乳腺癌内分泌治疗患者服药信念现状及影响因素分析

目的探讨乳腺癌内分泌治疗患者对服药信念现状及其影响因素,为提高患者服药依从性提供参考。方法采用一般资料调查表和服药信念量表(BMQ)对192例辅助内分泌治疗的乳腺癌患者进行现况调查。结果乳腺癌患者服药信念得分为(1.57±0.43)分,各维度中必要性得分13.78±2.46、服药顾虑得分12.21±2.31、药物有害得分11.69±1.54、药物过度使用得分9.07±1.33分。药物有害信念、对内分泌治疗的了解程度、药物种类、药物不良反应、服药时间、化疗是乳腺癌患者服药信念的影响因素(P0.05,P0.01),可解释24.4%的总变异。结论乳腺癌内分泌治疗患者服药信念处于低水平,医护人员应根据患者服药信念水平及影响因素采用针对性的干预措施,从而改善患者的服药信念,提高服药依从性。     

居家男性痛风患者服药依从性及影响因素分析

目的了解居家男性痛风患者服药依从性现状及相关影响因素。方法对425例痛风患者采用一般资料问卷、痛风影响量表和Morisky服药依从性量表进行调查。结果痛风患者服药依从性得分为(4.87±2.22)分,疾病影响评分为(60.08±15.77)分。除发作期间对活动的关注外,患者痛风影响程度总分及各维度得分与服药依从性总分呈负相关(P0.05,P0.01)。多元逐步回归分析显示,血尿酸、病程、痛风药物不良反应及未满足痛风治疗需要是影响居家男性痛风患者服药依从性的主要因素(P0.05,P0.01)。结论居家男性痛风患者服药依从性偏低,痛风影响程度是影响居家服药依从性的主要因素。需加强对患者疾病特征及药物治疗重要性的健康教育,提高患者对药物治疗的认识及重视程度,以提高其服药依从性。     

420例高血压患者服药依从性影响因素调查分析

目的:研究分析影响高血压患者服药依从性的因素,探讨提高其服药依从性的护理对策.方法:分析本院2008年9月～2011年4月收治的420例确诊为原发性高血压患者的服药情况,调查其相关影响因素,分析其对患者服药依从性的影响.结果:205例患者服药依从性较高,215例患者服药依从性较差,患者服药依从率48.8％.患者性别、年龄、家庭经济、教育程度、药物不良反应、高血压常识以及家族病史等因素影响患者的服药依从性.结论:影响高血压患者服药依从性的因素众多,选择积极的护理策略以及采用具有针对性的护理措施是提高服药依从性的关键.     

结直肠癌患者口服替吉奥依从性及其影响因素分析

目的分析结直肠癌患者口服替吉奥依从性及其影响因素。方法纳入2018年7月至2018年9月本院收治的接受SOX方案(替吉奥+奥沙利铂)化疗的200例结直肠癌患者,采用一般资料调查表及Morisky服药依从性量表进行问卷调查。按已经过的化疗周期,将患者划分为化疗早期(经过1～2个化疗周期,93例)、化疗中期(经过3～4个化疗周期,62例)、化疗晚期(经过5～8个化疗周期,45例),分析经过不同化疗周期患者用药依从性及其影响因素。结果 200例患者中,服药依从性良好者64例、中等者95例、差者41例,化疗早期组服药依从性好于其它两组,差异均有统计学意义(均P 0.05);化疗中期组服药依从性与化疗晚期组比较差异无统计学意义(P 0.05)。化疗早期组患者中,已婚是服药依从性良好的独立保护因素(P 0.05),发生不良反应是服药依从性的独立危险因素(P 0.05);化疗中期组患者中,较高的文化程度、较高的家庭月收入、了解治疗方案是依从性良好的独立保护因素(均P 0.05);化疗晚期组患者中,较高的家庭月收入是依从性良好的独立保护因素(P 0.05)。结论随着化疗周期的增加,结直肠癌患者口服替吉奥依从性下降。经过不同化疗周期患者,口服替吉奥依从性的影响因素不一致,护理人员需要进行针对性干预。     

