早期活动对ICU机械通气患者谵妄发生的影响

目的探讨早期活动对ICU机械通气患者谵妄发生的影响。方法将我院2016年10月-2017年4月ICU收治的137例机械通气患者随机分组并进行常规护理干预和早期活动干预,分别在入住ICU后第1天、第2天、第3天及停机械通气时对患者进行谵妄(CAM-ICU)评估、APACHEII评分,并记录患者ICU停留时间,分析早期活动对谵妄发生,病情改善及ICU停留时间的影响。结果与对照组相比,早期活动组在入院第3天后可以显著降低患者的ICU谵妄发生率、APACHEII评分,缩短患者ICU停留时间,差异有统计学意义(P0.05)。结论专业的早期活动可以降低ICU机械通气患者谵妄的发生率,改善患者病情。     

系铃铛法在预防老年痴呆住院患者坠床跌倒中的应用效果

目的：探讨系铃铛法在预防老年痴呆住院患者坠床跌倒中的应用效果。方法选择2013年6月－2014年3月入住我院老年科的轻中度老年痴呆患者110例，随机分为观察组和对照组各55例，两组均实施常规评估预防措施，观察组患者加用系铃铛法进行比较。结果阻止下床次数观察组243次，对照组155次，两组在阻止下床次数上差异有统计学意义（Mann‐Whitney U＝719，P＜0．001）。结论系铃铛法能有效预防轻中度老年痴呆住院患者坠床跌倒事件的发生，同时也能明显提高患者的满意度。     

精神分裂症有自杀行为患者的特点调查分析与护理对策

目的 了解精神分裂症有自杀行为患者的特点和临床特征,以便更好掌握这些高危因素,及时观察自杀先兆,防止自杀行为的发生。方法 用自设一般资料问卷,并检测阳性和阴性症状量表（PANSS）,锥体外系症状评定量表（SAES）,和异常不自主运动量表（AIMS）,吸烟严重程度采用问卷调查和尼古丁依赖测试评估（FTND）,并通过与家属和患者访谈,查阅病例资料,对我院住院的341名精神分裂症患者进行调查。结果 有自杀行为者发生率为9.7%,其中,男性为10.1%（24/238）,女性为8.7%（9/103）,男女之间比较,无统计学意义（P〉0.05）。与无自杀行为者相比,有自杀行为者单身人数较多、年龄较轻和住院次数较多（P〈0.05）。虽然有自杀行为者与无自杀行为者吸烟率比较差异无统计学意义（P〉0.05）,但有自杀行为者开始吸烟年龄早、每天吸烟量较多、尼古丁依赖FTND总分较高（P〈0.05）。另外有自杀行为者PANSS抑郁因子高于无自杀行为者（P=0.01）,差异有统计学意义。多元逐步Logistic回归分析显示,抑郁因子与自杀行为呈显著相关。结论 精神分裂症有自杀行为患者比一般人群高。护士应掌握这些人口学特点和临床特征,以便防止自杀行为的发生。     

Towards individualized cancer therapy: Challenges and prospects

At the 17th International Symposium in the annual series of prestigious meetings organized by the Fritz Bender Foundation, 07–09 November 2013, researchers, clinicians and students gathered to discuss and exchange knowledge on individualized cancer therapies. Co‐organized and hosted by the Vall d''Hebron Institute of Oncology (VHIO), Barcelona, Spain, the sessions covered genetic profiling of patients, tumor characterization, tumor–host relationships and therapeutic targets, with talks from many international experts in the field. The presentations summarized in this report illustrate the current status of our knowledge and the future directions for cancer research in these broad topic areas.     

The impact of the EU Directive on patients’ rights and cross border health care in Malta

The patients’ rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased patient mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of patients’ rights, negligible additional patient mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected patient mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on patients’ rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.     

Covid-19 vaccine immunogenicity in people living with HIV-1

IntroductionCOVID-19 vaccine efficacy has been evaluated in large clinical trials and in real-world situation. Although they have proven to be very effective in the general population, little is known about their efficacy in immunocompromised patients. HIV-infected individuals’ response to vaccine may vary according to the type of vaccine and their level of immunosuppression. We evaluated immunogenicity of an mRNA anti-SARS CoV-2 vaccine in HIV-positive individuals.MethodsHIV-positive individuals (n = 121) were recruited from HIV clinics in Montreal and stratified according to their CD4 counts. A control group of 20 health care workers naïve to SARS CoV-2 was used. The participants’ Anti-RBD IgG responses were measured by ELISA at baseline and 3–4 weeks after receiving the first dose of an mRNA vaccine).ResultsEleven of 121 participants had anti-COVID-19 antibodies at baseline, and a further 4 had incomplete data for the analysis. Mean anti-RBD IgG responses were similar between the HIV negative control group (n = 20) and the combined HIV+ group (n = 106) (p = 0.72). However, these responses were significantly lower in the group with <250 CD4 cells/mm³. (p < 0.0001). Increasing age was independently associated with decreased immunogenicity.ConclusionHIV-positive individuals with CD4 counts over 250 cells/mm³ have an anti-RBD IgG response similar to the general population. However, HIV-positive individuals with the lowest CD4 counts (<250 cells/mm³) have a weaker response. These data would support the hypothesis that a booster dose might be needed in this subgroup of HIV-positive individuals, depending on their response to the second dose.     

Beliefs about back pain: The confluence of client,clinician and community

Patient beliefs play an important role in the development of back pain and disability, as well as subsequent recovery. Community beliefs about the back and back pain which are inconsistent with current research evidence have been found in a number of developed countries. These beliefs negatively influence people's back-related behaviour in general, and these effects may be amplified when someone experiences an episode of back pain.In-depth qualitative research has helped to shed light on why people hold the beliefs which they do about the back, and how these have been influenced. Clinicians appear to have a strong influence on patients' beliefs. These data may be used by clinicians to inform exploration of unhelpful beliefs which patients hold, mitigate potential negative influences as a result of receiving health care, and subsequently influence beliefs in a positive manner.     

Preferences and needs of patients with a rheumatic disease regarding the structure and content of online self-management support

ObjectiveAim of this study was to investigate preferences and needs regarding the structure and content of a person-centered online self-management support intervention for patients with a rheumatic disease.MethodsA four step procedure, consisting of online focus group interviews, consensus meetings with patient representatives, card sorting task and hierarchical cluster analysis was used to identify the preferences and needs.ResultsPreferences concerning the structure involved 1) suitability to individual needs and questions, 2) fit to the life stage 3) creating the opportunity to share experiences, be in contact with others, 4) have an expert patient as trainer, 5) allow for doing the training at one’s own pace and 6) offer a brief intervention. Hierarchical cluster analysis of 55 content needs comprised eleven clusters: 1) treatment knowledge, 2) societal procedures, 3) physical activity, 4) psychological distress, 5) self-efficacy, 6) provider, 7) fluctuations, 8) dealing with rheumatic disease, 9) communication, 10) intimate relationship, and 11) having children.ConclusionA comprehensive assessment of preferences and needs in patients with a rheumatic disease is expected to contribute to motivation, adherence to and outcome of self-management-support programs.Practice implicationsThe overview of preferences and needs can be used to build an online-line self-management intervention.