护理干预对慢乙肝患者抗病毒治疗依从性的影响研究

目的:研究护理干预对慢乙肝患者抗病毒治疗依从性的影响。方法:资料选自我院2012年11月~2013年10月收治的慢乙肝患者76例,将其平均分为两组,研究组和对照组,给予两组患者相同的抗病毒治疗,在此基础上,对照组患者进行常规护理,研究组则实施系统性的护理干预,并对两组临床资料进行回顾性分析。结果:经护理干预后,研究组患者治疗的依从性92.11%,明显高于对照组治疗依从性76.32%,比较有差异具有统计学意义(P<0.05)。结论:慢乙肝患者抗病毒治疗基础上开展系统性的护理干预,不仅能够有效提升患者的依从性,而且还能进一步改善患者生活的质量,值得在临床中广泛推广应用。     

石墨烯及其衍生物的生物安全性

目的　建立慢性乙型肝炎（慢乙肝）患者用药依从性个体化预测模型并进行验证，为慢乙肝患者用药提供依据。方法　选取2019年11月—2021年4月于我院门诊就诊的235例慢乙肝患者作为研究对象，收集患者临床资料等数据，采用单因素和多因素Logistic回归分析分析影响用药依从性的因素，进而建立相关列线图模型。结果　年龄≥60岁、文化程度低、未定期在同一门诊随访、未接受过乙肝用药健康教育、医疗支付方式为自费、服药种类≥3种和有药物不良反应是慢乙肝患者用药依从性差的危险因素（P均＜0.05）。列线图模型验证结果显示训练集和验证集的C-index分别为0.811（95%CI：0.787～0.833）和0.802（95%CI：0.781～0.822），校正曲线均趋近于理想曲线，AUC分别为0.830（95%CI：0.804～0.872）和0.816（95%CI：0.797～0.834）。结论　年龄≥60岁、文化程度低、未定期在同一门诊随访、未接受过乙肝用药健康教育、自费支付、服药种类≥3种和有药物不良反应是与慢乙肝患者用药依从性差密切相关的危险因素，据此构建的列线图模型能够有效预测慢乙肝患者用药依从性差的风险，对提高慢乙肝患者遵医行为和增强治疗效果具有重要意义。     

皖北农村地区AIDS病人抗病毒治疗依从性及相关因素研究

[目的]了解皖北农村地区获得性免疫综合征(AIDS)病人抗病毒治疗依从性现状及其相关因素.[方法]整群抽取皖北3县(临泉、界首、萧县)农村地区正在服用抗病毒药物的AIDS病人,通过入户的方式进行询问调查和现场观察.[结果]研究发现,农村地区AIDS病人抗病毒治疗的服药依从性低于90%的有21人,占15.1%,调查时服用人数最多的药物为司他夫定(Stavudine),药物依从性最好的为茚地那韦(indinavir).服药者中有35人因为忘记而出现间断性停药,占85.4%.多因素Logistic分析显示,服药者身体越差服药依从性越好,而督导医生的水平差、服药者经常出现希望自己死了才好的念头则服药依从性差.[结论]该地区AIDS病人抗病毒治疗服药依从性不高,并受多种因素影响,应大力开展有针对性的健康教育及抗病毒治疗前的服药依从性教育.     

河南省部分地区艾滋病患者抗病毒治疗知识知晓状况及影响因素分析

目的了解河南省部分地区艾滋病(AIDS)患者抗病毒治疗知识、态度现况,并分析影响服药依从性知识知晓的因素。方法采用方便抽样的方式,对2009年4～12月在河南省部分地区接受高效抗逆转录病毒治疗的艾滋病患者进行问卷调查,内容涉及患者的社会人口学特征、艾滋病的基本治疗知识、抗病毒服药依从性知识、态度等,采用多因素logistic回归模型分析影响治疗服药依从性相关知识知晓的因素。结果调查对象共202名,问卷有效率100%;患者年龄(45.3±8.0)岁,男性52.7%,女性47.3%。患者对抗病毒治疗知识正答率范围5.9%～84.2%,能够正确回答服药依从性标准者130人,正答率为64.36%。另外,92.0%的患者认为服药依从性重要;74.3%的患者认为药物不良反应是影响服药依从性的因素。多因素logistic回归分析结果支持护理宣讲艾滋病抗病毒治疗知识、在县医院治疗是患者获得服药依从性知识的有益因素(P均<0.05)。结论河南省艾滋病患者的抗病毒治疗的知识、态度都有待提高,借助护理宣讲方式进一步开展相关的知识教育,以提升其治疗依从性是有效且有必要的。     

艾滋病母婴阻断抗病毒治疗依从性及相关因素分析

目的 探索艾滋病母婴传播阻断抗病毒治疗依从性的主要影响因素,为制定提高人类免疫缺陷病毒阳性孕产妇抗病毒治疗依从性的措施提供依据.方法 在云南省5个艾滋病高、中度流行县(市、区),对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了病例对照研究和定性调查.结果 抗病毒治疗依从性良好者占86.7%(137/158).影响人类免疫缺陷病毒阳性孕妇及婴儿服药依从性的主要因素为产次、民族、是否知情选择方案、方案复杂程度、对阻断成功的信心.结论 云南省人类免疫缺陷病毒感染孕产妇艾滋病母婴传播阻断抗病毒治疗依从性好,依从性受多种因素的影响,提高依从性要针对主要影响因素开展工作. 素,为制定提高人类免疫缺陷病毒阳性孕产妇抗病毒治疗依从性的措施提供依据.方法 在云南省5个艾滋病高、中度流行县(市、区),对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了病例对照研究和定性调查.结果 抗病毒治疗依从性良好者占86.7%(137/158).影响人类免疫缺陷病毒阳性孕妇及耍儿服药依从性的主要因素为产次、民族、是否知情选择方案、方案复杂程度、对阻断成功的信心.结论 云南省人类免疫缺陷病毒感染孕产妇艾滋病母婴传播阻断抗病毒治疗依从性好,依从性受 种因素的影响,提高依从性要针对主要影响因素开展     