维持性血液透析患者服用磷结合剂依从性调查分析

目的探讨维持性血液透析患者服用磷结合剂现状及其相关影响因素。方法采用Morisky-8服药依从性量表对232例维持性血液透析患者口服磷结合剂进行调查。结果 232例患者服药依从性总分为(5.45±1.80)分。112例(48.28%)服药依从性良好,120例(51.72%)依从性差。回归分析结果显示,年龄、婚姻状态、家庭人均月收入、是否在职是患者服药依从性的影响因素(P0.05,P0.01)。结论维持性血液透析患者口服磷结合剂的依从性不足,应建立科学合理的筛查标准,完善随访管理制度,针对高龄、低收入、在职及婚姻状态不佳等高危人群给予针对性的护理干预。     

肝移植受者术后发生门静脉血栓的危险因素分析及治疗方式探讨

目的探讨肝移植术后患者发生门静脉血栓(PVT)的危险因素及治疗方式。方法回顾性分析2015年7月至2019年4月在解放军总医院第五医学中心行肝脏移植手术的290例受者的临床资料, 其中男性245例, 女性45例, 中位年龄51(44, 56)岁。依据肝移植受者术后是否发生PVT分为两组:PVT组(n=16)和非PVT组(n=274)。对比两组肝移植受者性别、年龄等临床资料。采用门诊和住院方式进行随访。分析肝移植受者术后发生PVT的危险因素。结果 290例肝移植受者术后随访时间59(42, 73)个月, 明确术后存在PVT者16例, 发生率为5.5%(16/290)。多因素logistic回归分析显示, 受者术前存在PVT(OR=12.773, 95%CI:3.887～41.973)是肝移植术后发生PVT的独立危险因素。对于术后出现PVT的16例患者, 其中10例行门静脉介入干预治疗, 剩余6例患者由于症状轻微, 口服阿司匹林或者利伐沙班抗凝治疗。PVT组受者术后3年生存率为93.8%(15/16), 非PVT组受者术后3年生存率为90.1%(247/274), 两组受者术后3年生存率间...     

成人肾移植受者服药依从性与服药信念的研究

目的了解肾移植受者服药依从性和服药信念的状况,并探讨二者间的关系。方法采用便利抽样法选取北京市某三甲医院移植随访门诊就诊的255例肾移植受者,采用一般情况调查表、免疫抑制药物依从性Basel评估量表、服药信念量表进行调查。结果 54.90%肾移植受者术后服药依从性差;服药信念各维度得分:服药必要性20.35±2.76、服药顾虑16.85±3.69、药物过度使用10.29±2.89、药物有害11.15±2.86,服药必要性与顾虑差值得分为3.50±4.06。服药依从性好和依从性差组的服药必要性、药物有害、药物过度使用及服药必要性与顾虑差值得分比较,差异有统计学意义(P0.05,P0.01)。结论门诊肾移植受者服药依从性亟待改善,服药依从性与服药信念有关,应提高患者的服药信念,以改善其服药行为。     

成人原位肝移植受者术后急性肾损伤的危险因素分析

目的分析成人原位肝移植受者术后发生急性肾损伤(AKI)的危险因素。方法回顾性分析2019年1月至2021年4月于郑州大学第一附属医院进行原位肝移植手术的232例受者的临床资料, 其中男性195例, 女性37例, 年龄(49.1±9.4)岁。依据术后7 d内是否发生AKI分为两组:AKI组(n=112)和非AKI组(n=120)。对比两组患者基本信息、术前血液学指标、手术时间、术后住院时长等临床资料。对原位肝移植术后AKI的相关因素进行单因素分析, 将差异有统计学意义的因素纳入多因素logistic回归分析。结果在232例接受原位肝移植的患者中, 有112例在术后发生AKI, 发生率为48.3%(112/232), 其中AKI 1期64例(57.1%, 64/112), AKI 2期30例(26.8%, 30/112), AKI 3期18例(16.1%, 18/112)。logistic回归分析结果显示, 高血压(OR=5.874, 95%CI:1.931～17.863, P=0.002)和高终末期肝病模型(MELD)评分(OR=1.041, 95%CI:1.010～1.074, P=0...     

