The Content Validity of the Items Related to the Social and Spiritual Dimensions of the Utrecht Symptom Diary-4 Dimensional From a Patient's Perspective: A Qualitative Study

ContextIn palliative care, caregivers often lack words and competences to discuss patients' needs in social and spiritual dimensions. The Utrecht Symptom Diary-4 Dimensional (USD-4D) is an instrument that can be used to monitor symptoms and needs in the physical, psychological, social, and spiritual dimensions and to optimize communication between patients and caregivers.ObjectiveTo assess the content validity of the USD-4D items related to the social and spiritual dimensions from a patient's perspective, measured in terms of comprehensibility, relevance, and comprehensiveness.MethodsAn explorative qualitative study was conducted using in-depth semistructured interviews and thematic analysis. Twelve participants (male N = 7, 53–87 years old) with an estimated life expectancy of less than one year were recruited in two home care services: a general hospital and a hospice.ResultsThe instructions, items, and response options were comprehensible for almost all participants. The meaning that was provided to the items was expressed in themes: maintaining personal identity and autonomy, resilience, letting go, perceived balance in one's life, and death and afterlife. This corresponds with the intended meaning. The items were relevant at some points in time. Not all participants had needs for personal care during the interviews. Participants found the USD-4D comprehensive, no key concepts related to the social or spiritual dimensions appeared to be missing.ConclusionsThe USD-4D constitutes a content valid PROM from the patient's perspective. The items support patients in identifying needs in the social and spiritual dimensions and in the conversation to further explore these needs.     

肝移植受体直接照顾者生活质量调查分析

目的探讨肝移植受体直接照顾者的生活质量及影响因素。方法对肝移植受体直接照顾者46例进行一般情况和SF-36量表调查,采用Spearm an相关分析和多元回归分析影响因素。结果(1)与正常人群相比,在小于40岁的照顾者中,男性情感职能得分高于正常人群(P<0.05),其余纬度无统计学意义;女性情感职能得分高于正常人群(P<0.05),生理职能与精神状态得分低于正常人群(P<0.05),其余纬度无统计学意义;在大于40岁的照顾者中,男性生理职能、情感职能、社会功能、精神状态及健康总评价得分均低于正常人群(P<0.05);女性生理职能、情感职能、社会功能、精神状态及活力的分值均低于正常人群(P<0.01),其余纬度无统计学意义。(2)影响照顾者生活质量的因素:年龄、文化程度、经济状况、受体有无并发症、受体术后时间、医疗费用支付方式。结论肝移植受体直接照顾者当中,大年龄组较正常人群生活质量明显下降,而小年龄组较正常人群虽有所下降,但却能采取积极的应对方式,改善不良情绪对生活质量的影响;通过分析,发现影响这些照顾者生活质量的因素是多方面的;提示在临床工作当中,关注这部分特殊人群,有必要采取有效的干预措施,提高其生活质量。     

超声对引起原位肝移植术后黄疸相关因素的分析

目的探讨超声对于提示引起原位肝移植术后黄疸相关因素的价值。方法28例实施肝移植术后临床拟诊黄疸的患者，以二维超声检查移植肝内外胆管及肝周情况，以彩色多普勒超声（CDI）评估移植肝动、静脉血流情况，并结合临床资料、肝穿刺活检病理诊断结果和内镜逆行胰胆管造影（ERCP）综合分析。结果22例患者术后出现胆道并发症，其中5例CDI提示有肝动脉并发症，超声检出胆漏者4例，胆道梗阻者18例；其余6例肝穿刺活检证实有排斥反应。结论多普勒超声显像可以较好地提示引起原位肝移植术后黄疸的相关因素，有利于临床医师作出正确的病情判断及确定相应的治疗方案。     

21例亲体肝移植供体受体围术期护理

通过对21例活体肝移植供、受体围术期的观察和护理,认为术前对供体和受体做好充分有效的心理评估,进行有针对性的心理疏导和心理支持;针对供体为健康人群,术后应激反应重的特点,加强特护,严密观察生命体征,给予有效止痛,确保供体的安全和舒适;对受体术后严密监测各项生命体征,及时准确监测移植肝的功能。严密观察引流液的性质、颜色和量,以识别急性排斥反应、出血、胆漏、感染等并发症的先兆,做好预见性护理,并配合医生对并发症进行治疗和处理;同时监测抗排斥药物的血药浓度,及时发现药物不良反应并做好相应的护理措旋是保证活体肝移植供、受体手术成功的关键。     

