症伴多器官功能不全患者病情危重,死亡率较高,制定个体化治疗及中西医结合的护理方案可有效提高脓毒症患者的救治成功率。     

激素联合个性化药物治疗非动脉炎性前部缺血性视神经病变的疗效

 目的 探讨激素联合个性化药物治疗非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy, NAION)的效果。方法 选取NAION患者56例(61眼),根据其病因、发病时间、眼部检查、视野检查及眼底荧光血管造影(FFA)结果,制定激素联合个性化药物治疗方案,观察治疗前后视力、视野、眼底改善情况,判断综合疗效。结果 治疗后56例(61眼)视力均明显改善;治疗前56例(61眼)视野均出现特征性改变,治疗后视野缺损范围较治疗前缩小30°以上者48眼,显效率78.7%;治疗前FFA检查56例(61眼)荧光造影特征性改变, 治疗后54眼荧光造影改善,显效率88.5%。结论 激素联合个性化药物治疗,对NAION病预后有明显改善作用。     

影响无痛胃镜丙泊酚用量的个体化因素分析

目的 研究无痛胃镜中使丙泊酚用量明显增加和减少的个体因素,为提高个体化无痛胃镜的有效性和安全性提供参考。方法 纳入406例拟行无痛胃镜的患者,依次给予舒芬太尼0.10 μg/kg、丙泊酚1.00 mg/kg,随后采用滴定法追加丙泊酚,每次0.20 mg/kg,直至患者改良警觉/镇静评分（MOAA/S）=1分,然后行胃镜检查。记录并分析所有患者的信息和用药情况。丙泊酚的用量根据实际体重,以mg/kg计算,超过平均值的30%定义为用量增多,低于平均值的30%定义为用量减少。结果 在406例患者中,丙泊酚用量增加81例（19.95%）。其中,年龄 ≤ 35岁、重体力劳动或体育锻炼者、长期饮酒史和咽喉疾病患者丙泊酚用量明显增加（P < 0.05）,经Logistic回归分析得出,以上4个因素与丙泊酚用量增加有关,OR＾值分别为10.211、2.749、3.266和4.406;丙泊酚用量减少36例（8.87%）。其中,年龄 > 65岁和肥胖患者的丙泊酚用量明显减少（P < 0.05）,经Logistic回归分析得出,以上2个因素与丙泊酚用量减少有关,OR＾值分别为3.607和3.982。结论 有诸多个体因素导致无痛胃镜检查中丙泊酚较实际体重计算的用量增加或减少,提前识别这些个体因素,有利于个体化麻醉的实施。     

个体化开放楔形胫骨高位截骨治疗内侧间室膝骨关节炎的优势

文题释义：开放楔形胫骨高位截骨：是一种治疗内侧间室膝骨关节炎合并膝内翻的保膝术式。通过胫骨近端内侧切口,在水平面、冠状面双截骨后,进行楔形撑开、钢板固定。其治疗意义在于将内翻的下肢力线转移至相对正常的膝外侧,以缓解内侧症状,延长关节寿命,延缓骨关节炎进展,甚至避免关节假体置换。 个体化力线矫形：根据膝骨关节炎的多阶段性,针对不同退变程度的膝内侧间室,施行不同的力线矫形方案。通过术前规划截骨后的楔形撑开角度或距离,可以将内翻的下肢力线矫正至中线或偏外侧,以达到临床治疗效果。 背景：开放楔形胫骨高位截骨对于内侧间室膝骨关节炎合并膝内翻患者疗效明确,但目前关于力线矫正点的选择仍以Fujisawa点作为参考,个体化力线矫形是否能获得更优越的临床疗效？ 目的：探讨开放楔形胫骨高位截骨术中个体化下肢力线矫形治疗内侧间室膝骨关节炎的短期疗效。 方法：选择2016年6月至2018年5月无锡市人民医院骨科因内侧间室膝骨关节炎行开放楔形胫骨高位截骨治疗的46例患者。根据X射线片、MRI综合评估患膝并划分退变等级(Ⅰ-Ⅲ级),其中Ⅰ,Ⅱ级患者随机分为个体化组及对照组,每组16例;14例Ⅲ级患者作为Fujisawa组。个体化组轻度退变Ⅰ级矫正下肢力线至胫骨平台50%点,中度退变Ⅱ级矫正至胫骨平台外侧55%点;对照组、Fujisawa组均矫正力线至62.5%点。测量评估术后下肢力线,比较术前、术后膝关节活动度、股胫角、胫骨近端内侧角;随访术前及术后3,6,12个月患膝的美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数,比较患者术后综合满意度的自评分。结果与结论：①所有患者均获得12个月随访;②3组下肢力线矫形结果满意,术后膝关节活动度、胫骨近端内侧角较术前明显增加,股胫角明显减少(P < 0.05);③随着随访时间延长,3组患者的美国特种外科医院评分显著增加,西安大略和麦克马斯特大学骨关节炎指数显著减少,组内不同时点差异有显著性意义(P < 0.05);个体化组术后3,6个月美国特种外科医院评分高于对照组,西安大略和麦克马斯特大学骨关节炎指数低于对照组,差异有显著性意义(P < 0.05);个体化组及对照组术后12个月美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数差异无显著性意义(P > 0.05);④所有患者对手术矫形效果满意,个体化组术后综合满意评分高于对照组,差异有显著性意义(P < 0.05);⑤结果表明,个体化开放楔形胫骨高位截骨通过准确地力线矫形,有利于膝关节早期功能恢复,提升患者满意度。 ORCID: 0000-0003-0566-2858(俞颖豪) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

