炎症性肠病患者疏离感体验的质性研究

目的 探讨炎症性肠病患者患病过程中的疏离感并分析其产生原因，为制定针对性干预策略提供参考。方法 采用描述性质性研究法，通过目的抽样法选取15例炎症性肠病患者进行半结构式访谈。使用内容分析法对访谈资料进行分析整理并提炼主题。结果 归纳出3个核心主题及13个亚主题：患者疏离的客观表现形式(疾病疏离、人际疏离、自我疏离、劳动疏离、环境疏离)、患者疏离的主观情绪感知(无力感、无价值感、孤独感、厌世感)、患者产生疏离的原因(身体意象障碍、疾病管理过度、情绪心理障碍、社交能力受损)。结论 炎症性肠病患者存在多维疏离，负性情绪明显且强烈。患者出现疏离感的原因纷繁复杂，未来应制定多维干预策略，以减轻患者疏离感，促进其更好地接受疾病、认同自我、融入社会、积极生活。     

ICU患者替代决策者决策疲劳现象学研究

目的 分析ICU患者替代决策者的决策疲劳体验，为医护人员实施决策辅助提供参考。方法 采用目的抽样法，对12名ICU患者替代决策者进行半结构式访谈, 采用Colaizzi分析法进行资料分析及主题提炼。结果 ICU患者替代决策者存在决策疲劳，可归纳为5个主题：决策能力有限，负性情绪加剧，决策过程中的困境，决策过程中的冲突和决策支持资源不足。结论 ICU患者替代决策者者面临决策疲劳，医护人员应针对替代决策者决策疲劳采取干预措施，以推进决策辅助支持及共享决策的实施，提高决策质量，改善患者结局。     

家庭干预对炎症性肠病患者心理韧性及焦虑抑郁的影响

目的探讨家庭干预对炎症性肠病患者心理韧性及焦虑抑郁的影响。方法将100例炎症性肠病患者随机分为干预组与对照组各50例。对照组按照消化系统疾病给予常规护理干预。干预组在对照组基础上行家庭干预。采用心理韧性量表、焦虑抑郁量表及生活质量量表在干预前后对两组患者进行评估。结果干预后干预组心理韧性、负性情绪及生活质量评分较对照组显著改善(P0.05,P0.01)。结论对炎症性肠病患者实施家庭干预可提高患者心理韧性水平,减轻焦虑、抑郁等负性情绪,进而促进患者生活质量的提升。     

中青年终末期肾脏病患者决策困境的现象学研究

目的 分析中青年终末期肾脏病患者的决策困境,旨在为医护人员实施决策辅助提供参考.方法 采用现象学研究方法,对14例中青年终末期肾脏病患者进行半结构式访谈.结果 中青年终末期肾脏病患者存在决策困境.可归纳为4个主题:观念困境、情绪困境、信息困境、沟通困境.结论 中青年终末期肾脏病患者面临决策困境,医护人员应针对患者遭遇的...     

中国炎症性肠病生活质量问卷条目的编制

目的编制与我国文化背景相符的本土化炎症性肠病生活质量问卷,为临床工作和科学研究提供合适工具。方法通过与47例炎症性肠病患者进行面对面半结构式访谈,运用内容分析法分析资料,结合文献回顾,构建问卷的主题框架,再将三级主题转化为问卷条目。结果编制的中国炎症性肠病生活质量问卷包括疾病症状及影响、心理情绪的影响和日常生活的影响3大主题、12个亚主题及51个条目。结论编制的中国炎症性肠病生活质量问卷源于以往研究、患者需求及规范提炼,为后续的信效度检验奠定了基础。     