护理干预对乙肝患者抗病毒治疗依从性和疗效的影响

目的 探讨护理干预对乙肝患者抗病毒治疗依从性和疗效的影响.方法 抗病毒治疗的90例慢性乙肝患者,随机分观察组及对照组各45例,对照组进行慢性乙肝常规健康教育及护理,观察组实施系列护理干预.结果 两组患者治疗前抗病毒知识评分比较无显著性差异(P＞0.05),治疗后1年后观察组抗病毒知识评分22.86±4.29、用药依从性好93.33％、HBV - DNA阴转率44.44％、护理满意度97.78％均高于对照组的15.18±4.31、68.89％、26.67％、86.67％(P＜0.05)结论 有针对的护理干预可提高患者对抗病毒治疗知识的认识水平和从医的依从性,从而获得更好的治疗效果,是整个抗病毒治疗的关键环节措施之一[5].     

肝动脉化疗栓塞术治疗乙型肝炎病毒相关肝癌患者服药依从性调查研究

目的了解肝动脉化疗栓塞术(TACE)治疗乙型肝炎病毒(HBV)相关肝癌患者抗病毒治疗的依从性,分析影响因素,为制定针对性的干预措施提供依据。方法选取2014年3月-2015年2月收治的58例TACE治疗HBV相关性肝癌患者,采用自行设计的问卷进行抗病毒治疗服药依从性调查,采用多元线性回归方法分析影响患者服药依从性的因素。结果 TACE治疗的HBV相关性肝癌患者抗病毒治疗依从性差3例占5.2%,依从性较差25例占43.1%,依从性较好30例占51.7%;患者服药依从性实际得分(21.74±3.138)分、标准得分(80.52±11.621)分;多元线性回归分析结果显示,患者服药依从性的影响因素有医源性因素、经济状况、HBV三系、肝功能分级、职业等,差异均有统计学意义(P0.01)。结论根据患者依从性不佳的主要因素,医护人员应为患者制定个体化干预方案,提高患者抗病毒治疗的依从性。     

河南省艾滋病患者抗病毒治疗免疫学效果及其影响因素的研究

目的 了解河南省部分地区艾滋病患者抗病毒治疗免疫学效果,分析影响抗病毒治疗免疫学失败的主要危险因素.方法 采用横断面调查方法对河南省接受国家免费一线抗病毒治疗时间大于半年的艾滋病患者进行问卷调查,并测定CD4+T淋巴细胞计数,了解调查对象抗病毒治疗免疫学效果,通过多因素Logistic回归分析确定艾滋病患者发生免疫学失败的影响因素.结果 706例调查对象接受抗病毒治疗时间为0.5～6年,治疗后CD4+T淋巴细胞数计数平均为(432±325)个/μl,其中171例(24.2％)患者调查时CD4+T淋巴细胞数计数＜200 cells/μl.多因素Logistic回归分析显示,影响抗病毒治疗发生免疫学失败的危险因素是男性(AOR=1.480)、依从性差(AOR=1.765)和含去羟肌苷的治疗方案(AOR=1.724).结论 河南省部分地区抗病毒治疗免疫学效果较好,但仍有部分抗病毒治疗患者发生免疫学失败,建议加强抗病毒治疗的依从性管理,选用适合的初始抗病毒治疗方案,以更好地发挥抗病毒治疗的效果.     

艾滋病抗病毒治疗失败人群服药依从性及影响因素

目的 了解艾滋病抗病毒治疗失败人群的服药依从性及其影响因素。方法 以苏州市2019—2020年抗病毒治疗满6个月后,治疗失败的HIV感染者(病毒载量>1 000 copies/mL)为研究对象,分析人口学特征、对抗病毒药物的认知、社会支持程度等对服药依从性的影响。结果 共纳入治疗失败HIV感染者212人,过去1个月全部按时吃药145人,占68.4%。多因素logistic回归分析显示,住所方便服用艾滋病抗病毒治疗药物(OR=4.59,95%CI:1.05～19.96)和自我报告健康状况好(OR=3.58,95%CI:1.36～9.39)的患者服药依从性较高。结论 苏州市抗病毒治疗失败人员服药依从性较低,服药依从性跟住所服药方便程度和患者自我健康状况等相关。     

艾滋病母婴传播阻断抗病毒治疗依从性及影响因素

目的:探讨艾滋病母婴传播阻断抗病毒治疗的依从性水平与主要影响因素,为制定HIV阳性孕产妇及其所生婴儿抗病毒治疗规范用药的措施提供依据。方法:在云南省5个艾滋病高发县(市、区)及一家省级保健机构对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了现况调查。结果:抗病毒治疗依从性良好者占91.0%(111/122)。影响HIV阳性孕产妇及婴儿服药依从性的主要因素为医生对HIV阳性孕产妇的态度,医患间的沟通与合作程度,方案的复杂程度,家庭人均收入,家庭支持,是否在县级及以上助产机构住院分娩,以及患者对艾滋病抗病毒治疗方案的认识,对生育的态度。结论:HIV感染孕产妇艾滋病母婴传播阻断抗病毒治疗服药依从性较好,多个因素对HIV感染孕产妇服药依从性有影响。     

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.     

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.     

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。     

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.