综合护理干预减轻急性白血病化疗患者胃肠道反应的研究

目的探究在化疗期间实施综合护理干预对急性白血病患者胃肠道反应的改善效果。方法选取2010年7月至2012年12月间收治的78例急性白血病患者,采用随机数字表法分为研究组和对照组,每组39例。对照组患者采取常规护理,研究组患者采取综合护理。记录两组患者在化疗后1周末恶心、呕吐程度,并比较两组患者胃肠道反应发生率。结果研究组患者在化疗不同时间段内胃肠道反应发生率低于对照组,差异有统计学意义(P<0.05)。研究组患者恶心、呕吐程度均低于对照组,差异有统计学意义(P<0.05)。结论综合护理干预能减轻急性白血病化疗患者在的胃肠道反应,提高患者对化疗的耐受性。     

个性化护理对肝癌介入术后患者恶心呕吐的缓解效果

目的探讨个性化护理对肝癌介入术后患者恶心呕吐的缓解效果。方法选取2014年1月至2015年6月于四川大学华西医院接受肝癌介入术治疗的84例患者。根据随机数字表法分为观察组和对照组,每组42例。观察组患者在常规护理基础上给予个性化护理,对照组患者仅给予常规护理。比较两组患者护理前后恶心呕吐发生率、发生程度和生活质量评分。结果护理后,观察组患者的恶心呕吐发生率均显著低于对照组,恶心呕吐程度较对照组轻,躯体功能、心理功能、物质生活和社会功能等生活质量评分均高于对照组,差异均有统计学意义(均P<0.05)。结论个性化护理对肝癌介入术后患者恶心呕吐的缓解效果比较明显,提升患者的生活质量,值得临床推广。     

强化护理干预对骨肿瘤化疗患者不良反应和生活质量的影响

目的探讨强化护理干预对骨肿瘤化疗患者不良反应和生活质量的影响。方法选择2014年1月至2015年1月间收治的60例骨肿瘤化疗患者为观察组,采用强化护理和常规护理。另选2012年8月至2013年12月间收治的60例骨肿瘤患者作为对照组,采用常规护理。比较两组患者的不良反应及生活质量。结果观察组患者的骨髓抑制、皮肤黏膜损伤、胃肠道反应等不良反应的发生率均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者在情绪健康、个体认知功能、社会功能、躯体功能等生活质量方面的评分均高于对照组,差异均有统计学意义(均P<0.05)。结论强化护理干预能够减少骨肿瘤化疗的不良反应,提高患者的生活质量。     

临床护理路径在乳腺癌患者首次化疗中的应用

目的探讨临床护理路径乳腺癌首次化疗患者中的应用效果。方法选取2014年8月至2015年3月间收治的60例首次接受化疗的乳腺癌患者,按照随机数字表法分为观察组和对照组,每组30例。观察组患者接受临床护理路径,对照组患者接受常规护理,比较两组患者健康知识的掌握程度、不良反应以及生活质量的情况。结果观察组患者化疗后的知识、态度、行为评分均高于对照组,不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。观察组患者化疗后的功能量表和整体健康状况评分高于对照组,疲乏、恶心呕吐和疼痛的评分低于对照组,差异均有统计学意义(P<0.05)。结论临床护理路径可提高乳腺癌首次化疗患者健康知识的掌握程度,减轻不良反应,改善生活质量。     

早期止吐护理对肺癌首次化疗患者胃肠道及睡眠的影响

目的探讨早期止吐护理对肺癌首次化疗患者胃肠道及睡眠的影响。方法选取2015年2月至2016年2月间在哈尔滨医科大学附属肿瘤医院住院并接受首次化疗的84例肺癌患者,采用随机数字表分为观察组和对照组,每组42例。两组患者化疗方案基本一致,对照组患者采用常规护理,观察组患者在常规护理的基础上采用早期止吐护理,比较两组患者化疗7d时的恶心、呕吐、食欲以及睡眠情况。结果观察组患者化疗第7d时恶心、呕吐和食欲评分均低于对照组患者,两组比较差异有统计学意义(P<0.05)。观察组患者化疗第7d时入睡时间、睡眠质量、睡眠时间和药物催眠评分均低于对照组患者,两组比较差异有统计学意义(P<0.05)。结论早期止吐护理能够减轻肺癌首次化疗患者的恶心呕吐程度,改善食欲,提高睡眠质量。     

