我国慢性病患者赋权研究进展

通过文献研究，回顾我国慢性病患者赋权相关文献，对赋权概念、患者赋权影响因素及赋权测量工具研究现状进行综述。结果表明，我国慢性病患者赋权影响因素研究以针对糖尿病患者量性研究为主，影响因素包括患者一般资料、自我效能、社会支持利用度、人格特质、应对方式和护患关系等；患者赋权测量工具主要由国外引入，尚无针对慢性病人群的量表。进一步研究可采用质性研究方法，从患者和医护人员角度深入探索和分析患者赋权影响因素；研发针对我国慢性病患者群体赋权能力的量表，以全面评估患者赋权能力和影响因素。     

慢性病患者营养素养的研究进展

近年来公众的营养素养越来越引起国内外研究者的重视,膳食营养已成为影响慢性病患者预后的重要因素之一,故本文对国内外慢性病患者营养素养的评估工具、研究现状、影响因素及其干预研究进展进行综述,以期引起医护等相关专业人员重视,为深入研究慢性病患者营养素养提升对策提供借鉴和参考。     

产后疲乏评估工具及其应用研究进展

产后疲乏是威胁女性健康的重要问题。产后疲乏的评估有助于在早期阶段发现高危人群,并针对高危人群及时进行个性化的干预,预防或延缓如产后抑郁、过早终止母乳喂养、虐待儿童及婴儿发育水平低等不良结果的发生。本文综述了国外常用的产后疲乏评估工具,包括多维疲劳量表(MFI-20)、产后累积疲乏量表(PAFS)、李氏疲乏量表(LFS)、疲乏症状量表(FSC)、产后疲乏量表(PFS)和疲乏量表(FS-14),以及各个工具所评估的内容、特点、适用范围、信度和效度、优缺点及在研究中的应用情况,旨在为开发具有我国特色的产后疲乏评估工具、开展产后疲乏评估相关研究以及临床选择评估工具提供参考依据。     

医生“以患者为中心”自我效能中文版量表的信效度研究

目的 汉化“以患者为中心”自我效能量表（The self-efficacy in patient-centeredness questionnaire,SEPCQ），并检验其在医生群体中应用的信效度，为评估医生“以患者为中心”的自我效能水平提供可靠工具。方法 遵循Brislin量表翻译原则，经过直译、回译、文化调适及预调查，形成中文版SEPCQ。采用分层随机抽样方法，选取珠三角、粤东、粤西及粤北地区26所三甲综合医院1 318名临床医生进行问卷调查，并检验量表心理测量学特性。结果 中文版SEPCQ具有较好的内部一致性（Cronbach’s α=0.988）和折半信度（Guttman系数=0.961）。探索性及验证性因子分析结果均反映量表结构效度良好。量表共包含识别患者需求、共享信息和权力、应对沟通挑战3个维度、26个条目，与原量表结构基本一致，累积方差解释率为85.162%。验证性因子分析显示模型拟合良好。结论 中文版SEPCQ在医生群体中应用具有较好的信效度，可作为评估中国医生“以患者为中心”自我效能水平的工具。     

护理程序在心力衰竭患者临床护理中的应用

目的：针对本院应用护理程序对心衰患者实施整体护理做相关的阐述。方法：对本院2010年3月－2012年10月收治的58例心衰患者在临床护理中运用“评估、诊断、计划、实施、评价”这一护理程序，对其过程进行回顾性分析总结。结果：通过对心衰患者实施整体护理，将患者的治疗护理与心理护理调整至最佳状态，使患者主动参与整个医疗护理过程，并由过去的被动接受治疗转变为现在的主动配合治疗，为患者早日康复奠定了良好基础。结论：运用护理程序对心衰患者进行针对性的临床护理，是促进心衰患者心功能恢复的有效方法，可极大地提高患者生存质量。     

