疼痛教育联合心理干预对晚期癌痛病人疼痛症状及睡眠质量影响

目的:探讨疼痛教育联合心理干预对晚期癌痛病人疼痛症状、睡眠质量的影响。方法:选取晚期癌痛患者106例,随机分为对照组和观察组各53例,两组患者治疗时给予相同护理,观察组在此基础上给予疼痛教育并联合心理干预,分别在治疗前后采用数字评分法(NRS)及匹兹堡睡眠质量指数量表(PSQI)对两组患者疼痛症状及睡眠质量进行评价。结果:治疗前观察组和对照组NRS均分及爆发痛每日人均次数之间无统计学差异(P0.05)。治疗后观察组NRS均分、爆发痛每日人均次数较治疗前降低(t=15.37,9.14;P0.01),且显著低于对照组(t=-4.25,-4.57;P0.01)。观察组疼痛缓解总有效率为90.5%,对照组为83.0%,观察组患者疼痛缓解效果优于对照组,差异有统计学意义(z=2.36,P=0.018)。治疗后观察组患者PSQI总分及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、安眠药物、日间功能各因子得分较治疗前均明显降低(t=10.39,6.89,8.07,9.08,5.23,7.55,8.54,6.63;P0.01),且低于对照组治疗后得分(t=-8.09,-6.43,-8.19,-8.22,-4.32,-6.78,-7.11,-6.70;P0.01),提示治疗后观察组患者相对于对照组睡眠质量明显改善。结论:疼痛教育联合心理干预有助于疼痛的缓解,能有效减轻晚期癌痛病人疼痛症状,改善其睡眠质量,在临床上具有辅助治疗的作用。     

整体护理和循证护理在手术室护理中的作用分析

目的：探讨在手术室采用整体护理和循证护理的护理效果。方法对我门诊治疗的80例患者资料进行分析,将患者按照治疗时间分为实验组和对照组。对照组进行整体护理,实验组在对照组基础上联合循证护理,比较两组护理效果。结果实验组对我院护理治疗评价较高,"90分以上"所占比例较大多于对照组(P<0.05);实验组手术前有9例血压升高,12例心跳加快;护理后22例紧张情绪得到明显缓解,且手术后4例出现并发症优于对照组(P<0.05)。结论手术室救死扶伤的主要场所,能够拯救患者生命,患者手术前后采用整体护理和循证护理效果较好,能够有效的改善患者症状,提高临床手术治愈率。     

羟考酮控释片联合双膦酸盐治疗骨转移癌69例

背景:盐酸羟考酮控释片属于第3阶梯用药,是治疗中重度癌痛的主要方法之一。目的:观察盐酸羟考酮控释片联合双膦酸盐治疗骨转移癌性疼痛的疗效及不良反应。方法:对69例骨转移癌患者口服盐酸羟考酮控释片治疗,在用药过程中根据疼痛缓解程度调整剂量;同时静脉滴注唑来膦酸4mg每4周1次,连续2次后评价疗效和不良反应。结果与结论:发现骨转移癌患者的骨痛完全缓解25例(36%),部分缓解37例(54%),轻度缓解7例(10%),总有效率为90%(62/69);不良反应有便秘、恶心呕吐、腹胀、厌食、嗜睡、头晕、发热、肌肉痛等。结果表明,盐酸羟考酮控释片联合双膦酸盐治疗骨转移癌性疼痛疗效确切,有效率高,不良反应轻,患者可以耐受。     

内镜介入治疗食管狭窄

目的 探讨内镜介入治疗食管贲门狭窄的方法、疗效及不良反应，寻求较为合理的治疗组合。方法 223例癌性狭窄病人，随机分为内镜下注射化疗药物、微波凝固、注射加微波加温、食管内支架治疗，35例放、化疗为对照组。118例良性狭窄，分别用高频电切、微波凝固、支架治疗。观察梗阻缓解情况、平均生存期、转移灶情况、并发症及不良反应。结果 梗阻缓解情况，恶性狭窄组总有效率为91．03％，单纯化疗组为55％，单纯放疗组为87％。良性狭窄组分别为77．4％、98．8％和100％。平均生存期，恶性组为11．75个月，对照组分别为8．3、13．8个月。良性组分别为39、42、44个月。结论 内镜介入治疗食管贲门癌性狭窄缓解梗阻优于放疗和化疗。病人生存期长于化疗，而与放疗接近，各治疗方法中以支架加化疗最佳。良性狭窄以消融扩张为首选，对反复狭窄再考虑用内支架。     

