路径式健康教育对骨质疏松患者知信行的影响

目的探讨路径式健康教育对骨质疏松患者知信行的影响。方法选择在我院康复科住院的骨质疏松患者120例作为研究对象,随机分为研究组和对照组各60例。对照组给予药物治疗,同时进行常规健康教育,研究组采用在对照组的基础上实施路径健康教育,分别于干预前、干预后12个月比较两组患者对骨质疏松相关知识掌握情况、健康信念、健康行为内容进行评价。结果两组患者出院后12个月骨质疏松症相关知识得分、健康信念总得分、健康行为得分显著高于对照组(P0.05)。结论给予患者实施路径式健康教育能够改善骨质疏松患者的知信行,有效提高患者及其家属对骨质疏松症防治相关知识的认知水平,增强患者的自我护理能力,防止骨质疏松性骨折,进而提高治疗效果,改善患者的生活质量。     

微信教育在骨质疏松骨折患者延续护理中的应用效果

目的探讨微信教育在骨质疏松骨折患者延续护理中的应用效果。方法将120例骨质疏松骨折患者按入院先后顺序分为对照组与观察组各60例,两组患者住院期间均给予住院教育,教育内容包括骨质疏松症一般知识、饮食、运动、日照、药物服用方法、防跌倒。对照组出院后将住院教育内容打印发给患者,观察组住院时建立微信群,出院后通过微信进行互动实施健康教育,两组患者均随访12个月,分别在出院时、出院后12个月评估患者的骨质疏松知识、疼痛评分、护理满意度、生活质量。结果观察组患者实施延续护理后较对照组在骨质疏松知识、疼痛评分、护理满意度、生活质量各维度得分差异均有统计学意义(P0.05)。结论微信教育应用于骨质疏松骨折患者的延续护理,可提高患者对骨质疏松症的知识水平,降低患者的疼痛,提高患者满意度和生活质量,确保了骨质疏松骨折患者出院后健康教育的延续性。     

骨质疏松性骨折患者心理评估及干预的临床研究

目的观察骨质疏松性骨折住院患者的心理状况,以及心理干预对缓解疼痛、提高生活质量的影响。方法收集我院71例住院患者资料,其中椎体骨折55例,髋部骨折16例,以综合医院焦虑、抑郁(HCD)情绪测定表进行心理评估,并予心理疏导。结果 71例骨质疏松性骨折患者中,椎体骨折患者焦虑占56.36%,抑郁占29.09%;髋部骨折患者的焦虑和抑郁分别占68.75%、43.75%,并且女性髋部骨折患者发生焦虑、抑郁的比例明显高于男性。通过心理干预,椎体骨折患者焦虑及抑郁比例分别下降为16.36%及10.91%,髋部骨折患者焦虑和抑郁比例分别降为25%和12.50%,患者生活质量得到明显提高。结论积极的心理干预是缓解骨质疏松性骨折患者的焦虑和抑郁的有效途径。     

老年脑卒中患者基于IKAP理论的口腔管理健康教育

目的 探讨基于IKAP理论的口腔管理健康教育对老年脑卒中患者的影响。方法 将108例老年脑卒中患者按照住院时间分为对照组和干预组各54例。对照组实施常规健康教育,干预组在此基础上实施基于IKAP理论的口腔管理健康教育。比较干预前、干预完成时及干预后3个月两组患者口腔健康状况、口腔健康素养及口腔相关生活质量。结果 对照组50例、干预组51例完成研究。干预完成时及干预后3个月,两组口腔健康状况、口腔相关生活质量及口腔健康素养得分比较,组间效应、时间效应及交互效应差异有统计学意义（均P＜0.05）。结论 基于IKAP理论的口腔管理健康教育能够提高老年脑卒中患者口腔健康状况、口腔健康素养水平及口腔相关生活质量。     

浅谈骨质疏松症的护理

目的:探讨护理干预对骨质疏松患者生活质量提高,降低骨折发生。方法:对40例患者实现护理指导和健康教育出院一月至六月后随访,生活质量明显提高,2例患者发生骨折。结果:患骨质疏松的患者通过治疗与护理生活质量提高,减少了骨折和致残。结论:对骨质疏松的患者制订并实施有效的护理,可取得较满意的疗效。     

健康信念模式和自我效能理论在老年男性骨质疏松症中的应用

目的 探讨健康信念模式和自我效能理论教育对老年男性骨质疏松症患者生活质量和骨密度的影响。方法 选取骨质疏松筛查确诊骨质疏松症的老年男性患者52例,随机均分为对照组和干预组,干预组进行健康信念和自我效能教育,对照组进行常规健康指导,随访1年考察两组患者的健康信念量表评分、自我效能量表评分、健康调查量表评分、骨密度变化。结果 干预组与对照组分别有26和25例患者完成随访。与对照组比较,干预组患者健康信念量表和自我效能量表各维度评分均显著增加,差异均具有统计学意义(P <0. 05);干预组总体健康、生命活力、社会功能、情感职能、精神健康评分均显著高于对照组,差异具有统计学意义(P < 0. 01);与对照组比较,干预组骨密度变化,差异无统计学意义（P > 0. 05);干预组无骨折发生,对照组发生1例(3. 85%)。结论 健康信念模式和自我效能理论教育可以提高老年男性骨质疏松患者的生活质量、减少骨折的发生,值得临床推广使用。     

全程护理干预对早中期老年性痴呆患者生活质量的影响

目的探讨早、中期老年性痴呆(AD)患者的全程护理方法.方法将确诊为早、中期AD的80例患者随机均分为观察组和对照组.对照组采用一般住院护理指导;观察组实施住院-社区-家庭全程护理干预,即在科学组织管理的基础上进行全程护理干预,实施心理护理以及记忆、智能、逻辑思维、日常生活能力等训练,并进行安全护理指导.结果两组干预后简易精神状态检查量表(MMSE)、日常生活能力量表(ADL)评分均显著高于干预前(均P<0.05),干预后评分观察组与对照组比较,差异有显著性意义(P<0.05,P<0.01).结论全程护理干预可提高AD患者生活质量,延缓病情进展.     

全程综合管理对慢性阻塞性肺疾病出院患者生活质量的影响

目的探讨全程综合管理对慢性阻塞性肺疾病(COPD)患者生活质量的影响。方法将160例Ⅱ~Ⅳ级COPD患者按入院顺序编号,采用单双号数字分为观察组与对照组各80例。对照组住院期间进行常规对症支持治疗及护理,出院前进行运动、营养及药物指导,出院后每2个月随访复查1次;观察组采取全程综合管理方法,由14名医护人员组成全程综合管理小组,针对COPD患者的疾病、经济、心理、营养状况制定日常疾病管理方案,进行为期1年的干预。比较两组随访期再住院率及急诊就诊率、家庭氧疗执行情况、生活质量。结果观察组家庭氧疗执行率显著高于对照组,再住院率及急诊就诊率显著低于对照组(均P0.05);观察组生活质量总分、呼吸症状得分、疾病影响得分、活动受限得分与对照组比较,干预效应、时间效应及交互效应均P0.01。结论全程综合管理方案通过全面的药物指导、运动指导、心理指导及肺部康复指导,可提升患者对自我疾病管理的积极性,提高患者的家庭氧疗执行情况,降低再住院率及急诊就诊率,提升其生活质量。     

云克联合护理干预对痛风性关节炎伴骨质疏松的疗效分析

目的探讨云克(锝-亚甲基二膦酸盐注射液,99Tc-MDP)联合护理干预对痛风性关节炎患者骨密度及生活质量的影响。方法将182例痛风性关节炎合并骨量减低或骨质疏松患者随机分为对照组和试验组,对照组给予非甾体抗炎药、糖皮质激素及秋水仙碱治疗,试验组在此基础上加用云克及护理干预,使用美国Norland XR 600双能X线骨密度仪测量患者腰椎和髋关节骨密度值,采用Spitzer生活质量指数量表测评患者生活质量,比较两组干预前痛风性关节炎患者骨密度和生活质量及治疗6个月后痛风性关节炎患者骨密度和生活质量变化。结果治疗6个月后试验组骨密度及生活质量较对照组均明显提高,差异有统计学意义(P0.05)。结论云克联合护理干预能明显提高痛风性关节炎骨质疏松患者的骨密度及生活质量,明显改善临床症状。     