个体化护理服务模式对新生儿重症监护室早产儿预后的影响

目的探讨个体化护理服务模式对新生儿重症监护室(NICU)早产儿预后的影响。方法选取2017年1月至2019年2月入住该院NICU诊治的早产儿150例作为研究对象,根据入院先后顺序分为个体组(75例)和对照组(75例)。对照组早产儿给予常规护理,个体组在对照组护理的基础上给予个体化护理服务模式干预,记录与调查两组早产儿的预后。结果个体组早产儿护理1个月和3个月后的体质量与身长均明显高于对照组,差异均有统计学意义(P<0.05)。个体组早产儿护理3个月后的智力发育指数与心理运动发育指数评分均明显高于对照组,差异均有统计学意义(P<0.05)。两组早产儿护理3个月后的行为神经评分量表评分均明显高于护理前,并且个体组评分明显高于对照组,差异均有统计学意义(P<0.05)。个体组早产儿护理期间的再住院率为1.3%,明显低于对照组的10.7%,差异有统计学意义(P<0.05)。结论个体化护理服务模式在NICU早产儿中的应用能促进其生长发育,加快早产儿的神经发育与智力发育,降低再住院率。     

Individualized assessment and treatment program for alcohol dependence: results of an initial study to train coping skills

Aims Cognitive–behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment. Design Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an individualized assessment and treatment program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists with a detailed understanding of patients' coping strengths and deficits. Setting Out‐patient treatment. Participants A total of 110 alcohol‐dependent men and women. Measurements Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Time‐line follow‐back procedures were also used to record drinking at baseline and post‐treatment. Findings IATP yielded higher proportion of days abstinent (PDA) at post‐treatment (P < 0.05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses and less drinking in high‐risk situations, as recorded by experience sampling at post‐treatment. Post‐treatment coping response rates were associated with decreases in drinking. Conclusions The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting a high risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol‐dependent patients.     

Long‐term efficacy and safety of ranibizumab administered pro re nata in Japanese patients with neovascular age‐related macular degeneration in the EXTEND‐I study

Purpose: To evaluate the long‐term efficacy and safety of ranibizumab administered pro re nata (PRN) in Japanese patients with choroidal neovascularization secondary to age‐related macular degeneration during the extension phase of the EXTEND‐I study. Methods: EXTEND‐I, an open‐label, multicenter, Phase I/II study comprised: a single‐injection (Group A); a multiple‐injection (Groups A and B; the latter consisted of patients who did not participate in the single‐injection phase); and an extension phase. In the extension phase, a PRN regimen of ranibizumab (0.3 or 0.5 mg) guided by monthly best‐corrected visual acuity (BCVA) score and other ophthalmic examinations was employed. The efficacy variables included the mean BCVA change from Month 12 to the last visit in Group B. Safety was assessed in all patients. Results: In the extension phase, efficacy was assessed only in Group B patients. The number of ranibizumab injections per year in the 0.3 and 0.5 mg Group B patients was 4.19 and 4.27, respectively. The mean BCVA change (SD) from Month 12 to the last visit was ?3.6 (14.82) letters for 0.3 mg (n = 28) and ?2.2 (7.92) letters for 0.5 mg groups (n = 33) in Group B. Conjunctival haemorrhage and nasopharyngitis were the most commonly reported adverse events. Of the 13 serious adverse events reported, cerebral infarction (two incidences) was suspected to be study‐drug related. Conclusions: Pro re nata regimen of ranibizumab guided by monthly BCVA and other ophthalmic examinations appears effective in sustaining the BCVA gained with 12 monthly injections while reducing the number of injections during the extension phase. Ranibizumab was well tolerated during the extension phase.     

关于非小细胞肺癌的个体化治疗——第四期"中南三省肿瘤论坛"摘要

2007年3月4日，由华中科技大学同济医学院附属协和医院主办的第四期“中南三省肿瘤论坛”如期而至，来自湖北、湖南、江西三省的肿瘤治疗专家再次聚集江城武汉，围绕非小细胞肺癌（non-small cell lung cancer，NSCLC）的个体化治疗展开了深入讨论，本期讨论重点为非小细胞肺癌个体化治疗的临床因素和分子生物学因素，现简要总结如下。     

个性化教学在病理专科进修生教学中的应用

针对病理专科进修生水平参差不齐的现状,因材施教,在职业道德教育、理论知识学习、技能素质培养、科研意识开发和自学能力锻炼等方面实施个性化教学,明显提高了教学质量,得到进修生的肯定和赞许。     

Testing the individualized care model

BACKGROUND: Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear. OBJECTIVES: To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients. DESIGN AND METHODS: A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature. RESULTS: The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care. CONCLUSIONS: The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale.