瑜伽联合冥想训练对乳腺癌化疗患者癌因性疲乏及负性情绪的影响

目的 观察瑜伽联合冥想训练对乳腺癌化疗患者癌因性疲乏及负性情绪的影响。 方法 选取2017年1-6月在我科接受化疗的90例乳腺癌患者为研究对象,采用随机数字表法将其分为对照组和干预组,每组45例。对照组给予肿瘤科常规护理,干预组在对照组基础上给予瑜伽联合冥想训练,比较2组患者的癌因性疲乏程度、焦虑程度和睡眠质量评分。 结果 干预后,干预组癌因性疲乏程度、焦虑程度均轻于对照组(Z=-2.124,P=0.034;Z=-2.283,P=0.022),睡眠质量评分高于对照组(t=2.682,P=0.031)。 结论 瑜伽联合冥想训练能降低乳腺癌化疗患者的癌因性疲乏,改善其焦虑情绪和睡眠质量。     

正性音乐刺激对手外科患者术后疼痛及负性情绪的影响

目的 探讨正性音乐刺激对手外伤患者术后疼痛及负性情绪的影响。 方法 选取2017年1-6月我院手外科治疗的68例手外伤患者为研究对象,随机将其分为对照组和实验组各34例。对照组给予常规护理干预,实验组在对照组基础上加用正性音乐刺激。干预6周后,比较2组患者痛觉视觉模拟评分(visual analogue scale/score,VAS)、焦虑和抑郁情绪变化。 结果 入组时,2组患者负性情绪和痛觉视觉模拟评分比较,差异均无统计学意义(P>0.05)。干预6周后,实验组焦虑、抑郁评分及痛觉视觉模拟评分均低于对照组(t=14.645 ,P<0.001;t=12.728 ,P<0.001;t= 9.156,P<0.001)。 结论 正性音乐刺激能够显著减轻患者术后疼痛,改善手外伤患者负性情绪,值得在临床应用和推广。     

正念认知疗法对喉癌术后患者癌因性疲乏及情绪感受的影响

目的 探讨正念认知疗法对喉癌术后患者癌因性疲乏及焦虑、抑郁、幸福感指数的影响。方法 采用便利抽样方法,2018年6月—2019年10月选取在武汉市某三级甲等医院耳鼻喉科住院手术且拔除胃管的70例喉癌患者为研究对象,采用随机数字表将其分为对照组和观察组,2组各脱落 1例,最终2组各34例喉癌患者。对照组喉癌术后患者仅给予耳鼻喉头颈外科的常规护理,观察组喉癌术后患者在此基础上进行6周的正念认知疗法干预,在干预前和干预6周末采用简短疲乏评估表、焦虑自评量表、抑郁自评量表和幸福感指数量表对2组喉癌术后患者进行评估。结果 干预6周末,观察组12例喉癌术后患者无疲乏,对照组2例无疲乏,组间比较差异有统计学意义（P<0.01）;观察组喉癌术后患者焦虑总分、抑郁总分低于对照组（P<0.001）,幸福感指数量总分高于对照组（P<0.05）。结论 正念认知疗法能减轻喉癌患者的癌因性疲乏程度,改善癌喉术后患者的焦虑、抑郁情绪,提升喉癌术后患者的幸福感。     

治疗性沟通联合微信干预对急性心肌梗死患者自我感受负担和负性情绪的影响

目的 探讨治疗性沟通联合微信干预在急性心肌梗死患者中应用效果。 方法 选取2017年1-3月我院CCU治疗的48例急性心肌梗死患者对照组,接受常规住院护理;选取2017年4-6月我院CCU治疗的48例急性心肌梗死患者为实验组,接受治疗性沟通联合微信干预。比较2组患者自我感受负担、焦虑及抑郁评分。 结果 干预12周后,实验组自我感受负担量表各维度得分、SAS得分、SDS得分均低于对照组。 结论 对急性心肌梗死患者进行治疗性沟通联合微信干预能够显著减轻其自我感受负担,改善患者负性情绪。     

