经脐单孔腹腔镜治疗泌尿系疾病的围手术期护理体会

目的：讨论泌尿系疾病使用经脐单孔腹腔镜手术治疗的护理方法及体会。方法对我科2012年4月~12月住院患者行单孔腹腔镜手术治疗20例进行完善的术前准备、术后密切观察生命体征，实施各项护理措施预防并发症的发生。结果20例患者均顺利手术，手术后未发生并发症。结论单孔腹腔镜手术治疗泌尿系疾病在临床迅速发展，对手术患者实施针对性的护理，预防并发症，有助于加快康复，提高患者生活质量。     

Muscle strengthening intervention for boys with haemophilia: Developing and evaluating a best‐practice exercise programme with boys,families and health‐care professionals

BackgroundMuscle strengthening exercises have the potential to improve outcomes for boys with haemophilia, but it is unclear what types of exercise might be of benefit. We elicited the views of health‐care professionals, boys and their families to create and assess a home‐based muscle strengthening programme.ObjectiveTo design and develop a muscle strengthening programme with health‐care professionals aimed at improving musculoskeletal health, and refine the intervention by engaging boys with haemophilia and their families (Study 1). Following delivery, qualitatively evaluate the feasibility and acceptability of the exercise programme with the boys and the study''s physiotherapists (Study 2).DesignA person‐based approach was used for planning and designing the exercise programme, and evaluating it post‐delivery. The following methods were utilized: modified nominal group technique (NGT) with health‐care professionals; focus group with families; exit interviews with boys; and interviews with the study''s physiotherapists.ResultsThemes identified to design and develop the intervention included exercises to lower limb and foot, dosage, age accommodating, location, supervision and monitoring and incentivization. Programme refinements were carried out following engagement with the boys and families who commented on: dosage, location, supervision and incentivization. Following delivery, the boys and physiotherapists commented on progression and adaptation, physiotherapist contact, goal‐setting, creating routines and identifying suitable timeframes, and a repeated theme of incentivization.ConclusionsAn exercise intervention was designed and refined through engagement with boys and their families. Boys and physiotherapists involved in the intervention''s delivery were consulted who found the exercises to be generally acceptable with some minor refinements necessary.     

Healthcare transition from childhood to adulthood in pseudoxanthoma elasticum: Patient experience and recommendations for health practitioners

PurposeHealth-care transition (HCT) is a necessary part of the care process for allsick adolescents, to allow their empowerment while limiting disruption to follow-up care. Pseudoxanthoma elasticum (PXE) runs the risk of losing patients to follow-up because young patients are predominantly asymptomatic. This can be detrimental as it can prevent primary prevention measures from being properly implemented. The purpose of this study was to assess satisfaction of PXE patients with their health-care transition and to identify the factors associated with its success, in order to improve care management in young PXE patients.MethodsPatients aged 22 to 40 years diagnosed with PXE before the age of 16 years were included from the cohort of patients followed at Angers University Hospital. They were sent a questionnaire for the purposes of collecting data on medical management during adolescence, transition and adulthood.ResultsEleven responses were obtained from the 21 patients surveyed. The median satisfaction score of PXE patients regarding their transition was 5/10. Three patients reported having discontinued follow-up after transition. In adulthood, the majority of the participants were followed up by 4 specialists as recommended. It was incumbent on 50% of the patients who changed doctors to provide details of their own medical history to the new practitioner.ConclusionBetter intra-practitioner communication and a chart summarizing the principles of primary prevention, optimal follow-up care and its frequency are simple to implement and in all likelihood result in better health-care transition for young PXE patients.     

国医大师禤国维应用酸敛法治疗小儿特应性皮炎经验

介绍禤国维教授应用酸敛法治疗小儿特应性皮炎的临床经验。认为表虚兼有表燥是本病的基本病机特点,酸敛法可调理肺气、收敛心神、收敛肝气;治疗上注重散收并用,乌梅、五味子、白芍为其最常用的酸敛药,可调理肺、心、肝三脏的功能,并通过与辛散类药物(紫苏叶、防风、蝉蜕等)的配合,达到敛阴而不留邪、祛邪而不伤正的效果。并附验案1则。     

Using Simulation to Educate Rural NP students About Cultural Congruence

Between 2000 and 2010, the Hispanic population grew by 44% in rural areas. This community faces barriers to health care. Future nurse practitioners must be educated to provide culturally competent care for patients and families in a primary care setting. A simulation-based learning experience was used evaluate learning modules regarding rural health and Spanish language and culture. A “1 group: pretest–posttest” preexperimental design using the Transcultural Self-Efficacy Tool (TSET) was used to obtain quantitative and qualitative data from nurse practitioner students participating in a simulation-based learning experience to measure students’ self-perceptions of cross-cultural competence. All TSET measures achieved Cronbach’s alpha values of 0.98 or higher.     

Depression embodied: an ambiguous striving against fading

Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative‐based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patient's struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in‐between.     

Using Linked Data for polarity classification of patients’ experiences

Polarity classification is the main subtask of sentiment analysis and opinion mining, well-known problems in natural language processing that have attracted increasing attention in recent years. Existing approaches mainly rely on the subjective part of text in which sentiment is expressed explicitly through specific words, called sentiment words. These approaches, however, are still far from being good in the polarity classification of patients’ experiences since they are often expressed without any explicit expression of sentiment, but an undesirable or desirable effect of the experience implicitly indicates a positive or negative sentiment.This paper presents a method for polarity classification of patients’ experiences of drugs using domain knowledge. We first build a knowledge base of polar facts about drugs, called FactNet, using extracted patterns from Linked Data sources and relation extraction techniques. Then, we extract generalized semantic patterns of polar facts and organize them into a hierarchy in order to overcome the missing knowledge issue. Finally, we apply the extracted knowledge, i.e., polar fact instances and generalized patterns, for the polarity classification task. Different from previous approaches for personal experience classification, the proposed method explores the potential benefits of polar facts in domain knowledge aiming to improve the polarity classification performance, especially in the case of indirect implicit experiences, i.e., experiences which express the effect of one entity on other ones without any sentiment words.Using our approach, we have extracted 9703 triplets of polar facts at a precision of 92.26 percent. In addition, experiments on drug reviews demonstrate that our approach can achieve 79.78 percent precision in polarity classification task, and outperforms the state-of-the-art sentiment analysis and opinion mining methods.