全程护理干预对早中期老年性痴呆患者生活质量的影响

目的探讨早、中期老年性痴呆（AD）患者的全程护理方法。方法将确诊为早、中期AD的80例患者随机均分为观察组和时照组。对照组采用一般住院护理指导；观察组实施住院-社区-家庭全程护理干预，即在科学组织管理的基础上进行全程护理干预，实施心理护理以厦记忆、智能、逻辑思维、日常生活能力等训练，并进行安全护理指导。结果两组干预后简易精神状态检查量表（MMSE）、日常生活能力量表（ADL）评分均显著高于干预前（均P〈0．05），干预后评分观察组与对照组比较，差异有显著性意义（P〈0．05．P〈0．01）。结论全程护理干预可提高AD患者生活质量，延缓病情进展。     

住院骨质疏松性骨折患者危险因素与干预措施

目的 探讨住院老年骨质疏松骨折发生的危险因素,为指导骨质疏松性骨折的预防提出干预措施。方法 选择2010年5月～2012年 5 月在我院住院的203例老年骨质疏松症患者为研究对象,根据患者是否出现骨折分为老年骨质疏松性骨折组和老年骨质疏松症无骨折组,采用自编问卷的方法收集符合条件的患者的临床资料。采用多因素 Logistic回归分析骨质疏松性骨折患者的危险因素。结果 骨密度是骨质疏松症并发骨折的保护因素,而年龄、低钙饮食、跌倒、脆性骨折史及骨折家族史是发生老年骨质疏松性骨折的危险因素。结论 老年骨质疏松症并发骨折受多种因素影响,可从饮食、体育锻炼及药物等多方面进行干预。     

骨质疏松症营养干预研究进展

随着人口老龄化加剧,骨质疏松症及骨质疏松性骨折的发生率和死亡率明显升高,给家庭和社会带来沉重负担。如何有效干预骨质疏松症的发生,减少骨质疏松症及其并发症带来的不良后果,不仅是有效提高骨质疏松症患者生活质量的关键,还可以减轻家庭和社会的经济负担。目前研究发现,饮食营养及营养素补充与骨质疏松症密切相关,早期营养及营养素补充改变有助于避免骨质疏松症的发生发展。在本文中,我们阐述了蛋白质、钙、维生素D及其他维生素和矿物质等营养素补充在预防骨质疏松症、维持骨骼健康中的作用,重点关注以骨密度或骨折作为结果的营养干预研究,探讨了近期关注的营养干预预防骨质疏松症的可能机制,强调了营养补充对预防骨质疏松和维持骨骼健康的重要性。     

唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折的疗效分析

目的探讨唑来膦酸(密固达)联合骨水泥技术治疗老年骨质疏松性骨折的临床疗效。方法回顾性分析我科于2010~2011年收治老年骨质疏松性骨折并行PVP/PKP骨水泥技术治疗的病人,20例获得随访,依据PVP/PKP术后是否应用唑来膦酸治疗,分成对照组及实验组。所有病人分别于治疗前和治疗后1年进行股骨近端骨密度测量及疼痛VAS临床评分,评价治疗效果。结果治疗1年后实验组患者股骨近端骨密度明显提高,脊柱骨疼痛症状较对照组得到持续缓解,治疗后1年内无新发骨折。对照组1年期间有脊柱骨性疼痛加重趋势,1例患者术后2月后再次出现新发椎体骨质疏松性骨折。唑来膦酸用药后主要临床不良反应为类流感样反应,包括发热、面红、周身不适等,短期内可缓解,患者均可耐受。结论唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折效果显著,可明显提高骨质疏松性患者骨密度,预防骨量持续丢失,提高患者生活质量,并有效减轻全身及胸腰部骨性疼痛症状,预防再次骨折发生。应用唑来膦酸给药方便、依从性较好,不良反应轻微、可达到全身系统化治疗,可作为骨质疏松性骨折PVP术后一种良好的辅助治疗措施。     

骨密度结合股骨颈颈干角对各型髋部骨质疏松性骨折风险的预测

目的：探讨股骨近端骨密度和股骨颈颈干角与髋部骨质疏松性骨折的相关性。方法收集在我院住院的髋部骨折患者100例和健康老年对照组100例,采用美国GE公司生产的LUNAR-Bravo双能X线骨密度仪及其配置的高级骨科专用分析测量软件,分析股骨近端骨密度和股骨颈颈干角与骨质疏松的相关性。结果髋部骨折组与对照组比较,髋部骨折组BMD较对照组有明显下降,股骨外侧皮质骨厚度明显减小,股骨颈干角（ NSA）较对照组钝。结论髋部骨密度结合股骨颈颈干角变化特点可以提高对各型髋部骨质疏松骨折危险性的预测。     

Quality of life in patients with osteoporosis

Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)–independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.     

Major osteoporotic fragility fractures: Risk factor updates and societal impact

Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders(for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.     

Awareness of Osteoporosis and Compliance with Management Guidelines in Patients with Newly Diagnosed Low-Impact Fractures

A pre-existing fracture is a strong predictor of additional osteoporotic fractures. Consequently, current guidelines emphasize the need for treating patients with existing osteoporotic fractures. The present study aimed to assess the implementation of osteoporosis guidelines in routine practice. To this end, we reviewed the hospital charts of women and men aged 50 years and older with new fractures due to low or moderate impact treated in the emergency room, orthopedic surgery and rehabilitation departments. Notation of osteoporosis as a contributing cause for the fracture, performance of screening laboratory tests for possible secondary causes and treatment recommendations were abstracted from the record. In addition, we utilized the centralized pharmacy and laboratory computerized databases of the largest health maintenance organization in the area to follow dispensation of osteoporosis drugs and performance of screening laboratory tests in the community following fracture incidents. During the corresponding periods of January and February 1998 and 1999, 183 patients aged 50 years and older with low-impact fractures were treated in the emergency room only and 113 were hospitalized. Osteoporosis was rarely mentioned in the medical documentation. During the 6 month period after the fracture incident at least 70% of the emergency room patients and 62% of the hospitalized patients received no osteoporosis drugs. However, an encouraging significant trend toward increasing use of osteoporosis drugs, both prior to and after a fracture incident, was noted between the two survey periods among the emergency room fracture patients, but not among the hospitalized patients. Calcium supplements were the most commonly used osteoporosis drug. Bisphosphonates, hormone replacement therapy, raloxifene and calcitonin were rarely prescribed. Men were less likely than women to receive treatment for osteoporosis. Systematic laboratory evaluations for secondary causes of osteoporosis were not performed. We conclude that despite extensive attempts at increasing awareness among health professionals and the public at large, osteoporosis is still rarely singled out as a problem in patients with newly diagnosed low-impact fractures, and the majority of them are not managed according to guidelines. Further studies should address specific problems in physicians’ and patients’ attitude that may account for the present situation. Received: May 2000 / Accepted: January 2001     

The importance of taking care of osteoporosis

Consequences in terms of mortality and morbidity of osteoporotic fractures are serious and recent data show that mortality of osteoporosis is often a witness of poor health. Prevalent fracture is one of the most important risk factors for incident fracture. The risk of subsequent fractures is highest immediately after initial fractures. It is essential to treat postmenopausal osteoporotic women who had experienced a fragility fracture. Efforts to raise awareness of osteoporosis among the general public and medical profession are essential because only a minority of women is taken care and treated after a typical osteoporotic fracture. We have effective treatments, varied and adapted to all situations encountered in clinical practice for the management of osteoporosis. All available treatments showed an effect on vertebral fractures and some demonstrated an effect on nonvertebral fractures or hip fractures. The lack of adherence is perfectly demonstrated in osteoporosis. As for all patients affected by a chronic disease, patient education should become part of the global care of patients with osteoporosis.