结核病专科医院临床护士营养知识态度现状调查分析

目的了解结核病专科医院护士的营养知识和态度的现状,分析其相关性,为针对性地进行营养知识培训提供依据。方法采用方便抽样的方法,对某三甲结核病专科医院的256名临床护士的营养知识和态度进行调查。结果护士营养知识正确率53.74%,得分(16.12±4.56)分,其中良好、一般、差者分别占1.2%、41.0%、57.8%;不同年龄、工作年限、学历、职务、编制、工作状况护士的营养知识掌握情况比较,差异有统计学意义(P0.05,P0.01);态度得分为(94.56±10.53)分,持正性、中性、负性态度者分别占64.5%、33.6%、1.9%,不同职称护士的营养态度得分差异有统计学意义(P0.01);营养知识与态度呈正相关(P0.01)。结论护理管理者应加强对护士营养知识的培训,端正其对营养的态度,从而提高营养护理质量。     

L’avancée en âge des personnes atteintes de troubles du spectre de l’autisme. Éléments cliniques et psychopathologiques

ObjectivesThis article attempts, from a psychopathological perspective, to clarify the clinical evolution of patients with ASD during adulthood and into old age, and to assess the risks and the chances. In addition, the article also attempts to address the experiences of these people confronted with their own aging, the death of loved ones, and their own mortality. This study of a cohort of 314 elderly patients can provide some data concerning these changes.MethodThe study of the cohort of 314 adult and aging patients makes it possible to specify several aspects of ASD in adulthood: level of severity, associated disorders and co-morbidities (psychiatric disorders, intellectual deficit, epilepsy, neurosensory disorders, genetics). At the clinical and psychopathological level, the behavioral disorders are described therein with reference to the dominant psychopathological modes of functioning: typical autistic modalities (notion of post-autistic recourse), symbiotic modalities, acute anxious exacerbations, depressive and manic functionings.ResultsPropose an elucidation of challenging behaviors (or problem behaviors) and make it possible to address them; demonstrate that their evolution during advancing age is rather favorable while insisting on the permanent vulnerability of certain subjects. Specify the main courses of action, insisting on spatial, temporal, and relational security; on the central place of care procedures (fundamental physiological needs, consideration of somatic pathologies, specific care with psychotropic drugs, psycho-corporal approaches); and on the attention paid to everyday life, a major therapeutic mediator, through maintaining a reasonable amount of activity.DiscussionThe approach proposed here confirms that the main problem facing adults diagnosed with ASD is that of associated disorders and psychiatric co-morbidities, more than that of the fundamental symptomatic particularities necessary for the diagnosis of ASD (the autistic tripod). This requires going beyond the notion of challenge behavior and adopting a functional perspective that ultimately reveals sometimes major psychic suffering and the adaptive attempts that these patients make to cope with it.ConclusionThe clinical work with this particular population confirms the need for structured institutional work, the only thing that can ensure the coherence of the approaches to working with this diverse patient population, one that is diverse, with generally favorable developments, but which still remains very vulnerable.     

养老机构志愿者预立医疗照护计划培训效果评价

目的 开展养老机构志愿者预立医疗照护计划培训并评价其效果。方法 应用基于Bloom目标教学理论构建的养老机构志愿者预立医疗照护计划培训内容,结合《预立医疗照护计划》知识教育手册、《我的五个愿望》手册、案例视频等教具,通过角色扮演、案例讨论等方式对53名养老机构志愿者进行培训。培训前后使用养老机构志愿者预立医疗照护计划知信行及自我效能问卷对志愿者进行调查,根据志愿者角色扮演表现评价其预立医疗照护计划沟通技能。结果 培训前后志愿者预立医疗照护计划认知、态度、行为意愿及自我效能差异有统计学意义(P<0.05,P<0.01),培训后75.47%志愿者预立医疗照护计划沟通技能达合格及以上水平。结论 预立医疗照护计划培训能改善养老机构志愿者的预立医疗照护计划知信行及自我效能感,培养其预立医疗照护计划沟通能力。     

永久性肠造口患者健康素养量表的编制

目的 构建永久性肠造口患者健康素养评估工具。 方法 参考国内外文献与质性访谈,建立量表条目池,通过2轮专家咨询对条目进行删改,调查220例永久性肠造口患者进行信效度评定。 结果 正式量表包括3个领域31个条目,功能领域产生4个公因子（获取肠造口信息能力、阅读肠造口信息能力、理解肠造口信息能力、交流肠造口信息能力）,知识领域产生2个公因子（肠造口预防保健知识、肠造口护理技能知识）,态度领域产生2个公因子（肠造口观点、肠造口行为倾向）。8个公因子的方差累积贡献率56.787%。量表水平内容效度0.890,量表Cronbach′s α系数0.864,折半信度系数0.923。 结论 永久性肠造口患者健康素养量表信效度良好,可作为永久性肠造口患者健康素养测评工具。     

Association between preoperative serum albumin levels with risk of death and postoperative complications after bariatric surgery: a retrospective cohort study

