家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间的中介效应

目的 探讨家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间的中介作用，为开展护理干预以有效减轻脑卒中患者主要照顾者负担提供参考。方法 以便利抽样法选取286例脑卒中患者及其主要照顾者，采用一般资料调查表、改良Barthel指数量表中文版、家庭抗逆力评定量表中文简化版、Zarit照顾者负担量表进行调查。结果 脑卒中患者日常生活能力总分为(40.86±13.14)分，家庭抗逆力总分为(101.85±14.78)分，照顾者负担总分为(40.98±13.68)分。脑卒中患者日常生活能力总分与家庭抗逆力总分呈正相关，二者与主要照顾者负担总分呈负相关(均P<0.05);家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间起部分中介效应，效应量占比为37.44%。结论 脑卒中患者日常生活能力可通过家庭抗逆力的中介作用对主要照顾者负担产生影响。医护人员在促进脑卒中患者日常生活能力恢复的同时应以家庭抗逆力作为干预靶点，充分挖掘家庭内部整体力量，促进家庭抗逆力水平的提高，进而减轻脑卒中患者主要照顾者负担。     

家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间的中介效应

目的 探讨家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间的中介作用，为开展护理干预以有效减轻脑卒中患者主要照顾者负担提供参考。 方法 以便利抽样法选取286例脑卒中患者及其主要照顾者，采用一般资料调查表、改良Barthel指数量表中文版、家庭抗逆力评定量表中文简化版、Zarit照顾者负担量表进行调查。 结果 脑卒中患者日常生活能力总分为（40.86±13.14）分，家庭抗逆力总分为（101.85±14.78）分，照顾者负担总分为（40.98±13.68）分。脑卒中患者日常生活能力总分与家庭抗逆力总分呈正相关，二者与主要照顾者负担总分呈负相关（均P＜0.05）；家庭抗逆力在脑卒中患者日常生活能力与主要照顾者负担间起部分中介效应，效应量占比为37.44%。 结论 脑卒中患者日常生活能力可通过家庭抗逆力的中介作用对主要照顾者负担产生影响。医护人员在促进脑卒中患者日常生活能力恢复的同时应以家庭抗逆力作为干预靶点，充分挖掘家庭内部整体力量，促进家庭抗逆力水平的提高，进而减轻脑卒中患者主要照顾者负担。     

照顾者反应与缺血性脑卒中患者残障接受度的相关性分析

目的了解缺血性脑卒中(CIS)患者的照顾者反应和残障接受度现状并分析两者的相关性,为采取针对性措施改善患者残障接受度提供参考。方法采用照顾者反应量表和残障接受度量表对211例CIS患者和211名主要照顾者进行问卷调查。结果 CIS患者残障接受度总分为(127.89±29.11)分,其中低接受度占56.40%,中接受度占28.91%,高接受度占14.69%;不同残障接受度患者的健康问题、时间安排受打扰、经济问题、家庭支持缺乏和自尊评分比较,差异有统计学意义(P0.05,P0.01)。残障接受度总分及各维度得分与照顾者反应中的健康问题、时间安排受打扰、经济问题、家庭支持缺乏呈负相关(P0.05,P0.01);残障接受度总分及各维度得分与照顾者反应中的自尊呈正相关(P0.05,P0.01)。照顾者反应中的家庭支持缺乏、自尊和经济问题是患者残障接受度重要因素。结论 CIS患者残障接受度处于较低水平,照顾者反应为其影响因素,护士可从照顾者反应入手对患者进行护理干预来改善残障接受度。     

系统性红斑狼疮患者家庭抗逆力与照顾负担的相关性研究

目的 探讨系统性红斑狼疮患者家庭抗逆力对照顾者负担的影响,以实施针对性护理干预提供参考.方法 选择138个系统性红斑狼疮家庭,采用Zarit照顾者负担量表和家庭抗逆力调查表进行调查.结果 系统性红斑狼疮患者家庭抗逆力总分为(77.95士20.91)分,照顾负担总分为31.00(22.00,43.25)分;家庭抗逆力与照顾负担呈负相关(P＜0.01).患者性别、家庭类型、照顾者职业及婚姻状况是影响家庭抗逆力的因素(P＜0.05,P＜0.01).结论 系统性红斑狼疮家庭照顾负担处于中等水平,家庭抗逆力水平对照顾负担有负向缓冲作用,应积极采取提高患者家庭抗逆力水平的护理措施,以减轻家庭照顾负担.     

