肺康复干预辅助治疗稳定期COPD患者的效果观察

目的探讨肺康复干预辅助常规干预治疗稳定期慢性阻塞性肺疾病(COPD)患者的临床效果。方法将60例稳定期COPD患者随机分为两组各30例。对照组予以常规干预治疗,研究组予以肺康复干预辅助常规干预治疗。比较两组患者干预前后的临床指标。结果干预前,两组患者的FVC、 FEV_1、 PaO_2、 PaCO_2水平, 6 min步行距离及Borg评分比较无统计学差异(P>0.05);干预后,两组的FVC、 FEV_1、 PaO_2水平及6 min步行距离均显著高于干预前, PaCO_2水平、 Borg评分均显著低于干预前,且研究组的FVC、 FEV_1、 PaO_2水平、 6 min步行距离均显著高于对照组, PaCO_2水平、 Borg评分均显著低于对照组,差异均有统计学意义(P <0.05)。结论肺康复干预辅助常规干预治疗稳定期COPD患者的疗效确切。     

呼吸功能锻炼联合心理护理在COPD康复期患者中的干预价值

目的:分析呼吸功能锻炼联合心理护理在慢性阻塞性肺疾病(COPD)康复期患者中的干预价值。方法:将2018年11月——2019年12月我院收治的78例COPD康复期患者作为研究对象,通过系统抽样法将其分为研究组和参照组,每组39例,对照组实施常规护理,采用呼吸功能锻炼联合心理护理对观察组进行干预,并对比两组的肺功能指标和心理状态变化状况。结果:治疗后,研究组的用力肺活量(FVC)、第1秒用力呼气量(FEV1)、深吸气量(IC)均高于参照组,差异有统计学意义(P 0.05)。结论:呼吸功能锻炼联合心理护理有助于促进COPD康复期患者改善肺功能。     

健康管理在院外稳定期慢性阻塞性肺疾病患者中的应用

目的探讨健康管理在院外稳定期慢性阻塞性肺疾病(COPD)患者中的应用效果。方法选取稳定期COPD患者84例,随机分为研究组与对照组,每组42例。对照组院外行常规健康指导,研究组在对照组基础上实施全面COPD健康管理。比较两组干预前后治疗的依从性、肺功能、6 min步行距离测试(6MWT)、改良呼吸困难(Borg)评分、疾病认知(BCKQ)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、生活质量(CAT)评分。结果干预后研究组的依从性明显高于对照组,差异有统计学意义(P0.05)。BCKQ、6MWT评分明显高于对照组, SAS、SDS、Borg、CAT评分均明显低于对照组,差异有统计学意义(P0.05)。研究组第1秒用力呼气末容积(FEV_1)、第1秒用力呼气末容积/用力肺活量(FEV_1/FVC)、第1秒用力呼气末容积占预计值的百分比(FEV_1%)明显高于对照组,差异有统计学意义(P0.05)。结论在COPD稳定期患者中实施院外健康管理能有效提高患者治疗的依从性及对疾病的认知度,改善患者的心理状态和生活质量及肺功能。     

社区护理干预对稳定期慢性阻塞性肺疾病患者康复的影响

目的通过观察社区护理干预稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者的不良心理、遵医行为、临床疗效及再次入院率,探讨社区综合性护理干预对其康复疗效的影响。方法 2011年1月—2013年11月选择出院后入社区的稳定期COPD患者随机分为干预组55例和对照组30例,对照组给予常规治疗与护理,干预组在对照组常规治疗与护理基础上实施综合性护理干预措施,并随访观察12个月内的不良心理、遵医行为及再次入院率。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果干预后,干预组的不良心理发生率(9.1%)、吸烟率(7.3%)及再次入院率(5.5%)显著低于对照组(46.6%、56.7%、37.5%)(均P0.05),不良心理明显好转率82.1%显著高于对照组6.7%(P0.05);干预后干预组临床症状积分显著低于对照组,FEV1/FVC值、FEV1(L)值及FEV1(%)值均显著高于对照组(P0.05)。结论社区综合性护理干预可显著改善稳定期COPD患者的心理情绪、提高遵医行为及降低再次入院率,可显著改善肺功能及提高临床疗效,是稳定期COPD患者康复与保健的有效干预措施。     