BackgroundHypoalbuminemia is common among individuals with obesity who qualify for bariatric surgery, but its relevance to clinical outcomes after bariatric surgery remains to be established.ObjectivesTo examine the association of preoperative serum albumin with 30-day postoperative outcomes.SettingData from the 2015–2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files were used.MethodsPreoperative serum albumin level was categorized as hypoalbuminemia (<3.5 g/dL), and normoalbuminemia (3.5–5.5 g/dL) among patients who underwent bariatric surgery. Multivariate logistic regression models were used to determine the association of preoperative hypoalbuminemia with 30-day postoperative mortality and other co-morbid outcomes.ResultsAmong 633,011 adult patients, 85.1% were women and the mean (standard deviation) age was 44.8 (12.0) years. The prevalence of hypoalbuminemia was 6.13% (n = 38,792). After adjustment for procedure type and demographic, lifestyle, and co-morbidity covariates, the odds ratio (OR) (95% confidence interval [CI]) for mortality was 1.42 (1.10, 1.82) for hypoalbuminemia. For all other outcomes, the ORs (95% CIs) for hypoalbuminemia ranged from 1.03 (.67–1.60) for cardiac arrest requiring CPR to 2.32 (1.66–3.25) for failure to be discharged by day 30. The ORs for several associations were higher for severe hypoalbuminemia than marginal hypoalbuminemia.ConclusionPreoperative hypoalbuminemia was associated with several negative 30-day postoperative bariatric surgery outcomes and tended to be worse for severe hypoalbuminemia compared with marginal hypoalbuminemia. These findings suggest that serum albumin may be a useful biomarker to screen for negative bariatric surgery outcomes.     

Foot care knowledge,attitudes and practices among patients with diabetic foot and amputation in St. Kitts and Nevis

About one‐third of admissions to the surgical unit annually are diabetes foot infections in need of amputation In St. Kitts and Nevis. However, the risk factors related to diabetes foot and amputation remain unknown. This study investigated factors associated with diabetic foot and amputation (DFA). Retrospective case control study design, and purposive and quota sampling method was used to recruit the participants. Patients with and without DFA were interviewed at two main hospitals, several primary health centres, and a private doctor's office during July and August 2018. Self‐development questionnaires were applied to assess patients' demographic, physical and behaviour, foot care knowledge, attitudes, and practices related to DFA. Chi‐square, t‐test, and multiple logistic regressions were used to analyse the data. A total of 210 patients were evaluated, 89 had DFA, while 121 did not, with a mean age of 61.10 (SD = 11.85). Participants' responses indicated good knowledge, favourable attitudes, and adequate practices related to foot care. The two items of the questionnaire, ways to maintain blood flow in the lower extremities and wash their feet daily, had significant lower score in DFA group. In multiple logistic regression, knowledge, attitudes, and practices related to foot care were not a significant predictor of DFA. Being male was a predictor of DFA than female (OR = 3.53; 95% CI = 1.65‐7.57; P < .01). Participants who were currently unemployed were less likely to have DFA than those who were employed (OR = 0.38; 95% Cl = 0.17‐0.86; P < .05). Comparing patients with the longest experience of diabetes mellitus (31 years or more) with those who had diabetes for the shortest period of time (between 1 and 10 years) was less likely to have DFA (OR = 0.38; 95% CI = 0.15‐0.97; P = <.05). The combination of these independent variables could explain 29% of the variance in DFA. Based on these findings, strategies to prevent diabetic foot and amputation should focus on male and outdoor heavy worker, and longer duration of diabetes patients which are identified in this study.     

线粒体损伤在急性胰腺炎发病机制中的作用

急性胰腺炎(AP)是一种严重的炎症性疾病,其发病机制尚未完全阐明,因此临床上缺乏特异性的治疗方案。越来越多的研究表明线粒体损伤在AP的发病机制中处于中心地位。目前认为,线粒体损伤与钙超载、细胞内ATP耗竭、线粒体膜通透性改变、自噬受损等关系密切,这些病理变化共同参与AP的发生发展。此外,线粒体对腺泡细胞死亡途径的调控也在AP中发挥着重要作用。笔者就AP中线粒体损伤的病理机制研究进展作一综述。     

乌鲁木齐市少数民族大学生艾滋病知识、态度、行为现况调查研究

[目的]了解乌鲁木齐市少数民族大学生艾滋病相关知识、态度、行为及其影响因素,为制定针对性干预措施提供依据.[方法] 采用统一调查问卷,在乌鲁木齐市4所高校随机抽取3 676名少数民族大学生,进行横断面现场调查,了解少数民族大学生艾滋病相关知识、态度、行为;采用多元线性回归分析方法筛选艾滋病相关态度的影响因素.[结果]艾滋病相关知识均分为9.94分(满分22分),对艾滋病感染者的态度均分为1.96分(满分20分);知识分值与态度分值呈正相关(r=0.326,P＜0.05);多元线性回归分析表明,艾滋病知识、专业、年级是影响大学生对待艾滋病/人类免疫缺陷病毒感染者态度的主要因素.[结论]少数民族大学生艾滋病相关知识贫乏,对人类免疫缺陷病毒感染者与艾滋病病人存在较明显的歧视态度.高校应结合少数民族学生特点针对性地开展预防艾滋病健康教育工作,端正学生对艾滋病病人的态度,提高自我保护意识.