光疗法对鼻咽癌同步放化疗患者癌因性疲乏的影响

目的探讨光疗法对鼻咽癌同步放化疗患者癌因性疲乏的干预效果。方法便利抽样法选取南宁市某三级甲等医院行同步放化疗的鼻咽癌住院患者78例为研究对象。将其随机分为观察组和对照组。对照组接受常规护理,观察组在此基础上实施光疗法干预。比较两组患者干预前及干预后2、4、6周时癌因性疲乏、焦虑抑郁及生活质量得分。结果观察组癌因性疲乏得分、抑郁得分和生活质量得分均低于对照组(P0.05)。结论光疗法可以有效缓解鼻咽癌患者放化疗期间疲乏症状,降低抑郁情绪,提高生活质量。     

家庭尊严干预在老年轻度认知障碍患者主要照顾者中的应用

目的 探讨家庭尊严干预对老年轻度认知障碍患者主要照顾者照顾负担及负性情绪的影响。方法 便利选取80对老年轻度认知障碍患者及其主要照顾者,按出院单双日分为实验组和对照组各40对。实验组在实施常规心理护理的基础上增加家庭尊严干预,对照组实施常规心理护理。应用照顾者负担量表、医院焦虑抑郁量表、Herth希望指数量表评价干预效果。结果 干预后实验组主要照顾者的照顾负担评分和焦虑抑郁评分明显低于对照组,希望指数评分明显高于对照组,差异有统计学意义（P<0.05）。结论 家庭尊严干预能够明显减轻老年轻度认知障碍患者主要照顾者的照顾负担,有效缓解其负性情绪,提高其希望水平。     

配偶同期家庭访视对宫颈癌患者情绪状态和癌因性疲乏的影响

目的探讨配偶同期的家庭访视对宫颈癌患者情绪状态和癌因性疲乏的影响。方法将入选的60例宫颈癌患者随机分为实验组和对照组,每组30例;实验组接受配偶同期的家庭访视,对照组接受常规家庭访视指导。干预3个月后,采用焦虑自评量表、抑郁自评量表和癌因性疲乏量表对宫颈癌患者的情绪状态和癌因性疲乏状况进行比较。结果干预结束后比较,实验组的焦虑抑郁和癌因性疲乏程度明显低于对照组,差异均有统计学意义(P0.05)。结论采用配偶同期的家庭访视干预模式对宫颈癌患者及其配偶进行指导和干预可减轻宫颈癌患者的焦虑抑郁情绪,并可缓解其癌因性疲乏程度。     

多学科协作下路径护理联合多模态运动干预在肿瘤相关肌少症患者中的应用研究

目的探讨多学科协作下路径护理联合多模态运动干预在肿瘤相关肌少症患者中的应用效果。方法采用便利抽样法, 选择2020年1月—2021年12月于河南省人民医院肿瘤中心就诊的120例肿瘤相关肌少症患者为研究对象, 根据随机数字表法分为观察组(n=60)与对照组(n=60)。对照组实施常规护理, 观察组实施多学科协作下路径护理联合多模态运动。比较并分析两组患者的骨骼肌质量指数(SMI)、手握力测量值(HGS)、日常步行速度、癌因性疲乏量表(CFS)及激惹、抑郁和焦虑量表(IDA)得分。结果干预4周后, 观察组的HGS、日常步行速度均高于对照组, 差异均有统计学意义(P<0.05)。干预4周后, 观察组的CFS总分低于对照组, 且观察组的身体疲乏、情感疲乏、认知疲乏得分均低于对照组, 差异均有统计学意义(P<0.05)。干预4周后, 观察组的IDA总分低于对照组, 且焦虑、抑郁、外向刺激及内向刺激得分均低于对照组, 差异均有统计学意义(P<0.05)。结论多学科协作下路径护理联合多模态运动有助于改善肿瘤相关肌少症患者的体能, 提高患者体力活动水平, 缓解患者疲乏程度并减少患者焦...     

