优质护理服务供需平衡的扎根理论研究

目的探索优质护理服务运行规律,为发展完善优质护理服务模式奠定基础。方法采用参与式观察与深度访谈收集资料,通过开放编码、主轴编码和核心编码方式进行分析。结果优质护理服务需要护理服务、护理支持系统与患者需求、患者支持系统之间的平衡,支点为基于经济社会发展、疾病谱和人口老龄化制定的国家政策。结论优质护理服务的开展,可促进临床护理服务质量和患者满意度的提升,但需强化护理支持系统,以提高护理人员满意度。     

Supply and demand balance theory for high-quality nursing service practice

目的 探索优质护理服务运行规律,为发展完善优质护理服务模式奠定基础.方法 采用参与式观察与深度访谈收集资料,通过开放编码、主轴编码和核心编码方式进行分析.结果 优质护理服务需要护理服务、护理支持系统与患者需求、患者支持系统之间的平衡,支点为基于经济社会发展、疾病谱和人口老龄化制定的国家政策.结论 优质护理服务的开展,可促进临床护理服务质量和患者满意度的提升,但需强化护理支持系统,以提高护理人员满意度.     

新护士职业发展需要与组织支持系统的研究

目的 了解新护士职业发展需要与组织支持系统的现状,为护士职业发展管理提供参考依据.方法 根据相关文献,拟定访谈提纲,经专家函审后通过访谈归纳新护士职业发展需要与组织支持系统并根据访谈结果自制调查问卷,经过预调查后进行现状调查,并进行数据分析.结果 新护士对职业发展需要与组织支持系统有共同感受；不同学历的新护士对组织支持...     

造血干细胞移植期间患者饮食质量影响因素的质性研究

目的 探讨造血干细胞移植期间患者饮食质量的影响因素,为拟定饮食干预计划,改善患者营养状态提供参考.方法 运用质性研究中的现象学方法以深度访谈的方式收集8例个案的资料,并运用Colaizzi分析程序进行分析.结果 造血干细胞移植期间患者的饮食质量受疾病治疗、患者个人因素以及支持系统三个层面的影响,其中支持系统包括照顾者、临床医务人员和临床营养管理环境三个方面.结论 造血干细胞移植期间患者的饮食质量受多个层面的影响,应从多角度进行综合干预,逐步改善患者的饮食质量.     

脊柱手术后失明的研究进展

背景 手术后失明是脊柱手术患者的一种严重并发症,尽管发生率低,但其结果是灾难性的.因此,近年来该问题引起了骨科、眼科和麻醉科医师的高度关注. 目的 综述脊柱手术后失明的研究进展情况. 内容 阐述脊柱手术后失明的临床概况、病因和预防处理措施的研究进展. 趋向 对手术后失明病因的深入了解有助于减少脊柱手术术后眼科并发症.     

进展期胃癌多模式治疗的研究进展

目的介绍进展期胃癌多模式治疗的研究进展。方法收集国内、外近年来有关进展期胃癌多模式治疗的研究进展文献并作一综述。结果多模式治疗能提高可切除进展期胃癌患者RO切除率，降低术后死亡率，延长总生存期，提高生活质量。结论进展期胃癌多模式治疗的应用将具有广阔的发展前景。     

结肠测压技术在成人结肠动力障碍中的研究进展

近年来, 结肠测压技术逐步在临床开展应用, 帮助临床医生更深入地了解健康成人和结肠动力障碍患者结肠收缩活动的生理学和病理生理学。借助结肠测压技术, 越来越多的结肠运动模式被发现, 然而这些发现的临床意义仍需进一步研究。本综述通过对结肠测压相关文献分析总结, 概括结肠测压技术的发展和应用现状, 探讨该技术在评估治疗对结肠运动模式影响的局限性、未来方向和潜力, 以增强我们对结肠测压技术的理解。     

外科手术机器人的研究进展及临床应用

手术机器人是近年发展起来的计算机辅助内窥镜手术器械控制系统。手术机器人的出现使外科手术模式发生了革命性的变化。由于其突出的优越性,受到越来越多的关注,现已逐渐推广应用于临床各科疾病的诊治,并取得了良好的社会和经济效益。本文就近年来国内外手术机器人系统的研究进展和临床应用现状作一简要综述,对外科手术机器人的优势、局限性和存在的缺陷进行总结,并对未来外科手术机器人的发展方向进行预测。     

急性肝衰竭动物模型及人工肝支持系统动物实验

在过去的40年中,对于急性肝衰的认识和治疗发展很快,从而使病死率有所下降。通过研究能够反映人类临床、生化和病史特征的动物模型对这个疾病的认识有了很大的进展。而急性肝衰竭通过体外人工肝支持系统治疗也越来越受到重视。这篇综述评价了手术和药物等各种建立急性肝衰动物模型的方法,简要介绍其在生物型人工肝支持系统研究中的应用。     