猪肝移植术中无肝期前后的护理

目的探讨原位猪肝移植无肝期前后的病理生理变化 ,并提出相应的护理措施。方法共行 5 5例原位猪肝移植 ,在无肝期前和无肝期后 (包括无肝期和新肝期 )检测体温、血流动力学、血气、生化、肝肾功变化情况。结果平均动脉压 (MAP)、中心静脉压 (CVP)以及心排出量 (CO)在无肝期后下降明显 (与无肝期前相比 ,P <0 .0 5 )。无肝期后出现明显的代谢性酸中毒、低血糖、低体温 ,供肝复流后出现一过性高血钾。新肝期谷草转氨酶 (AST)、谷丙转氨酶 (ALT)、总胆红素 (TB)升高明显 (与无肝期前相比 ,P <0 .0 1)。结论　猪原位肝移植术中受者经历了一系列的病理生理变化。明确以上危险因素的发生发展 ,并给予正确的护理 ,可以极大地提高手术成功率 ,延长术后存活时间     

小儿肝移植受体的选择和评估

肝移植是治疗小儿各种终末期肝病唯一有效的手段,经过数十年的发展,肝移植技术在国内外已日趋成熟。由于多种原因,国内小儿肝移植的发展滞后于成人肝移植,并且与成人比较,小儿肝移植有其自身的特点,反映在适应证、供体选择、手术技术难度、术后管理等方面均与成人有明显不同,如原发性胆道疾病和先天性代谢疾病占较大比例。本文就小儿肝移植受体的选择和评估作一文献综述     

Differences in the Symptom Experience of Older Oncology Outpatients

ContextThe relatively low number of older patients in cancer trials limits knowledge of how older adults experience symptoms associated with cancer and its treatment.ObjectivesThis study evaluated for differences in the symptom experience across four older age groups (60–64, 65–69, 70–74, ≥75 years).MethodsDemographic, clinical, and symptom data from 330 patients aged >60 years who participated in one Australian and two U.S. studies were evaluated. The Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, frequency, and distress of 32 symptoms commonly associated with cancer and its treatment.ResultsOn average, regardless of the age group, patients reported 10 concurrent symptoms. The most prevalent symptoms were physical in nature. Worrying was the most common psychological symptom. For 28 (87.5%) of the 32 Memorial Symptom Assessment Scale symptoms, no age-related differences were found in symptom occurrence rates. For symptom severity ratings, an age-related trend was found for difficulty swallowing. As age increased, severity of difficulty swallowing decreased. For symptom frequency, age-related trends were found for feeling irritable and diarrhea, with both decreasing in frequency as age increased. For symptom distress, age-related trends were found for lack of energy, shortness of breath, feeling bloated, and difficulty swallowing. As age increased, these symptoms received lower average distress ratings.ConclusionAdditional research is warranted to examine how age differences in symptom experience are influenced by treatment differences, aging-related changes in biological or psychological processes, or age-related response shift.     

胎肝作辅助性移植的应用解剖学研究

作者对80例6～9月胎龄胎肝及附属结构进行大体解剖观察,测量胎肝长宽高、体积、重量、胆囊、胆管、门静脉、脐静脉、肝动脉、腹腔动脉、腹主动脉、肝上和肝下腔静脉的管径和长度;同时观测5例6～10月胎龄胚胎的脐静脉压力,结果提示妊娠中晚期的胚胎肝脏,特别是妊娠7月以后的胎肝,具有较适宜的应用解剖结构,有作为异位辅助性肝移植供肝的可能性。     

肝移植患者2例护理体会

总结2例肝移植木的护理体会。术前充分准备为手术创造有利条件，而术后对患者出血，肝存活情况和排异反应的观察以及在控制感染和预防胆道并发症方面的护理工作更和手术的成功密切相关。作者认为护理是保证手术效果的重要环节。     