综合护理干预对COPD患者肺功能及生活质量的影响

目的探讨综合护理干预对慢性阻塞性肺疾病(COPD)患者肺功能及生活质量的影响。方法选取2018年3月-2019年3月辽阳市某医院收治的114例COPD稳定期患者作为研究对象。采用随机数字表法将患者分为对照组与观察组,每组57例。对照组患者给予常规护理干预,观察组患者在对照组患者护理基础上进行综合护理干预。比较2组患者护理前及护理1个月时用力肺活量(FVC)、第1秒用力呼气容积(FEV_1)、1秒率(FEV_1/FVC)、最大吸气压(MIP)水平及COPD评估测试量表(CAT)评分。结果护理1个月时,观察组患者FVC,FEV_1及FEV_1/FVC水平分别为(4.32±0.39)L,(2.89±0.75)L及(68.48±4.67)%,高于对照组的(3.99±0.48)L,(2.40±0.51)L及(61.17±5.06)%,差异均有统计学意义(P0.05)。护理1个月时,观察组患者MIP水平及CAT评分为(2.34±0.63)k Pa及(1.52±0.38)分,低于对照组的(2.82±0.88)k Pa及(1.96±0.70)分,差异均有统计学意义(P0.05)。结论综合护理通过采取全方位的护理措施,可有效改善COPD患者的肺功能,提高患者生活质量,效果显著,值得临床推广。     

协同护理干预对患者肺功能康复及心理健康的影响

目的 研究围住院期协同护理干预对COPD稳定期患者肺功能康复效果及抑郁焦虑情绪的影响.方法 选择2015年1-12月在本院接受治疗的160例稳定期COPD患者,用随机数表法分为对照组和干预组,每组各80例.对照组给予常规的COPD护理干预,干预组在对照组的基础上给予协同护理于预.结果 干预后对照组和干预组患者的FEV1、FEV1/FVC、PEF和Sp02等肺功能指标上升,干预组患者的肺功能优于对照组,差异有统计学意义(P＜0.05).干预后两组患者的自我概念、自我护理技能、自护责任感、健康知识水平和自我护理能力总分上升,干预组患者的自我护理能力更强,差异有统计学意义(P＜0.05).干预后两组患者的SGRQ评分中症状部分、活动能力、疾病影响和总分下降,干预组患者的生活质量更强,差异有统计学意义(P＜0.05).干预后对照组和干预组患者的SAS和SDS评分均下降,干预组患者的SAS和SDS评分更低,差异有统计学意义(P＜0.05).结论 围住院期协同护理干预可以提高COPD稳定期患者的肺功能和自我护理能力,改善其抑郁焦虑情绪及生活质量.     

自拟温补脾肾方治疗慢性阻塞性肺疾病稳定期患者对其肺功能及生活质量的影响

目的探讨自拟温补脾肾方治疗慢性阻塞性肺疾病(COPD)稳定期患者对其肺功能及生活质量的影响。方法选取COPD稳定期患者50例作为研究对象,随机均分为两组。常规组给予常规西药治疗,干预组在常规组基础上加用自拟温补脾肾方治疗。结果治疗后,干预组患者的FVC、FEV_1、FEV_1/FVC水平及6MWT距离均显著高于常规组,生活质量评分显著低于常规组(P<0.05)。结论采用自拟温补脾肾方治疗慢性阻塞性肺疾病稳定期患者,可显著改善肺功能和临床症状,提高生活质量。     

