上海市癌症患者连续性照护现况调查

目的了解上海市癌症患者连续性照护现况,为构建上海市癌症患者连续性照护模式提供参考。方法选取上海市6所三级医院、2所二级医院、3所社区卫生服务中心和1所区疾病预防控制中心进行实地询问调查。结果有2所医院对出院后的患者进行主动病情跟踪,1所医院通过患者自评量表的方式进行症状管理;分别有2所通过网络、1所医院通过联谊会进行健康教育活动;1所医院与社区卫生服务中心建立了合作关系。各机构均建立了机构内的患者档案,3所医院加入了医院间的信息共享平台。结论医疗机构对患者的服务呈现出连续性照护的雏形,存在医院对出院后患者提供的服务不完善、社区服务与医院服务不协调和机构之间缺乏互动等问题。建议增强医院对出院患者的服务,衔接好医院社区对患者的照护服务,建立医院社区间的互动平台,以完善癌症患者的连续性照护机制和提高照护质量。     

初诊乳腺癌患者照护需求的质性研究

目的了解初诊乳腺癌术后患者的照护需求与期望,找出现有护理中存在的问题。方法采用个人深入访谈法,收集16例初诊乳腺癌患者的资料,应用内容分析法对访谈资料进行萃取和提炼。结果初诊乳腺癌患者有3个主要需求:对及时规范的治疗与护理的需求、对信息的需求、对情感与社会支持的需求。结论初诊乳腺癌患者的需求具有持续性,护理工作应延伸到患者出院后的康复阶段,体现护理服务的连贯性。     

ICU患者家属不同阶段照护体验的质性研究

目的探讨ICU患者家属在疾病不同阶段的照护体验。方法采用现象学研究法,对36名处于不同照护阶段的ICU患者家属进行非结构式访谈,用质性研究分析法对资料进行分析。结果ICU患者家属不同阶段的照护体验分别为:诊断期,应激反应强烈;治疗期,信息支持不足;转科准备期,缺乏人性化管理;临终期,提倡临终关怀。结论患者入住ICU期间,患者家属在不同照护阶段的需求是动态变化的,医护人员应针对性地提供个性化服务,不断提高医疗服务质量。     

PICC延续性照护服务现状及制约因素分析

目的从患者和社区医疗机构层面了解PICC延续性照护服务现状并分析制约因素,为PICC维护技术在社区医疗机构的推广提供参考。方法对在株洲市3所三级医院进行PICC置管维护的196例患者采用自行设计的问卷进行调查,对10家社区医疗机构负责人进行半结构式深入访谈。结果 88.8%的PICC带管者平时的维护地点为三级医院,31.1%的患者愿意到社区医院进行导管维护,61.2%的患者因社区诊疗技术不足而不到社区医疗机构进行导管维护。访谈共提取6个主题:人力资源不足,相关知识及技术缺乏,担心风险,收费标准缺乏文件依据,缺乏国家政策支持,建议提高医疗风险的保额。结论社区医院PICC维护情况不容乐观,推进PICC维护进社区存在较多的制约因素,政府、三级医院及社区医疗机构应积极采取对策加以改进,以发挥社区医疗机构初级医疗保健作用。     

重庆市养老机构老年人长期照护需求的现象学研究

目的深入了解重庆市养老机构老年人的长期照护需求,为提高养老机构照护服务水平提供参考。方法采用现象学研究方法,对3家养老机构12名老年人进行半结构式深入访谈,使用Colaizzi内容分析法进行资料分析。结果养老机构老年人的长期照护需求可以归纳为4个主题:躯体功能照护、精神心理支持、社会功能维持、环境营造。结论当前政策及经济条件下,老年人长期照护需求有其特殊性,社会公共系统、养老机构及照护者应当重视老年人长期照护需求评估,有针对性提供长期照护服务。     

