Feasibility of Mindfulness-based Stress Reduction Intervention for Parents of Children with Developmental Delays

Mindfulness-based stress reduction (MBSR) interventions are popular as a treatment strategy for myriad diagnoses in various settings, and may be beneficial for parents of children with developmental delays (DD). However, prior research suggests extreme levels of stress and extraordinary demands on time among these parents, making the feasibility of effectively implementing MBSR with this population questionable. This study examined the feasibility of administering standard MBSR to a diverse community-based sample of parents of young children with DD. The potential impact of MBSR interventions includes improvement in parents’ mental health, and collateral benefits for the family environment, including improved child behavior. Nurses may have an integral role in interdisciplinary teams providing MBSR.     

Eosinophilic myocarditis in patients awaiting heart transplantation

OBJECTIVE: To determine the possible causative agents of eosinophilic or hypersensitivity myocarditis in patients awaiting heart transplantation. DESIGN: Consecutive patient series. SETTING: Large university-affiliated hospital. PATIENTS: A total of 190 consecutive patients who had heart transplantation at our center. INTERVENTIONS: The myocardium of the explanted heart was examined for a mixed inflammatory cell infiltrate containing an identifiable component of eosinophils. The relative quantity of each cell type was evaluated by a semiquantitative grading system (scored 0 to 3). The clinical findings and medications were reviewed, and patients were followed after heart transplantation. MEASUREMENTS AND MAIN RESULTS: Eosinophilic myocarditis (EM) was found in the explanted heart in 14 patients (7.4%). Myocardial infiltration by eosinophils ranged from mild (n = 6), often focal involvement to marked (n = 8), usually multifocal or widespread involvement. Twelve patients (86%) had peripheral blood eosinophilia before transplant, and in ten (71%), the eosinophil count at least doubled. Loop or thiazide diuretics were used in all 14 patients, and angiotensin-converting enzyme inhibitors were used in 12. Preoperative characteristics were similar in patients with and without EM, except for a higher frequency of inotropic support and assist devices in EM patients. Dobutamine was used in 12 (86%) and dopamine in seven (50%; one with dopamine alone), and one patient (7%) received neither dopamine nor dobutamine. In two patients receiving dobutamine and one receiving dopamine, tapering or discontinuation of the inotropic infusion resulted in a significant diminution of the peripheral eosinophilia and the EM before transplantation. Postoperative survival in patients with and without EM was similar at 8 yrs (50% +/- 13% and 54% +/- 4%, p =.34). No patient in this study has had EM on biopsy after transplant. CONCLUSIONS: EM is a complication of multiple drug therapy in patients awaiting heart transplantation, and should be suspected when peripheral blood eosinophilia is present or the eosinophil count increases by at least two-fold. EM may be related to intravenous inotropic therapy, and this is the first study to document improvement in myocardial pathology after inotropic drug withdrawal. Hypersensitivity to thiazide and loop diuretics, angiotensin-converting enzyme inhibitors, and antibiotics must also be considered. Survival after heart transplantation is not impaired, and postoperative steroid therapy may prevent EM.     

门诊胃食管反流病患者应用正念减压腹式呼吸训练的效果观察

目的 探讨正念减压腹式呼吸训练在门诊胃食管反流病患者中的应用效果。方法 采用便利抽样法选择我院消化内科门诊就诊的胃食管反流病患者68例,予以正念减压腹式呼吸操训练3个月,比较干预前、干预4周末、8周末、12周末时68例患者的胃食管反流病症状、健康相关生活质量及焦虑抑郁状况。结果 胃食管反流病患者在干预前、干预4周末、干预8周末、干预12周末胃食管反流病状况比较,差异具有统计学意义（F=11.837,P<0.001）;胃食管反流病患者在干预前、干预4周末、干预8周末、干预12周末焦虑抑郁得分比较,差异具有统计学意义（P<0.01）,随着干预时间的延长,胃食管反流病患者焦虑、抑郁得分降低。胃食管反流病患者在干预前、干预4周末、干预8周末、干预12周末健康相关生活质量得分比较,差异具有统计学意义（P<0.01）,随着干预时间的延长,健康相关生活质量得分提高。结论 正念减压腹式呼吸训练能够缓解胃食管反流病患者症状,减轻其焦虑抑郁情绪,提高其生活质量。     

