中医辩证护理对肾病综合征患者不良情绪及生活质量的影响

目的探讨中医辩证护理对肾病综合征患者不良情绪及生活质量的影响。方法选取2014年6月~2016年3月我院收治的肾病综合征患者96例,随机分成观察组和对照组,各48例,对照组患者行常规护理,观察组在常规护理基础上,实施中医辩证护理,连续干预30d,运用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价两组患者护理前后不良情绪变化;运用SF-36生活质量量表评定护理前后两组生活质量改善情况。结果两组护理前SAS、SDS评分比较差异无统计学意义(P﹥0.05),护理后较护理前均有明显改善,比较差异有统计学意义(P﹤0.05),观察组改善幅度明显高于对照组,比较差异有统计学意义(P﹤0.05);护理后观察组SF-36量表除生理职能外,其余各项指标评分均明显优于对照组,比较差异有统计学意义(P﹤0.05)。结论中医辩证护理能够明显改善肾病综合征患者焦虑、抑郁等不良情绪,提高生活质量,和常规护理模式比较具有明显优势。     

社区延续性护理干预对脑卒中患者生存质量的影响

目的探析社区延续性护理干预对于提高脑卒中患者生存质量的积极意义。方法在2015年1月-2017年3月出院来社区康复中心的脑卒中患者78例作为本次研究对象,将患者随机分成两组,每组各39例。对照组实施常规社区护理,观察组实施延续性社区护理干预,比较两组患者护理6个月时的生活质量评分(SF-36量表)和治疗依从性。结果观察组治疗依从性为97.44%,高于对照组的82.05%,观察组护理6个月时的SF-36量表各个维度评分高于对照组,差异均有统计学意义(P0.05)。结论社区延续性护理干预有助于帮助脑卒中患者养成健康生活方式,提高患者的生存质量,值得在社区护理中推广应用。     

中频脉冲治疗仪联合康复护理在脑出血偏瘫患者中的应用

目的 探讨中频脉冲治疗仪联合康复护理在脑出血偏瘫患者中的应用效果。方法 选择2019年6月至2021年2月九江市中医医院收治的68例脑出血偏瘫患者为研究对象,按随机数字表法将其分为两组,各34例。对照组实施康复护理,观察组在对照组基础上加用中频脉冲治疗仪,持续干预1个月,比较两组运动能力[采用Fugl-Meyer肢体功能评估量表(FMA)评估]、生活能力[采用日常生活能力评定量表(ADL)评估]及生命质量[采用健康调查简表(SF-36)评估]。结果 干预1个月后,两组FMA、ADL、SF-36评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论 中频脉冲治疗仪联合康复护理在脑出血偏瘫患者中的应用效果确切,可提升患者的运动能力与生活能力,改善患者的生命质量。     

“心境-促进协作医疗”模式对社区老年抑郁症的疗效评价

[目的]探讨"心境-促进协作医疗"(IMPACT)管理模式对社区老年抑郁症患者疗效的影响。[方法]在上海市浦东新区精神卫生网络系统中,抽取符合病例要求的60例社区老年抑郁症患者,分为干预组和对照组,每组30例,干预组实施为期18个月的IMPACT管理治疗,对照组为常规的社区精神病康复管理。使用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和自知力与治疗态度问卷(ITAQ)评价两组干预前与干预后第6、12、18个月时的抑郁症状及服药依从性得分变化情况,比较两组患者在干预期间的复发住院率。使用生活质量表(SF-36)评价干预前、后(第18个月)两组患者的生存质量得分变化情况。[结果]在干预后第6、12、18个月,干预组患者的HAMD和SDS得分改善情况优于对照组(P均0.05),ITAQ得分提升高于对照组(P0.05)。SF-36评价中,干预组患者的躯体疼痛、一般健康状况、精力、社会功能、精神健康及健康变化得分提升均优于对照组,两组差异有统计学意义(P均0.05)。干预组无1例复发住院,对照组有6例复发住院,复发住院率为20%(χ2=6.67,P0.05)。[结论]IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,降低复发住院率,改善老年抑郁症患者的生活质量。     