临床护理路径在住院抑郁症病人健康教育中的效果观察

目的 探讨临床护理路径对住院抑郁症病人健康教育的作用。方法 将86例抑郁症病人分为实验组和对照组。实验组采用抑郁症病人教育路径进行健康教育；对照组只采用传统的方法进行健康教育（即无时间限制），随机进行教育。结果 经过1年临床护理路径对住院抑郁症病人健康教育活动，实验组掌握抑郁症相关知识、自我管理能力、病情稳定、改善服药依从性、恢复社会功能的情况明显优于对照组（P〈0．01）。结论 抑郁症病人教育路径可以提高健康教育的效果，满足病人的健康需求，对预防抑郁症病人的复发具有重要的意义。     

硫酸吗啡控释片与芬太尼透皮贴剂控制晚期癌症患者疼痛的比较

目的：比较硫酸吗啡控释片与芬太尼透皮贴剂控制晚期癌症患者疼痛的效果和不良反应。方法：84例中重度晚期癌症疼痛患者分成两组，美施康定组44例，初始剂量30mg，q12h，多瑞吉组40例，根据疼痛情况调整剂量．结果：两组在治疗后，疼痛强度有明显下降；治疗后第1、4、7、14天，美组疼痛指数较多组低；不良反应发生率美组比多组高．结论：两药对晚期癌性疼痛疗效较好，美组优于多组，但不良反应较多。     

心理暗示的探讨

心理暗示是临床和护理中常用的；行之有效的治疗手段，也是心理护理的内容之一。方法简便易行。经济、安全，临床和护理中合理应用会收到事半功倍的效果。最常见的一些癌症性失语、抽搐、偏瘫、预项强直等，就诊时急急匆匆，患者和家属都十分紧张，使检查一旦确诊．给予恰当的心理暗示治疗，均可收到立竿见影的效果。一些癌性疼痛等，虽是器质性疾病，积要取得病人的信认和配合，均可经过心理暗示，给予一般药物，达到明显的缓解作用。暗示应注意的事项，总结多年临床护理体会，为提高心理暗示的效果，必须注意以下几点：l尽量取得病人的信…     

手术室开展无缝隙护理的探索

目的 探讨无缝隙护理在手术室的运用方式，更好地做好病人的心理护理，提高服务质量。方法 对80例手术病人进行无缝隙护理，并对其效果进行评价。结果 80例手术病人焦虑情绪均有不同程度的减轻，术后满意度由98％上升到99．9％。结论 无缝隙护理满足了病人的心理需求，体现了个体化，人性化的护理理念。     

应用临床护理路径对慢性阻塞性肺疾病急性加重期患者进行健康教育的研究

目的 建立完善的慢性阻塞性肺疾病急性加重期(AECOPD)病人的健康教育路径.方法 随机将病人分成2组,每组46例.对照组46例病人采用按常规医嘱进行护理,观察组46例病人采用制订好的健康教育路径进行护理,观察2组病人症状缓解时间、住院天数、并发症的发生率、健康教育知晓率及病人满意度有无差异.结果 观察组病人症状缓解时间、住院天数、并发症发生率比对照组明显减少,健康教育知晓率及病人满意度与对照组比较有了显著提高.结论 对AECOPD患者应用健康教育路径,可提高治愈率和病人的满意度,缩短住院时间,减少并发症.     

疼痛教育对晚期癌痛病人疼痛控制及睡眠质量的影响

目的:探讨和分析疼痛教育在晚期癌痛病人中的临床应用意义。方法:选择2012年3月至2014年3月期间在我院进行治疗的晚期癌痛患者作为临床研究对象,采用随机数字表法将入选研究对象随机分为研究组和对照组各45例。两组晚期癌痛患者均给予规范的癌症疼痛治疗与常规护理干预,对照组给予常规健康教育,研究组则在对照组基础上再给予系统的疼痛教育方案,并分别对研究组与对照组患者的疼痛控制情况和睡眠质量变化情况予以比较和分析。结果:与对照组相比,研究组患者经教育后的数学评分(NRS)值(2.41±1.25)显著降低、爆发痛次数(2.15±1.10)次/天明显减少,并且两组间比较差异均具有统计学意义(t=6.996,4.490;P0.05);研究组患者睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物和日间功能等睡眠质量指标均显著改善,匹兹堡睡眠质量指数量表的总分值(8.86±2.05)分明显降低,并且两组间比较差异均具有统计学意义(t=3.014,3.209,3.144,3.370,4.943,4.114,3.034,3.744;P0.05);研究组患者对护理服务的满意度(97.92%)显著提升,并且两组间比较差异具有统计学意义(χ~2=10.766,P0.05)。结论:疼痛教育能够使晚期癌痛病人的疼痛症状得以有效控制,睡眠质量进一步改善,可作为晚期癌痛病人的辅助治疗予以临床推广和应用。     