胆道闭锁患儿住院期间父母照护体验的质性研究

目的 基于慢性病轨迹模式,探讨胆道闭锁患儿住院期间父母的照护体验,为制定针对性的护理支持方案提供参考。 方法 采用现象学研究方法,对19名胆道闭锁住院患儿父母进行半结构式访谈,采用Colaizzi 7步分析法分析访谈资料。 结果 胆道闭锁患儿住院期间不同阶段父母的照护体验可归纳为3 个主题 ,即诊断阶段：疾病认知与自我概念缺乏,情绪反应强烈;术后阶段：支持需求突出,照护负担沉重;出院阶段：希望与压力并存。 结论 胆道闭锁患儿父母在其住院期间不同阶段有着不断变化的复杂照护体验,医护人员应给予针对性的照护支持与指导,以提高患儿健康水平及减轻父母的照护负担。     

儿童和青少年癌症患者灵性照护的研究进展

综述儿童和青少年癌症患者灵性的特点、灵性照护的作用、方法,影响因素等,提出应根据儿童和青少年癌症患者的特点制定针对性的灵性照护方案,建立跨学科灵性照护团队,开发护士专业化灵性照护教育课程等,以更好地满足其灵性照护需求。     

基于连续性记录与评估工具分析养老院老年人的照护时长及影响因素

目的基于连续性记录与评估工具(CARE)分析养老院老人的照护时长及其影响因素。方法对5名评估员(1位医生、1位护士、3位护理员)进行统一培训,利用基于CARE量表设计的手机App收集239名养老院老年人的健康状况及照护时长等数据,并采用主成分分析法和多元有序Logistic回归模型分析照护时长的影响因素。结果老年人每24小时所需照护时长平均为93.56 min,中位数为0(0,179.83)min,其中照护时长为0 min者119人(49.79%),120 min者63人(26.35%),120～360 min者43人(17.99%),360 min者14人(5.86%)。回归分析结果显示,年龄、生活自理能力、肌力是养老院老人照护时长的关键影响因素(均P0.01)。结论养老院在为老年人提供照护服务时,应优先考虑非高龄、生活自理能力较差、肌力衰退的老年人,合理分配医疗照护资源。     

精神分裂症患者家属照护体验的质性研究

目的深入了解精神分裂症患者家属(下称患者家属)的照护体验及照护对自身造成的影响,为针对性社区干预提供参考。方法对20名患者家属采取深入访谈和观察法获得其真实感受和体验,采用现象学分析提炼主题。结果获得照护缺乏系统性,获取精神康复知识渠道单一,身心负担过重,经济压力过大,家庭关系恶化5个主题。结论患者家属在照护过程中存在较多问题,应针对性地完善社区护理机构,提供知识、心理援助,减轻其负担,提高照护水平。     

晚期癌症患者预立医疗照护计划参与现状及影响因素研究

目的 了解晚期癌症患者预立医疗照护计划参与现状,分析影响因素,为针对性干预提供参考。方法 采用一般资料调查表、中文版预立医疗照护计划参与问卷、家庭支持量表、创伤后成长量表对349例晚期癌症患者进行调查与分析。结果 患者中文版预立医疗照护计划参与总分为84.54±23.05;处于行为改变前意识阶段、思考阶段、准备阶段、行动阶段的患者比例依次为36.7%、37.2%、22.3%及3.7%。回归分析显示,文化程度、病程、替别人做过医疗决定、家庭支持、创伤后成长是患者预立医疗照护计划参与的主要影响因素（均P＜0.05）。结论 晚期癌症患者预立医疗照护计划参与水平处于中等偏下,仅少部分患者处于行为改变准备与行动阶段;应加强文化程度低、病程短、家庭支持及创伤后成长水平较低患者的干预与支持。     

延续性护理对胃癌患者希望水平的影响

目的探讨延续性护理对胃癌患者院外希望水平的影响。方法将44例胃癌患者随机分为观察组和对照组各22例。对两组患者均采取常规的出院指导和护理干预,观察组患者在此基础上进行延续性护理。于出院时及出院3个月采用Herth希望量表对两组患者进行调查。结果出院3个月后,观察组患者的希望水平显著优于对照组(P0.01)。结论对胃癌患者出院后应用延续性护理干预可改善患者的希望水平,提高患者的生活信心。     