同步放化疗宫颈癌患者癌因性疲乏与焦虑抑郁的研究

目的调查同步放化疗宫颈癌患者癌因性疲乏与焦虑、抑郁现状,并探讨其相关性。方法采用一般资料问卷、Piper疲乏量表、医院焦虑抑郁量表对321例同步放化疗宫颈癌患者进行调查。结果同步放化疗宫颈癌患者癌因性疲乏呈中度水平,患者存在明显的焦虑、抑郁情绪,且疲乏程度与焦虑、抑郁呈正相关(P0.05);多元线性回归分析显示焦虑、抑郁能影响宫颈癌患者的癌因性疲乏状况。结论同步放化疗宫颈癌患者癌因性疲乏发生率高,与焦虑、抑郁密切相关,应关注患者的心理状况,加强心理干预,降低疾病带来的负面影响。     

追踪护理模式对宫颈癌放化疗患者负性情绪及癌因性疲乏的影响

目的：分析追踪护理模式对宫颈癌放化疗患者负性情绪及癌因性疲乏的影响。方法：选择2019年3月至2021年3月肿瘤科收治的100例宫颈癌放化疗患者,随机分为对照组和观察组各50例。对照组行常规护理,观察组予以追踪护理模式。3个月后对比两组的负性情绪、遵医行为、癌因性疲乏及生存质量。结果：护理后,观察组焦虑、抑郁自评量表（SDS）评分、癌症疲乏量表(CFS)评分低于对照组,遵医依从性、中文版癌症患者生命质量通用量表（FACT-G）评分高于对照组,差异有统计学意义（P<0.05）。结论：追踪护理模式可改善宫颈癌放化疗患者的负性情绪,提高遵医行为,缓解癌因性疲乏,提高其生存质量。     

Detecting cardiac involvement with magnetic resonance in patients with active eosinophilic granulomatosis with polyangiitis

Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (EGPA, Churg–Strauss syndrome). The aims of this study were to describe findings of cardiac magnetic resonance (CMR) in patients with active EGPA and to find factors associated with cardiac involvement detected by CMR that could help identify patients who would benefit from the examination. Medical records and CMR images in 16 consecutive EGPA patients (8 women and 8 men, median age of 47 years ranging from 34 to 68 years) were reviewed. Clinical features and results of laboratory tests were compared according to the presence of myocardial late gadolinium enhancement (LGE) on CMR images. The patients were followed for the development of cardiac symptoms and signs (mean follow up duration, 40.5 ± 12.8 months). Among the total of 16 patients, 8 (50 %) had myocardial LGE according to CMR, located in the subendocardial layer in 7 of them (87.5 %). The extent of LGE had a significant negative correlation with left ventricular ejection fraction (LVEF, ρ = ?0.723, p = 0.043). The presence of LGE was associated with larger end-systolic left ventricle internal dimension (34 vs. 28 mm, p = 0.027) and presence of diastolic dysfunction (75 vs. 0 %, p = 0.008) on echocardiography, elevated NT-proBNP (75 vs. 12.5 %, p = 0.012), and elevated CK-MB (62.5 vs. 0 %, p = 0.010) compared to the group without LGE. Only one patient (6.3 %) had cardiac symptoms before CMR and another patient (6.3 %) developed heart failure 4 years later during remission. The other 14 patients remained free from cardiac signs and symptoms during the follow-up period. In patients with active EGPA, CMR enables detection of cardiac involvement when cardiac symptoms are not present. Echocardiographic diastolic dysfunction and elevated NT-proBNP or CK-MB may help identify active EGPA patients who can benefit from CMR to detect cardiac involvement without cardiac symptoms.     

