The role of physician extenders in managing patients with chronic hepatitis C

The number of "physician extenders" (nurse practitioners and physician assistants) caring for patients with chronic hepatitis C is rising rapidly. Their growing role in the management of these patients promises greater efficiency in the delivery of care and more provider interaction with patients. This may yield benefits in terms of patient education and support, management of medication side effects, and patient adherence to treatment regimens. This article reviews the role of physician extenders in the management of patients with hepatitis C and outlines strategies for maximizing their contribution to the care of these patients.     

个体化护理干预对慢性丙型肝炎患者抗病毒治疗期间自我效能的影响

目的探讨个体化护理干预对慢性丙型肝炎患者抗病毒治疗期间自我效能的影响。方法将121例接受抗病毒治疗的慢性丙型肝炎患者分为对照组59例和干预组62例,对照组抗病毒治疗采取常规健康教育指导,干预组抗病毒治疗中采用一对一健康教育与电话随访服务。分别在干预前、干预后4周、12周、24周时评价两组患者自我效能。结果干预组患者自我效能总分及各维度得分在治疗4周、12周、24周时均高于对照组(P0.01或P0.05)。结论个体化护理干预能有效提高慢性丙型肝炎患者抗病毒治疗期间的自我效能水平,帮助患者顺利完成抗病毒治疗。     

The role of hepatitis C virus RNA detection in various substrates of patients with chronic hepatitis C

Puncture biopsy of the liver and blood count were made in 72 patients with chronic hepatitis C (CHC). Morphological alterations in the liver were assessed by Knodell index. The blood serum, lymphocytes and hepatic tissue were examined for a genome form of hepatitis C virus (HCV) RNA, blood lymphocytes and hepatic tissue--for a relevant replication form. HCV RNA was detected using "nested" RT-PCR. Only 26% patients had symptoms of asthenovegetative and dyspeptic syndromes. Normal alaninaminotransferase (ALT) level was observed in 24% patients, the rest had it high. HCV RNA was encounted more frequently in hepatic tissue than lymphocytes or serum (83, 68 and 46%, respectively). A replication form of HCV RNA was present in hepatic tissue of 31% patients and was absent in the lymphocytes. The incidence of the RNA detection was not related either to the disease symptoms or morphological alterations in hepatic tissue. The occurrence of the genome and replication forms in hepatic tissue does not correlate to ALT level. HCV RNA occurs more often in the serum, blood lymphocytes and in three substrates simultaneously in patients with hyperalatemia.     

Developing a nursing service for patients with hepatitis C

Hepatitis C is a chronic viral infection, which can progress to cirrhosis, liver failure, liver cancer and death. This article describes a model implemented to improve the care of people with hepatitis C in Calderdale and Huddersfield. The aim was to design a model of care based on patient need and create a flexible hepatitis C testing service for current and former injecting drug users. The new service concentrated on three elements: developing the local hepatitis C support group; introducing an integrated care pathway and booklet for assessing patients on treatment for hepatitis C; and implementing a viral hepatitis clinical nurse specialist role in the local drug and alcohol action team.     

The role of nurses in managing patients with heart failure

Heart failure is a clinical syndrome caused by a reduction in the heart's ability to pump blood around the body. The prevalence of heart failure due to coronary heart disease (CHD) is increasing, despite the declining overall mortality from CHD. This is thought to be due to both an ageing population and to more people surviving acute heart attacks but then experiencing residual left ventricular dysfunction (Department of Health, 2002). The National Service Framework for Coronary Heart Disease (DoH, 2002) sets out clear standards for the treatment of patients with heart failure.     

Case study on drug-related adverse effects of hepatitis C therapy

The case of a 46-year-old woman with chronic hepatitis C who was prescribed subcutaneous pegylated interferon once a week and oral ribavirin once a day is presented. Within 24 h after the first injection to her left arm, the patient developed pruritus and erythematous papules at the injection site and painful papules on her hands. After immediate administration of antihistamines, the pruritus and papules remitted. One wk later, after injection in the right arm, skin lesions and pruritus were seen. After the third injection to the abdomen, the patient developed a rash, and after the fourth and fifth injections to other areas of the abdomen, injection-site papules were seen. The patient had no skin reactions for the next 12 mo, with the exception of injection-site papules. Hepatitis C virus RNA was negative after 12 mo of treatment. Clearly, patience is important during hepatitis C therapy in order to avoid unnecessary examinations and to promote successful outcomes.     