延续性护理对肾病终末期维持性血液透析患者的应用效果观察

目的探讨延续性护理对肾病终末期维持性血液透析患者应用效果。方法选取2014年6月~2016年6月我院收治的肾病终末期维持性血液透析患者120例为研究对象,随机分为观察组和对照组,各60例。对照组行常规护理,观察组在常规护理基础上,实施延续性护理干预,运用国际通用症状自评量表SCL-90和生活质量评估量表SF-36,观察两组护理干预前后患者心理状态和生活质量变化。结果两组患者护理干预前SCL-90和SF-36评分比较,差异无统计学意义(P﹥0.05);干预后两组较干预前有明显改善,观察组明显优于对照组,比较差异均具有统计学意义(P﹤0.05)。结论延续性护理能够使患者在院外接受系统的护理干预,明显提高患者心理状况和生活质量。     

社区慢性阻塞性肺疾病合并糖尿病患者的康复干预效果评价

[目的]探讨干预措施对社区慢性阻塞性肺疾病合并糖尿病患者康复及生存质量的影响。[方法]对52例慢性阻塞性肺疾病合并糖尿病患者的康复进行干预指导8~12个月,比较干预前后患者肺功能,并利用生存质量量表(SF-36)测评患者的生活质量。[结果]干预后患者的肺功能各项指标均有明显的改善(P<0.05);生存质量各维度评分与干预前比较差异有统计学意义(P<0.05)。[结论]对社区慢性阻塞性肺疾病合并糖尿病患者康复治疗的干预有助于患者肺功能改善和生存质量的提高。     

综合护理在直肠癌术后癌因性疲乏患者中的应用价值分析

目的:探讨综合护理在直肠癌术后癌因性疲乏患者中的应用价值。方法:选择2016年3月-2017年7月80例直肠癌术后癌因性疲乏患者分组。对照组给予普通护理,综合组给予综合护理。比较两组直肠癌术后癌因性疲乏缓解率;干预前后患者SF-36评分、PIPER疲乏修定量表分值、积极应对情况。结果:综合组直肠癌术后癌因性疲乏缓解率高于对照组,P 0.05;干预前两组SF-36评分、PIPER疲乏修定量表分值、积极应对情况相近,P 0.05;干预后综合组SF-36评分、PIPER疲乏修定量表分值、积极应对情况优于对照组,P 0.05。结论:综合护理在直肠癌术后癌因性疲乏患者中的应用价值高,可缓解疲乏,提高积极应对能力,提升生活质量,值得推广应用。     

神灯治疗仪联合个性化护理在类风湿关节炎患者中的应用效果

目的 探讨神灯治疗仪联合个性化护理在类风湿关节炎患者中的应用效果。方法 采用随机数字表法将医院2021年1月至2022年6月收治的68例类风湿关节炎患者分为两组，每组34例。对照组采用个性化护理，观察组在对照组基础上加用神灯治疗仪，比较两组临床效果、疼痛程度[采用疼痛数字评分法（NRS）评估]、生活自理能力[采用日常生活能力量表（ADL）评估]、生命质量[采用中文版简明健康调查问卷（SF-36）评估]、心理状态[采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评估]和不良反应发生率。结果 观察组总有效率高于对照组，差异有统计学意义（P<0.05）。干预前，两组NRS评分、ADL评分、SF-36各维度评分、HAMD评分、HAMA评分比较，差异均无统计学意义（P>0.05）；干预后，观察组NRS评分、HAMD评分、HAMA评分低于对照组，ADL评分、SF-36各维度评分高于对照组，差异均有统计学意义（P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论 类风湿关节炎患者应用神灯治疗仪联合个性化护理的效果优于单独采用个性化护理，...     