老年专科护士临床护理角色现状调查

目的了解广东省老年专科护士临床护理角色的现状,探讨存在的问题,促进其角色的发展。方法采用自设问卷对54名经过专科培训的老年专科护士的角色现状进行调查。结果 52名(96.3%)老年专科护士在临床实践中开展专科护理工作,27.8%～86.3%承担着教育者、咨询者和科研者的角色。结论老年专科护士在临床护理实践、研究、咨询、教育这四方面均发挥了一定的作用。应该在加强专科临床护理实践的基础上,积极开展老年护理研究,增加研究成果的利用,进一步探索老年专科护理模式,促进老年专科护理发展。     

精准肝脏外科时代无痛病房建设

精准、微创、有效是21世纪肝脏外科的发展方向,建立肝脏外科无痛病房,实施围手术期规范化疼痛管理是快速康复外科的核心内容,也是精准肝脏外科研究的核心内涵之一.开展医护人员培训、重视疼痛的健康宣教、选择合理的疼痛评估策略、围手术期超前镇痛和多模式镇痛联合使用以及注重个体化镇痛是肝脏外科无痛病房建设的重要内容.积极开展多中心临床研究、探索无痛病房建设的临床路径和围手术期镇痛模式是肝脏外科无痛病房建设发展的方向.     

Radical prostatectomy improves progression-free and cancer-specific survival in men with lymph node positive prostate cancer in the prostate-specific antigen era: a confirmatory study

Study Type – Therapy (outcomes research)
Level of Evidence 2b What’s known on the subject? and What does the study add? Historically, surgeons were reluctant to perform radical prostatectomy (RP) in LN positive disease. Nowadays, a shift towards multimodal treatment strategies in such patients, comprising RP with extended lymph node dissection followed by radiation and/or hormonal therapy can be detected. However, this change of paradigm is not supported by evidence derived from treatment guidelines. Retrospective studies on this topic, comprising small numbers of patients from the pre‐PSA era in the US suggest a survival advantage, if RP is performed. Our analyses of cancer control rates between patients with discontinued vs. completed prostatectomy revealed a superior clinical progression free‐ and cancer specific‐survival rate in those patients with completed prostatectomy. These results add knowledge on treatment outcome of a current patient population since previous retrospective studies include patients from the pre‐PSA era.

OBJECTIVE

? To assess the prognostic role of radical prostatectomy (RP) in lymph node (LN) positive patients with prostate cancer (PCa) in a contemporary RP cohort.

PATIENTS AND METHODS

? Between 1992 and 2004, 158 consecutive patients with clinically localized PCa and regional LN metastasis were identified. Fifty patients underwent LN dissection and discontinued RP, combined with early hormonal therapy (HT) (RP?), whereas, in 108 patients, RP was completed followed by adjunctive HT (RP+). ? Clinical progression‐free‐ (CPFS) and cancer‐specific survival (CSS) were studied using Kaplan–Meier analysis. ? Disease characteristics and the impact of RP on CPFS and CSS were further assessed using Cox proportional hazard models. ? A matched pair analysis between RP? and RP+ patients was performed based on clinical and pathological factors.

RESULTS

? Median follow‐up was 98 months (interquartile range, 88–113). Five‐ and 10‐year CPFS was 77% and 61% for RP+ patients vs 61% and 31%, for RP? patients (P= 0.005), respectively. ? A similar trend was observed for CSS (84% and 76% for RP+ vs 81% and 46% for RP?; P= 0.001). ? Type of treatment (RP? vs RP+) and number of positive LN were multivariate predictors of CPFS and CSS (all P≤ 0.05). ? In the matched pair analyses, RP+ patients showed superior CPFS and CSS (P < 0.005).

CONCLUSIONS

? RP had a beneficial impact, resulting in the superior survival of patients with LN positive PCa after controlling for LN tumour burden in a contemporary RP series. ? The findings obtained in the present study support the role of RP as an important component of multimodal strategies of LN positive PCa.     

