基于理论域框架的ICU护士执行身体约束缩减行动障碍因素的质性研究

目的：探讨ICU护士执行身体约束缩减行动的障碍因素，为制定身体约束标准化管理方案提供依据。方法：基于理论域框架（TDF）制定访谈提纲，采用目的抽样法对天津市某三级甲等医院的12名ICU护士进行半结构式访谈，按照TDF的相关领域对转录后的资料进行归类，用内容分析法对访谈资料进行分析。结果：ICU护士对身体约束缩减行动理解存在偏差、对约束替代措施内容的不熟悉是其执行身体约束缩减行动的障碍因素之一；身体约束缩减方案评估工具、决策流程的不规范对缩减约束行动的开展造成了一定阻碍；环境因素的限制及对缩减约束结果的担忧，使ICU护士没有足够的信心去执行；科室缺乏支持缩减约束的组织氛围，难以引起护士对执行约束缩减行动的重视，进而削减执行的动力。结合理论域框架将上述因素分别归属为知识、自我效能、环境背景和资源、社会影响、行为规范5个领域。结论：知识、自我效能、环境背景和资源、社会影响及行为规范为ICU护士执行身体约束缩减行动的障碍因素。科室要在明确障碍因素的基础上，加强领导层对执行缩减约束的重视和支持。制定缩减约束评估决策规范化流程以及培训方案，倡导团队协作，创造支持身体约束缩减行动的组织氛围，坚定ICU护士执行缩减约束的信心，促进身体约束缩减行动的持续实施。     

Sports injury prevention programmes from the sports physical therapist's perspective: An international expert Delphi approach

ObjectiveTo provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports.DesignDelphi.SettingLimeSurvey platform.ParticipantsExperienced sports physical therapists from the International Federation of Sports Physical Therapy member countries.Main outcome measuresFactors related to sports IPP planning, organization and implementation.ResultsWe included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement).ConclusionStrong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.     

骨科围手术期患者静脉血栓栓塞症物理预防的最佳证据总结

目的总结骨科围手术期患者静脉血栓栓塞症（VTE）物理预防的证据，提高护理人员VTE物理预防措施实施依从性。方法根据澳大利亚JBI循证卫生保健中心证据总结方法学，检索骨科围手术期患者VTE物理预防相关文献，根据纳入文献类型，由研究人员独立进行质量评价，并提取、汇总最佳证据。结果共纳入文献17篇，包含10篇指南、1篇证据总结、2篇专家共识、4篇系统评价。经过分析，总结出7类共30条骨科围手术期患者VTE物理预防最佳证据。结论最佳证据可为护士提供循证依据。但在应用时，还需评估具体临床情境，结合专业判断和患者意愿，针对性选择证据，以促进护理质量的持续改进。     

Delineating the geographic context of physical activities: A systematic search and scoping review of the methodological approaches used in social ecological research over two decades

BackgroundThe social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature.MethodsOnline databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included.ResultsSubjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies.ConclusionsCurrent social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.     

Effects of virtual Reality-Based Training and aerobic training on gaming disorder,physical activity,physical fitness,and anxiety: A randomized,controlled trial

Background and aimThe effects of physical activity and exercise on gaming disorder severity in individuals with gaming disorder are unknown. The present study aimed to address the empirical gap in the current literature by comparing the effects of virtual reality-based training (VRT) and aerobic training (AT) exercise programs on gaming disorder severity, physical activity, physical fitness, and anxiety versus control group.Materials and methodsForty-four young male adults (18–28 years) with gaming disorder and a sedentary lifestyle were included in the study. The primary outcomes of the study were changes in gaming disorder severity and physical activity, and secondary outcomes included changes in physical fitness and anxiety levels. The participants were randomly assigned to VRT (n = 15), AT (n = 14) and control (n = 15) groups. Training sessions were performed at 50–70% of the maximal heart rate. Exercise programs consisted of 6 weeks of training 3 times a week for 30 min.ResultsThere was a decrease in the severity of gaming disorder as well as an increase in the level of physical activity in the VRT and AT exercise groups compared to the control group. In addition, a reduction was observed in the gaming time and sedentary time in both exercise groups versus control group. VRT group experienced greater improvements in physical fitness parameters than the AT group.ConclusionVRT and AT were effective in reducing gaming time and the severity of gaming disorder in individuals with gaming disorder. The therapeutic effects of VRT and AT can be used for reducing the severity of gaming disorder.     