全科团队信息化健康管理对上海市泥城社区原发性骨质疏松患者生存质量的影响

目的观察全科团队信息化健康管理对社区原发性骨质疏松患者生存质量的影响。方法 2015年1月,选择上海市浦东新区泥城社区卫生服务中心在体检中确诊的男性≥65岁、女性≥55岁的原发性骨质疏松症患者126例,随机分为干预组和对照组各63例。对照组进行常规药物治疗,干预组在常规药物治疗基础上进行信息化健康管理。记录两组患者干预前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分及生存质量(SF-36)量表各维度的分值。结果两组患者干预前SAS评分、SDS评分、生存质量8个维度评分比较,差异均无统计学意义(P0.05),干预一年后再次比较,差异均有统计学意义(P0.05)。结论健康管理可减轻患者痛苦和心理压力,提高患者生存质量,达到防治骨质疏松的目的。     

社区护理干预对老年高血压患者生活质量影响研究

目的：探讨社区护理干预对老年高血压患者生活质量影响。方法：将167例老年高血压患者按照护理方法分为对照组（n=83）与观察组（n=84）,分别采用常规护理与社区护理干预。比较两组患者护理前后生活质量。结果：观察组患者护理后SF-36生活量表中PF、BP、GH、SF、RE及MH评分均显著高于护理前（P＜0.05）,但对照组患者护理前后SF-36生活量表各维度评分差异均无统计学意义（P＞0.05）。结论：社区护理干预能够有效改善老年高血压患者的生活质量,应加以推广、应用。     

社区综合心理干预对老年痴呆症的疗效观察

摘要：目的研究社区综合心理干预对老年痴呆症患者的治疗效果。方法对58例经专科医院确诊后转入社区康复的老年痴呆症患者随机分为干预组与对照组,其中干预组30例,对照组28例。在两组原有药物治疗不变且各方面条件无显著性差异的前提下,对干预组进行社区综合心理干预,于干预前后应用长谷川智力表（HDS）、日常生活活动能力量表（ADL）、简明精神状态量表（MMSE）和生活质量量表（QOL—100）进行测试。结果两组患者在干预前HDS、ADL和MMSE测定的结果差异无显著性。干预2年后,干预组的HDS、ADL和MMSE评分分别为7．93±3．72、52．84±15．45、22．89±7．31,对照组分别为5．39±2．91、56．22±20．76、18．89±6．49,干预组病情较对照组改善,差异有显著性（P〈0．05）;干预组QQL—100评分较干预前明显好转（P〈0．05）。结论社区综合心理干预能改善老年痴呆症患者的病情。     

Effectiveness of Powerful Tools for Caregivers on Caregiver Burden and on Care Recipient Behavioral and Psychological Symptoms of Dementia: A Randomized Controlled Trial

ObjectiveThe aim of this study was to evaluate the effectiveness of a psychoeducational intervention, Powerful Tools for Caregivers (PTC), for family caregivers of individuals with dementia.DesignA pragmatic, 2-arm randomized controlled trial compared the PTC intervention, as delivered in practice, to usual care. Participants randomized to usual care functioned as a control group and then received the PTC intervention.InterventionPTC is a 6-week manualized program that includes weekly 2-hour classes in a group setting facilitated by 2 trained and certified leaders. The educational program helps caregivers to enhance self-care practices and manage emotional distress.Setting and participantsTwo stakeholder organizations delivered the intervention in community settings. Participants were family caregivers of individuals with dementia recruited from the community in Florida.MethodsPrimary outcomes were caregiver burden and behavioral and psychological symptoms of dementia of the care recipient. Secondary outcomes included caregiver depressive symptoms, self-efficacy, self-rated health, and life satisfaction. Measures were collected at baseline (n = 60 participants), postintervention (n = 55), and at 6-week follow-up (n = 44).ResultsIntent-to-treat analyses found PTC reduced caregiver burden (d = −0.48) and depressive symptoms (d = −0.53), and increased self-confidence (d = 0.68), but found no significant benefit for behavioral and psychological symptoms of dementia in care recipients. PTC was rated highly by participants and program attrition was low, with 94% of caregivers completing at least 4 of the 6 classes.Conclusions and implicationsAlthough no significant effects were found for behavioral and psychological symptoms of dementia, this trial supports the effectiveness of PTC to improve caregiver outcomes as delivered in the community.     