中国成人心理健康量表的编制与其标准化

目前国内常用的成人心理健康评估工具之一为症状自评量表（SCL-90）。该量表的信度效度指标较好。但由于该量表是在西方化背景下开发，包含比较广泛的精神病症状学的内容。更适用于临床诊断和研究。鉴于目前缺乏针对我国普通成人所开发的心理健康量表的情况，作在多年调查研究的基础上编制了适用于我国成人的心理健康量表。并对该表的信度和效度进行检验，探索初步的常模资料，为国内成人心理健康研究提供更具针对性的有效评估工具。     

儿童青少年健康素养评估工具的研究进展

目前我国儿童青少年健康素养水平亟待提高,但国内针对儿童青少年健康素养测评工具的研究十分有限,一方面是根据我国相关政策标准自制的测量工具,另一方面是国际已有测量工具的本土化。国外应用较多的儿童青少年健康素养测评工具,多将成人经典健康素养量表进行适宜化改造,评估儿童青少年健康素养水平。本文对国内外儿童青少年健康素养的定义及测评工具进行综述总结,以期为相关研究提供参考和依据。     

公立医院开展制度廉洁性评估的实践与思考△

该文运用“理论分析与文献综述”相结合，“国内与国外研究”相比较，“问题导向与对策分析”相匹配的研究方法，综合国内外学者在制度廉洁性评估领域总结出的成果，针对公立医院开展制度廉洁性评估工作遇到的问题进行剖析，查找原因、寻求对策，探索形成科学、高效的制度廉洁性评估模式，为医院快速、健康、可持续发展营造风清气正的政治生态，为深化医药卫生体制改革保驾护航。     

中国认知障碍患者与心力衰竭发病关系的meta分析

【目的】心力衰竭(心衰)和认知障碍已成为我国负担严重的医疗问题,本研究运用meta分析综合评价中国心力衰竭患者认知障碍的患病情况,为该人群的认知障碍干预和防治提供参考依据。【方法】检索1980年1月1日至2020年7月10日中国知网数据库、万方数据库、中国生物医学文献服务系统、维普中文科技期刊数据库、PubMed数据库中有关中国心力衰竭患者认知障碍患病相关研究文献。根据Agency for Healthcare Research and Quality(AHRQ)和Newcastle-Ottawa Scale(NOS)量表分别对纳入的横断面研究和病例对照研究进行文献质量评价,采用Stata16.0合并患病率及效应量。【结果】最终纳入20篇文献,文献均为中等质量。其中6篇为病例对照研究,总样本量为933人,以健康人群为对照,心衰与认知障碍的OR值为2.77(95%CI:2.05～3.74)。14篇为横断面研究,总样本量为3 000人,中国心衰患者认知障碍总患病率为54.3%(95%CI:0.43～0.65)。亚组分析显示,认知障碍患病率随心衰患者年龄的增大而升高,女性心衰患病率(58.4%)高于男性(48.4%),蒙特利尔认知评估量表筛选的患病率(63.6%)较简易精神状态检查量表(41.7%)高。【结论】中国心衰患者认知障碍患病率较高,且在年龄、性别等方面存在差异,应采取相应的措施及时防治和干预。     

基于德尔菲法的城市社区老年人健康综合评估量表的构建

目的 构建适用于城市社区老年人健康综合评估量表，为城市社区老年人健康风险防控提供合理有效评估工具。方法 应用文献研究法构建社区老年人健康综合评估初始指标，包含6个一级指标、52个二级指标。使用德尔菲专家咨询法，通过对相关领域50名专家进行两轮咨询，形成城市社区老年人健康综合评估量表。采用SPSS 22.0软件进行统计分析，对咨询专家的积极程度、权威程度进行统计描述，根据专家对社区老年人健康综合评估量表的各维度、条目的重要性评分，计算其算数均数、满分比、变异系数、协调系数。结果 两轮专家咨询问卷的有效回收率均为100%，两轮咨询的专家权威系数为0.84、0.86，第一轮咨询结果一级、二级指标均值为4.22～4.98，满分比为0.49～0.98，变异系数≤0.23；第二轮咨询结果一级、二级指标均值为4.45～5.00，满分比为0.51～1.00，变异系数≤0.20;Kendall协调系数分别为0.116、0.110(P<0.05)，专家积极性和权威性较好，专家意见较一致，函询结果可靠。最终构建的老年人健康综合评估量表有6个一级指标（患病状况、身体功能、认知状况、社会支持与心理、饮食营...     