Fatigue Influences Social Participation in Aphasia: A Cross-sectional and Retrospective Study Using Patient-Reported Measures

ObjectiveTo examine associations between social participation, fatigue, and aphasia severity using patient-reported outcome measures and to examine associations between demographic/diagnostic variables and fatigue in people with aphasia.DesignRetrospective analysis of patient-reported outcome measures using a Bayesian framework.SettingUrban rehabilitation research hospital.Participants67 participants (N=67) with chronic aphasia (mean age=54.1 years) as a consequence of stroke.InterventionsNot applicable.Main Outcome MeasuresAbility to Participate in Social Roles and Activities, Fatigue, and Global Health Questionnaire scales from the Patient-Reported Outcomes Measurement Information System initiative and the Western Aphasia Battery–Revised. We hypothesized an association between social participation and fatigue in people with aphasia.ResultsPeople with aphasia with higher fatigue levels tended to report less social participation. Also, people with aphasia who were a longer time post-stroke tended to report higher social participation. People with aphasia who reported better physical health were more likely to report higher social participation.ConclusionsThere is an association between fatigue and social participation in people with aphasia. Fatigue should be considered in clinical assessments and treatments for this population.     

血糖动态监测在原位肝移植术中的临床意义

目的:探讨血糖的动态变化在原位肝移植术中的临床意义。方法:术中不同时间点抽取静脉血进行血糖的测定。结果:无肝前期,血糖水平高于正常并有逐渐升高的趋势;无肝期,血糖较无肝前期进一步升高;新肝期,随着移植肝循环开放,血糖有所降低,但仍高于正常。结论:在原位肝移植术中,无肝前期血糖明显升高;无肝期血糖升至峰值,随后逐渐下降。血糖动态监测有助于术中根据它的变化及时采取相应的治疗措施。     

Pharmacokinetics and Pharmacodynamics of Once-daily Prolonged-release Tacrolimus in Liver Transplant Recipients

PurposeLimited published data are available regarding the pharmacokinetic (PK) and pharmacodynamic (PD) variables of prolonged-release tacrolimus (PRT) after liver transplantations. The goal of this study was to compare the PK and PD profiles of PRT in early and stable liver transplant recipients by developing a population PK model of PRT and investigating the profile of calcineurin activity (CNA) in the peripheral blood mononuclear cells.MethodsA conversion from BID immediate-release tacrolimus (IRT) to once-daily PRT based on a one-to-one daily dose was performed at day 7 (D7) and D90 posttransplantation in groups A (n = 12) and B (n = 12), respectively. Extensive PK samplings, including whole-blood tacrolimus (TAC) concentration, and CNA assessments were performed at D14 and D104 in groups A and B, respectively. TAC concentration–time data (N = 221) were analyzed by using nonlinear mixed effects modeling.FindingsA 2-compartment model with linear elimination and a delayed first-order absorption characterized by 2 transit compartments best described the PK data. Model-predicted dose-normalized (6.0 mg/d) area under the TAC concentration–time curve over the dosing interval in groups A and B was similar (geometric mean, 235.6 ng/mL · h [95% CI, 139.6–598.7] vs 224.6 ng/mL · h [95% CI, 117.6–421.5], respectively; P = 0.94). Area under the CNA versus time curve over the dosing interval did not differ between groups (4897 [3437] and 4079 [1008] pmol/min/10⁶ cells; P = 0.50). In group A, trough CNA at D14 posttransplantation was statistically higher than that measured just before the switch to PRT (ie, D7 posttransplantation) (198 [92] vs 124 [72] pmol/min/10⁶cells, n = 8; P = 0.048); no statistical difference in TAC concentration was observed (P = 0.11). In group B, no statistical difference between D90 and D104 was observed in either trough CNA (149 [78] vs 172 [82] pmol/min/10⁶ cells, n = 6; P = 0.18) or TAC (P = 0.17) concentration. No graft rejection was observed in either of the groups.ImplicationsThis study suggests that one-to-one dosage conversion to once-daily PRT during the early posttransplantation period could result in significant CNA variations but without causing graft rejection. Further investigations in larger cohorts are warranted to confirm these results. ClinicalTrials.gov identifier: NCT02105155.     

