上海市闸北社区慢性阻塞性肺疾病病人疾病认知和护理服务需求调查

[目的]了解慢性阻塞性肺疾病（COPD）病人对疾病认知情况和护理服务需求情况。[方法]采用自制的调查表对上海市闸北区大宁、临汾与彭浦社区320名COPD病人进行面对面问卷调查。[结果]COPD病人对呼吸功能锻炼方法、疾病康复的家庭因素、治疗措施、患病原因4方面知识认知率较低。分别为16．3％、26．6％、50．0％、35．9％;COPD病人对用药指导、营养饮食、家庭护理、功能锻炼护理服务需求高，均大于60．0％，对家庭氧疗的需求低于其他4项；经非参数检验，不同病程COPD病人对用药指导、功能锻炼护理服务需求比较差异有统计学意义。[结论]应重视社区COPD病人的健康教育，提高COPD病人对实施持续家庭氧疗重要性的认识。社区护士应根据COPD病人不同病程的护理需求，提供个性化的护理服务，以提高COPD病人的生活质量。     

城乡结合区慢性阻塞性肺疾病病人家庭氧疗现状调查分析

[目的]了解城乡结合区慢性阻塞性肺疾病(COPD)病人家庭氧疗状况及用氧知识掌握情况.[方法]采用自行设计调查问卷,对66例COPD病人进行家庭氧疗的使用情况及了解程度调查.[结果]66例COPD病人接受家庭氧疗者有28例,占42.4%,未行氧疗者38例,占57.6%.不吸氧的主要原因是不了解长期家庭氧疗对疾病的治疗作用12例(31.2%).实施氧疗的28例病人对用氧知识欠缺.[结论]本地区大多数COPD病人对家庭氧疗的认知程度偏低,缺乏家庭氧疗知识.医护人员应大力宣传家庭氧疗对于COPD的重要意义,以提高病人对家庭氧疗意义的认识.     

城市社区老年COPD病人健康教育内容需求调查分析

[目的]了解社区稳定期慢性阻塞性肺疾病(COPD)病人健康教育内容的需求情况。[方法]采用自行设计的问卷对147例社区稳定期COPD病人健康教育内容需求进行调查。[结果]病人对疾病知识、用药知识、氧疗知识、康复锻炼、疾病预防知识的需求得分分别为2.31分±0.53分、2.28分±0.56分、2.63分±1.08分、2.25分±0.65分、2.38分±0.52分。对疾病知识和康复锻炼知识的需求与文化程度呈正相关,对氧疗知识的需求则与文化程度呈负相关。对康复锻炼知识和疾病预防知识的需求与病程和疾病严重程度呈负相关,但对氧疗知识的需求则与病程和疾病严重程度呈正相关。[结论]社区稳定期COPD病人对各项健康教育内容的需求程度为中度,COPD病人健康教育内容需求与文化程度、病程和疾病严重程度等因素的相关性有所不同。     

基于多维度的COPD病人家庭氧疗护理模式的构建

[目的]探讨并构建慢性阻塞性肺疾病(COPD)病人家庭氧疗护理模式。[方法]选取本市三级医院呼吸内科住院67例病人作为研究对象,采用自行设计的调查问卷对病人的护理需求进行调查,在此基础上构建切实可行有效的护理模式。[结果]COPD家庭氧疗病人对医院、社区和家庭都有不同程度的护理需求。[结论]医院-社区-家庭无缝对接的护理服务模式能够满足病人的护理需求,提高家庭氧疗效果,是目前COPD家庭养疗病人较为理想的护理模式。     

社区护士慢性阻塞性肺疾病防治知识认知水平和学习需求调查

[目的]了解社区护士对慢性阻塞性肺疾病(COPD)认知水平及学习需求。[方法]采用自制调查问卷对98名社区卫生服务中心(站)在岗护士做COPD防治知识及学习需求调查。[结果]社区护士缺乏COPD基本知识、用药护理、吸入治疗、饮食护理、家庭氧疗、呼吸功能锻炼、无创呼吸机使用7方面知识。[结论]社区护士对COPD防治知识严重缺乏,迫切需要相关知识培训。     

