会所康复模式在女性精神分裂症恢复期病人中的应用

目的:探讨会所康复模式在女性精神分裂症恢复期病人中的应用效果。方法:选取2019年2月—2020年3月精神科收治的100例女性精神分裂恢复期病人作为研究对象,按随机数字表法分为对照组、观察组各50例,对照组采取常规康复治疗,观察组在常规康复治疗基础上应用会所多维度康复治疗模式。采用阳性和阴性症状量表(PANSS)、疾病家庭负担量表(FBS)、日常生活能力量表(ADL)、生活满意度指数B量表(LSIB)评价两组病人干预前、干预3个月、干预6个月精神症状、家庭负担、日常生活能力、生活自理能力。结果:两组病人干预3个月、干预6个月PANSS、FBS、ADL及LSIB评分比较差异有统计学意义(P<0.05);两组组内干预前后PANSS、FBS、ADL及LSIB评分比较差异有统计学意义(P<0.05)。结论:女性精神分裂症病人在恢复阶段应用会所康复模式进行干预可改善其精神症状,缓解其家庭负担,调节其日常生活能力和生活自理能力,提升其生活满意度。     

基于ADOPT问题解决模式下的个体化护理对口腔正畸患者自我 护理能力的影响

目的 探讨ADOPT问题解决模式下的个体化护理对口腔正畸患者自我护理能力的影响。方法 选 取2021年1月-12月我院正畸科收诊的80例正畸患者作为观察对象，采用自拟抽签法随机分为对照组与观察 组，各40例。对照组采用常规护理，观察组采用ADOPT问题解决模式下的个体化护理，比较两组干预前后 自我管理能力、生活质量以及社会心理适应能力。结果 两组干预后1个月生活质量以及自我管理能力评分 高于干预前，且观察组高于对照组，差异有统计学意义（P＜0.05）。观察组接受水平、持续担忧、积极 面对评分高于对照组，差异有统计学意义（P＜0.05）。结论 ADOPT问题解决模式下的个体化护理有助于 提升口腔正畸患者自我管理能力及社会心理适应能力，进而提高患者生活质量。     

Characterizing Standardized Functional Data at Inpatient Rehabilitation Facilities

ObjectiveThe Improving Medicare Post-Acute Care Transformation Act of 2014 mandates using standardized patient functional data across post-acute settings. This study characterized similarities and differences in clinician-observed scores of self-care and transfer items for the standardized section GG functional domain and the functional independent measure (FIM) at inpatient rehabilitation facilities.DesignWe conducted secondary analyses of 2017 Uniform Data System for Medical Rehabilitation national data. Patients were assessed by clinicians on both section GG and FIM at admission and discharge. We identified 7 self-care items and 6 transfer items in section GG conceptually equivalent with FIM. Clinician-assessed scores for each pair of items were examined using score distributions, Bland-Altman plot, correlation (Pearson coefficients), and agreement (kappa and weighted kappa) analyses.Setting and ParticipantsIn all, 408,491 patients were admitted to Uniform Data System for Medical Rehabilitation-affiliated inpatient rehabilitation facilities with one of the following impairments: stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility.MeasuresSection GG and FIM.ResultsPatients were scored as more functionally independent in section GG compared with FIM, but change score distributions and score orders within impairment groups were similar. Total scores in section GG had strong positive correlations (self-care: r = 0.87 and 0.95; transfer: r = 0.82 and 0.90 at admission and discharge, respectively) with total FIM scores. Weak to moderate ranking agreements with total FIM scores were observed (self-care: kappa = 0.49 and 0.60; transfers: kappa = 0.43 and 0.52 at admission and discharge, respectively). Lower agreements were observed for less able patients at admission and for higher ability patients of their change scores.Conclusions and ImplicationsOverall, response patterns were similar in section GG and FIM across impairments. However, variations exist in score distributions and ranking agreement. Future research should examine the use of GG codes to maintain effective care, outcomes, and unbiased reimbursement across post-acute settings.     

Inspiratory muscle training improves performance of a repeated sprints ability test in professional soccer players

BackgroundInspiratory muscle training (IMT) is an important method of attenuating both respiratory and peripheral effort perceptions, consequently improving neuromuscular performance and resulting in greater improvements in exercise capacity than exercise training alone.ObjectiveThe aim of this study was to investigate the effects of IMT on exercise tolerance, repeated sprint ability (RSA) performance, maximal inspiratory pressure (MIP), and peak inspiratory flow (PIF) in a cohort of professional male soccer players.MethodsTwenty-two healthy male professional soccer players (18.3 ± 1.4 years; 174.5 ± 6.1 cm; 70.5 kg ± 4.6 kg; body fat 10.1 ± 4.2%) from a club in the Brazilian first division soccer league participated in this study. IMT consisted of 15 and 30 self-paced inspiratory breaths (each to 50% maximal static inspiratory pressure [P₀]) in the 1-and 2-week intervention period, respectively. IMT was performed prior to soccer training (1 sets.d⁻¹; 6 d.wk⁻¹) with repeated sprint ability (RSA) assessed pre- and post- the 2-week period of IMT.ResultsStatistical analyses identified a significant (p < 0.001) decrease in sprint time post-IMT. Additionally, RSA_best, RSA_mean, total sprint time and percentage of RSA performance decrement (RSA _{% dec}) also showed significant decreases (p < 0.0001) post-IMT. Additional measures including MIP and PIF were also significantly elevated (p < 0.0002) following the 2-week period of IMT.ConclusionIn conclusion, our results raise two important issues. Firstly, IMT demonstrated enhanced inspiratory muscle strength in professional soccer players. Secondly, this increase in inspiratory muscle efficiency led to a decrease in sprint time and improved exercise tolerance. We recommend that a standard training protocol be developed and tested in an experimental and control group with a large representative sample.     