肝移植术后腹压监测的临床研究

目的 研究腹压（intraabdominal pressure,IAP）增高对肝移植术后患者尿量、平均动脉压（MAP）和中心静脉压（CVP）的影响。方法 对105例肝移植患者进行腹压监测;根据腹压情况将患者分为两组：腹压正常组53例（IAP〈20cm H2O,1cmH2O=0．098kPa）和腹压异常组52例（≥20cmH2O）,其中又将腹压异常组分为20～〈30cmH2O（42例）、30～〈40cmH2O（4例）、≥40cmH2O（6例）3个亚组。患者入ICU后即测量基础腹腔压力,平均每8～12h测量1次,当腹压≥20cmH2O时每4h监测1次。结果 正常腹压组患者的MAP、CVP、尿量与腹压改变无相关性（P〉0．05）;异常腹压组患者的尿量与腹压呈显著负相关（P〈0．05）,同时MAP、CVP上升;当腹压升至30～40cmH2O且尿量减少时,MAP、CVP也下降（P〈0．01）。结论 正常腹压不影响肝移植患者尿量和循环稳定性;腹压增高导致少尿,而且腹压增高患者的CVP、MAP呈现双相变化。     

老年肝移植患者术后护理

报道老年肝移植患者的术后护理,根据13例老年肝移植患者的生理、心理特点制定相应的护理措施,分别从循环系统、呼吸系统以及老年药代动力学变化、心理等几方面特点结合术后患者出现的各种临床症状进行护理,12例患者在术后30～50 d出院,1例患者因术后肺部白色念珠菌感染于第26天死亡.对于老年肝移植术患者,充分评估,制定合理有效的护理措施是提高手术成功率,降低死亡率的重要手段.     

女性压力性尿失禁病人报告结局评估工具的研究进展

介绍了女性压力性尿失禁病人症状严重程度、疾病困扰程度和生活质量方面病人报告结局评估工具的研究情况，旨在为女性压力性尿失禁研究提供更有效的评估工具。     

18例肝移植病人术后并发症的观察及护理

自１９９４年５月～１９９９年４月的５年内,我际移植外科部为１８例肝炎后肝硬化病人施行了原位肝移植手术,在临床护理中我们体会到,积极预防、早期发现、准确鉴别及时发现并正确处理肝移植手术后的并发症是取得手术成功的关键,因此,术后严密观察和精心护理是非常重要的。     

肝移植手术患者对健康教育内容和方式的需求调查

目的探讨肝移植手术患者对健康教育内容和方式的需求。方法采用目的抽样法选择165例接受肝移植手术的患者,调查其手术前后对健康教育内容的需求,并比较不同年龄、文化程度和医疗费用支付方式患者间的差异;同时调查患者对5种健康教育实施方式的接受程度。结果肝移植手术患者对术前各项健康教育内容的需求率为58．2％～69．7％,对术后健康教育内容的需求率为81．8％～97．6％;不同年龄及文化程度患者对术前了解器官移植基本知识的需求率差异有统计学意义（P〈O．01或P〈O．05）;最受患者认可的健康教育方式是医护人员讲解和演示。结论护士在为肝移植患者进行健康教育时,建议采取现场面对面讲解和演示的方式,重点讲解肝移植基本知识和术后用药方法;同时根据患者的年龄和文化程度,有针对性地进行宣教。     

术中彩色多普勒超声检查在原位肝移植术中的应用

目的为确保原位肝脏移植手术后移植肝的血流量,减少由于手术造成的血管并发症,采取肝移植手术中进行彩色多普勒超声检查.方法选用高频手术专用探头,于手术中门静脉、肝动脉吻合完成后立即测量肝动脉及门静脉血流速度,并计算快速充盈时间及阻力指数.结果 (1)彩色多普勒超声可直接观察到移植肝门静脉、肝动脉血流灌注情况;(2)肝动脉峰值流速不得低于25 cm/s, 门静脉平均流速不得低于(45±16.5) cm/s; (3)肝动脉加速度时间应<0.07 s,阻力指数>0.56;(4)可对照结扎分流静脉前后门静脉血流速度的变化.结论术中彩色多普勒超声检查是确保移植肝血流灌注的最有效手段.