循证护理干预对急性心梗患者住院早期的症状及 心理状态改善作用分析

目的 探究循证护理干预对急性心梗患者住院早期的症状改善及心理状态改善作用。方法 随机选取2016年1月~2017年1月入我院住院治疗的急性心肌梗死患者74例为研究对象,采用随机数字表法分为观察组与对照组,每组37例。对照组予以常规护理,观察组予以循证护理干预,观察两组经护理后疼痛程度、持续时间、疼痛频率等疼痛相关指标下的症状表现,采用SAS、SDS、MOS SF-36评价中心理改善情况。结果 护理后,观察组疼痛持续时间（2.70±0.50）min、疼痛频率（0.50±0.40）次/24h、疼痛程度（2.90±0.90）分改善程度均优于对照组,SDS（38.26±5.09）分、SAS（39.35±5.05）分与MOS SF-36中的情感指数（9.25±2.10）分、健康指数（9.86±2.98）分、生活满意度（10.27±2.21）分改善程度均优于对照组,差异具有统计学意义（P＜0.05）。观察组并发症发生率低于对照组（8.11% vs 18.91%）,差异具有统计学意义（P＜0.05）。结论 循证护理干预对急性心梗住院早期的症状表现有较好的改善效果,对保持良好的心理状态具有积极作用。     

循证运动医学的定义、基础、实践与发展

背景：随着传统运动医学的发展,运动医学研究与实践越来越多的采用“循证医学”的思想和方法。循证运动医学是循证医学与运动医学相结合的一门学科,也是一种新的运动医学实践模式。 目的：分析并总结循证运动医学的定义、基础、发展与实践。 方法：以电子检索方式检索The Cochrane Library(2015年第12期)、EMbase、PubMed 、SPORTDiscus、CNKI、WanFang Data和VIP数据库的研究文献,检索时间为从建库至2015年8月,英文检索词为：sports medicine和evidence-based;中文检索词为：运动医学和循证,排除重复性研究。 结果与结论：共纳入156篇文献,检索结果表明,循证运动人体科学、循证运动预防医学、循证运动创伤学和循证运动康复学发表文章数量均衡,说明这4个领域的学术研究进展的相对良好,而循证运动营养学和循证体育保健学,发表文章数量相对较少,说明这两个领域的学术研究进展相对缓慢。科学的循证运动医学实践与循证体育决策,不但能够系统指导运动员科学训练、有效防治运动员伤病以及高效提高运动员成绩,而且也能够系统指导大众科学健身、增强人民体质,增进人民健康。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程      

Viewpoint: Moving beyond evidence-based medicine.

The evidence-based medicine movement has remained both well known and controversial since its inception. The authors reframe the evidence-based medicine debate by pointing out an underappreciated epistemological deficiency: evidence-based medicine as currently conceptualized cannot accommodate concepts that resist quantitative analysis and therefore cannot logically differentiate human beings from complex machines. The authors use Michael Polanyi's philosophy of tacit knowing (which refers to the taken-for-granted knowledge at the periphery of attention that allows persons to understand the world and discern meaning in it) as a starting point for rectifying this deficiency and for working towards an improved, person-centered epistemology of medical practice. The authors demonstrate that not only evidence-based medicine but also most traditional theories of medical practice need a concept such as tacit knowing to account for the kinds of knowledge human beings actually use. Polanyi's philosophy of tacit knowing is defined and briefly explained. A medical epistemology that can account for the tacit dimension of human knowledge and recognize physicians and patients as persons requires a revised conception of medical uncertainty and a recognition that clinician-patient interactions are central to medicine. The authors discuss practical implications of tacit knowing for medical practice, education, research, and health care policy and suggest ways for moving beyond evidence-based medicine towards a comprehensive epistemology of medical practice.     

Evaluation of an evidence-based education package for men with prostate cancer on hormonal manipulation therapy

Prostate cancer has become a public health problem worldwide with considerable social and economic consequences. Many men have extraprostatic spread at diagnosis, and treatment usually involves hormonal manipulation therapy, which can challenge the stereotypical male image. It is often assumed that merely the provision of educational material for patients in an accessible form is sufficient to address informational needs. However, with the increasing emphasis on evidence-based practice, an essential element of the patient education process is evaluation of the impact of educational interventions. In this study, a randomised controlled trial was used to evaluate the effect of an evidence-based education package on the knowledge of disease and treatment, quality of life, coping and satisfaction of a sample (n=55) of men with prostate cancer on hormonal manipulation therapy in the UK. The men were randomly assigned to experimental (n=28) and control group (n=27). Established instruments with satisfactory reliability and validity were used to measure the dependent variables. The independent variable, namely the education package, had been developed following the results of a previous study, which assessed the informational needs of this client group. This package consisted of an information booklet supplemented by the verbal teaching of a urology nurse. Results demonstrated that delivery of the education package had a significant effect on knowledge, quality of life and satisfaction with care, but not on coping. This study has contributed to the evidence-base for practice in urological nursing. This education package should become a routine, and not merely incidental aspect of care for this client group.     