School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature

The development and implementation of school policies is considered a key strategy for the promotion of physical activity (PA) in children and adolescents. This study aimed to systematically review and synthesise existing literature focusing on the associations between formal written school-based PA policies and (a) school PA practices and (b) PA behaviours of school-aged children and adolescents. Fifty-one papers reporting on 52 studies met the eligibility criteria. All but two studies were from high income countries, most used cross-sectional designs and demonstrated fair methodological quality, and just over a third examined language aspects of policies. Findings predominantly indicated a lack of or inconclusive associations between the various characteristics examined and PA outcomes. Inconclusive associations were identified between both PA practice and behaviour outcomes and state level policies, policies focusing on PE and school-day PA, and in studies examining language aspects of policies. Inconclusive associations with both types of outcomes were more likely to be identified compared to a lack of associations in studies using self-report measures and in studies not providing information about the quality of exposure and outcome measures used. Overall, findings highlight the need for further research that acknowledges the complex relationship between school policies and PA outcomes and employs robust methodological approaches to enhance our understanding of this area.     

眼科检查在神经遗传性疾病诊断及评估中的应用

神经遗传性疾病在临床上较罕见,且常因有多系统受累,临床表现复杂多变,故在疾病诊断,尤其在散发的不典型病例中更为困难。眼部,尤其是视网膜为中枢神经系统可视窗口,因其从胚胎期的神经管发育而来的,故在神经遗传性疾病中多有受累。利用眼底照相、光学相干层析成像(OCT)等常见眼科检查,可发现特征性的眼部改变。本文主要按照解剖分类,从眼球壁(角膜、巩膜、虹膜和脉络膜、视网膜)、眼内容物(玻璃体、晶状体)及视神经等几个方面,综述常见的有特征性眼部改变神经遗传性疾病,以提高临床医师对眼科检查在此类疾病中应用的认识,促进疾病的诊断。     

Latin dance and Qigong/Tai Chi effects on physical activity and body composition in breast cancer survivors: A pilot study

BackgroundBreast cancer survivors (BCS), particularly Latina BCS, experience weight gain and reduced physical activity (PA) post-treatment increasing the risk for recurrence. There is a lack of evidence on the intensity and type of PA needed to engage cultural subgroups and improve clinical outcomes. This study developed and piloted two non-traditional PA interventions among a diverse sample of BCS.MethodsTwenty BCS (65% Latina; age 25–75) participated in a 2-arm parallel group-randomized pilot study to test the effects of an 8-week Latin dance and Qigong/Tai Chi intervention on PA and body composition. A seven-day pedometer protocol was used to measure steps/week and a bioelectric impedence scale was used to assess BMI and %body fat. T-tests were used to examine preliminary outcomes across both interventions and within intervention arms.ResultsThere were no significant changes in steps/week, BMI, or %body fat across or in each separate intervention. A small effect size for increase in steps/day was found among participants in the Qigong/Tai Chi arm (0.10) and low-to-moderate effect sizes for reductions in % body fat overall (0.36), and separately for participants in Latin dance (0.26) and Qigong/Tai Chi (0.46).ConclusionLatin dance and Qigong/Tai Chi are engaging and acceptable PA modalities that are promising for improving PA and body fat among diverse, high-risk BCS. Our findings highlight the need to continue to reach and engage high-risk BCS, including Latina survivors, using novel, culturally-sensitive PA interventions. Future studies should extend and more rigorously test these novel approaches to improving outcomes associated with recurrence.