Factors influencing sexual function in patients with rectal cancer

Only few studies have investigated the impact of surgery for rectal cancer on sexual function. Little of that research included quality of life (QoL) aspects and hardly any study analyzed the impact of age, gender and type of surgery on sexual function. The aim of the presented study was to address these issues. Over a 5 y period, EORTC-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12 and 24 months postoperatively. Comparisons were made between patients receiving abdominoperineal resection (APR), anterior resection (AR) with or without Pouch and Sigmoid resection. Furthermore, effects of surgery on female and male patients, and age groups were analyzed. A total of 819 patients participated in the study: 412 were males and 407 were females. The groups were comparable in terms of adjuvant treatment, tumor stage and histology. Patients after APR and AR with Pouch had worst sexual function. Men reported significantly more difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period. These problems tended to remain. Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older. The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery, gender and age have tremendous impact on sexual function and sexual enjoyment. APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid. Through impaired sexual enjoyment, men are put more under strain than women. Patients aged 69 y and younger experience more stress through deteriorated sexual function.     

Factors influencing prognosis in elderly patients with primary breast cancer

A retrospective analysis was performed on 260 elderly and 294 middle-aged patients with primary breast cancer. Cox regression analysis showed that the classic prognostic factors, such as negative lymph node status, small tumour size and positive oestrogen receptor (ER) status, were favourable indicators of survival and were similar in both the elderly and the middle-aged. When the elderly and middle-aged were considered together, older age (favourable) and the presence of association disease (detrimental) were additional significant prognostic factors. It is concluded that a physically fit elderly woman in the present study had a more favourable survival outlook than a younger counterpart with similar tumor size, lymph node and ER status and should be given the best available treatment based on tumour characteristics and not on age alone.     

Factors influencing perioperative blood transfusions in patients with gastrointestinal cancer

BACKGROUND: Patients undergoing major cancer resections often receive blood transfusions (TFs). Preoperative erythropoietin (EPO) offers the rationale to reduce TFs and related morbidity. METHODS: Perioperative TF information was collected prospectively in a single surgeon practice over 5 years. RESULTS: Three hundred forty-four patients underwent a major procedure, including pancreatic (n = 130, 38%), hepatobiliary (n = 87, 25%), gastroesophageal (n = 69, 20%), and other operations (n = 58, 17%). Median estimated blood loss (EBL) was 375 mL. PRBC TFs were given in 83 cases (24%), at a median of 2 units [1-16]. TF frequency and EBL did not differ between diagnoses. Multivariate TF associations existed for Hgb (P < 0.0001, OR 0.335), EBL (P < 0.0001, OR 1.007), serum Cl (P = 0.004, OR 1.25), serum Na (P = 0.02, OR 0.810), and age (P = 0.04, OR 1.033). TFs (versus no TFs) were linked to major complications (43 versus 20%, P = 0.0002), mortality (12% versus 3%, P = 0.001), and increased LOS (9 versus 7 days, P < 0.0001). A potential benefit for preoperative EPO to avoid TFs could be derived for only 31 patients (9%). CONCLUSIONS: In this low TF rate of 24% for major visceral resections, few preoperative parameters are able to identify subgroups at risk for TFs aside from blood counts. Our data would not support generalized preoperative EPO administration.     

Factors influencing changing bowel habits in patients undergoing sphincter-saving surgery for rectal cancer

A research survey research was conducted to identify factors affecting changes in bowel habits of rectal cancer patients undergoing sphincter-saving surgery and to provide basic information useful in nursing interventions supporting treatment for rectal cancer patients. The subjects were rectal cancer patients who had undergone sphincter-saving surgery over 2 years ago. The final analysis included 107 patients who had made outpatient visits to the colorectal surgery from 12th to 31st May, 2014. Collected data were processed with SPSS Version 21.0. Changes in bowel habits in the subjects were observed: frequent bowel movement in 74 patients (69.2%) and faecal incontinence in 48 (44.9%). Most of the patients used self-care to improve their bowel function including dietary modification (78.5%), regular exercise (72.0%) and pelvic floor exercise (34.6%). Frequent defecation was associated with adjuvant chemoradiation therapy (P < 0.001) and faecal incontinence was associated with age of ≥65 years (P = 0.019) and a group who underwent adjuvant radiation therapy (P < 0.001). It is necessary to give sufficient information about possible postoperative changes in bowel habits to patients with the risk factors before surgery.     