育龄期男性癌症患者生育忧虑的潜在剖面分析及影响因素

目的 探究育龄期男性癌症患者生育忧虑的异质性,为不同亚群体患者制定个性化干预方案提供参考。方法 选取236例育龄期男性癌症患者为研究对象,采用一般资料调查表、癌症后生育忧虑量表-男性版及癌症患者同伴支持量表进行调查,对其生育忧虑进行潜在剖面分析。结果 育龄期男性癌症患者生育忧虑得分为63.19±8.25,其生育忧虑分为低生育忧虑-挂念子女健康组（30.93%）、中等生育忧虑-担忧个人健康组（42.37%）与高生育忧虑-顾忌伴侣知晓组（26.70%）3个潜在剖面。年龄小、文化程度高、未育、具有生育意愿、缺乏同伴支持者更易发展为高生育忧虑-顾忌伴侣知晓组(均P<0.05)。结论 育龄期男性癌症患者生育忧虑处于中等偏高水平,呈现3种类别。临床工作中医护人员应对患者不同忧虑状况进行识别,以实施针对性干预措施减轻男性患者的生育忧虑。     

二元关系视角下青年女性肾癌患者生育相关心理痛苦的质性研究

目的 探讨二元关系视角下青年女性肾癌患者生育相关心理痛苦,了解配偶在其中发挥的作用,为制订个性化的护理决策提供参考。方法 采用目的抽样法对13例青年女性肾癌患者及其配偶进行半结构式访谈,通过Colaizzi 7步分析法进行资料分析。结果 提炼出4个主题：生育相关不确定性给患者带来的消极情绪;配偶真实反应给患者带来的负性体验;夫妻双方面临共同挑战;配偶帮助患者共同积极面对。结论 青年女性肾癌患者存在多种生育相关不确定性带来的消极情绪,配偶反应给青年女性肾癌患者带来众多负性体验。应改善夫妻家庭功能适应性,鼓励配偶提供积极支持,同时要开展生育咨询教育,促进夫妻双方共同应对。     

羊膜腔穿刺术前孕妇决策困境的现象学研究

目的 深入了解孕妇面临羊膜腔穿刺术的决策困境,为针对性干预提供参考。方法 运用现象学研究方法,对孕12～32周产前检查胎儿呈现异常、拟行羊膜腔穿刺术的15例孕妇进行半结构式访谈,采用Colaizzi七步分析法分析资料、提炼主题。结果 提炼出决策内容困境（决策知识困境,决策信息冲突）、决策支持困境、决策时间困境3个主题。结论 孕妇面临羊膜腔穿刺术存在多重决策困境,受多种因素影响,医护人员应加以重视,及时采取针对性措施改善其决策困境。     

育龄期女性癌症患者生育力保存决策的研究进展

对育龄期女性癌症患者生育力保存决策现状及影响因素进行综述。影响因素包括社会人口学因素、信息支持、社会支持、生育力保存风险、经济负担、癌症类型、情绪状态、伦理因素、时间压力、文化宗教等。以期为开展决策支持干预提供依据，缓解患者不良情绪，减少决策冲突。     

炎症性肠病患者对卫生保健服务期望水平的调查研究

目的 了解炎症性肠病患者对卫生保健服务的期望水平,分析其影响因素.方法 采用中文版炎症性肠病卫生保健质量问卷对303例炎症性肠病患者进行调查.结果 炎症性肠病患者对卫生保健服务期望的平均得分为（7.79±0.97）分,其对医务人员职业素养和患方知情权利的期望水平较高,得分均＞8分.回归分析结果显示,性别、病种、病程、文化程度为影响期望的主要因素（P＜0.05,P＜0.01）.结论 炎症性肠病患者对卫生保健服务的期望较高,尤其是对医务人员职业素养和患方知情权利.女性、溃疡性结肠炎患者对卫生保健服务的期望较高,病程较长的患者对医务人员的职业素养期望较高,文化程度较高的患者对医疗可及性的期望较高.     