艾滋病抗病毒治疗患者服药依从性现状及其影响因素

综述了AIDS抗病毒治疗患者服药依从性的重要性、现状及其影响因素,提出患者服药依从性较差,并与多种影响因素相关,如与患者相关因素、医疗服务质量和医患关系、与治疗方案或药物不良反应相关因素、社会环境因素等.提出在今后的研究中,应更注重加强患者、医护人员的干预,从而提高患者的服药依从性.     

类风湿关节炎患者服药信念与服药依从性调查

目的了解类风湿关节炎患者服药信念和服药依从性现状及其相关性,为制定提高患者服药依从性的护理措施提供理论依据。方法采用风湿病用药依从性问卷(CQR)及服药信念量表(BMQ)对177例类风湿关节炎患者进行调查。结果仅33.9%类风湿关节炎患者的服药依从性好;患者服药信念中位数为1分;患者服药依从性的主要影响因素是服药信念及药物毒性(P0.05,P0.01)。结论类风湿关节炎患者的服药依从性较差,服药信念影响患者服药依从性。应加强对患者服药方面的健康教育,提高其服药信念,减少药物毒性等方面的顾虑,从而提高其服药依从性。     

基于手机应用程序的居家用药管理对肺移植受者依从性及生存质量的影响

目的探讨"肺病与移植管理"App结合1日药盒用药法居家用药管理方案对肺移植受者自我管理、用药依从性及生存质量的影响。 方法选取2019年1至6月无锡市人民医院肺移植中心门诊随访的73例肺移植受者进行自我管理、用药依从性及生存质量的问卷调查。成立用药随访管理小组，制订肺移植受者居家用药管理方案。予肺移植受者"肺病与移植管理"APP结合1日药盒用药法居家用药管理方案干预3个月后再次对其进行问卷调查，比较干预前后受者自我管理、自我效能、用药依从性及生存质量差异。采用配对t检验比较"肺病与移植管理"App结合1日药盒用药法居家用药管理方案干预前后肺移植受者自我管理、自我效能、用药依从性和生存质量得分，P<0.05为差异有统计学意义。 结果干预3个月后，受者自我管理、认知性症状管理实践、用药依从性、生存质量及生理方面生存质量得分分别为(37±7)、(16±3)、(7.0±1.0)、(154±26)和(77±14)分，均高于干预前[(33±9)、(13±6)、(6.5±1.1)、(141±30)和(67±17)分]，差异均有统计学意义(t＝-0.609、-3.383、-12.864、-2.818和3.586，P均<0.05)。干预前后受者自我效能、运动锻炼、与医师的沟通、症状管理、疾病共性管理和心理方面生存质量得分差异均无统计学意义(t＝-1.972、-0.609、-1.486、-1.747、-1.746和1.487，P均>0.05)。干预前用药依从性好、中和差受者分别有16、41和16例，干预后分别为27、40和6例。 结论基于移动健康平台制订的居家用药管理方案可提高肺移植受者自我管理、用药依从性及生理方面的生存质量。     

