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991.
[目的]分析安徽省淮河两岸地区恶性肿瘤死亡率时间变化趋势。[方法]收集安徽省淮河两岸地区5个县区2009—2018年恶性肿瘤死亡数据,标化死亡率采用2000年中国人口普查标准人口进行标化,采用年度变化百分比(APC)分析死亡率时间变化趋势,并用年度变化贡献率分析各个癌种对恶性肿瘤死亡率趋势的贡献大小。[结果]无论性别,2009—2018年安徽省淮河两岸地区恶性肿瘤标化死亡率均呈下降趋势,但年均降幅较小。各癌种变化趋势不尽相同,其中食管癌、胃癌、肝癌下降较为明显,女性乳腺癌和宫颈癌上升明显。女性乳腺癌和宫颈癌APC分别为4.60%和12.45%,对女性恶性肿瘤上升趋势的贡献达85.21%。[结论]去除人口老龄化因素,自2009年以来安徽省淮河两岸地区恶性肿瘤死亡率有所下降,但降幅较小。消化系统恶性肿瘤死亡率呈下降趋势或可归功于癌症早诊早治项目工作的开展。妇女"两癌"防治值得重视。 相似文献
992.
In this paper, we propose a model for medical costs recorded at regular time intervals, e.g. every month, as repeated measures in the presence of a terminating event, such as death. Prior models have related monthly medical costs to time since entry, with extra costs at the final observations at the time of death. Our joint model for monthly medical costs and survival time incorporates two important new features. First, medical cost and survival may be correlated because more 'frail' patients tend to accumulate medical costs faster and die earlier. A joint random effects model is proposed to account for the correlation between medical costs and survival by a shared random effect. Second, monthly medical costs usually increase during the time period prior to death because of the intensive care for dying patients. We present a method for estimating the pattern of cost prior to death, which is applicable if the pattern can be characterized as an additive effect that is limited to a fixed time interval, say b units of time before death. This 'turn back time' method for censored observations censors cost data b units of time before the actual censoring time, while keeping the actual censoring time for the survival data. Time-dependent covariates can be included. Maximum likelihood estimation and inference are carried out through a Monte Carlo EM algorithm with a Metropolis-Hastings sampler in the E-step. An analysis of monthly outpatient EPO medical cost data for dialysis patients is presented to illustrate the proposed methods. 相似文献
993.
McHugh MD 《The International journal of eating disorders》2007,40(7):602-612
OBJECTIVE: To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). METHOD: Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). RESULTS: Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. CONCLUSION: Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN. 相似文献
994.
Background. Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. Aims and objectives. The specific aims of the study were to identify: ? Staff nurses’ attitudes towards pressure ulcer prevention. ? The behaviour of staff nurses’ in relation to pressure ulcer prevention. ? Staff nurses’ perceived barriers towards pressure ulcer prevention. Design. A cross‐sectional survey method was used. Methods. A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1. Results. The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses’ positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area. Conclusion. This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change. Relevance to clinical practice. This study provides a unique exploration of Irish nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management. 相似文献
995.
996.
Jessy A. Terpstra Rosalie van der Vaart Saskia Spillekom-van Koulil Arno van Dam Judith G.M. Rosmalen Hans Knoop Henriët van Middendorp Andrea W.M. Evers 《Patient education and counseling》2018,101(9):1702-1707
Objective
Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.Methods
The training consists of 1.5?days and covers the implementation domains “knowledge”, “skills”, “motivation”, and “organization”, by focusing on the therapy’s rationale, iCBT skills, and implementation strategies. Using an evaluation questionnaire, implementation determinants (therapist characteristics, e-health attitude, and implementation domains) and iCBT acceptance were assessed among participants after training.Results
Twenty-two therapists participated, who generally showed positive e-health attitudes, positive implementation expectations, and high iCBT acceptance. Organizational aspects (e.g., policy regarding iCBT implementation) were rated neutrally.Conclusions
An iCBT therapist training was developed and initial evaluations among participants showed favorable implementation intentions.Practice implications
Therapists’ positive training evaluations are promising regarding the dissemination of iCBT in daily practice. Organizational support is vital and needs to be attended to when selecting organizations for iCBT implementation. 相似文献997.
998.
999.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献1000.
目的 探讨左心房改变与心房颤动发生的关系.方法 根据心电图和动态心电图的检测,将160例患者分为三组,持续性房颤患者54例为A组,阵发性房颤患者52例为B组,仅有心电图P波增宽的患者54例为C组.所有入选患者均经超声心动图检测左心房内径,观察患者窦性心律时心电图P波最大时限(Pmax)和P波离散度(Pdisp),并分析与房颤发生的关系.结果 患者心电图P波切迹明显,Pmax增宽,Pdisp大者房颤发生率高;超声心动图检测左房内径大者房颤发生率高,持续性房颤比阵发性房颤患者左房内径更大(P<0.01).结论 左心房扩大、Pmax增宽、Pdisp增大与房颤的发生以及持续的时间有密切关系. 相似文献