Fertilitätsuntersuchungen maligner Tumoren (Hodentumoren, maligne Melanome, Schilddrüsenkarzinom)

The examination of 83 patients suffering from tumours (78 tumours of the testicle, 4 melanoblastomas, 1 carcinoma of the thyroid gland) led to conclusions on the effect of complex therapy on spermiogenesis. By means of spermiograms carried out in the course of the illness we found out restrictions of fertility which were more distinctly marked with patients suffering from gonadal tumours than with patients suffering from extragonadal tumours. The loss in ejaculation after RLN with existing tumours of the testes has to be considered as a disturbance in fertility to the highest degree. X-ray therapy impairs spermiogenesis more than chemotherapeutics. After chemotherapy we observed a recovery of spermiogenesis, after x-ray therapy only then if there were no irreversible damages of the germinal epithelium.     

Regression Toward the Mean in Fertility Research — An Empirical Study of Semen Quality

Regression toward the mean denotes circumstances, where extreme observations tend to normalize at repetition. The phenomenon is caused by random variation and may occur whenever mainly persons with extreme values are subject to repeated examinations. We furnish empirical evidence that the phenomenon may be quantitatively important in fertility research with regard to some, but probably not all indicators of semen quality.     

Grundfragen bei andrologischen Gutachten vor Gericht — Zeugungsfähigkeit in der Vergangenheit —

Das andrologische Gutachten vor Gericht zur Beurteilung der Zeugungsfähigkeit eines Mannes muß den Grad der Zeugungsfähigkeit während der gesetzlichen Empfängniszeit (181.-302. Tag vor dem Tage der Geburt mit Einschluß dieser beiden Tage BGB§ 1592) berücksichtigen. Der andrologische Gutachter ist Hilfsperson des Gerichtes und nicht Richter. Jeder von der Norm abweichende Befund ist wenigstens zweimal zu kontrollieren. Vor-Befunde sind voll zu berücksichtigen.
Fundamental Questions Concerning Andrological Appraisals in a Court of Law — Procreative Ability in the Past —
Bei einer Oligozoospermie zum gegenwärtigen Zeitpunkt und Fehlen von anamnestischen Angaben über irgendwelche Erkrankungen in der zurückliegenden Zeit muß davon ausgegangen werden, daß auch während der gesetzlichen Empfängniszeit ein gleichsinniger Befund bestand hat, wie er jetzt erhoben wurde. Das bedeutet: Der jetzige Befund hat auch bereits in der Vergangenheit bestanden.

Summary

In a court of law the andrological appraisal towards the assessment of the procreative ability of a man is concerned with the degree of procreative ability during the legal time of conception (181 st to 302nd day prior to the date of birth including both of these days BGB § 1592). The andrological expert is a servant of the court, not a judge. Each finding deviating from the norm must be controlled at least twice. Preliminary diagnoses must be fully considered.
In the case of oligozoospermia manifested at the present point in time, whereby anamnestic data regarding any past sicknesses are lacking, it must be assumed that during the legal time of conception a condition similar to that now detected also existed. This means that the present finding was already in a state of effect in the past.     

Alcohol and Male Fertility (Preliminary Report)

A communication on three studies of alcohol abusers. In patients at an in-patient unit for alcohol abusers we found defective spermiograms in comparison to a control group and a return to normal in the course of 10 weeks of treatment. We determined the existence of an aethio-pathogenic (nosological) unit--alcohologenic reversible azoospermia.     

Semen analysis and fertility prognosis in andrological patients

Semen analyses of 529 men who consulted our department due to infertility problems, were related to the time period prior to conception, with factors adversely affecting the fertility of the female partner taken into consideration. The statistical method used was Cox's proportional-hazard model of regression. Untransformed, logarithmically transformed and dichotomized semen analysis variables were included in the calculations. The relationship between the following parameters and the probability of conception was examined: sperm count, sperm motility, progressive sperm motility, morphology and sperm motility remaining 24 h after ejaculation. All variables co-varied with the probability of conception; however, the exact type of relationship could not be determined by regression analyses. Cox's model assumes an exponential relationship. Our data suggest that this assumption is not suitable for fertility investigations. Using conventionally defined limiting values for normal and pathological semen quality, statistical analysis yielded significant differences in fertility between both categories for all of the variables considered; in the stepwise regression analysis, however, it could be shown that progressive motility and morphology alone were sufficient to discriminate between normal and pathological semen quality. The results are interpreted as indicating that, as a result of semen analysis, it is possible to predict the individual probability of conception if the exact shape of the relationship can be determined, which, up to now, has not been accomplished.     