276例胰腺癌临床预后因素分析

目的 探讨影响胰腺癌预后的因素.方法 回顾性分析1995年9月至2005年8月收治的276例胰腺癌患者的临床资料,采用Cox比例风险模型分析可能影响胰头癌、胰体尾癌预后的独立因素,用Kaplan-Meier方法描述不同位置胰腺癌的中位生存时间,并进行Log-rank和Breslow检验.结果 Cox比例风险模型发现包块直径、肠系膜上血管浸润情况和治疗方式是胰头癌预后的独立影响因素;年龄、淋巴结肿大和治疗方式是胰体尾癌预后的独立影响因素.根治术后胰头癌和胰体尾癌患者的中位生存时间分别为460 d和480 d,显著高于姑息治疗或放弃治疗患者的240 d和200 d.在肿瘤位置对生存时间的影响中,全胰癌患者总体中位生存时间为117 d,明显低于胰头癌的330 d和胰体尾癌的300 d.结论 根治性手术是目前改善胰腺癌预后最好的方法.包块直径＞4 cm、肠系膜上血管浸润的胰头癌预后较差;年龄≤60岁和淋巴结肿大的胰体尾癌预后较差.胰头癌与胰体尾癌的预后相近,全胰癌是胰腺癌中极为晚期的状态,预后极差.     

乳腺癌患者延续护理研究现状

论述乳腺癌患者延续护理需求、干预模式和提出建议。护理需求包括后续治疗、伤口护理、功能锻炼、日常自理等;干预模式包括基于医院的延续护理(随访,成立乳腺癌患者俱乐部,制定出院计划等)、基于社区的延续护理(日间医院,家庭医院/访视)及医院-社区-家庭三位一体的延续护理。建议加强延续护理相关培训,发展专业护理人员及健全相关法规制度,以促进乳腺癌患者延续护理体系的健全与发展。     

Medical liaisons for continuity of head and neck cancer care.

The role of assistance in coordinating treatment and follow-up on the effectiveness and reliability of long-term care of head and neck cancer patients was evaluated. A comparison between the Department of Radiation Oncology, where a liaison team assists cancer patients, and the Department of Otolaryngology, where there were no such personnel, was made. Of 124 consecutive patients with head and neck squamous cell carcinoma, 31 were treated with surgery alone and 93 had radiation therapy alone or in combination with surgery. Patients were nearly equally divided among stages, although a higher percentage receiving surgery were stage I and those receiving radiation were stage IV. Nineteen radiation patients and 1 surgery patient have died; this is consistent with the differences in stage distribution. Thirteen of 31 surgery patients had unreliable follow-up, with 7 lost to follow-up. Only 8 of 93 radiation patients were unreliable, with 4 lost. The difference is statistically significant. The importance of nursing/social work liaisons in coordinating treatment and follow-up of head and neck cancer patients is discussed.     

Factors influencing prognosis in gastric cancer

In a group of 322 patients with adenocarcinoma of the stomach, 158 underwent resection. The only 5 year survivors came from the resection group. Increasing age, lymph node metastases and increasing depth of invasion of the gastric wall were all adverse prognostic features. There was a high incidence (19%) of resected patients who had suture line involvement. In spite of this there were 5 year survivors among those patients with suture line involvement and also those with lymph node involvement. The judicious implementation of an aggressive resection policy will give patients with favourable tumours the chance of a 5 year cure without involving patients with widespread neoplasm in radical surgery. Patients who had undergone previous gastric surgery for any cause had an extremely bad prognosis. Improvement in 5 year survival rates in patients undergoing resection for gastric cancer could be attributed to the increase in the number of patients with early gastric cancer.