正念减压疗法联合音乐生物反馈疗法在不孕症患者中的应用

目的:探讨正念减压疗法(MBSR)联合音乐生物反馈疗法在不孕症患者中的应用效果。方法:选取2019年9月1日~2020年2月29日收治的438例不孕患者为研究对象,统一编号后采用抽签法随机分为干预组和对照组各219例;两组均给予常规健康教育和护理,对照组给予音乐生物反馈疗法,干预组给予MBSR联合音乐生物反馈疗法;比较两组干预前后的病耻感[采用不孕症病耻感量表(ISS)]、负性情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]、睡眠质量[采用匹兹堡睡眠质量指数(PSQI)]及应对方式。结果:干预后,两组ISS、SAS、SDS、PSQI评分均低于干预前(P<0.05),且干预组低于对照组(P<0.05);干预后,两组应对方式中解决问题和求助因子评分均高于干预前(P<0.05),自责、幻想、退避及合理化因子评分均低于干预前(P<0.05),且干预组优于对照组(P<0.05)。结论:MBSR联合音乐生物反馈疗法可降低不孕症患者的病耻感,改善其负性情绪、睡眠质量及应对负性事件的能力。     

Health related quality of life in patients awaiting heart transplantation

Quality of life is an important outcome measure in patients with end-stage heart failure waiting for heart transplantation. The purpose of this study was to investigate the relationship between aspects of quality of life and physiological and psychosocial variables in patients with end-stage heart failure. A total of 123 patients participated in the study. The functional status was assessed with New York Heart Association (NYHA) functional classification, a 6-minute walk test (6 MWT) and peak oxygen uptake (pVO(2)). Health related quality of life (HRQOL) was measured with Medical Outcomes Study, 36-item Short Form Survey (SF-36), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were used to assess psychological symptoms. A significant relationship was found between HRQOL (SF-36 and MLHFQ) and functional status (NYHA, 6 MWT and pVO(2)) (p < 0.05). Psychological symptoms (BDI) were associated with HRQOL (p < 0.05). In addition to clinical derangements, functional limitation and psychological distress can lead to limitations in activities of daily life through impairment of quality of life. It would be helpful to evaluate psychological symptoms and quality of life in patients with end-stage heart failure besides routine clinical evaluations.     

无创通气在肾移植术后巨细胞病毒性肺炎并呼吸衰竭患者中的临床疗效

目的 探讨无创通气在肾移植术后巨细胞病毒(CMV)性肺炎并呼吸衰竭患者的临床疗效.方法 35例肾移植术后CMV性肺炎并呼吸衰竭患者,在综合治疗基础上,给予无创正压通气治疗,观察其临床疗效.结果 35例患者经无创正压通气治疗31例有效(有效率为88.5%),无效4例.31例治疗有效患者动脉血氧分压明显增高,呼吸频率明显下降(P<0.01),血流动力学特征明显改善,7例出现较轻的不良反应,经对症处理后好转.结论 无创正压通气治疗改善肾移植术后CMV性肺炎患者低氧血症,缓解呼吸窘迫症状,不良反应轻.     

Atracurium infusions in patients with fulminant hepatic failure awaiting liver transplantation