循证护理对乳腺癌患者化疗期间不良反应的影响

目的分析循证护理对乳腺癌患者化疗期间恶心、呕吐及焦虑情绪的改善作用。方法在2013年1月至2013年6月,中国医科大学附属第一医院收治的乳腺癌患者中,随机抽取100例,按照随机数字表法分为对照组和观察组,每组各50例,对照组患者采用常规药物和护理干预治疗,观察组患者则采用循证护理疗法。比较两组患者的恶心、呕吐症状发生率和焦虑、抑郁等级评分。结果观察组患者恶心、呕吐和焦虑症状发生率明显低于对照组;生活质量评分为(86.56±3.34)分,高于对照组患者的(71.56±3.32)分,差异均有统计学意义(均P<0.05)。两组患者对治疗满意度差异较大,观察组患者的满意率为92.0%,明显高于对照组。结论循证护理能有效缓解乳腺癌患者的恶心、呕吐及焦虑情绪,提高患者的生活质量,且安全性高,患者较为满意,值得推广。     

护理干预对肺癌化疗患者疗效和生活质量的影响

目的探讨护理干预应用于肺癌化疗的临床疗效和对患者生活质量的影响。方法选取2013年8月至2015年8月间湖北省宜城市人民医院中医院收治的90例肺癌化疗患者,采用随机数字表法随机分为观察组和对照组,每组45例。观察组患者采用护理干预,对照组患者采用常规护理,观察和比较两组患者化疗期间焦虑、抑郁情绪、不良反应和护理后的生活质量。结果观察组患者护理后焦虑、抑郁评分较对照组均明显降低,差异有统计学意义(P<0.05)。观察组患者不良反应发生率较对照组均显著降低,差异有统计学意义(P<0.05)。观察组患者护理后生活质量各维度和总分较对照组均明显提高,差异有统计学意义(P<0.05)。结论护理干预能够明显改善患者的负面情绪,降低化疗期间不良反应,提高生活质量。     

国产帕洛诺司琼对预防胃肠道肿瘤化疗所致恶心呕吐的临床观察

[目的]观察国产帕洛诺司琼预防胃肠道肿瘤化疗所致恶心呕吐的临床疗效和安全性。[方法]将胃肠道肿瘤化疗患者随机分为治疗组（帕洛诺司琼）和对照组（托烷司琼）,每组30例,观察两组对急性呕吐、延迟性呕吐的有效率,恶心改善率及相关不良反应。[结果]治疗组的急性呕吐总有效率高于对照组（86．7％VS63.3％）．两组比较差异有显著性（P〈0．05）：治疗组的延迟性呕吐总有效率明显高于对照组（73.3％ vs 46．7％）,两组差异有显著性（P〈0．05）。恶心程度改善率两组无湿著差异（P〉0．05）。两组的不良反应主要有便秘、头痛、腹胀,发生率相似,均为1～2级,差异无统计学意义（P〉0．05）。[结论]国产帕洛诺司琼可有效预防胃肠道肿瘤化疗所致的恶心呕吐．对急性和延迟性恶心呕吐均有良好疗效．值得临床应用。     

药学干预改善胃癌患者生活质量的初步研究

目的：：观察药学干预对在接受化疗期间的胃癌患者的生活质量的影响。方法：解放军第202医院2012年3月至2014年3月期间收治的178例胃癌术后患者,随机分为接受静脉化疗和药学干预的干预组（n ＝89）和仅接受静脉化疗的对照组（n ＝89）。针对术后化疗所引起的胃肠道症状,临床药师根据患者对药物的反应情况进行药学干预。药学干预内容为与临床医生沟通,将对症治疗方案优化并且对临床用药进行指导。观察两组患者在治疗期间的消化道反应及两组患者生活质量。结果：干预组患者在化疗前3个周期对止吐药物的完全缓解率分别为53.9％,61.8％和64.0％,对照组为32.6％,43.8％和46.1％,两组差异有统计学意义（P ＝0.004,P ＝0.016, P ＝0.016）。干预组的急性和迟发性恶心症状明显低于对照组（P ＝0.032,P ＝0.029）;干预组的急性和迟发性呕吐程度明显低于对照组（P ＝0.020;P ＝0.031）。生活质量评分：干预组总健康状况评分高于对照组（P ＝0.022）,而食欲丧失、恶心和呕吐的症状评分低于对照组（P ＝0.021,P ＝0.018）。结论：以临床药师主导的药学干预可降低胃癌患者在辅助化疗期间恶心、呕吐发生率,可改善患者生活质量。     