Factors associated with work ability in adults with diabetes

AimsThe aims of this study were to explore associations between clinical and diabetes-related factors with work ability in a sample of working adults with diabetes.BackgroundAdults with diabetes may face challenges in the workplace, including managing their diabetes and overall physical and mental health.MethodsThis was a cross-sectional design with a sample of 101 working adults. Subjects completed valid and reliable surveys assessing depressive symptoms, diabetes self-care, fear of hypoglycemia, diabetes distress, cardiovascular health using American Heart Association's Life's Simple 7 (range 0–7) and work ability. Factors significantly associated with work ability at bivariate level were included in linear and logistic regression.ResultsThe majority of the sample was female (65%) (mean age 54.1 ± 10.5), White (74%), non-Hispanic (93%), worked full-time (65%) and had type 2 diabetes (87%) (mean duration 12.4 ± 9.5 years). The majority (55%) had low diabetes distress, but 24% had high distress and 28% had depressive symptoms. The sample achieved 2.5 ± 1.4 ideal AHA heart health indices and 33% rated their work ability as excellent. In linear regression higher depressive scores were associated with lower work ability scores (b = −0.45, p = .002). In logistic regression, scores on heart health (OR = 1.4; 95%CI:1.0–1.9, p = .03) and diabetes distress (OR = 0.6, 95%CI:0.4–0.9, p = .048) were significantly associated with work ability at its best.ConclusionBoth cardiovascular and psychological health may impact work ability in adults with diabetes. Routinely screening for diabetes distress and depression while also promoting ideal cardiovascular health may improve overall health and work ability in this population.     

Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPA

Summary. Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin‐1 (Ang‐1) and granulocyte‐colony stimulating factor (G‐CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color‐coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0–2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G‐CSF and Ang‐1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G‐CSF (OR, 1.02) and Ang‐1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang‐1 (P < 0.0001). Ang‐1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G‐CSF (P < 0.0001). G‐CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t‐PA, although they might increase the HT.     

Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy

AimThis study aimed to examine the relationship between the health literacy level and treatment adherence in patients with chronic disease.BackgroundNonadherence to treatment and insufficient health literacy can cause a decrease in understanding treatment methods, an increase in medication errors, and an increase in morbidity and mortality rates.Materials and methodsThis cross-sectional study comprised a total of 200 patients who were taking medication for a chronic disease. Data were collected using an 18-item questionnaire for sociodemographic and medical characteristics, the Adult Health Literacy Scale (AHLS), and the Morisky Medication Adherence Scale (MMAS).ResultsOf the patients, 42.5% reported that they took three or more medications per day, and 32.0% reported that they did not know the side effects of these medications. Of the patients, 39.0% had low adherence to treatment. The mean score of the AHLS was 12.8 ± 4.74 (min = 2; max = 21). A statistically significant positive correlation was found between the AHLS scores and MMAS scores (r = 0.604; p = 0.001).ConclusionsThis study revealed that patients' adherence to treatment increased as their health literacy increased. Thus, it is recommended that health literacy levels of the patients be raised through effective interventions to ensure better adherence to treatment.     

Conducting participatory photography with children with disabilities: a literature review

Purpose: This review summarized studies that used participatory photography with children with disabilities, including those with communication impairments, and described modifications made to the methodology to facilitate their participation in qualitative research.

Methods: In the fall of 2016, we searched Psycinfo (OVID), ERIC, CINAHL and Web of Science to identify studies that used participatory photography with children with disabilities. The search was repeated in January 2018 to retrieve any new publications. The first author extracted data that described the characteristics of each study and the modifications used.

Results: Of the 258 articles identified, 19 met inclusion criteria. Participants ranged from 4–21?years old and had a variety of disabilities. Study topics included education, leisure activities and adulthood. Researchers modified participatory photography to enhance accessibility by: modifying cameras; providing individual training; teaching consent through role play; allowing children to direct adults to take photographs; including additional forms of media; using diaries and questionnaires; providing individual interviews with simplified questions; using multiple forms of communication; and modifying how photographs are shared.

Conclusions: Participatory photography can be an effective method for studying the lived experiences of children with disabilities, particularly those with communication impairments. Methodological modifications can enhance the accessibility of this approach for this population.