Effects of the frequency of ostomy management reinforcement education on self-care knowledge,self-efficacy,and ability of stoma appliance change among Korean hospitalised ostomates

Patients who undergo stoma surgery experience difficulties in adapting physically and psychologically. The priority is to support them in learning self-care for successful rehabilitation and psychosocial adaption to a new life. In order to do this, it is important to provide ostomates with repetitive reinforcement education on self-care in a continuous and individual manner, not just to increase knowledge or perform related skills. This study aims to evaluate the effects of ostomy management reinforcement education (OMRE) in ostomates and to identify the optimal frequency of reinforcement education using an equivalent control group post-test design. Participants were 60 ostomates admitted to a university hospital after ostomy formation surgery, and they were randomly assigned to a control and two experimental groups of this study. The OMRE was given to the control group (n = 20), experimental group 1 (n = 20), and experimental group 2 (n = 20) once, twice, and three times, respectively. Participants' self-care knowledge, self-efficacy, and ability of stoma appliance change were evaluated before and after the OMRE. Major results of this study were as follows: the self-care knowledge score of post-test was higher than the pretest in the control, experimental 1, and experimental two groups (P < 0.001). The self-efficacy score of post-test was higher than the pretest in the control, experimental 1, and experimental 2 groups (P < 0.001). The self-care knowledge score according to the frequency of OMRE did not differ among the control, experimental 1, and experimental 2 groups (F = 1.921, P = 0.156). The self-efficacy score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 8.616, P = 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). The ability of stoma appliance change score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 49.546, P < 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). Results of this study suggested that the OMRE was effective for promoting hospitalised ostomates' self-care knowledge, self-efficacy, and ability of stoma appliance change, and two sessions of the OMRE was the most effective. Findings of this study may be useful in planning education programmes designed to improve self-care ability for hospitalised ostomates.     

住院医师规范化培训中科研能力的同质化培养

住院医师规范化培训是提高我国临床医师队伍整体素质和水平的重要举措。培训内容和培训方式也需要与时俱进才能培养出真正适应快速发展的医学事业人才。当前住院医师的培养多局限于理论知识灌输及临床操作技能的训练,忽视了科研能力的提高。特别是社会学员的科研能力训练往往被忽视,不符合目前住院医师规范化培训对同质化的要求。本文结合既往研究和自身从事规培管理工作的实践,从多角度对规培中针对科研能力培养存在的问题进行梳理,主要包括:带教教师的科研培训、学生自身提高、考核标准完善和基地配套保障四个方面。先提出各方面存在问题,再深入分析出现上述问题的原因,最后结合既往研究及自身实践,对上述各问题的解决方法进行分析和讨论,最后得出相应的具有可行性的解决方案。     

基于PDCA循环的过渡期护理对老年人瓣膜置换术后ICU出科时期的干预效果

目的探讨基于PDCA循环的过渡期护理对老年人瓣膜置换术后重症监护室（ICU）出科时期的干预效果。 方法选取2020年10月至2021年9月在遵义医科大学附属医院行瓣膜置换术的老年患者60例，其中30例在ICU出科过渡期采用常规护理（对照组），余30例采用基于PDCA循环的过渡期护理（观察组）。观察两组患者干预前后超声心动图相关指标左室射血分数（LVEF）和左心室舒张末期容积（LVEDV）、医院焦虑抑郁评分量表（HADS）评分、中文版Mishel疾病不确定感量表（MUIS）评分，以及日常生活能力评估量表（ADL）评分变化情况。计数资料的比较采用χ²检验，计量资料的比较采用t检验。 结果护理后，观察组LVEF和LVEDV指数均高于对照组（t=3.286、2.035，P<0.05），HADS-A、HADS-D和MUIS评分均低于对照组（t=3.873、3.873、6.076，P<0.01），ADL评分高于对照组（t=6.076，P<0.01）。 结论基于PDCA循环的过渡期护理可明显改善老年人瓣膜置换术后从ICU转入普通病房期间的焦虑情绪和疾病不确定感，促进心功能恢复，提高自理能力。     

临床医学专业“5+3”一体化本科全程导师制创新人才培养的实践与探索

以培养创新型人才为目标，大连医科大学制定实施了“5+3”创新人才培养改革方案，以导师制培养为载体，在医学本科教育全过程中，制定分阶段创新能力培养体系，涵盖课程、讲座、实验设计、论文等基本科研能力训练，强化本科生科研能力培养。通过对首届“5+3”学生阶段性培养成果的统计学分析发现，“5+3”学生发表中文期刊、SCI，主持国家级创新项目、省级创新项目的比例均显著高于普通5年制学生，差异具有统计学意义（P<0.05）。虽然实施过程中存在一些问题和不足，但以导师制为核心的科研基础训练对提高学生科研思维和创新能力效果显著，对培养医学创新型人才具有可实施性。