Sooner or later? Issues in the early diagnosis of dementia in general practice: a qualitative study

OBJECTIVE: The aim of this study was to explore the perspectives of primary care practitioners on the early diagnosis of dementia. METHODS: A total of 247 GPs, 146 community nurses, 36 practice nurses, 79 community mental health nurses and others working in a range of hospital, residential and community settings attended 24 one-day workshops in 21 cities and towns in the UK. A nominal group approach was used relating to the early diagnosis of dementia in the community. RESULTS: Groups agreed on the benefits and risks of early diagnosis of dementia; disagreed about screening for dementia, and about professional resistance to making the diagnosis; constructed comprehensive guidelines on diagnosis, but without much reference to resource implications; yet described actual local resource limitations in detail; and avoided dilemmas about dementia care by framing it as a specialist activity. CONCLUSION: Practitioners situate dementia in a family context but do not yet use a disablement model of dementia which might reduce tensions about early diagnosis and the disclosure of the diagnosis. The term diagnosis could usefully be replaced by recognition, to aid this shift in model. Service gaps may emerge or widen if earlier diagnosis of dementia is pursued as a policy objective.     

'Part of the family': sources of job satisfaction amongst a group of community-based dementia care workers

The development of community‐based services for people with dementia brings new challenges for health and social care providers, not least that of sustaining an enthusiastic workforce who are motivated to provide care and support under potentially isolating and difficult conditions. The present paper, based on interview data gathered from a group of community‐based dementia care workers, seeks to identify their sources of job satisfaction and reward. Interviews were conducted with seven workers at two points in time and the data were analysed using a case by theme matrix approach. The results indicate that there were high levels of job satisfaction amongst the group, which were enhanced by several factors, including: good organisational support; day‐to‐day autonomy; the ability to maintain relationships with people with dementia and their families; and staffs’ feelings of contributing to and improving the status and quality of life of people with dementia. Implications for workforce development are briefly considered.     

Effects of the Medicare Alzheimer''s Disease Demonstration on the use of community-based services.

STUDY QUESTION: Did the Medicare Alzheimer''s Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers? DATA SOURCES: Baseline and periodic caregiver interviews. Measures include client and caregiver attributes and self-reported service use. STUDY DESIGN: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. The actual monthly entitlement varied among the eight demonstration communities due to regional cost and inflation adjustments over time. Analyses are for the year after enrollment. DATA COLLECTION: Analyses are of cases surviving six months or more in the community after enrollment (n = 5,209). Cases received baseline and semi-annual assessments. PRINCIPAL FINDINGS: The intervention of case management and community service reimbursement had a strong, consistent, and positive effect on the likelihood of using home care (including homemaker/chore services, personal care services, companion services) and adult day care. Treatment group clients were at least twice as likely as control group clients to be using any of the four community-based services. A similar, but less pervasive effect was achieved with caregiver training and support group participation. Reimbursement provided by the demonstration''s Medicare waiver was generally not sufficient to exceed the level of control group service acquired through private payment. CONCLUSIONS: Reimbursement levels within the demonstration may have enabled more individuals to purchase some services, but they were not sufficient to increase the average level of use over those in the control group. No consistent differences between demonstration models were found in service use likelihood or average use among users.     

Effects of the Medicare Alzheimer''s Disease Demonstration on nursing home entry.

STUDY QUESTION: Did the Medicare Alzheimer''s Disease Demonstration, with its goal of improving caregiver outcomes through case management and subsidized community services, affect the nursing home entry rate of treatments with dementia compared to controls? DATA SOURCES: Interviews conducted at baseline and six months thereafter. Measures include date of nursing home entry, client and caregiver health, and income. STUDY DESIGN: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits, up to about $600 per month. DATA COLLECTION: All cases received baseline and semi-annual assessment interviews for up to three years after enrollment. Analyses are among cases that remained in the demonstration for more than 30 days after enrollment (n = 8,095). PRINCIPAL FINDINGS: The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall, compared to those of controls, and few effects on treatment subgroups, with the exception of one site where it may have increased nursing home entry rates. CONCLUSIONS: Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia.     