基于多维度的慢性阻塞性肺疾病病人家庭氧疗护理模式的应用与效果评价

[目的]探讨基于多维度的慢性阻塞性肺疾病(COPD)病人家庭氧疗护理模式的应用效果。[方法]将101例COPD家庭氧疗病人随机分为观察组(52例)和对照组(49例),观察组病人采用医院-社区-家庭无缝对接护理服务模式,对照组病人实施常规护理,比较两组病人的氧疗执行、相关知识知晓、氧疗操作技能掌握、病人缺氧症状改善、急性加重再住院等情况。[结果]观察组与对照组比较,氧疗执行依从性高,疾病与氧疗相关知识的掌握多,病人缺氧症状改善明显,急性加重再住院人次明显减少,经比较差异均有统计学意义(P0.05)。[结论]医院-社区-家庭无缝对接的护理模式是COPD家庭氧疗病人较为理想的护理模式,该模式有利于COPD病人缺氧症状的缓解,减少急性加重再住院次数,延缓疾病进展。     

社区老年慢性病及其家庭护理情况调查

[目的]调查社区老年慢性病痛人疾病的严重程度.研究慢性病老人家庭护理项目,找出存在的问题,为开展社区护理与家庭护理服务提供依据.[方法]采用日常活动功能量表(ADL)、精神状态简易速查表(MMSE)与抑郁状态问卷表(DSI)评价病人身体功能与心理问题,并据此了解病人护理需求.[结果]90例忠有慢性病的老人,以心脑疾病、呼吸系统疾病与消化系统疾病为主.53.3%病人有不同程度的身体功能障碍,23.6%病人认知功能轻度与重度受损.28.9%病人存在抑郁状态.半数病人需要全日护理.需要服务项目为日常生活料理及协助治疗.[结论]家属是社区慢性病老人的主要护理者,由于疾病的严重性与复杂性,需要不同护理服务.加强时老年慢性病痛人的家庭护理与指导.是今后我国开展社区护理与家庭护理应考虑的问题.     

健康指导对稳定期慢性阻塞性肺疾病病人生活质量的影响

[目的]探讨健康指导对稳定期慢性阻塞性肺疾病(COPD)病人生活质量的影响。[方法]对36例稳定期COPD病人开展教育指导,教育并督促其进行呼吸肌锻炼、长期家庭氧疗、戒烟、营养支持、用药指导等,确保病人及家属掌握疾病相关知识,确保护理措施得以实施。[结果]干预后病人生活质量显著提高(均P<0.05)。[结论]健康指导可有效提高稳定期COPD病人的生活质量。     

慢性阻塞性肺疾病病人用药依从性影响因素分析

[目的]了解慢性阻塞性肺疾病(COPD)病人用药依从性影响因素.[方法]采用问卷调查法对呼吸科住院的123例稳定期COPD病人进行调查.[结果]不同性别病人用药依从性比较差异无统计学意义(χ2=2.144,P＞0.05);但年龄大、文化程度低的病人用药依从性较差.影响病人用药依从性的因素有知识缺乏、缺乏用药监督、药物不良反应、用药种类多、心理因素、病情及病程、经济状况、家庭支持水平、对生活是否满意.[结论]健康教育要注重年龄大、文化程度低的COPD病人,加强心理护理,提高家庭支持力度.     

城乡结合区慢性阻塞性肺疾病病人家庭氧疗现状调查分析

[目的]了解城乡结合区慢性阻塞性肺疾病（COPD）病人家庭氧疗状况及用氧知识掌握情况。[方法]采用自行设计调查问卷,对66例COPD病人进行家庭氧疗的使用情况及了解程度调查。[结果]66例COPD病人接受家庭氧疗者有28例,占42.4%,未行氧疗者38例,占57.6%。不吸氧的主要原因是不了解长期家庭氧疗对疾病的治疗作用12例（31.2%）。实施氧疗的28例病人对用氧知识欠缺。[结论]本地区大多数COPD病人对家庭氧疗的认知程度偏低,缺乏家庭氧疗知识。医护人员应大力宣传家庭氧疗对于COPD的重要意义,以提高病人对家庭氧疗意义的认识。     

Myocardial disease in inherited disease

To detect cardiac Fabry's disease, plasma alpha-galactosidase activity was measured in 230 male patients with left ventricular hypertrophy (LVH). Seven patients were diagnosed as having cardiac Fabry's disease. They did not have typical clinical manifestations of Fabry's disease. All seven had symmetric LVH. Endomyocardial biopsies revealed marked sarcoplasmic vacuolization in all five patients examined. Typical lysosomal inclusions with a concentric lamellar configuration were observed. Two novel mutations, A20P in exon 1 and M296I in exon 6, were detected in two patients, respectively. The remaining five had no mutations in the coding region for the alpha-galactosidase gene, and had marked decreases in the amount of alpha-galactosidase mRNA. Cardiac Fabry's disease should be considered as one of the cause of LVH.     