终末期肝病肝移植受体的术后生存状况及影响因素分析

目的了解终末期肝病肝移植受体术后的生存状况,探讨影响肝移植受体特别是恶性终末期肝病受体长期生存的危险因素。方法 2005年10月至2009年10月,在上海交通大学附属瑞金医院器官移植中心接受同种异体肝移植且随访记录完整的受体99例,收集其临床资料进行回顾性分析。所有患者均签署知情同意书,符合医学伦理学规定。根据肝移植受体的原发病分为良性组(54例)和恶性组(45例)。应用Kaplan-Meier法计算肝移植受者术后的1年、2年、3年、4年存活率,绘制生存曲线,并用Log-rank法比较生存曲线。将肝移植受体围手术期的12项指标和恶性组10项指标进行Cox比例风险回归模型分析,筛选出影响受者生存的危险因素。结果截止至2009年10月,生存64例,死亡35例,受体术后的1年、2年、3年、4年存活率分别为68%、57%、53%、53%。良性组术后的1年、2年、3年、4年存活率分别为78%、70%、61%、61%,恶性组术后的1年、2年、3年、4年存活率分别为60%、46%、46%、46%。两组术后各年存活率比较,差异无统计学意义(均为P>0.05)。良性组的存活时间为(35.8±3.0)个月,恶性组的存活时间为(28.7±2.9)个月,两组比较差异无统计学意义(P>0.05)。Cox比例风险回归模型分析表明,围手术期的12项指标中,急性生理和慢性健康评估(acute physiology and chronic health evaluation,APACHE)Ⅱ评分(优势比1.21,95%可信区间1.05～1.39,P<0.01)和无肝期时间(优势比2.28,95%可信区间1.26～4.13,P<0.01)对肝移植受体术后存活时间的影响有统计学意义。恶性组的10项指标中,术前甲胎蛋白水平(优势比5.94,95%可信区间2.49～14.16,P=0.001)和肿瘤微卫星灶(优势比3.40,95%可信区间1.50～7.74,P<0.01)对肝移植受体术后存活时间的影响有统计学意义。结论终末期肝病肝移植受体术前APACHEⅡ评分和术中无肝期时间是影响受体术后长期生存的主要危险因素,而术前甲胎蛋白水平和有肿瘤微卫星灶则是影响恶性肝脏疾病肝移植受体长期生存的主要危险因素。     

Adherence to medication after liver transplantation in Scotland: a pilot study.

This study assessed adherence to medication after liver transplantation and consisted of 2 components: a retrospective audit involving the examination of the Scottish national database, and a preliminary study assessing psychological factors implicated in poor adherence. In order to first establish an idea of the extent of poor adherence within the Scottish liver transplant population, a retrospective audit was carried out on all patients (N = 435) who received transplants before November 2003. Adherence was assessed by attendance at follow-up clinic appointments, blood immunosuppressant levels, and episodes of cellular rejection. It was found that attendance and immunosuppressant levels were often suboptimal and that nonadherence may have contributed to retransplantation and death. Cellular (acute) rejection after 6 months was associated with higher mortality. Explanations as to why liver transplant patients may not take their medication as recommended were then explored in detailed psychological assessments of 33 liver transplant recipients. The results indicated that low self-reported patient adherence was related to greater concerns regarding the potential adverse effects of medication, and a stronger belief that medicines in general are harmful. In addition, the greater the effect the transplantation had on patients' lives and the more it affected them emotionally, the less adherent the patients were likely to be. The results highlight potential areas that, if confirmed in a larger study, might be targeted in a psychological intervention to improve patient adherence and thereby transplantation outcomes.     

Non‐adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross‐sectional study

Schmid‐Mohler G, Pechula Thut M, Wüthrich RP, Denhaerynck K, De Geest S. Non‐adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross‐sectional study.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01056.x
© 2009 John Wiley & Sons A/S. Abstract: Background: Non‐adherence to immunosuppressive medication is strongly associated with poor outcomes. Identifying the factors influencing it is a first step in developing adherence interventions. This study’s objective was to investigate the prevalence of self‐reported and collaterally‐reported non‐adherence to immunosuppressives, and, based on the Integrative Model of Behavioral Prediction, to explore the association between non‐adherence, intention to adhere, attitudes, norms and self‐efficacy. Methods: This cross‐sectional study included a convenience sample of 114 renal transplant recipients in follow‐up care, one to five yr post‐transplant. Non‐adherence was measured by self‐reports and collateral reports. Factors of the Integrative Model of Behavioral Prediction were assessed using a self‐report questionnaire. Results: Self‐reports showed non‐adherence of 23.7%; collateral reports showed 3.8%; and a combination of the two showed 26.4%. Logistic regression analysis showed that the attitude “Not all immunosuppressive drugs are necessary to prevent rejection” was less frequent in patients with higher intentions to adhere, with an odds ratio (OR) of 0.05 (95% CI 0.01–0.50). The barrier of “Forgetfulness/Interruption of daily routine” was associated with non‐adherence, with an OR of 3.74 (95% CI 1.55–9.03). Conclusions: Forgetfulness is the most powerful barrier against adherence. Intention to adhere plays a minor role in non‐adherence in renal transplant recipients.     