The district nurse's role in managing patients with heart failure

Heart failure is a complex disorder that affects patients and their carers in many ways. Recommendations for improving the quality of care for people with heart failure are set out in the government's National Service Framework for Coronary Heart Disease (Department of Health (DH) 2000a) and in the guideline commissioned by the National Institute for Clinical Excellence (NICE 2003a), which describes best practice for the management of patients with heart failure. This article discusses the role of the district nurse in meeting the challenges of the NICE guideline, and suggests that district nurses are better placed than other health professionals in primary care to have a central role in delivering such care. The contribution of district nurses to the management of patients with chronic diseases and those who are terminally ill at home is also discussed. The impact of The NHS Cancer Plan (DH 2000b) on the care of cancer patients in primary care is examined briefly to ascertain whether the NICE guideline is likely to have a similar impact on the scope and capacity of district nursing.     

Challenges and issues in managing hepatitis C

Hepatitis C virus infection is the most common chronic bloodborne infection in the world. Injecting drug users are most at risk of infection in the UK and other industrialised countries but this group remains hard to reach. This article discusses the epidemiology, diagnosis and treatment of HCV, including new treatment strategies. It also explores and gives advice for general nurses.     

护理干预对慢性乙型肝炎患者抗病毒治疗依从性的影响

慢性乙型肝炎是我国感染率和发病率最高的传染病,目前临床主要应用干扰素、拉米夫定等进行抗病毒治疗[1]。但抗病毒药物具有用药时间长,费用高等特点,干扰素疗程一般需9个月,拉米夫定疗程至少1 a[2]。因此,加强对患者的用药指导,提高治疗依从性,具有重要意义。本研究对我院肝病     

护理干预对慢性乙型肝炎患者抗病毒治疗依从性的影响

目的通过护理干预，提高慢性乙型肝炎患者抗病毒治疗的依从性。方法将68例使用干扰素治疗和／或拉米夫定抗病毒治疗的慢性乙型肝炎患者随机分为实验组和对照组各34例，实验组实施一系列护理干预，对照组则不予以干预，分别对2组患者于疗程结束后进行遵医行为调查。结果实验组有23例患者能完全遵医，占67．65％，对照组19例患者能完全遵医，占55．88％．2组遵医程度差异显著。结论护理干预可提高慢性乙型肝炎患者抗病毒治疗的依从性。     

左西孟旦治疗急性失代偿性心力衰竭患者不良反应的观察和护理

观察45例急性失代偿性心力衰竭患者应用左西孟旦治疗前后的症状和体征,记录左西孟旦治疗过程中的不良反应,包括血压降低、心律失常和头痛。护理要点是加强用药期间的心电监护,尤其是负荷剂量给药时及持续给药初期;监测血钾、肝肾功能及自觉症状变化;根据患者自身状况和反应通知医生,调整剂量和用药时间等。     

血浆置换联合血浆灌流治疗重型肝炎病人不良反应的观察及护理

重型肝炎是我国常见传染病之一,由于病情发展迅速,预后极差,尽管保肝支持治疗和监护技术不断进步,病死率仍高达70%～80%.     