针刺联合穴位按摩治疗乳腺癌患者化疗胃肠道反应的临床疗效

目的:观察针刺联合穴位按摩对乳腺癌患者化疗后胃肠道反应的临床疗效,发掘针刺及穴位按摩在治疗化疗后胃肠道反应的优势,为改善乳腺癌化疗患者的生活质量提供一种新的途径.方法:60例乳腺癌患者随机分成两组,治疗组采用针刺联合穴位按摩治疗,对照组采用盐酸雷莫司琼治疗,评价患者化疗后恶心、呕吐等情况.结果:治疗组与对照组化疗后恶心、呕吐控制的有效率分别是86.7%和73.3%.结论:针刺联合穴位按摩防治乳腺癌化疗后导致的胃肠道反应疗效确切.     

Assuring the quality of quality assurance

BACKGROUND.

Rapid rescreening (RR) of negative Papanicolaou smears (PS) is used in many countries as a quality‐assurance measure. Seeding of abnormal slides has been suggested as a way to increase the sensitivity of this procedure. Since 2004, the authors have carried out RR with seeding before issuing reports. In this article, they describe their experience.

METHODS.

Abnormal seeds were sourced from the previous day's high‐grade cases, both squamous and glandular. Slides were evaluated for the ‘degree of difficulty’ (which was defined as the number of fields required to find (fields‐to‐find [FTF]) the abnormality), relabeled, and redotted to make them indistinguishable from the routine RR work. The number of seeds found/missed, the identity of the screener, the type of seeded abnormality, the degree of difficulty of the seed, and the mapping technique used all were recorded. The cytologists also were surveyed about their views on seeding.

RESULTS.

Overall, 14.8% of 3082 high‐grade seeds were missed during RR. There was no relation between seeds missed and the mapping technique used. However, the difficulty of the seed was relevant to the number missed and ranged from 8.3% when the FTF was <5 to 36% when the FTF was >10 (P = .000). The difference between intraepithelial seeds and invasive seeds was significant for squamous seeds (P = .031) but not for glandular seeds. Glandular seeds also were more likely to be missed than squamous seeds (23.1% vs 14.3%; P = .002). Most cytologists believed that seeding was a good idea and that seeds increased their level of vigilance.

CONCLUSIONS.

The authors' experience demonstrated that routine seeding is practicable for both conventional and liquid‐based slides. With the advent of the human papillomavirus vaccine, abnormalities will become rarer, and seeding will be necessary to maintain the alertness of cytologists. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.     

The quality of chemotherapy and its quality assurance.

AIMS: Assessment of the quality of chemotherapy care and its quality assurance in clinical trials and daily practice. METHODS: Using Medline, literature was searched combining the following words: quality assurance or quality of care, combined with anti-neoplastic agents. The bibliography of each article was reviewed for additional literature. Those reports in English, French, German or Dutch focusing quality assurance or quality of care and chemotherapy were selected. RESULTS: One hundred and five articles were selected by Medline and after review and adding of additional literature 53 articles remained. In clinical trials information on quality of chemotherapy is sparse. Different cooperative groups reported on suboptimal dosing, suboptimal registration of chemotherapy and several trials indicated that suboptimal dosing led to impaired outcome. Most quality assurance activities in clinical trials are concerned with audit and feedback and on-site visits. In daily practice the quality of chemotherapy is mostly impaired by the fact that it is not given although indicated and if it is given non-evidence based chemotherapy or administration schedules and reduced dose intensity decrease the quality of care. Especially, age, comorbidity and socio-economic status reduce the chance of receiving good quality of care regarding chemotherapy. Activities mostly used for quality assurance are generation of guidelines, specialisation and multidisciplinary care. CONCLUSIONS: Most quality assurance activities in clinical trials and daily practice are directed to structure and process parameters. More evidence that quality of care is related to outcome should be sought. Quality assurance in daily practice should aim at guideline implementation, specialisation and multidisciplinary care and should pay attention especially to the older patients, patients with comorbidity and patients from lower socio-economic classes.     