良性前列腺增生患者对非那雄胺治疗的依从性研究

目的:本组以应用非那雄胺治疗的门诊BPH患者为对象,研究服药依从性、停药和换药的影响因素。方法:回顾性分析门诊电子数据库资料,自2008年1月至2010年6月共入组655例初诊接受非那雄胺治疗的BPH患者,平均观察期12个月,计算依从性、停药和换药例数,采用多因素分析,分别评估其影响因素。结果:依从性良好、停药、换药比例分别为32.4%、58.0%和9.6%。年龄较大(≥60岁),非那雄胺与α受体阻滞剂联合治疗,有慢性合并症等是依从性良好的预测因子。年龄较小者易于停药和换药。非那雄胺单药治疗者易于停药。结论:年龄<60岁以及接受非那雄胺单药治疗的患者总体依从性较差,临床医生应注意提高这些人群的依从性。     

Efficacy and Safety Evaluation After Conversion From Twice-Daily to Once-Daily Tacrolimus in Stable Liver Transplant Recipients: A Phase 4, Open-Label,Single-Center Study

BackgroundSimplifying immunosuppressive therapy after liver transplant may improve patient compliance, thereby preventing acute rejection and graft loss. This phase 4, open-label, single-center study was conducted to evaluate the efficacy and safety of twice-daily to once-daily tacrolimus conversion in stable liver transplant recipients.MethodsBetween May 2017 and January 2019, twice-daily tacrolimus was converted to once-daily tacrolimus in 101 stable recipients at least 12 months post-liver transplant in Asan Medical Center. The doses of both drugs was converted to 1:1, and the target trough level was 5 to 10 ng/mL. We prospectively analyzed graft function, drug compliance, and adverse reactions after switching regimen for 24 weeks.ResultsThere was no acute rejection confirmed histologically within 24 weeks, which was the primary endpoint, and there was no chronic rejection, fatal deterioration of liver function, or death in any patient during this period. After conversion, the trough level of tacrolimus decreased, and the mean ± standard deviation differences between the trough level and baseline level were 1.46 (±2.41) ng/mL, 0.43 (±2.08) ng/mL, and 0.07 (±2.73) ng/mL at 3, 12, and 24 weeks after conversion, respectively. Despite transient fluctuations of the trough level, there was no evidence of rejection or graft dysfunction. There were 37 adverse reactions after conversion; most of them were mild, and thrombocytopenia developed in 1 patient as an adverse drug response. Drug compliance improved after conversion according to questionnaire responses.ConclusionsThe conversion to once-daily tacrolimus in stable liver transplant recipients is an effective and safe therapeutic strategy improving drug compliance.     

Immunosuppressant treatment adherence, barriers to adherence and quality of life in renal and liver transplant recipients in Spain

To assess the adherence to immunosuppressant therapy (IST) and perceived barriers affecting IST adherence and quality of life (QOL) in patients who had received a renal (RT) or liver transplant (LT), a questionnaire was sent to over 9000 RT and LT recipients in Spain. Questionnaire comprised questions about patient's socio-demographic, organ transplant and medication characteristics; IST adherence and patient's perceived barriers to adherence; and patient's QOL using the EuroQol. Data from 1983 RT patients and 1479 LT patients were analyzed. Self-reported adherence to IST in RT (92.6%) and LT (88.5%) recipients was high. Daily medication intake (mean of 2-3 doses/d per patient) was considered a lifestyle restriction in about 25% of transplant recipients and was the most common barrier to adherence perceived by over 30% of RT and LT patients. Overall, high-intensity treatment regimens were associated with poorer QOL (EuroQol <70) compared with low-intensity treatment regimens. Most RT (71.0%) and LT (61.4%) patients would prefer to suppress the evening dose if they were able to. Although high adherence rates to IST were reported in this first large Spanish survey in RT and LT patients, adjustment of daily treatment intensity by less frequent dosing may be an adequate strategy to minimize barriers to adherence and improve QOL.     