基于SEER数据库的胃癌肝转移预后因素分析与预后模型构建

背景与目的：胃癌其因具有恶性程度高、易早期转移等特点而导致患者往往具有较差的临床预后,其中胃癌肝转移（GCLM）更是导致患者死亡的主要因素,然而,目前对于GCLM的预后评价手段仍然存在着一定的不足。因此,本研究利用SEER数据库分析GCLM患者的临床病理特征和预后风险因素,从而建立具有良好预测能力的评估模型,以提升对患者个体化预后的评估能力。 方法：从SEER数据库中提取2010—2015年确诊的GCLM患者的临床资料。根据纳入和排除标准,严格筛选后纳入研究病例共2 554例,按7:3比例随机分配为建模集（1 790例）和验证集（764例）,比较建模集与验证集中患者的临床基线特征差异,用Cox等比例回归模型与Fine-Gray竞争风险模型分别筛选出GCLM患者总体生存期（OS）与癌症特异性生存期（CSS）的独立危险因素。基于建模集Cox或Fine-Gray风险模型的多元回归分析及AIC因素优化的结果,构建预测GCLM患者OS或CSS的列线图模型。最后,采用一致性指数、ROC曲线和校正曲线评估模型预测的可靠性。 结果： 建模集与验证集患者的基线特征无明显差异。分析结果显示,患者年龄、化疗、肿瘤分级、原发灶切除和原发灶数目是影响GCLM患者OS预后的独立危险因素,而化疗、肿瘤分级、原发灶切除和原发灶数目是影响GCLM患者CSS预后的独立危险因素（均P<0.05）。基于上述指标分别构建列线图模型并进行评价,预测OS与CSS列线图模型的一致性指数均明显高于AJCC-TNM分期系统（建模集：0.706 vs. 0.560、0.670 vs. 0.554;验证集：0.769 vs. 0.534、0.744 vs. 0.518）,并且ROC曲线分析亦展示出预测模型具有较高的准确度。最后,校正曲线分析显示,构建的列线图模型预测患者OS或CSS的生存率与实际观察值均具有良好的一致性。 结论： 基于SEER数据库分析构建的列线图模型在预测GCLM患者OS和CSS方面有较高的准确性,将有助于临床医师对GCLM患者制定个体化的治疗策略。     

多模态超声技术在乳腺癌诊断中的新进展

超声是临床诊断乳腺癌的常规技术之一,但乳腺癌在声像图上表现的多样性,使得临床早期明确诊断和评估预测需要更多的信息,因此多模态超声新技术的联合应用对乳腺癌的诊断尤为重要。笔者概述了近年来多模态超声技术的新进展,包括自动乳腺全容积成像技术,弹性成像和超声造影技术等。这些新技术在临床乳腺癌诊断中发挥重要作用,并在将来有更广阔的应用前景。     

Development and validation of prognostic nomograms and a web-based survival rate calculator for sarcomatoid renal cell carcinoma in pre- and post-treatment patients

BackgroundTo develop a clinical prediction model and web-based survival rate calculator to predict the overall survival (OS) and cancer-specific survival (CSS) of sarcomatoid renal cell carcinoma (SRCC) for clinical diagnosis and treatment.MethodsSRCC patient data were retrieved from Surveillance, Epidemiology, and End Results (SEER) database. Factors independently associated with survival were identified by a Cox regression analysis. Nomograms of the prediction model were constructed using a SEER training cohort and validated with a SEER validation cohort. At the same time, the decision analysis curve, receiver operating characteristic curve, and calibration curve were also used to examine and evaluate the model. A web-based survival rate calculator was constructed to help assist in the assessment of the disease condition and clinical prognosis.ResultsThe records of 2,742 SRCC cases were retrieved from SEER, while 1,921 cases with a median OS of 14 and CSS of 32 months were used as the training cohort. The developed nomograms were more accurate than that of the American Joint Committee on Cancer staging (C-indexes of 0.767 versus 0.725 for OS and 0.775 versus 0.715 for CSS), with better discrimination than that of the American Joint Committee on Cancer (AJCC) stage model and the calibration was validated in the SEER validation cohort. The model’s 3- and 5-year OS and CSS were superior to AJCC and T staging on the analysis decision curve. The prognosis prediction of SRCC established by the prediction model could be evaluated through the web-based survival rate calculator, which plays a guiding role in clinical treatment.ConclusionsNomograms and a web-based survival rate calculator predicting the OS and CSS of SRCC patients with better discrimination and calibration were developed.     

Staging systems for papillary thyroid carcinoma: a review and comparison

OBJECTIVE: To find out the most predictive staging system for papillary thyroid carcinoma (PTC) currently available in the literature. BACKGROUND: Various staging systems or risk group stratifications have been used extensively in the clinical management of patients with PTC, but the most predictive system for cancer-specific survival (CSS) based on distinct histologic types remains unclear. METHODS: Through a comprehensive MEDLINE search from 1965 to 2005, a total of 17 staging systems were found in the literature and 14 systems were applied to the 589 PTC patients managed at our institution from 1961 to 2001. CSS were calculated by Kaplan-Meier method and were compared by log-rank test. Using Cox proportional hazards analysis, the relative importance of each staging system in determining CSS was calculated by the proportion of variation (PVE). RESULTS: All 14 staging systems significantly predicted CSS (P < 0.001). The 3 highest ranked staging systems by PVE were the Metastases, Age, Completeness of Resection, Invasion, Size (MACIS) (18.7) followed by the new AJCC/UICC 6th edition tumor, node, metastases (TNM) (17.9), and the European Organization for Research and Treatment of Cancer (EORTC) (16.6). CONCLUSIONS: All of the currently available staging systems predicted CSS well in patients with PTC regardless of which histologic type from which they were derived. When predictability was measured by PVE, the MACIS system was the most predictive staging system and so should be the staging system of choice for PTC in the future.     