Celiac disease: pathogenesis of a model immunogenetic disease

Celiac disease is characterized by small-intestinal mucosal injury and nutrient malabsorption in genetically susceptible individuals in response to the dietary ingestion of wheat gluten and similar proteins in barley and rye. Disease pathogenesis involves interactions among environmental, genetic, and immunological factors. Although celiac disease is predicted by screening studies to affect approximately 1% of the population of the United States and is seen both in children and in adults, 10%-15% or fewer of these individuals have been diagnosed and treated. This article focuses on the role of adaptive and innate immune mechanisms in the pathogenesis of celiac disease and how current concepts of immunopathogenesis might provide alternative approaches for treating celiac disease.     

Chagas disease immunogenetics: elusive markers of disease progression

Introduction: Chagas disease (CD) is caused by a parasitic infection. The disease usually occurs after decades of the primary infection and can involve the myocardium or the digestive system. Of note, around 30% of T. cruzi infected patients develop CD while the other 70% may remain asymptomatic for their entire life. CD is usually observed as familial clustered phenomena. Moreover, individuals with chronic Chagas heart disease (CCHD) usually present a strong, deregulated immune response, which strongly suggests an immunogenetic effect.

Areas covered: In this article we review and discuss the information currently available from the published scientific literature regarding the genetic variants of molecules of the immune system that contribute to the clinical presentation of the disease.

Expert commentary: Of note, the most promissory results are found on the polymorphisms of chemokine receptors, particularly CCR5 and CCR2. Additional investigations are required, particularly with a focus on the genes that regulate the immune system.     

Graves' disease (clinical aspects of Graves' disease)]

Graves' disease (GD) is an autoimmune thyroid disease. In addition to the etiology of hyperthyroidism, TSH receptor antibodies play an important role in the pathogenesis of pretibial myxedema, ophthalmopathy, and neonatal GD. The previous epidemiological surveys have revealed that 0.08-0.6% of the population were affected by GD in Japan. Clinical signs and symptoms as well as laboratory abnormalities are described with emphasis on elevated serum VEGF and G-CSF levels in untreated GD patients. It should be noted that elderly patients may not have typical symptoms of hyperthyroidism, but cardiac symptoms and weight loss usually predominate. Abnormal laboratory findings may help to make a diagnosis in asymptomatic patients. Patients with ophthalmopathy may have antibodies to 64 kD/55 kD external orbital muscle proteins.     

Liver disease as presenting manifestation of Hodgkin's disease.

Six patients who were referred to the liver unit on account of jaundice are described. A different initial diagnosis has been made in each case, these being fulminant hepatic failure, severe hepatitis with renal failure, toxoplasma hepatitis, extrahepatic obstruction, sclerosing cholangitis, and liver abscess. After delays of four weeks to 12 months from the time of first symptoms all six patients were eventually found to have advanced Hodgkin's disease (stage 4). In four patients the diagnosis was made during life, but in two only at autopsy. In four lymphoma tissue was finally demonstrable in the liver, but in two liver biopsy showed only minor non-specific changes despite grossly abnormal liver function tests. Three of the six patients were treated with chemotherapy, and two of these recovered sufficiently to leave hospital. With the encouraging survival figures now being obtained in Hodgkin's disease, an awareness of the varied hepatic manifestations of the disease may allow treatment to be instituted at an earlier stage.     

Clinical epidemiology of cardiovascular disease in chronic kidney disease

Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The clinical epidemiology of CVD in CKD is challenging due to a prior lack of standardized definitions of CKD, inconsistent measures of renal function, and possible alternative effects of 'traditional' CVD risk factors in patients with CKD. These challenges add to the complexity of the role of renal impairment as the cause or the consequence of cardiovascular disease. The goal of this review is to summarize the current evidence on: (1) the incidence and prevalence of CVD in chronic renal insufficiency and in ESRD, (2) risk factors for CVD in CKD, (3) the outcomes of patients with renal failure with CVD, and (4) CKD as a risk factor for CVD. The epidemiological associations implicating the huge burden of CVD throughout all stages of CKD highlight the need to better understand and implement adequate screening, and diagnostic and treatment strategies.