子宫内膜异位症腹腔镜术后复发的相关因素分析

目的：探讨子宫内膜异位症患者腹腔镜手术后复发的危险因素,为临床治疗提供依据。方法：回顾分析2009年5月至2011年5月134例子宫内膜异位症患者（Ⅰ、Ⅱ期62例,Ⅲ期49例,Ⅳ期23例）腹腔镜术后复发情况,并对相关影响因素进行logistic回归风险分析,筛查复发的相关因素。结果：经logistic回归分析显示,纳入分析的患者复发率为16．4％（22／134）,与内异症患者术后复发率相关的因素有r-AFS分期（OR=5．785,CI=1．939—17．261,P=0．002）、手术方式（OR=0．301．CI=0．109-0．830,P=0．020）、术后联合用药（OR=0．062,CI=0．016—0．234,P=0．000）。结论：r—AFS分期、手术方式及术后联合用药是影响子宫内膜异位症患者腹腔镜手术后复发率的相关因素,临床应加强干预,以降低术后复发率。     

Modifiable risk factors for non-adherence to immunosuppressants in renal transplant recipients: a cross-sectional study.

BACKGROUND: Non-adherence to immunosuppressants is a major cause of renal transplant failure. Interventions to improve adherence need to target modifiable risk factors. METHODS: Adherence was measured using the 'gold standard' measure of electronic monitoring in 58 adult renal transplant recipients from a UK transplant unit. Subjects were identified from a stratified random sample of 153 recipients recruited to a larger cross-sectional study comparing different measures of adherence. Inclusion criteria included age over 18 years and a functioning renal transplant, transplanted 6-63 months previously. Exclusion criteria included residence outside the region served by the unit and inability to give informed consent. Health beliefs, depression and functional status were measured using standardized questionnaires (Beliefs about Medicines Questionnaire, Illness Perception Questionnaire, Revised Clinical Interview Schedule and SF-36) and semi-structured interview. Transplant and demographic details were collected from the notes. RESULTS: Seven [12%, 95% confidence interval (CI) 4-20%] subjects missed at least 20% of days medication and 15 (26%, 15-37%) missed at least 10% of days. Lower belief in the need for medication and having a transplant from a live donor were the major factors associated with non-adherence. Depression was common, although not strongly associated with non-adherence. CONCLUSIONS: Beliefs about medication are a promising target for interventions designed to improve adherence. The lower adherence in recipients of transplants from live donors needs confirming but may be clinically important in light of the drive to increase live donation.     

调节性T细胞与肾移植受者术后免疫变化的相关性研究

目的：研究外周血CD4^-CD25^high Treg细胞（regulatory T cell,Treg）比例对肾移植受者免疫力的影响,为CD4^＋CD25^high Treg细胞的比例变化作为评估移植受者免疫状态及作为预测排斥反应和感染的特异性指标提供实验依据。方法：肾移植受者52例按肾移植术后恢复情况分为免疫力正常组26例,发生排斥反应组17例,发生感染组9例,用流式细胞仪检测外周血CD4^＋CD25^high Treg细胞的比例,所得结果进行相关分析。结果：发生急性排斥反应组CD4^-CD25^high Treg细胞比例较免疫力正常组显著降低（P〈0．05）,发生感染组外周血CD4^＋CD25^high Treg细胞的比例较正常组显著升高（P〈0．01）,差异均有统计学意义。FK-506和CsA分别对CD4^＋CD25^high Treg细胞比例的影响差异无统计学意义。结论：肾移植术后受者外周血CD4^-CD25^high Treg细胞比例与受者免疫状态密切相关。CD4^＋CD25^high Treg细胞比例的变化可以反应机体的免疫状态的变化,其升高或降低可以作为预测肾移植受者术后发生感染或排斥反应的指标之一。