血浆置换联合血浆灌流治疗重型肝炎病人不良反应的观察及护理

重型肝炎是我国常见传染病之一，由于病情发展迅速，预后极差，尽管保肝支持治疗和监护技术不断进步，病死率仍高达70％-80％。近年来，人们不断探索治疗重型肝炎的新疗法，取得了一定的效果。我科于2004年2月-2007年5月在内科综合治疗的基础上，采用血浆置换联合血浆灌流治疗慢性重型肝炎35例，取得较好疗效。现将不良反应的观察及护理总结如下。     

人文关怀护理在慢性乙肝病人中的应用

目的 评价人文关怀护理在慢性乙肝病人中的应用效果。方法 将2004年1～12月在我院住院实行人文关怀护理慢性乙肝病人98例，与2003年1～12月实施人文关怀护理前80例慢性乙肝病人进行病人满意度比较。结果 病人对护理的满意度从2003年的86．25％提高至2004年的97．95％，经x^2检验，差异有非常显著性（P〈0．01）；护患纠纷从3降为0。结论 在慢性乙肝病人中实施人文关怀护理可提高病人满意度，减少护患纠纷，帮助病人掌握健康知识，利于病人康复。     

延续性护理对老年冠心病不稳定性心绞痛患者的护理效果及不良事件预防

目的探究延续性护理对老年冠心病不稳定性心绞痛患者的护理及不良事件预防的效果。方法选择本院收治的冠心病不稳定性心绞痛老年患者150例,随机数字分为对照组与观察组各75例,对照组实施常规护理,观察组在此基础上实施延续性护理。2组分别以各自的方式护理6个月后进行抑郁自评量表(SDS)、焦虑自评量表(SAS)评分,比较患者心绞痛发作频率和持续时间,评价2组护理方式的护理效果,记录患者心脏不良事件(顽固性心绞痛、急性心肌梗死、心律失常、心源性休克、心力衰竭、猝死)的发生率。结果 2组护理前SDS和SAS评分、心绞痛发生频率、心绞痛持续时间以及不良事件发生率无显著差异(P0.05),护理后观察组得分优于对照组,心绞痛发生频率、持续时间显著降低和减少,不良事件发生率降低(P0.05)。结论延续性护理可以缓解冠心病不稳定性心绞痛老年患者的焦虑和抑郁情绪,改善心绞痛症状,减少不良事件的发生。     

护理不良事件管理体系的构建和成效

目的构建一套标准的不良事件管理体系,以提升医院管理水平,保障患者安全。方法成立护理不良事件管理委员会和质量管理小组,完善护理不良事件报告系统,开展全员医护人员不良事件培训,形成一套符合JCI评审标准的不良事件管理体系。结果护理不良事件上报从2014年1月份的80例(6.02%)上升到2014年12月份的142例(10.68%)。不良事件管理系统实施后,医护人员不良事件知识理论知识得分及不良事件督查得分均较实施前提高(P<0.01)。结论护理不良事件管理体系的构建有利于促进医护人员上报不良事件,提高医护人员不良事件管理理论知识水平和督查得分,对维护患者安全和提高护理质量有促进作用,值得进一步推广和应用。     

Azacitidine adverse effects in patients with myelodysplastic syndromes

Azacitidine is now considered one of the standard-of-care agents for patients with high-risk myelodysplastic syndromes who are not candidates for high-dose chemotherapy. Considering the mechanism of action of the agent, it is critical to maintain adequate dose intensities for prolonged periods of time in order for treatment to be effective. Therefore, aggressive prevention as well as treatment of side effects is critical. The drug mainly causes hematological toxicity that is managed with growth factor support, blood transfusions, and dose and schedule adjustment. Nonhematological side effects are mainly gastrointestinal and cutaneous in nature, and can be easily managed with symptomatic treatment and correct administration techniques.     

个性化心理护理对乙型病毒性肝炎焦虑患者的作用

目的:通过对乙型病毒性肝炎伴发焦虑的患者,在其住院期间采用个性化心理护理干预,了解个性化心理护理对缓解乙型病毒性肝炎患者焦虑症状的有效性。方法:将77例慢性病毒性乙型肝炎伴有焦虑的患者,按进入调查组的先后顺序随机分为干预组39例,对照组38例,干预组在常规护理基础上,接受具有国家级心理咨询师资格的高年资护士实施的个性化心理护理,对照组给予常规护理。结果:干预组焦虑情绪得分低于对照组(P0.05)。结论:个性化心理护理能有效缓解慢性乙型肝炎患者的焦虑情绪。