艾滋病健康素养研究进展及思考

目的 综述艾滋病健康素养现状。方法 以“艾滋病”、“健康素养”为中文关键词搜索CNKI数据库，“AIDS”、“Health literacy”为英文关键词搜索Pubmed数据库。结果 我国艾滋病健康素养探讨尚处于起始阶段，缺乏特异性定义及测评工具，针对性干预措施对健康结局关联性影响研究不足。结论 应立足国内艾滋病基本现状，汲取他国先进经验，开发与国情相适应的艾滋病健康素养评价工具和制定精准健康素养干预措施，促进联合国2030年前终结艾滋病流行目标早日实现。     

Methodology of Clinical Nutrition Guidelines for Adult Cancer Patients

Background: Malnutrition delays recovery from cancer treatment and can lead to additional serious complications. Clinical guidelines for the management of malnutrition in cancer patients are essential tools for optimizing nutritional care; therefore, their methodological quality is of great importance. This review assesses the methodological quality of international clinical guidelines for the management of malnutrition in adult cancer patients. Methods: Guidelines were identified through searches in multiple electronic databases; afterward, they were systematically reviewed with the AGREE instrument, which is one method of evaluating the methodological quality of guidelines. Results: The methodological quality of the guidelines reviewed varied greatly. The highest scores were observed in the domains “scope and purpose” and “clarity and presentation,” while the lowest scores were awarded in the domains “editorial independence,” “stakeholder involvement,” and “applicability.” Furthermore, there was consensus on the indication for parenteral nutrition and nutrition screening. However, there was a lack of consensus on how nutritional therapy should be provided. No improvement was observed in methodological quality of the more recent guidelines compared to the older ones. Conclusions: The methodological quality of clinical guidelines on malnutrition for cancer patients and the way they are reported need to be improved. To achieve this, developers should utilize available guideline assessment tools, such as the AGREE instrument, when writing or updating guidelines on this topic.     

Children's Interpretation of Nutrition Messages

The purpose of this research was to further our understanding of how children understand and use nutrition messages. As part of formative assessment for the development of nutrition messages for elementary age school children, focus groups and one-on-one interviews were conducted with 141 students, grades K to 6. Children were asked to interpret the messages found in the Dietary Guidelines for Americans and the Food Guide Pyramid and to indicate how they use food labels. In addition, they were asked to discuss their opinion of “good and bad foods” and “dieting” and to link specific foods with nutrition terms. Differences by cognitive development were found with younger children having more difficulty interpreting more abstract terms such as “variety” and “healthy weight.” Children in grades 3 to 6 who were asked about reading food labels had difficulty describing how they use labels and offered unrealistic criteria for determining the acceptability of food based on label information. While younger children freely used terms such as “low fat” or “low sugar,” they had difficulty in naming three foods within those categories. Our research suggests that nutrition messages need to be developmentally appropriate and give specific behavioral messages in order to positively inform the eating choices of children.     

Protein-Energy Undernutrition and the Risk of Mortality Within Six Years of Hospital Discharge

Objective: The primary objective was to determine whether protein-energy undernutrition among elderly patients discharged from the hospital remains a significant risk factor for mortality beyond 1 year.

Design: Prospective Survey (cohort study).

Setting: Outpatient follow-up of patients discharged from a Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

Participants: Of 350 randomly selected admissions to the GRU, 322 were discharged alive from the hospital. These 322 patients represented the study population of whom 99% were male, and 75% were white. The average age of the study patients was 76 (range 58 to 102) years.