Objective: To determine the pharmacokinetics and pharmacodynamics of the neuromoscular blocking agent atracurium besylate in patients with fulminant hepatic failure (FHF).Design: Open study of patients receiving atracurium infusions to facilitate mechanical ventilation.Setting: Intensive care unit in a tertiary referral university teaching hospital.Patients: Ten encephalopathic patients with FHF reuiring mechanical ventilation while awaiting orthotopic liver transplantation. Three patients died before transplantation could be performed, three died after transplantation, and four survived following successful transplantation.Methods: Plasma, urine and dialysate fluid were analysed for atracurium and its metabolites using HPLC. Neuromuscular blockade was measured using transcutmeous ulnar nerve stimulation and an accelerometer. Electroencephalography and liver function tests were performed daily.Results: Patients received atracurium infusions for a period ranging from 38 to 217 h. Six patients required continuous arteriovenous haemodiafiltration (CAVHD) to replace renal function. Atracurium mean steady state clearence was 8.6 ml/min/kg, and train-of-four recovery ratio, to 75% took 63 min (range 32–108). Laudanosine clearance was markedly reduced in the non-survivors; the half-life was 38.5 hrs compared with 5.3 h in the 4 patients who underwent successful transplantation. Laudanosine accumulation could be observed in all patients before transplantation, but kinetics returned to normal after successful transplantation. The highest laudanosine level recorded was 6,860 ng/ml. There was no evidence of adverse central neurological effects attributable to laudanosine. CAVHD did not contribute significantly to clearance of atracurium or its metabolites.Conclusions: Atracurium kinetics and dynamics are nearnormal even in patients with fulminant hepatic failure and renal failure; laudanosine accumulation will occur, but this is not associated with measurable central neurological effects. Implantation of a functioning liver graft results in clearance of laudanosine, which seems to be independent of renal function. Atracurium is an appropriate choice for producing neuromuscular blockade for periods of several days in patients with fulminant hepatic failure and renal impairment.     

肝移植术前等待患者的死亡原因分析

目的 调查分析住院等待肝移植患者的死亡原因,为加强肝移植术前等待患者的管理提供方向和依据.方法 回顾性分析我院2003年1月-2007年6月住院等待肝移植手术期间死亡的63例患者等待时间、治疗过程和死亡原因.结果 63例患者的平均住院等待时间为(32.53±17.21)d,重症加强治疗病房(ICU)住院时间为(12.75±9.77)d.等待期间上消化道出血、意识障碍、感染的发生率分别为47.62%、39.68%和74.60%.主要死因感染性休克和感染性多器官功能衰竭(MOF)以及曲张静脉破裂出血的病死率分别为39.68%和26.98%.血液净化治疗对肝性脑病治疗有效.结论 当前肝移植术前等待住院患者的主要死亡原因是感染和致命性上消化道出血.     

Atracurium infusions in patients with fulminant hepatic failure awaiting liver transplantation

Objective: To determine the pharmacokinetics and pharmacodynamics of the neuromoscular blocking agent atracurium besylate in patients with fulminant hepatic failure (FHF). Design: Open study of patients receiving atracurium infusions to facilitate mechanical ventilation.     

Pre-admission booklets for patients awaiting surgery

The aim of this study was to analyse the pre-admission booklets currently being sent to patients awaiting admission for surgery. Content analysis of the booklets reveals that many districts fail to include the types of information shown in the literature to be of most relevance and benefit to patients. An objective assessment of readability indicates that over half the booklets are fairly difficult or difficult to read. The study highlights the need to revise the information content and readability of many of the pre-admission booklets currently being dispatched to prospective patients.     

正念减压疗法对肺癌化疗患者自我效能及正念水平的影响

目的 探讨正念减压疗法对提高肺癌患者化疗期间自我效能及正念水平的效果及意义。方法 将某三级甲等医院肿瘤内科100例首次接受化疗的肺癌患者,按随机数字表法分为干预组和对照组,每组各50例。2组均接受常规护理干预,其中干预组接受为期8周的正念减压疗法,在首次（干预前入组时）、第2次（干预后第6周）、第3次（干预后第12周）,对2组进行自我效能及正念水平进行评价,比较2组得分差异。结果 2组的自我效能与正念水平得分的组间效应差异具有统计学意义（P<0.001）;其中,在自我效能量表中,2组间自我减压、正性态度维度存在组间效应差异（P<0.05）。2组的自我效能、自我减压维度、正性态度维度、正念水平时间效应差异具有统计学意义（P<0.05）;2组的自我效能水平、正性态度维度、正念水平得分的干预与时间因素存在交互效应（P<0.001）。结论 正念减压疗法有效提高肺癌化疗患者的自我效能及正念水平。     

肾移植后骨质疏松症的护理

目的 探讨肾移植后骨质疏松症的相关因素和护理对策。方法 20例肾移植后受者进行骨密度测量，同时捡测其血清骨代谢指标，如骨特异性碱性磷酸酶、骨钙素、血清Ⅰ型前胶原羧基末端前肽、Ⅰ型胶原交联羧基末端肽、甲状旁腺素和25经维生素D。结果 35％(7例)存在骨质疏松症，其成骨细胞活性和破骨细胞活性均增高，但无继发性甲状旁腺功能亢进和维生素D代谢异常。结论 高质量的护理配合对肾移植后骨质疏松症的预防、早期发现和早期治疗有重要的临床意义。     