肺康复锻炼结合心理干预对慢性阻塞性肺疾病患者心理状态及肺功能的影响

目的 探讨肺康复锻炼结合心理干预对慢性阻塞性肺疾病(COPD)患者心理状态及肺功能的影响。方法 选择2017年12月—2018年12月期间于某医院就治的慢性阻塞性肺疾病(COPD)稳定期患者84例,按随机数字表法分为两组,各42例。对照组进行常规护理干预,研究组在此基础上采取肺康复锻炼结合心理干预。对比两组心理状态及肺功能。结果 干预前,2组SAS和SDS评分及肺功能相比,差异无统计学意义(P>0.05);研究组干预后SAS和SDS评分[(40.11±5.06)分、(38.53±5.44)分]低于对照组[(44.25±6.18)分、(42.28±5.47)分],FEV1/FVC、FEV1%水平[(61.93±7.06)%、(55.34±5.61)%]高于对照组[(57.26±5.13)%、(51.28±6.05)%],差异均有统计学意义(P<0.05)。结论 肺康复锻炼结合心理干预能够改善慢性阻塞性肺疾病患者心理状态,增强肺功能,利于减轻患者痛苦。     

COPD急性加重期和稳定期睡眠质量及其与肺功能相关性探究

目的比较慢性阻塞性肺病(COPD)患者急性加重期和稳定期的睡眠质量,并分析其与肺功能的相关性。方法选取某院收治并长期随访的稳定期和急性加重期病例资料记录完整的80例COPD患者作为研究对象,采用匹兹堡睡眠质量调查问卷(PSQI)对患者不同时期睡眠质量进行调查,并测定肺通气功能、肺换气功能指标,采用Pearson线性相关方法分析COPD患者PSQI评分和上述指标的相关性。结果 COPD患者稳定期睡眠质量、入睡时间、睡眠时间、习惯睡眠效应、催眠药物、日间功能以及感觉不适等睡眠质量维度评分均较急性加重期显著降低(P0.05);COPD患者稳定期一秒用力呼气容积(FEV_1)、二氧化碳分压(PaCO_2)水平较急性加重期显著升高(P0.05),用力肺活量(FVC)、FEV_1/FVC、PaO_2和血氧饱和度(SaO_2)水平较急性加重期显著降低(P0.05);COPD患者FEV_1和FVC与睡眠质量各个维度均无明显相关性,睡眠质量评分中睡眠质量、入睡时间、睡眠时间、习惯睡眠效应及日间功能等维度均和FEV_1/FVC、PaO_2和SaO_2存在正向相关性和Pa CO2存在负向相关性,而催眠药物和感觉不适2个维度和上述指标无明显相关性。结论COPD患者急性加重期肺功能较差,与睡眠质量差存在一定相关性。     

改良森田疗法联合运动想象在老年职业性COPD患者肺康复中的运用

目的探讨改良森田疗法联合运动想象在老年职业性慢性阻塞性肺疾病(COPD)稳定期患者肺康复中的运用效果。方法选择常州市德安医院康复中心住院治疗的稳定期老年职业性COPD患者60例,随机分为观察组与对照组各30例,对照组采取改良森田疗法干预,观察组采取运动想象联合改良森田疗法干预。两组患者入组时与出院前进行焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、肺功能[用力肺活量(FVC)、最大呼气第1秒呼出的气量容积(FEV1)、FEV1占预计值的比率(FEV1%)、FEV1与FVC的比值(FEV1/FVC)]检测以及圣乔治呼吸问卷(SGRQ)评分。结果治疗后观察组SAS与SDS评分明显低于同期对照组[(50.07±5.36)vs(56.69±7.08)和(47.81±6.91)vs(52.35±7.33)],差异有统计学意义(P0.05);观察组患者治疗后FVC、FEV1、FEV1%与FEV1/FVC指标水平改善均明显优于对照组,差异有统计学意义(P0.05);在SGRQ评分方面,治疗后观察组SGRQ评分明显低于同期对照组[(41.69±5.52)vs(46.06±6.49)],两组比较差异有统计学意义(P0.05)。结论对稳定期老年职业性COPD患者采取改良森田疗法与运动想象疗法进行干预,可明显改善患者的情绪状况,并促进患者肺功能与生活质量的提高。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.