Effects of the frequency of ostomy management reinforcement education on self-care knowledge,self-efficacy,and ability of stoma appliance change among Korean hospitalised ostomates

Patients who undergo stoma surgery experience difficulties in adapting physically and psychologically. The priority is to support them in learning self-care for successful rehabilitation and psychosocial adaption to a new life. In order to do this, it is important to provide ostomates with repetitive reinforcement education on self-care in a continuous and individual manner, not just to increase knowledge or perform related skills. This study aims to evaluate the effects of ostomy management reinforcement education (OMRE) in ostomates and to identify the optimal frequency of reinforcement education using an equivalent control group post-test design. Participants were 60 ostomates admitted to a university hospital after ostomy formation surgery, and they were randomly assigned to a control and two experimental groups of this study. The OMRE was given to the control group (n = 20), experimental group 1 (n = 20), and experimental group 2 (n = 20) once, twice, and three times, respectively. Participants' self-care knowledge, self-efficacy, and ability of stoma appliance change were evaluated before and after the OMRE. Major results of this study were as follows: the self-care knowledge score of post-test was higher than the pretest in the control, experimental 1, and experimental two groups (P < 0.001). The self-efficacy score of post-test was higher than the pretest in the control, experimental 1, and experimental 2 groups (P < 0.001). The self-care knowledge score according to the frequency of OMRE did not differ among the control, experimental 1, and experimental 2 groups (F = 1.921, P = 0.156). The self-efficacy score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 8.616, P = 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). The ability of stoma appliance change score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 49.546, P < 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). Results of this study suggested that the OMRE was effective for promoting hospitalised ostomates' self-care knowledge, self-efficacy, and ability of stoma appliance change, and two sessions of the OMRE was the most effective. Findings of this study may be useful in planning education programmes designed to improve self-care ability for hospitalised ostomates.     

A standing posture support device that reduces laparoscopic surgeons’ occupational lower limb stress

Background: We developed a surgical knee rest (SKR) that can be used to decrease the stress placed on the lower half of the body when surgeons work in the standing position. We tested the effectiveness of this device in the context of laparoscopic surgery.

Material and methods: Five healthy, right-handed male surgeons participated, and we recorded surface electromyography (sEMG) signals from the two heads of the left and right gastrocnemius (Gc) muscles during laparoscopic resections of colorectal cancer. The outcome variable was the percentage of maximum Gc muscle effort generated, reported as percent maximal isometric voluntary contraction (%MVC), and this variable was compared between surgeries performed with and without use of the SKR. Assessment covered the first 100?min of surgery, subdivided into two 50-min periods.

Results: Mean %MVC of the left Gc muscle for the full 100-min test period was significantly decreased when the SKR was used (p?=?.027, vs. SKR not used). Notably, mean %MVC of both Gc muscles was significantly decreased during the first 50?min of surgery (p?=?.008 and p?=?.0046).

Conclusion: The SKR is useful for decreasing physical stress incurred by laparoscopic surgeons when working in the standing position.     

Confessions of a New York rupture researcher: An insider’s guide and critique

Objective: The study of alliance rupture has become quite prevalent since 1990 and especially in the past 10 years where we have seen a noticeable surge in empirical publications on the subject. This honorary paper attempts to provide a critical review of this literature from the perspective of someone who has contributed to it in his collaborative work on a research program designed to investigate ruptures and to develop intervention and training models to resolve them. Method: This paper is organized into three topics or sections: (1) alliance rupture, (2) rupture resolution, and (3) alliance training; and it addresses definitions, findings, questions, and lessons with regard to each topic. Results/Conclusions: It suggests some clinical conceptualizations (concerning agency and communion as well as mutual recognition), training implications (regarding emotion regulation and deliberate practice), and methodological considerations (promoting pluralism and contextualism), along with future directions.     

从“湿疫”论治新型冠状病毒肺炎的思考

本文基于中医经典文献及临床实践思考,立足于"湿疫"理论阐释新型冠状病毒肺炎(简称"新冠肺炎")的病因、病机、传变规律及治疗方药。认为新冠肺炎乃湿毒疫邪所致,其病机特点为内外病邪相引,合而致病;本病除遵循卫、气、营、血传变规律外,同时也表现出三焦传变的过程。同时,通过归纳梳理相关中医经典著作中关于湿疫的证治方药,为新冠肺炎的中医诊治提供临床思路。     

从认知到行动——浅谈中国医疗健康机构应对气候变化和减少碳排放的措施

介绍了医疗健康机构应对气候变化的必要性,梳理了影响医疗机构碳排放的主要因素,列举了一些国家案例来阐释减少医疗服务碳排放的可能性,最后指出了医疗健康机构在实施温室气体核算和报告过程中须要注意的问题。     

2010-2018年重庆市恶性肿瘤发病死亡趋势分析

目的:分析重庆市2010-2018年恶性肿瘤发病死亡变化趋势。方法:收集整理2010-2018年重庆市肿瘤登记点恶性肿瘤发病死亡资料，采用SPSS 25.0分析恶性肿瘤发病率、中国人口标化发病率、世界人口标化发病率、年龄别发病率、死亡率、中国人口标化死亡率、世界人口标化死亡率、年龄别死亡率等。男性与女性、城市与农村发病率、死亡率的比较采用χ2检验,趋势变化采用年度变化百分比（APC），对APC的检验采用t检验。结果:重庆市恶性肿瘤发病率、中标率与世标率分别由2010年的200.08/10万、147.03/10万、162.53/10万上升至2018年的289.63/10万、195.85/10万、209.74/10万，APC分别为5.02%(4.39%～5.65%)、4.29%(3.77%～4.81%)、3.87%(3.36%～4.39%)，变化趋势均有统计学意义（P＜0.01）。恶性肿瘤发病率历年均是男性高于女性（P＜0.05）。2011年与2015年城市与农村地区恶性肿瘤发病率差异无统计学意义（P＞0.05），其它年份恶性肿瘤发病率均是城市高于农村，差异有统计学意义（P＜0.05）。男性与女性、城市与农村恶性肿瘤发病率均明显上升（P＜0.05）。2010年重庆市恶性肿瘤死亡率、中标死亡率与世标死亡率分别为152.10/10万、103.49/10万、117.91/10万,2018年死亡率、中标死亡率与世标死亡率分别为184.77/10万、110.87/10万、125.53/10万，死亡率以年均3.15%(2.33%～3.98%)上升（t=4.03,P=0.005）。恶性肿瘤死亡率历年均是男性高于女性。2010-2018年男性与女性恶性肿瘤死亡率分别以3.46%(2.63%~4.29%)与2.63%(1.92%～3.36%)上升（t=4.36,P=0.003;t=3.43,P=0.011）。2010-2018年城市地区恶性肿瘤死亡率变化趋势差异无统计学意义（P＞0.05）。2010-2018年农村地区恶性肿瘤死亡率以年均3.05%(2.33%～3.77%)上升（t=4.03,P=0.005）。结论:重庆市恶性肿瘤发病率与死亡率呈快速上升的趋势，应针对危险因素进行干预和普及早诊早治，降低恶性肿瘤的发病率与死亡率。