Evaluating the quality of cancer care: development of cancer quality indicators for a global quality assessment tool

BACKGROUND: The rise of managed care has increased interest in measuring, reporting, and improving quality of care. To date, quality assessment has relied on a leading indicator approach, which may miss important variations in care. The authors developed cancer specific indicators using a novel case-based approach for a quality measurement tool designed to compare different managed care organizations. METHODS: Based on a review of the literature, quality indicators were developed for 6 types of cancer and the human immunodeficiency virus (HIV) as well as 39 general adult conditions (GAC). The validity and feasibility of these candidate indicators were evaluated using three modified Delphi expert panels. The strength of evidence, type of care (preventive, acute, or chronic), function (screening, diagnosis, treatment, and follow-up), and modality (history, physical examination, laboratory, medication, or other intervention) of the cancer/HIV quality indicators were compared with indicators developed for GAC. RESULTS: The final system included 117 of the 145 proposed cancer/HIV quality indicators (81%) and 569 of the 705 proposed GAC indicators (81%). A greater percentage of the cancer/HIV indicators were based on evidence from clinical trials compared with the GAC indicators (59% vs. 31%; P = 0.001). Cancer/HIV had significantly more indicators pertaining to chronic care than did GAC (74% vs. 56%; P = 0.001) as well as more indicators for treatment (53% vs. 39%; P = 0.004). CONCLUSIONS: Using the case-based approach, it is feasible to develop quality indicators for cancer that cover the continuum of care. Future studies will evaluate the reliability and validity of measurements made using these indicators in three managed care plans.     

Measuring quality of life

This article provides a brief review of how quality of life (QOL) studies can contribute to the care of cancer patients. The problem of actually defining QOL is considered, and it is emphasized that quality is the presence of positive factors not merely the absence of negative aspects of life. The information that can be gained from using QOL instruments and how this is achieved is outlined. These studies have important implications for health care professionals for side-effects of treatment are often identified that can be helped by nursing intervention. Finally, specific examples of how the implementation of QOL studies has helped modify treatment and patient care are given     

关于细胞制剂产品质量研究与质量控制的一些思考

近年来,细胞治疗成为研究热点,为肿瘤等重大和难治性疾病提供了新的治疗手段.本文针对细胞制剂产品的特点,提出细胞制剂产品质量研究和质量控制的一些思路和原则,包括生产质量管理规范、细胞制剂产品生产用原材料、制备工艺与过程控制、质量研究和质量控制等,希望通过不断完善的质量管理推进细胞制剂产品研发的健康发展.     

Diet quality is directly associated with quality of life in breast cancer survivors

Summary Purpose To determine whether there is a direct relationship between diet quality and quality of life in breast cancer survivors. Methods Subjects (n = 714) were members of the Health, Eating, Activity, and Lifestyle study, a study of breast cancer prognosis conducted in three areas of the western United States. Approximately 2 years after entry to this study, diet data were collecting using food frequency questionnaires. These data were used to classify diet quality using the Diet Quality Index. Approximately 10 months later, data on quality of life were gathered using the Medical Outcomes Study 36-Item short form health survey. Results After controlling for age, education, race/ethnicity, body mass index, stage of disease, and time from diagnosis to quality of life measurement, women with excellent diet quality had significantly better scores than women with poor diet quality for overall mental health functioning and for 3 of 4 mental health subscale scores and 2 of 4 physical health subscale scores. Conclusion Post-diagnosis diet quality is directly associated with subsequent mental and physical functioning in breast cancer survivors. This association is stronger for mental functioning than for physical functioning. The association remains strong after control for potential confounding variables.     

优质护理对晚期肝癌患者生活质量的影响

目的探讨优质护理对晚期肝癌患者生活质量的影响。方法收集2012年10月至2014年10月间诊治的100例晚期肝癌患者,根据随机数字表法分为对照组和观察组,每组50例。对照组患者接受常规护理,观察组患者接受优质护理,观察和比较两组患者护理后焦虑、疼痛、睡眠评分情况、护理后生活质量评分以及护理满意度。结果与对照组相比,观察组患者护理后焦虑、疼痛、睡眠评分均明显降低,组间差异有统计学意义(P<0.05)。与对照组相比,观察组患者护理后躯体功能、心理功能、社会功能、客观环境、总体生活质量评分均明显提高,差异有统计学意义(P<0.05)。与对照组相比,观察组患者护理满意度明显改善,差异有统计学意义(P<0.05)。结论优质护理能够改善晚期肝癌患者的生活质量,提高患者对护理服务的满意度,值得临床推广。