Teaching evidence-based practice: implications for psychology

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.     

Provider perceptions of limited health literacy in community health centers

OBJECTIVE: To examine techniques used by community health center (HC) providers to care for patients with limited health literacy (LHL). METHODS: Survey mailed to 803 HC providers in 10 Midwestern states. Response rate was 47.5%. Associations between variables were examined using generalized estimating equations (GEE) models to account for clustering of respondents within HCs. RESULTS: The average provider estimates of LHL prevalence among English- and Spanish-speaking patients were 41+/-24% (mean+/-S.D.) and 48+/-30%, respectively. Those with training in health literacy were more likely to have patients repeat instructions back to check understanding (OR=2.05 and p=0.04) and were more likely to give out health education materials designed for patients with LHL (OR=2.80 and p=0.0002). Providers differed by type in encouraging patients to bring friends or family members to appointments (p=0.02). CONCLUSION: Providers estimate LHL to be highly prevalent in their HCs, and use various techniques to assist patients. PRACTICE IMPLICATIONS: Training in health literacy is associated with increased usage of evidence-based techniques to assist patients with LHL. Providers at all levels would likely benefit from LHL training. Most providers believe providing health education materials designed specifically for patients with LHL would be very helpful.     

江苏省盱眙县农村居民麻风病健康教育效果

目的了解健康教育前后农村居民对麻风病知识知晓率的变化状况,评价健康教育的效果。方法选择盱眙县历史病人较多或目前有现症麻风病人的6个村开展麻风病健康教育活动。健康教育的方法为发放麻风病基本知识宣传资料和张贴宣传画,并配合广播和电视等媒体进行麻风病知识讲座,为期3个月。干预前后随机抽取有关村民进行麻风知识问卷调查,评价干预效果。结果干预前试点地区农村居民对麻风病病因、传染性、症状和治疗的认知偏低,干预后,农村居民对病因、传染性、症状和治疗的认知均较干预前有明显的改善（P〈0.01）。农村居民对麻风病的相关态度和行为有了一定程度的变化。结论健康教育能有效地提高农村群众对麻风病的认识并能转变部分群众态度,在农村地区应利用多种形式开展麻风病健康教育。     

心理卫生课程教育对低年级大学生SCL-90评分的影响

目的探讨心理卫生课程教育对低年级大学生心理状况的影响。方法选取徐州师范大学2002级本科学生446人,对试验对象进行2个学期心理卫生课程教育。测量工具为症状自评量表,分别作课程教育前后测评比较。结果心理卫生课程教育干预后,SCL-90测试在强迫症状,人际关系敏感,恐怖,偏执项目上得分比干预前显著下降(P<0.001);SCL-90因子分≥3的检出率有明显的变化,经χ2检验除躯体化项目外,其余9个项目都有显著的降低。结论心理卫生课程教育可以影响大学生SCL-90评分,提示心理卫生课程教育可以作为高校心理辅导重要形式之一。     

Evidence-based Practice: Improving Outcomes for Patients with a Central Venous Access Device

PurposeTo apply evidence-based practice when flushing central venous access devices (CVADs).Background/IntroductionThere is a lack of standardized flushing protocols for CVADs among health care institutions. Identifying best practice and assuring skillful implementation of evidence-based practice protocols is essential to maintaining catheter patency.Review of Relevant LiteratureEvidence supports the use of nonheparinized saline flush, positive-pressure valve caps, and proper flushing technique to maintain CVAD patency (Bowers, Speroni, Jones, & Atherton, 2008; Hadaway, 2006; & Jasinsky & Wurster, 2009). Reinforcement of proper flushing techniques has demonstrated improved patency rates of CVADs (Feehery, Allen, & Bey, 2003).MethodsCorporate and individual in-services were conducted to improve nurses’ skill and knowledge of evidencebased practice related to flushing CVADs. Outcomes were measured by comparing baseline data with data collected in the same manner post-education. Data was obtained by means of a questionnaire and direct observation of nurses’ flushing technique.OutcomesThe evidence-based practice project demonstrated a significant improvement (p <0.05) in both the nurses’ knowledge and skill in flushing CVADs.ConclusionContinuing education and reinforcement of proper flushing technique is an appropriate strategy to increase knowledge of and compliance with evidence-based practice protocols.Implications for practiceProviding continuing education and periodic reinforcement of nursing skills can lead to improved patient outcomes. These strategies, along with changing flushing protocols to non-heparinized saline, can also reduce health care costs. Future studies are needed to determine the appropriate frequency of in-service education.