Montelukast and Churg-Strauss syndrome

Several cases of eosinophilic conditions including Churg-Strauss syndrome (CSS) have recently been reported in asthmatic patients being treated with antileukotriene receptor antagonists. One patient with CSS who experienced a clinical relapse after treatment with montelukast and two asthmatic patients who developed CSS while receiving montelukast treatment are described. In one case reduction in the dose of oral steroid preceded the onset of CSS. To our knowledge, no case of CSS relapse has previously been reported in association with leukotriene antagonists.     

Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers

OBJECTIVE: To find out the most applicable and consistent staging system for papillary thyroid carcinoma (PTC) available in the literature. BACKGROUND: The commonly used staging systems for PTC have predicted cancer-specific survival (CSS) well. However, their applicability and generalizability have not yet been evaluated in different clinical settings. METHODS: A MEDLINE search from 1965 to 2005 was carried out to identify different staging systems available in the literature and 9 systems were applicable to 1634 PTC patients within 2 tertiary-referral centers. The CSS of each staging system within individual centers were calculated using Kaplan-Meier method and the CSS of each tumor stage in one individual center was compared with that of the other by log-rank test. In addition, within each center, the predictability of each staging system relative to the others was ranked based on the proportion of variation explained (PVE) value. RESULTS: Clinicopathologic features, treatment received, and tumor stages were significantly different between the 2 centers. There were also significant differences in CSS within at least one tumor stage between the 2 centers in 8 of the 9 staging systems. The TNM was a highly predictive and consistent staging system within the 2 centers. Although the absolute PVE values differed between the 2 centers, the relative ranking of the 9 staging systems within each center correlated significantly to each other (P < 0.05). CONCLUSIONS: Despite referral, treatment, and data collection biases inherent within each center, the TNM system remained to be the most applicable and consistent staging system for PTC in 2 centers managing the same population group.     

Construction of a predictive model for clinical survival in male patients with non-metastatic rectal adenocarcinoma

BackgroundNo clinical prediction model is available for non-metastatic rectal adenocarcinoma in males. Based on demographic and clinicopathological characteristics, we constructed a survival prediction model for the study population.MethodsAt a ratio of 7:3, 3450 eligible patients were divided into training and validation sets. Optimal cutoff values were calculated using X-tile software. Cox proportional hazards regression was used to find prognostic factors for cancer-specific survival (CSS) and overall survival (OS). Corresponding nomogram prognostic models were also constructed based on predictors.The validity, discriminative ability, predictability, and clinical usefulness of the model were analyzed and assessed.ResultsWe identified predictors of survival in the target population and successfully constructed nomograms. In the nomogram prediction model for OS and CSS, the C-index was 0.724 and 0.735, respectively, for the training group and 0.754 and 0.760, respectively, for the validation group. In the validation group, the area under the curve (AUC) of the receiver operating characteristic curve for OS and CSS nomograms was 0.768 and 0.769, respectively, for the 3-year survival rate and 0.755 and 0.747, respectively, for the 5-year survival rate. Kaplan–Meier Survival Curves showed excellent risk discrimination performance of the nomogram (P < 0.05) Calibration curves, time-dependent AUC and decision curve analysis showed that the prediction model constructed in this study had excellent clinical prediction and decision ability and performed better than the TNM staging system.ConclusionOur nomogram is helpful to evaluate the prognosis of non-metastatic male patients with rectal adenocarcinoma and has guiding significance for clinical treatment.     

Cyclophosphamide-sensitive and cyclophosphamide-resistant suppressor cells in the immune response to alloantigens.

We have demonstrated that within a given system Cy may alter the immune response in different ways. It may augment the response by inactivating CSS cells or induce immunosuppression by activating CRS. Furthermore, our studies provide a means of analyzing the mechanism of suppression, that is, delineating the target cell for suppression, the properties and life span of the suppressed cells, and the nature of the cell interactions involved. Furthermore, with the available information on the immunosuppressive activity of Cy, clinical studies may be best monitored in transplantation immunology and tumor chemotherapy. It is possible that the induction of CRS cells, which are antigen-nonspecific and non-H-2-restricted, may be useful for inducing specific immunosuppression to alleviate GVH reactions. These studies are currently in progress.