• Implications for Rehabilitation

• Participatory photography may be an effective qualitative research method for learning about the perspectives and experiences of children with disabilities on a wide array of topics.

• There are many specific modifications that researchers can use to support the inclusion of children with disabilities in participatory photography research.

• The findings of studies that use participatory photography methodology may provide rehabilitation professionals with important insights into the lives of children with disabilities.

     

The risk associated with hyperoncotic colloids in patients with shock

Objective  Crystalloids, artificial and natural colloids have been opposed as representing different strategies for shock resuscitation, but it may be relevant to distinguish fluids based on their oncotic characteristics. This study assessed the risk of renal adverse events in patients with shock resuscitated using hypooncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin or crystalloids, according to physician’s choice. Participants and setting  International prospective cohort study including 1,013 ICU patients needing fluid resuscitation for shock. Patients suffering from cirrhosis or receiving plasma were excluded. Measurements and results  Influence of different types of colloids and crystalloids on the occurrence of renal events (twofold increase in creatinine or need for dialysis) and mortality was assessed using multivariate analyses and propensity score. Statistical adjustment was based on severity at the time of resuscitation, risks factor for renal failure, and on variables influencing physicians’ preferences regarding fluids. A renal event occurred in 17% of patients. After adjustment on potential confounding factors and on propensity score for the use of hyperoncotic colloids, the use of artificial hyperoncotic colloids [OR: 2.48 (1.24–4.97)] and hyperoncotic albumin [OR: 5.99 (2.75–13.08)] was significantly associated with occurrence of renal event. Overall ICU mortality was 27.1%. The use of hyperoncotic albumin was associated with an increased risk of ICU death [OR: 2.79 (1.42–5.47)]. Conclusions  This study suggests that harmful effects on renal function and outcome of hyperoncotic colloids may exist. Although an improper usage of these compounds and confounding factors cannot be ruled out, their use should be regarded with caution, especially because suitable alternatives exist. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. This study was presented in part at the 17th annual congress of the European Society of Intensive Care Medicine, Berlin, 10–13 October 2004 [1]. This article is discussed in the editorial available at: doi:.     

Approach to patients with unexplained multimorbidity with sensitivities

Objective

To explore the underlying causation of unexplained multimorbidity with sensitivities and to discuss the management of patients who present with this perplexing condition.

Sources of information

Medical and scientific literature was used from MEDLINE (PubMed), several books, toxicology and allergy journals, conference proceedings, government publications, and environmental health periodicals.

Main message

Multimorbidity with sensitivities has become an increasingly common and confusing primary care dilemma. Escalating numbers of debilitated individuals are now presenting to family physicians and specialists with multisystem health complaints, including sensitivities and fatigue, with no obvious causation, a paucity of laboratory findings, and a lack of straightforward solutions. In the recent scientific literature, there is discussion of sensitivity-related illness, an immune-mediated disorder that frequently manifests with multisystem symptoms, commonly including sensitivities and fatigue. This condition appears to be originally caused by adverse environmental exposures and toxicant bioaccumulation—an increasingly prevalent and well-documented problem in contemporary culture.

Conclusion

Various toxic exposures and their bioaccumulation within the body frequently manifest as sensitivity-related illness. In clinical settings, patients with this disorder often present with otherwise unexplained multimorbidity and sensitivities. The health status of patients with this condition can be ameliorated by removing triggers (eg, scented products), optimizing biochemistry, removing further sources of toxicant exposures, and eliminating the internal dose of persistent toxicants.     