Understanding treatment attitudes toward dementia: differences among community residents and health care professionals

To examine how the severity of dementia affects attitudes to treatment preferences in a lay group of community residents and a group of medical care professionals who provide direct care to dementia affected patients. The participants were 259 community residents aged between 40 and 65, and 217 care professionals working at nursing homes or group homes. Respondents were randomly assigned to one of two scenarios involving moderate or severe dementia and each was asked questions about their preferences and attitudes to the employment of eight types of active treatments (ATs) to deal with a newly acquired illness as well as eight types of life-sustaining treatment (LST). Among the community residents, there were no significant differences in preferences toward any treatment items between the moderate dementia and severe dementia scenarios. Similarly, care professionals showed no significant differences in attitudes toward 15 of the 16 treatment items. The community residents had more negative attitudes than care professionals in attitudes to all types of LST, including four variations of AT that have a good chance of success. After dementia deprives an individual of decision-making capacity, progress of the disease has little effect on both community residents and care professionals' preferences. When discussing about end-of-life decision-making, care professionals need to be careful about the gaps in perception of good chance treatments with patients.     

How to stay motivated: A focus group study of Norwegian caregivers' experiences with community healthcare services to their parents with dementia

Motivation to provide care is a significant predictor of informal caregiving among family caregivers of persons with dementia. Adequate support is an important source of help and relief to caregivers, but fragmentation of dementia care services is common and better ways of supporting these caregivers are needed. Knowledge of adult-child caregivers' motivation and how this motivation is influenced by community healthcare services is lacking. The aim of this study is therefore to describe and explore adult children's experiences with community healthcare services for their home-dwelling parent with dementia and how these influence their caregiver motivation. The study applied a qualitative design based on three focus group interviews with 15 of these caregivers (40–69 years) in Norway in 2017. The study results indicate three categories supporting adult children's sustained motivation as caregivers: (a) caregivers prioritize their parent's need for healthcare services over their own need for support; (b) caregivers need acknowledgement through respect and involvement; and (c) caregivers need timely information and competence as the dementia progresses. To stimulate collaboration among adult-child caregivers, their parents with dementia, and community healthcare services, we claim that a relationship-centred care framework could be emphasised as a way of supporting sustained motivation among caregivers to parents with dementia as part of community healthcare services.     

Effects of the Medicare Alzheimer''s Disease Demonstration on caregiver burden and depression.

STUDY QUESTION: Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia? DATA SOURCES: Baseline and periodic caregiver interviews with participants in the Medicare Alzheimer''s Disease Demonstration. Client and caregiver attributes and caregiver outcomes such as depression and burden scores were among the measures. STUDY DESIGN: Applicants to the demonstration (all voluntary) were randomly assigned into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. (The actual monthly entitlement varied among the eight demonstration communities due to regional cost differences and inflation adjustments over the four-year demonstration period.) DATA COLLECTION: A total of 5,307 eligible individuals received a baseline assessment at the time of application to the demonstration and at least one semi-annual reassessment. Clients and their caregivers were periodically reassessed producing a total of 20,707 observations. PRINCIPAL FINDINGS: Persons in the treatment group had a high exposure to case management and a greater likelihood of community service use relative to those in the control group. Treatment group membership was associated with statistically significant, but very small reductions in caregiver burden (in four of eight sites) and depression (three of eight sites) over a 36-month tracking period. These findings are not sustained with all cases combined, or among a higher-resource demonstration model considered separately. CONCLUSIONS: Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression, and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested: 24-hour care, crisis intervention, coordination with primary care, or chronic disease management.     

Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial

ObjectivesAdvance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care.DesignA single-blinded cluster randomized controlled trial.Setting and participantsIn 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice.MethodsIntervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering.Results38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs.Conclusions and ImplicationsOur educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown.