先心病过敏患儿照顾者喂养知信行情况调查

目的了解先心病过敏患儿营养状况、照顾者喂养知识、态度及行为水平及其影响因素。方法基于知信行理论模式,自行设计先心病过敏患儿照顾者喂养知信行调查问卷,对151名患儿主要照顾者进行调查。结果调查的151例先心病过敏患儿中,营养不良者占42.38%,患儿主要照顾者喂养知识掌握情况不理想。照顾者对于患儿喂养的知识、态度、行为得分之间均呈现线性相关关系。患儿父母过敏情况、照顾者文化程度等对照顾者喂养知识得分及知信行总分有显著影响(P0.05),患儿过敏症状、营养状况及居住城市均对照顾者的喂养态度得分有一定影响(P0.05)。结论应以患儿家长的喂养知信行水平为依据,对先心病过敏患儿实施有针对性、个性化的健康宣教及支持,并根据具体情况调整营养支持方案。     

老年认知功能障碍患者主要照顾者对误吸预防的知信行调查及护理干预效果

目的：通过调查和分析老年认知功能障碍患者主要照顾者对误吸预防的知信行现状,进行护理干预,从而提高主要照顾者对误吸预防的知识、态度及护理行为,降低老年认知功能障碍患者误吸的发生。方法：采用便利抽样法,选取老年精神科认知功能障碍患者的主要照顾者120名,对其进行误吸预防的知信行调查,根据调查结果,制定和采取干预措施,评价干预前后老年认知功能障碍患者主要照顾者对误吸预防知信行的得分情况。结果：老年认知功能障碍主要照顾者误吸预防的知识得分干预前为(27.25±4.922)分,干预后为(33.86±4.314)分;态度得分为干预前(44.13±4.559)分,干预后为(47.52±4.015)分;行为得分干预前为(36.46±5.158)分,干预后为(39.94±5.520)分。老年认知功能障碍患者主要照顾者对误吸预防的知识、态度、行为得分干预前后比较差异有统计学意义(P<0.01)。结论：根据老年认知功能障碍患者主要照顾者对误吸知信行的调查结果,进行针对性的护理措施,可提高主要照顾者的照护能力,减少老年认知功能障碍患者误吸的发生,确保患者生命的安全,提高护理质量。     

住院高龄患者主要照顾者对误吸预防的知信行调查分析

目的：分析住院高龄患者的主要照顾者对误吸预防的知识、态度及行为现状,并分析三者相关性,为提出针对性护理措施提供依据。方法采用便利抽样法,选取杭州市3所三级甲等医院神经内科、呼吸内科、老年科与康复科高龄患者的主要照顾者220名,对其进行高龄患者误吸预防的知信行现状调查。结果高龄患者主要照顾者误吸预防的知识、态度、行为得分分别为（28.82±3.22）分、（38.98±3.75）分、（36.04±4.67）分。不同陪护经历的主要照顾者误吸预防知识得分比较差异有统计学意义（P<0.05）;不同个人角色、文化程度、陪护经历的主要照顾者误吸预防态度得分比较差异有统计学意义（P<0.05）;不同陪护经历、误吸预防教育情况的主要照顾者行为得分比较差异有统计学意义（P<0.05）。高龄患者主要照顾者误吸预防的知识、态度及行为得分均呈正相关（P<0.05）。结论高龄患者主要照顾者误吸预防态度尚可,但误吸预防知识及行为水平较低。医护人员需加强高龄患者主要照顾者误吸预防知识学习,提高临床照护能力,减少高龄患者误吸的发生。     

冠心病病人主要照顾者的心肺复苏知信行现状及其相关性研究

[目的]对冠心病病人主要照顾者心肺复苏(CPR)知识、态度、行为现状进行调查,并分析其相关性。[方法]采用方便抽样法选取我科冠心病病人主要照顾者150人作为研究对象,采用CPR知信行问卷进行调查。[结果]主要照顾者CPR知识得分为(9.73±4.72)分,CPR态度得分为(23.03±2.93)分,CPR行为得分为(28.24±4.67)分。CPR知识与态度(K分与A分)得分、知识与行为(K分与P分)得分、态度与行为(A分与P分)得分呈正相关。[结论]主要照顾者CPR态度条目得分较高,知识、行为得分较低,应对冠心病病人主要照顾者知识、态度、行为进行全方位干预,以提高知信行整体水平,降低院外心搏骤停病人的致残率和病死率。     

白血病患儿照顾者PICC知信行及其影响因素的调查分析

目的调查本市某三甲医院血液内科白血病患儿主要照护者对经外周静脉置入中心静脉导管(Peripherally inserted central catheter,PICC)的知识、态度和行为水平现状并分析其影响因素,以期能够为临床PICC的应用和并发症的预防提供理论指导。方法采用目的抽样法选取2017年1月—2018年4月血液内科170名置管的白血病患儿主要照护者,使用一般资料调查问卷、PICC知信行调查问卷进行调查,使用SPSS20.0软件对调查结果进行统计与分析。结果回收有效问卷164份,问卷有效率为96.4%,白血病患者照顾者PICC知信行问卷总得分为(73.15±6.28)分,知识维度得分为(28.29±3.36)分,态度维度得分为(15.38±1.42)分,行为得分为(29.48±3.55)分,白血病患儿照顾者文化程度、从事职业以及患儿置管时间和置管经历是白血病患儿照顾PICC知信行的影响因素,可解释总变异的44.3%。结论白血病患儿照护者对PICC的知信行处于中等水平,有待进一步提高,医护工作者要对白血病患儿照护者具体情况进行针对性的健康教育,以提高照护者PICC维护能力,减少置管并发症的发生,改善白血病患儿生活质量。     

临床护士预防PICC导管相关感染的知信行现状及影响因素分析

目的：探讨临床护士对预防PICC导管相关感染的知信行现状,并分析其影响因素。方法：采用便利抽样法于2019年10月选取天津市5家医院215名临床护士,使用自行设计的知信行调查问卷进行调查,采用多重线性逐步回归分析其影响因素。结果：临床护士预防PICC导管相关感染的知信行总分为（90.86±5.23）分、知识（17.36±3.00）分、态度（24.13±1.83）分、行为（49.37±2.36）分;多重线性逐步回归分析结果显示,学历、是否为PICC专科护士、是否接受过PICC-CRI的知识培训是知识得分的主要影响因素（P<0.05）;是否为PICC专科护士、是否接受过中心静脉导管更换敷料的考核是影响预防态度的主要因素（P<0.05）。结论：临床护士预防PICC导管相关感染的知信行水平总体良好,其中预防PICC导管相关感染的态度和行为得分较高,但预防知识得分较低,建议加强相关理论知识的学习和培训,提高护士预防感染相关认知。     

长沙市肿瘤专科医院护士临终关怀知信行调查及影响因素分析

目的：了解长沙市肿瘤专科医院护士临终关怀知信行现状及影响因素,为长沙市肿瘤专科医院开展临终关怀服务提供理论依据。方法通过护士临终关怀知信行问卷,对长沙市2所肿瘤专科医院的408名护士进行调查。结果肿瘤专科医院护士临终关怀知识、态度、行为得分及标准分分别是（14.03±3.31）分、70.15分,处于及格水平;（3.50±0.27）分、69.95分,处于及格水平;（4.11±0.73）分、82.17分,处于良好水平。月收入、学历、性别、是否通过专门培训学习临终知识、是否通过其他医护人员学习临终知识、行为得分对临终知识有影响（R2=0.279,F=12.767,P=0.000）;是否通过专门培训学习临终知识、是否通过电视、网络等媒体学习临终知识、行为得分对临终态度有影响（R2=0.147,F=9.863,P=0.000）;家庭形态、知识得分、态度得分对临终行为有影响（R2=0.120,F=18.513,P=0.000）。结论肿瘤专科医院护士临终关怀知信行存在知信分离、知行分离、信行分离现象,因此肿瘤专科医院应进一步提高护士临终关怀知识水平,促进临终关怀态度转变,规范临终关怀行为。     

社区老年人主要照顾者预防跌倒知信行及与老年人跌倒相关性调查

目的调查社区老年人主要照顾者跌倒预防知识、态度、行为情况并分析其与照顾期间老年人跌倒发生的关系。方法采用横断面调查法,自设预防老年人跌倒知-信-行调查问卷于2012年2—3月对北京市某社区112名老年人主要照顾者进行调查。结果共发放问卷112份,回收有效问卷112份,问卷有效回收率为100％。社区老年人主要照顾者预防跌倒知识正确率为19．6％,态度和行为得分的优秀率分别为69．6％和23．2％;以知信行总分为因变量,以社区老年人主要照顾者年龄、性别、文化程度、职业、照顾时间以及是否获取跌倒相关知识为自变量进行多元逐步回归分析,结果表明,主要照顾者的文化程度和是否接受过培训是其知信行的主要影响因素（P〈0．01）。照顾期间社区老年人跌倒发生率为31．25％,不同组别照顾老年人年龄、自理能力以及主要照顾者照顾时间等因素下的老年人跌倒发生率比较,差异无统计学意义（P〉0．05）。以社区老年人照顾期间跌倒发生情况为因变量,以照顾者年龄、性别、职业、与照顾者的关系、照顾时间、文化程度、获取跌倒预防相关知识情况跌倒预防知识、态度、行为总分、文化程度、获取跌倒预防相关知识情况、被照顾者年龄和自理能力为自变量进行Logistic回归分析,结果表明,照顾者知识总分和获取跌倒预防相关知识进入回归方程。老年人主要照顾者获取相关知识的主要途径为个人经验和电视网络（42．8％）,通过专业途径获取到相关知识（18．9％）,有85．7％照顾者希望通过社区能够给予专业的跌倒相关预防知识的指导。结论社区老年人主要照顾者跌倒预防知-信-行水平低,建议社区卫生工作者采取有效措施提高其知识水平,从而改善其行为,以减少老年人跌倒的发生。     

社区护士安宁疗护知信行现状及培训需求分析

目的：了解上海市长宁区10家社区卫生服务中心护士安宁疗护知信行现状及护士对安宁疗护培训需求。方法：使用一般资料调查表、医务人员安宁疗护调查表及培训需求调查表，对长宁区10家社区卫生服务中心护士进行问卷调查。采用问卷星设计电子问卷，通过网络进行资料收集，回收360份有效问卷，通过问卷分析了解社区护士安宁疗护知信行现状及培训需求。结果：上海市长宁区10家社区卫生服务中心护士安宁疗护调查表得分为（210.98±28.44）分,态度、知识、行为、评价4个维度的得分中，评价得分和知识得分高，行为得分最低；培训需求调查表得分为为（141.46±20.93）分，8个维度的得分中，症状管理及舒适照顾最高，而中医护理最低。结论：我们要规范培训，经过获取知识、改变信念（态度）、最终达到转变行为的目的。针对社区护士安宁疗护培训需求，重视症状管理、舒适照顾及心理精神社会支持相关知识培训，同时在培训中关注中医相关内容的重要性。     

山西省某三级甲等医院近视儿童用眼卫生现状及影响因素

目的:调查山西省某三级甲等医院近视儿童用眼卫生知识、信念、行为水平及其影响因素，为延缓儿童近视进展提供参考依据。方法:选取2022年1月—2022年2月在山西省某三级甲等医院就诊的124例5～12岁近视儿童，对近视儿童进行用眼卫生知信行水平的问卷调查，同时对其家长进行近视防控态度的问卷调查。结果:近视儿童用眼卫生知识得分为（10.27±3.45）分，信念得分为（4.15±2.47）分，行为得分为（17.30±2.82）分，不同户口所在地、就读学校性质、父母文化水平的近视儿童用眼卫生得分不同（P<0.05），家长近视防控态度与近视儿童用眼卫生知信行水平相关（P<0.05）。结论:近视儿童用眼卫生知识、信念、行为水平均有待提高，医护人员应制定相应的近视管理策略，且对近视儿童的管理措施需从家长入手，提高近视儿童用眼卫生的知信行水平。     

Parkinson's disease: the disease concept, etiology and diagnostic bases

Parkinson's disease (PD) is caused by degeneration of nigral dopaminergic neurons. This results in dysfunction of the basal ganglia, thereby exhibiting movement disorders. The four cardinal signs of PD include bradykinesia, rigidity, resting tremor and postural instability. In the majority of patients with PD, the four cardinal signs are ameliorated by levodopa. In addition to anti-parkinson medication, surgery of the basal ganglia for PD has been applied. Local electrical stimulation of particular nuclei of the basal ganglia (deep brain stimulation) for PD has also proved to give satisfactory outcome. Both genetic and environment factors are considered to contribute to the initiation of PD. Some mutations of particular genes (e.g., alpha-synuclein) are found to link to parkinsonian families.     

Infectious disease, the innate immune response, and fibrosis

The unrelenting and destructive progression of most fibrotic responses in the pulmonary, cardiovascular, integumentary, and alimentary systems remains a major medical challenge for which therapies are desperately needed. The pathophysiology of fibrosis remains an enigma, but considerable research and debate surrounds the question of whether chronic inflammation is the key driver of unrestrained wound healing (i.e., the fibrotic response) in these and other organ systems. This Review describes how infectious pathogens, chronic inflammation, and unrestrained fibroproliferation are likely to be part of a dynamic, unrelenting process propelling human fibrotic diseases.     

Receptors, antibodies, and disease

Abnormal antibody production is now recognized as the basis of specific endocrine and neurological diseases and their complications. Among the autoimmune diseases, the best understood from a mechanistic point of view are myasthenia gravis, Graves' disease, several variants of insulin resistance, and a variant of bronchial asthma. In each of these human disorders, the clinical symptoms can be traced to the actions of antireceptor antibodies produced by a deranged immune system. The autoantibodies produced in these diseases are functionally heterogeneous. They may produce the clinical symptoms of hormone or neurotransmitter insufficiency either by blocking the binding of these agents to target cell surface receptors or by accelerating the internalization and degradation of these receptors. In other cases, the autoantibodies may produce the clinical signs of hormone excess by mimicking the actions of the hormone, in an uncontrollable fashion. In some cases, functionally different types of autoantibodies will appear in the same patient at different stages of the disease. For all of these autoantibodies, of whatever function, assays for their presence in serum are available, in forms suitable for clinical chemists, as well as for researchers; these will be described in this review. In addition to the known anti-receptor autoimmune diseases, there are a large number of other autoimmune diseases for which there is fragmentary evidence that their clinical symptoms have an anti-receptor autoantibody etiology. Several examples of this group will be discussed, and assays suitable for establishing the presence of anti-receptor antibodies in the sera of such patients will be provided. The disorders to be considered are: type I diabetes mellitus, chronic atrophic gastritis, autoimmune Addison's disease, autoimmune hypoparathyroidism, type II pseudohypoparathyroidism, resistant ovary syndrome, connective tissue diseases, and the HLA-B8/DR3 antigen haplotype as a potential marker for autoimmune diseases of the anti-receptor type.     

Bowen's disease, Paget's disease, and malignant melanoma in situ

The histologic differential diagnosis of skin lesions characterized by large, atypical, clear cells in the epidermis includes Bowen's disease, Paget's disease (mammary and extramammary), malignant melanoma in situ (pagetoid precancerous melanosis), mycosis fungoides, Spitz nevus, and artifact. Our experience with these lesions indicates that these diseases can be differentiated immunohistologically by the standard peroxidase-antiperoxidase technique, using antibodies directed against keratin (KER), carcinoembryonic antigen (CEA), and S-100 protein (S-100). Based on a study of 11 cases of Bowen's disease, eight cases of Paget's disease, and nine cases of malignant melanoma in situ, we conclude that the atypical clear cells of Bowen's disease stain only with antibodies to KER; those of Paget's disease, exclusively with antibodies to CEA; and those of malignant melanoma in situ, with antibodies to S-100. Additionally, we report a case in which clinical and histologic findings suggested Bowen's disease, but immunohistologic findings supported the diagnosis of Paget's disease.     

Cardiac disease and the family: impact, assessment, and implications

Cardiac disease is a major threat to the quality of life of both patients and families. Using King's definition of a social system, this article provides a general overview of the impact of cardiac disease on the family social system. Acute and chronic illness require emotional, cognitive, and materials support to prevent maladaptive coping by patients and family members. Techniques for family assessment are detailed. Specific interventions appropriate for acute, transitional, and rehabilitative care are provided. Implications for nursing practice and research that includes family members are given.     

Lowering the risks of diabetes, hypertension, and heart disease

Review care specifics for prediabetes, including details of hypertension and metabolic syndrome.