Male fertility preservation–Methods,indications and challenges

Male fertility preservation has been steadily increasing over the past two decades. Significant improvements have been achieved in the treatment modalities of cancer and other severe chronic medical conditions, leading to an increase in patient survivorship and the resulting demand for future parenthood. Recognition and proper patient counselling before commencing therapies with a potential gonadotoxic effect are of paramount importance. Similarly, nonmedically indicated fertility preservation is on the rise. Social sperm banking, gender dysphoria prior to affirmation procedures and posthumous reproduction preservation are becoming more common. When timing and logistics are appropriate, sperm cryopreservation is considered the gold standard for fertility preservation. Testicular tissue and spermatogonial stem cell autotransplantation is considered experimental and represents a promising alternative for pre-pubertal patients. The current paper aims to review the recent trends in male fertility preservation, the common indications for sperm cryopreservation, techniques for sperm retrieval and experimental frontiers.     

Male fertility in long-term survivors of childhood acute lymphoblastic leukaemia

To study long-term testicular function following the treatment of acute lymphoblastic leukaemia (ALL) in childhood, 37 young adult males were assessed at two separate time points. The initial assessment was made by a wedge testicular biopsy after completion of treatment (median 9.7 years; range 4.1-16.3 years) and the subsequent assessment (median 18.6 years; range 15.4-26.8 years) consisted of the clinical examination of pubertal stage, measurement of serum gonadotrophins and testosterone and, in 19 patients, semen analysis. All 37 men completed pubertal development normally and had a testosterone concentration within the normal adult range. Six men showed evidence of severe damage to the seminiferous epithelium, five were azoospermic and one, who did not provide semen for analysis, had a reduced mean testicular volume (11 mls; normal greater than or equal to 15 mls) and a raised basal FSH level (13 UI 1-1; normal less than or equal to 6 IU 1-1). All six men with germ-cell damage had received either cyclophosphamide or both cyclophosphamide and cytosine arabinoside as part of their chemotherapy regimen. Approximately 10.7 years earlier all 37 men had undergone a testicular biopsy after completion of their chemotherapy. Morphological damage to the seminiferous epithelium had been calculated by estimating the tubular fertility index (TFI), which is the percentage of seminiferous tubules containing identifiable spermatogonia (age-matched normal = 100%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Untersuchungen zur Fertilität von Patienten mit malignen Hodentumoren zum Zeitpunkt der Orchidektomie Beitrag zur Frage nach dem Sinn der Kryokonservierung

Semen analyses from 29 patients with testicular tumours were done, 19 were examined before and after orchidectomy but before any other treatment. There was no evident difference in both of these examinations. Therefore it is possible to obtain enough time for cryopreservation, because the stricken patients can be first treated by unilateral orchidectomy without loss in quality of the semen. Hendry et al. (1983) accepted for sperm freezing only samples with more than 10 mill/ml spermatozoa and more than 30% motility. 17 of our 29 patients (58.6%) fulfilled that condition. Thus, in more patients cryopreservation can be considered.     

Bilateral retractile testes--subsequent effects on fertility.

A group of 43 adults who as children had been diagnosed as having bilateral retractile testes were traced. Seventy-four per cent of the married patients had children. The testicular volume was normal in all the 19 patients examined.     

尿毒症对男性生育能力的影响

目的 探讨尿毒症对男性患者生育能力的影响.方法 检测40例尿毒症患者和40例不育患者以及40例正常生育者的精液,并根据公式:精子密度(×106/ml)×精子活动力×精子正常形态率计算出生育力指数.结果 正常生育者生育力指数为11.10(15.24),不育者的生育力指数为4.18(6.36),而尿毒症患者的生育力指数仅为0.23(0.76).结论 尿毒症患者的生育能力明显下降,造成"继发性"不育、应引起人们的重视.