Measurements: At admission and again at discharge, each patient completed a comprehensive medical, functional, neuro-psychological, socioeconomic, and nutritional assessment. Subsequent to discharge, each subject was tracked for an average of 6 years. In addition to including serum albumin and other putative nutrition indicators in the data set, a “nutrition-risk” indicator variable was created. Subjects were stratified into the nutrition “high-risk” group if their albumin was less than 30 g/L or BMI was less than 19; and, “low-risk” group if albumin was equal to or greater than 35 g/L and BMI equal to or greater than 22. All others represented the “moderate-risk” group.

Results: Within the 6-year post-hospital-discharge follow-up period, 237 study subjects (74%) died. Based on the Cox proportional hazards survival model, the variable most strongly associated with mortality was discharge “nutrition-risk” followed by the Katz Index of ADL Score, diagnosis of congestive heart failure, discharge location (home vs. institution), age, and marital status. Within the first 4.5 years of follow-up, the relationship between “nutrition-risk” and mortality remained constant. After 4.5 years, the strength of the correlation began to diminish.

Conclusions: Among the elderly, protein-energy undernutrition present at hospital discharge appears to be a strong independent risk factor for mortality during the subsequent 4.5 years or longer.     

Nutrition assessment, care, and considerations of ventricular assist device patients

A ventricular assist device (VAD) is an implantable mechanical device that is used to partially or completely replace the circulatory function of a failing heart. VADs may serve as a bridge to heart transplantation or as permanent circulatory assistance, also referred to as destination therapy. There is a paucity of information regarding the nutrition complications in VAD patients, and as such, little is presently known of the optimal means of nutrition assessment and management of these complex and often critically ill patients. In this review, a general overview of the VAD, comparisons of nutrition assessment measures, and strategies to meet the nutrition needs of these patients are provided using evidence-based information wherever possible. Because there is a lack of nutrition studies and assessment guidelines specifically for VAD patients, many of the guidelines for care of these patients are currently based on the information available for the care of patients with heart failure. Although the optimal measure to assess nutrition status remains poorly studied, a systematic, thorough nutrition assessment of patients with heart failure and heart transplant candidates prior to VAD placement appears to be important to identify those at nutrition risk and, with appropriate nutrition therapy, decrease their risk for morbidity and mortality. VAD patients with inadequate oral intake may require nutrition support to meet their nutrition needs; however, feeding the hemodynamically compromised patient provides additional challenges.     

Patient and Family Caregivers’ Experiences of Living With a Jejunostomy Feeding Tube After Surgery for Esophagogastric Cancer

Background:Jejunostomy feeding tubes (JFTs) can be used to provide nutrition support to patients who have had surgery for esophagogastric cancer. Although previous research reports how patients cope with a gastrostomy tube, little is known about the impact of having a JFT. The aim of this qualitative study was to explore how patients and their informal caregivers experience living with a JFT in the first months following surgery. Methods: Participants were purposively sampled from a cohort of patients recruited to a trial investigating home enteral nutrition vs standard care after esophagogastric surgery for cancer. The sampling framework considered age, sex, and marital status. Informal caregivers were also invited to participate. Interviews were audio recorded, transcribed verbatim, and anonymized. Inductive thematic analysis was used to identify key themes related to living with a JFT. Results: Fifteen patient interviews were conducted; 8 also included a family caregiver. Analysis of the data resulted in 2 main themes: “challenges” and “facilitators” when living with a JFT. While “physical effects,” “worries” and “impact on routine” were the main challenges, “support,” “adaptation” and “perceived benefit” were what motivated continuation of the intervention. Conclusion: Findings suggest that participants coped well with a JFT, describing high levels of compliance with stoma care and the feeding regimen. Nonetheless, disturbed sleep patterns and stoma‐related problems proved troublesome. A better understanding of these practical challenges, from the patient and family caregiver perspective, should guide healthcare teams in providing proactive support to avoid preventable problems.     

Morbus Diureticus in the Elderly: Epidemic Overuse of a Widely Applied Group of Drugs

Diuretics (thiazides, loop diuretics) are established as treatments of common diseases: arterial hypertension, heart failure, and renal disease. In aging societies, their prevalence sharply rises with age. Thus, diuretic efficacy and safety need to be considered in the elderly as main consumers. Diuretics expose several disadvantages with particular relevance for the elderly. The most acknowledged side effects concern electrolyte disturbances. Hypokalemia (up to 8%) may not only precipitate cardiac arrhythmias and related sudden death but also adynamia by muscular weakness. Hyponatremia (up to 17%) may contribute to confusion, delirium, and irreversible brain damage adding to age-related dementia. Thiazides are the antihypertensive drugs with the strongest diabetogenic activity. In heart failure treatment, overdosing of diuretics is common, as doses often reflect requirements for acute recompensation, which is two- to threefold the requirement of that in maintenance therapy. Trial data demonstrate a positive correlation between mortality and diuretic use/dose, which may also be related to volume contraction, related ACE-inhibitor intolerance, renal impairment, and venous thromboembolism. Combining loop and thiazide diuretics may be indicated for severe cardiac or renal failure, but it is also excessively used in less severe stages, causing an even more severe threat to patients; thiazides are often added unintentionally if overlooked in combination pills. Diuretics may be used to treat peripheral “edema” in obese patients, patients on calcium antagonists, or those with venous thrombotic disease. Here they are not indicated and may even induce edema. In statistics on adverse drug reactions leading to hospitalization, diuretics are among the 5 leading drug classes. Misleading interpretations of clinical trials and their low cost have pushed them into the front position of hypertension treatment. Here, side effects, including the urge of voiding, lead to the lowest adherence rate among first-line antihypertensives.It is proposed to term the syndrome of inappropriate diuretic application “morbus diureticus.” It should be diagnosed by history taking, force assessment (timed-up-and-go, chair-rise tests), clinical hydration assessment, and laboratory tests (electrolytes, creatinine). In heart failure, dose reductions/step-down from loop to thiazide diuretics should be tested routinely at 3- to 6-month intervals. In hypertension treatment, diuretics should be third in line if control by RAS inhibitors and long-acting dihydropyridine calcium antagonists is insufficient. If symptoms improve after diuretic step-down (including improved tolerance to RAS inhibitors or renal function), this diagnosis may also be made “ex juvantibus.”     

术前体成分及营养状况对消化道肿瘤病人临床结局的影响

营养不良是消化道肿瘤病人术前常见并发症,对其临床结局可产生不良影响。为保证病人围术期安全性,术前需对病人进行综合评估。针对肿瘤病人营养状况评估指标较多,然而目前针对消化道肿瘤病人营养状况有效评估方法尚不明确且缺乏肿瘤相关营养不良的评估路径。因此,本文通过综述形式探讨不同营养相关指标对消化道肿瘤病人临床结局的预测作用,以期为临床医生对消化道肿瘤病人行术前营养状况评估提供参考。     

Impact of infusion frequency on quality of life in patients receiving home parenteral nutrition

Home parenteral nutrition (HPN) may be needed as a long-term therapy for patients with chronic intestinal failure whose clinical condition does not allow complete weaning of the parenteral nutrition (PN) solution. HPN is a time-consuming and clinically complex therapy and can negatively affect quality of life (QOL). The level of dependency on HPN, specifically, infusion frequency, has been proposed as a factor that may have an effect on QOL in patients receiving HPN. The primary aim of this qualitative review is to identify the impact of HPN frequency (days per week of HPN infusion) on QOL measurements in adult patients receiving HPN. A comprehensive literature search was completed in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Primary clinical research studies were included if they were conducted in adult patients receiving HPN and included the assessment of the associations between the frequency of HPN infusion and QOL measurements. Six articles ultimately met the criteria for this review. There was variability among the studies, including use of different tools to measure QOL. However, all six studies suggest that a reduction in HPN frequency may be associated with an improvement in QOL. Whenever patients’ clinical situation allows, a reduction in HPN frequency should be considered to improve QOL in patients receiving HPN.