等待肺移植患者生存质量及其相关影响因素的调查

目的调查等待肺移植患者生存质量及其相关因素,为制订提高等待肺移植患者生存质量的措施提供理论依据。方法采用简明健康问卷(short form36health survey questionnaires,SF-36)、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-ratingdepression Scale,SDS)和领悟社会支持量表(perceiving social support scale,PSSS)对55例等待肺移植患者进行调查。采用Stepwise法对影响等待肺移植患者生存质量的相关因素进行分析。结果等待肺移植患者SF-36各维度得分为(23.18±37.53)-(74.57±26.02)分,低于常模(均P<0.001);SAS及SDS得分分别为(48.09±9.06)分及(52.18±9.98)分,高于常模(均P<0.01);PSSS社会总支持因子得分为(5.56±1.04)分,家庭内支持因子得分高于家庭外支持因子(P<0.05)。呼吸困难和抑郁是影响患者生存质量的主要因素。结论等待肺移植患者的生存质量较低,其生存质量受多种因素的影响,呼吸困难和抑郁是其主要影响因素。因此,医护人员应从患者的生理及心理方面进行有效的干预,以提高患者的生存质量。     

Selection of patients for kidney organ transplantation.

Renal transplantation is a viable alternative for most patients with end-stage renal disease, either before or after the institution of dialysis. Evaluation of potential recipients is necessary before transplantation and is mandatory to exclude patients who are likely to have a poor outcome. Such evaluation also may identify special problems and conditions in patients with end-stage renal disease who will require intervention before transplantation. Identification and evaluation of each transplant donor is also very important. Although organs from related living donors usually have better long-term function, survival, and fewer complications, most efforts in the transplantation community are spent attempting to extend the survival of cadaver kidney transplants. This goal could be accomplished by increasing availability of cadaver organs, improving histocompatibility of donor-recipient pairs, and improving available immunosuppressive therapy.     

正念减压对早中期乳腺癌患者灵性水平和睡眠质量的影响

目的:探讨正念减压疗法对早中期乳腺癌患者灵性状况和睡眠质量的影响。方法:采用便利抽样法,抽取湖南省某三级甲等医院肿瘤科早中期乳腺癌患者72例,根据就医时间分为对照组和干预组各36例,对照组给予常规护理,干预组在对照组基础上给予正念减压疗法;采用中文版慢性疾病治疗功能评估-灵性量表[包括癌症治疗功能评估-通用量表(FACT-G)和慢性病治疗功能评估-灵性量表12(FACIT-sp-12)]和匹兹堡睡眠质量指数(PSQI)对两组患者干预前后的灵性水平、睡眠质量进行评价。结果:干预前,两组FACT-G、FACIT-sp-12、PSQI评分比较差异均无统计学意义(P>0.05);干预8周,干预组FACT-G、FACIT-sp-12评分均高于对照组(P<0.05),PSQI评分除日间功能外,各维度评分均低于对照组(P<0.05)。结论:正念减压疗法能在一定程度上改善乳腺癌患者的灵性状态和睡眠质量,可作为一种有效的干预方式应用到乳腺癌患者的护理中,提高患者的整体健康水平。     

Plasmapheresis followed by intravenous immunoglobulin in presensitized patients awaiting thoracic organ transplantation.

Four highly sensitized patients awaiting thoracic organ transplantation were treated immediately preceding transplantation with 1 plasmapheresis and infusion of high dose intravenous immunoglobulin (IVIG). All 4 underwent successful surgery and have had minor to no rejection episodes over a range from 5 1/2 to 12 months. All panel reactive antibodies (PRA) were dithiotheitol (DTT) resistant, and 1 patient had IgG specific alloantibodies to a donor alloantigen. All 4 patients had positive donor cross matches prior to transplantation, and 3 of the 4 patients remained PRA negative for up to 9 months after allografting. Possible mechanisms of this therapy include inhibition of proliferating alloreactive B cells or suppression by antiidiotypic antibodies. Further study is warranted.