Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents

BackgroundPatients with intellectual and developmental disabilities (IDD) are more likely to experience poor health outcomes and family physicians receive inadequate training to provide appropriate care to this patient group. Little prior research has studied how to effectively train family physicians to care for patients with IDD.ObjectiveThe aim of this pilot study was to assess the value of adding an experiential component to didactic education strategies to improve family medicine resident perceived comfort, skills and knowledge related to caring for patients with IDD.MethodsStructured education programs for residents were implemented at three primary care practices in Ontario, Canada. Two practices received didactic information only (didactic-only group); one received didactic information and an experiential training model including clinical interactions and a written reflection on that experience (didactic plus experiential group). In this separate-sample pre-post design, residents were invited to complete a brief anonymous survey prior to and following the training assessing their perceived comfort, skills and knowledge related to patients with IDD.ResultsAt baseline, there were no significant differences between the two groups of residents. At follow up, the experiential group reported significantly higher levels of comfort, skills, and knowledge compared to baseline for most items assessed, while in the didactic-only group most items showed little or no improvement.ConclusionThis pilot study suggests that providing residents the opportunity to participate in clinical encounters with patients with IDD, as well as a structured process to reflect on such encounters, results in greater benefit than didactic training alone.     

ICU患者家属创伤后成长体验的质性研究

目的 深入了解神经外科ICU患者家属创伤后成长的真实体验。方法 采用质性研究中描述性现象学研究法,于2019年4月—8月对12名上海市某三级甲等综合医院神经外科ICU患者家属进行深入访谈,借助Nvivo 11软件管理访谈资料,采用Colaizzi 7步分析法进行归纳分析并提炼主题。 结果 共提炼出4个主题：人生哲学的改变,包括对生命的欣赏、关注自身健康、确立生活的优先次序、不确定的未来;个人力量增强,包括挖掘优势潜能、责任感增强、自我依靠感增强;与他人关系改善,包括“为己利他”行为、人际交往中获益;有效应对,包括设定希望、向下比较、学会自我调适。 结论 神经外科ICU患者家属在对抗逆境的过程中能体验到创伤后成长,呈现积极的自我变化现象,临床医护人员应关注患者家属的积极体验,将创伤后成长与临床心理护理整合,促成临床干预向以激发潜能、培养积极力量、促进成长为主题的范式转变。     

首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历，为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid 、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE 数据库，检索时限均从建库至2021年7月31日，使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献，并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献，提炼出60个研究结果，整理成8个类别，得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化，营造患者及家属无障碍化就医环境；关注家庭照顾者早期心理健康的干预，满足其社会支持的需要，提高该类人群应激应对能力，促进照顾者心理康复。     

Fatty acid changes help to better understand regression of nonalcoholic fatty liver disease

AIM: To investigate whether liver steatosis reduction due to a six-month dietary intervention results in significant changes in the concentrations of fatty acids.METHODS: A group of 35 Caucasian individuals diagnosed with different levels of steatosis were prospectively enrolled in the present study.Analysis of the fatty acid profiles was performed according to changes in liver steatosis(liver steatosis reduction by one or two degrees) after a six-month dietary intervention.The diet helped reduce body mass in obese and overweight patients,and stabilize both glycemia and dyslipidemia.Fatty acids were extracted according to the Folch method and analyzed by gas chromatography.RESULTS: This study showed significant changes in fatty acid profiles in patients who had reduced liver steatosis by one as well as two degrees.A reduction in liver steatosis by one degree caused a significant increase in the level of the n-3 family: eicosapentaenoic acid(P < 0.055),docosapentaenoic acid-C 22:5(P < 0.05) and docosahexaenoic acid(P < 0.05).A reduction in liver steatosis by two degrees caused a significant decrease in serum palmitoleic acid-C 16:1(P < 0.05).CONCLUSION: Liver steatosis reduction is associated with changes in fatty acid profiles,and these changes may reflect an alteration in fatty acid synthesis and metabolism.These findings may help better understand regression of nonalcoholic fatty liver disease.     

脑卒中患者家属照顾者焦虑、抑郁水平与照顾者负荷的相关性研究

目的：探讨卒中家属照顾者的焦虑、抑郁水平与照顾者负荷之间的关联。方法以156例脑卒中患者的家属照顾者为研究对象，应用照顾者压力指标评估照顾者负荷，应用Hamilton抑郁量表和Hamilton焦虑量表评估抑郁、焦虑状态。简单相关分析用于探讨焦虑、抑郁评分与照顾者负荷评分之间的相关性。结果照顾者抑郁评分为（19．2±8．8）分，其中35．9％的家属照顾者有抑郁症状；焦虑评分为（15．7±5．6）分，其中53．2％的患者家属照顾者有焦虑症状。身体负荷、心理负荷、社会功能负荷和总负荷评分分别为（7．7±4．5）分、（12．8±7．4）、分（11．4±6．1）分和（31．9±16．6）分。相关分析发现，焦虑、抑郁评分与各负荷评分呈显著正相关。结论卒中患者的家属照顾者的焦虑、抑郁水平与照顾者负荷之间密切相关，通过护理工作降低照顾者负荷，可能会促进照顾者的心理健康。