乳腺癌随访和药物副作用管理策略的研究进展

乳腺癌是全球女性发病率最高的恶性肿瘤,随着诊断技术及治疗手段的不断提高,乳腺癌患者接受系统治疗后生存期明显延长。乳腺癌患者需要长时间的随访以便及早监测到局部复发和远处转移。此外,激素敏感性乳腺癌患者还需要给予5~10年的内分泌治疗,针对其副作用的全程管理也需要随访,进而提高患者的生活质量,减轻患者疾病负担。本文就近年来乳腺癌随访相关方面进行简要综述。     

Enhancing adherence and management in patients with hypertension: Impact of form and frequency of knowledge intervention

BackgroundThe alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension.Materials and methodThe study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely ‘Direct Interaction’ and ‘Audio-Visual’. Each form was presented in two frequencies namely ‘single exposure’ and ‘double exposure’. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20.ResultsANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD.ConclusionThere was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.     

PDCA循环在皮肤科护理管理中的应用观察

目的 探究PDCA循环在皮肤科护理管理中的应用效果.方法 纳入医院皮肤科2017年8月—2018年10月间的患者,共100例,计算机筛选后分为对照组和观察组,均有50例,在治疗期间前者接受常规护理,后者采取PDCA循环管理护理,比对护理满意度、并发症、生活质量和瘙痒情况.结果 不良反应发生率[观察组(4.00%)vs.对照组(18.00%)],P<0.05;护理满意度[观察组(98.00%)vs.对照组(80.00%)],P<0.05;观察组各维度的生活质量评分值均显著高于对照组,P<0.05;瘙痒程度评估观察组显著低于对照组,P<0.05.结论 在皮肤科护理管理中采取PDCA循环管理,可改善患处皮肤状况,提升患者的舒适度,提高其生活质量,整体提升护理的水平.     

人性化护理模式在手术室护理中的应用价值评价

目的讨论人性化护理模式对手术室患者治疗效果。方法回顾分析我院2018年1月-2018年12月份手术室收治的160例患者,按照患者的个人意愿随机分为常规护理组和人性化护理组,每组各80例。分别采取常规护理和人性化护理,对比两组患者的治疗效果。结果根据数据统计结果显示,人性化护理组患者的护理满意度(73.75%)高于常规护理组(58.75%),P<0.05,具有统计学意义。结论由于手术室患者的病情较重,而且很容易对手术产生明显的恐惧情绪。而人性化护理模式能够照顾患者情绪,有效减少手术时间,增强患者的手术信息,确保整个手术顺利进行,也能够促进术后患者的康复效果。     

个性化营养管理在慢性阻塞性肺疾病患者中的应用

目的 探讨个性化营养干预对慢性阻塞性肺疾病（COPD）患者的营养知信行水平、营养指标及活动耐力的影响。方法 选取我院2017 年1 月～2018 年12 月收治入院的COPD 患者224 例，用NRS 2002 对224 例COPD 住院患者进行营养风险筛查，其中存在营养风险者（NRS 2002≥3 分）68 例，按照入院先后顺序分为对照组和观察组，每组34 例，对照组给予常规饮食护理，观察组根据个体营养状况给予个性化营养管理，均持续干预1 个月。比较两组干预前后的营养知信行水平、营养指标及活动耐力的影响。结果 观察组在干预后其营养知信行水平、BMI、血清总蛋白（TP）、白蛋白（ALB）、淋巴细胞（LMP）数值及6 min 步行距离均显著高于对照组（P＜0.05）。结论 个性化营养干预能有效提高COPD 患者的营养知信行水平、提高营养指标、改善营养状况、增强活动耐力，从而提高生活质量。     

Rare patients in routine care: Treatment and outcome in advanced papillary renal cell carcinoma in the prospective German clinical RCC-Registry

Non-clear cell renal cell carcinoma is a very rare malignancy that includes several histological subtypes. Each subtype may need to be addressed separately regarding prognosis and treatment; however, no Phase III clinical trial data exist. Thus, treatment recommendations for patients with non-clear cell metastatic RCC (mRCC) remain unclear. We present first prospective data on choice of first- and second-line treatment in routine practice and outcome of patients with papillary mRCC. From the prospective German clinical cohort study (RCC-Registry), 99 patients with papillary mRCC treated with systemic first-line therapy between December 2007 and May 2017 were included. Prospectively enrolled patients who had started first-line treatment until May 15, 2016, were included into the outcome analyses (n = 82). Treatment was similar to therapies used for clear cell mRCC and consisted of tyrosine kinase inhibitors, mechanistic target of rapamycin inhibitors and recently checkpoint inhibitors. Median progression-free survival from start of first-line treatment was 5.4 months (95% confidence interval [CI], 4.1–9.2) and median overall survival was 12.0 months (95% CI, 8.1–20.0). At data cutoff, 73% of the patients died, 6% were still observed, 12% were lost to follow-up, and 9% were alive at the end of the individual 3-year observation period. Despite the lack of prospective Phase III evidence in patients with papillary mRCC, our real-world data reveal effectiveness of systemic clear cell mRCC therapy in papillary mRCC. The prognosis seems to be inferior for papillary compared to clear cell mRCC. Further studies are needed to identify drivers of effectiveness of systemic therapy for papillary mRCC.     

BIM技术在医院建设与运维管理中的应用与设想

医院建筑功能复杂,改造工程工期紧张,如何能够借助BIM技术更好地实现医院、设计单位、施工单位协同工作、加快推进工程进度、提高管理效率成为亟待解决的问题。北京协和医院西单院区北楼改造工程在设计与实施过程中,以问题为导向,借助BIM技术进行设计、施工、运维管理,最终解决医院改造项目中的棘手难题。结合BIM技术优势与特点,提出该技术在医院运维管理中应用的设想。     

PDCA循环在消化道肿瘤伴糖尿病患者营养全程管理中的效果观察

目的 探讨PDCA 循环在消化道肿瘤伴糖尿病患者营养全程管理中的效果观察。方法 运用PDCA循环对80例不同程度营养不良的消化道肿瘤伴糖尿病患者实施营养全程管理,比较干预前后患者的体重、BMI指数、糖化血红蛋白、血红蛋白、总蛋白、白蛋白及球蛋白水平。结果 患者血红蛋白、总蛋白、白蛋白及球蛋白水平均有提高,比较差异均有统计学意义(P＜0.05)。结论 PDCA循环管理在消化道肿瘤伴糖尿病患者营养全程管理中有较大的优势, 值得推广。