Classic-Pattern Dyssynchrony Is Associated with Outcome in Patients with Fontan Circulation

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Influential Variables Associated with Outcomes in Patients with Cervicogenic Headache

Cervicogenic headache (CGH) is a common sequela of upper cervical dysfunction with a significant impact on patients. Diagnosis and treatment have been well validated; however, few studies have described characteristics of patients that are associated with outcomes of physical therapy treatment of this disorder. A retrospective chart review of patient data was performed on a cohort of 44 patients with CGH. Patients had undergone a standardized physical therapy treatment approach that included spinal mobilization/manipulation and therapeutic exercise, and outcomes of treatment were determined by quantification of changes in headache pain intensity, headache frequency, and self-reported function. Multiple regression analysis was utilized to determine the relationship between a variety of patient-specific variables and these outcome measures. Increased patient age, provocation or relief of headache with movement, and being gainfully employed were all patient factors that were found to be significantly (P<0.05) related to improved outcomes.Key Words: Cervicogenic Headache, Physical Therapy, Treatment Characteristics, Manual TherapyAlthough cervicogenic headache (CGH) has been described as a “final common pathway” of cervical spine dysfunction¹, its true prevalence is difficult to determine due to inconsistent use of diagnostic criteria in the literature. Incidence of cervicogenic headache has been reported to range from 0.7% to as high as 13.8% in populations of patients suffering from headache disorders². Others have reported cervicogenic origins of higher values (14% to 18%) in all chronic headaches³.gThe anatomical basis for CGH is the convergence of the afferent input of the upper cervical spine nerve roots (C1-C3) with the afferent tracts of the trigeminal nerve in the trigeminocervical nucleus. This convergence results in cervical spine nociceptive input being expressed in the sensory distribution of the trigeminal nerve, most commonly the ophthalmic branch of the trigeminal nerve, which innervates the forehead, temple, and orbit and has its greatest topographic representation near the dorsal horns of spinal nerves C1-C3^4,5. Therefore, any structure innervated by C1, C2, or C3 spinal nerves can be implicated in the etiology of CGH. This includes the atlanto-occipital, median atlanto-axial, lateral atlanto-axial, and C2-3 zygapophyseal joints as well as the C2-3 intervertebral disc, suboccipital, upper posterior cervical, and upper paravertebral musculature, the trapezius and sternocleidomastoid muscles, upper cervical spinal dura mater, and the vertebral arteries^4–6. Because of the ability of afferent nerves to travel up to three segments cephalically or caudally in the cervical spinal cord, bony and soft tissue structures of the middle and lower cervical spine cannot be excluded from contributing to CGH^4,5.The diagnosis of CGH has been a source of contention in the literature ever since the inception of the term by Sjaastad et al in 19837-9. Currently, two major sets of diagnostic criteria exist for CGH (Table ​(Table1).1). The International Headache Society (IHS) accepted the diagnosis of CGH in 1988 as a type of secondary headache and, at that time, included criteria for its diagnosis in the International Classification of Headache Disorders, which was most recently updated in 2004¹⁰. However, the criteria established in 1990 by Sjaastad and the Cervicogenic Headache International Study Group (CHISG) and revised in 1998¹ are the most utilized clinically. The exception of the clinical utility of Sjaastad''s criteria is Point II, which stipulates the use of a nerve block to diagnose CGH in scientific works. The use of a nerve block may be impractical for daily clinical practice, despite being the only means by which a structure in the cervical spine can truly be isolated as the pain generator^5,11,12. Furthermore, although Point III of Sjaastad''s criteria specifies unilaterality of symptoms, the presence of bilateral symptoms or “unilaterality on two sides” has been documented^1,13. Differential diagnosis includes hemicrania continua, occipital neuralgia, migraine, and tension-type headache, with the differentiation of CGH from migraine and tension-type headache being the most challenging due to the overlap of many symptoms among these three disorders^2,14.

TABLE 1

Diagnostic criteria for cervicogenic headache

The use of cognitive behavioural therapy with people with schizophrenia

• ? The role of cognition as one aspect of the stress-vulnerability model of schizophrenia is discussed, and the use of cognitive therapy reviewed.
• ? A holistic approach to the development of schizophrenia is explored.
• ? The stress vulnerability model is explained and the way in which individuals suffering from schizophrenia are vulnerable to attentional, perceptual and cognitive difficulties, are discussed.
• ? Using case examples, it is demonstrated that the use of cognitive behavioural techniques can be used by nurses to effectively reduce client problems associated with schizophrenia.