胃肠癌患者家属照顾者反应及与成人依恋关系的研究

目的了解胃肠癌患者家属照顾者反应水平及与成人依恋的相关性。方法采用修订版照顾者反应评估量表和亲密关系体验量表对192名胃肠癌患者家属照顾者进行调查。结果照顾者反应中自尊维度得分最高(4.33±0.45)分,缺乏家庭支持维度得分最低(1.86±0.55)分;照顾者依恋焦虑得分(3.51±0.85)分,依恋回避得分(2.62±0.80)分。依恋回避与自尊呈负相关,与缺乏家庭支持呈正相关;依恋焦虑与经济负荷、缺乏家庭支持呈正相关(均P0.01)。结论胃肠癌患者家属照顾者对照顾压力负荷既有积极感受也有消极反应,成人依恋可影响照顾者反应,以依恋理论为指导制定干预措施可以减轻照顾者负担。     

老年痴呆患者照顾者负担与需求的相关性分析

目的了解我国老年痴呆患者照顾者的照顾负担、需求状况及两者之间的相关性,为减轻照顾者负担,制定有效的干预措施提供依据。方法采用自编一般问卷调查表、照顾负担量表(CBI)和家庭照顾者需求问卷对54名老年痴呆患者照顾者进行调查。结果老年痴呆患者照顾者照顾负担CBI总分为41～89(59.16±13.65)分,5个指标的得分率为38.10%～81.50%;照顾需求总分为89～132(112.05±7.22)分,条目均分为(4.00±0.26)分;照顾者照顾负担与需求呈正相关(r=0.695,P0.01)。结论老年痴呆患者照顾者承受着较重的负担,满足照顾者的相关需要,有针对性地提供社会支持,可减轻照顾者的负担,提高照顾者生存质量。     

以家庭功能为导向的首发脑卒中患者照顾者支持干预方案实施

目的 评价以家庭功能为导向的首发脑卒中患者照顾者支持干预方案的实施效果。 方法 便利抽取103名首发脑卒中患者照顾者,按时间段分为对照组51名和干预组52名。对照组实施常规护理;干预组在此基础上实施以家庭功能为导向的照顾者支持干预方案,共3个月。比较两组照顾者做好家庭护理的准备、综合照顾能力及家庭功能得分。 结果 干预组出院时照顾者做好家庭护理的准备得分显著高于对照组（P＜0.05）;两组综合照顾能力总分及各维度得分、家庭功能得分比较,组间效应、时间效应和交互效应差异有统计学意义（均P＜0.05）。 结论 以家庭功能为导向的照顾者支持干预方案的实施可提高首发脑卒中照顾者家庭护理准备、综合照顾能力及改善患者家庭功能水平,可帮助患者更好地从医院过渡到家庭。     

血液透析患者家庭照顾者生活质量量表汉化及信效度检验

目的 汉化血液透析患者家庭照顾者生活质量量表,检验其信效度。 方法 采用Brislin模式将英文版血液透析患者家庭照顾者生活质量量表翻译成中文,采用中文版量表对738名血液透析患者家庭照顾者进行调查,检验量表信效度。 结果 中文版量表各条目水平的内容效度指数为0.848～1.000,量表水平的内容效度指数为0.935,探索性因子分析提取5个公因子,共35个条目,累积方差贡献率为64.172%。验证性因子分析的模型适配度良好。总量表Cronbach′s α系数为0.831,5个公因子的Cronbach′s α系数为0.694～0.821,重测信度为0.886。中文版量表总分与ZBI照顾者负担量表总分相关系数为-0.821（P＜0.05）。 结论 中文版血液透析患者家庭照顾者生活质量量表具有较好的信效度,适用于我国血液透析患者家庭照顾者生活质量测量。     

癌症患者家庭照顾者疾病获益感现状及影响因素分析

目的了解癌症患者家庭照顾者疾病获益感现状及影响因素,为针对性心理护理提供参考。方法采用疾病获益感量表、预期性悲伤量表、照顾者准备度量表对208名癌症患者家庭照顾者进行调查。结果照顾者疾病获益感得分中位数为86.00分,与预期性悲伤、照顾者准备度呈正相关(均P0.05);居住地、预期性悲伤及照顾者准备度是癌症患者家庭照顾者疾病获益感的主要影响因素(均P0.01)。结论癌症患者家庭照顾者疾病获益感处于中上水平;医护人员与照顾者沟通时应注重其信息与心理方面的引导,采取相应措施,增进其疾病获益感水平。     

外科手术患者家庭功能与家庭负担状况的研究

目的 探讨外科手术患者家庭功能与家庭负担状况及相关因素,为提高整体护理服务质量提供数据支持.方法 采用家庭关怀度指数量表(APGAR量表)和家庭负担会谈量表(FBS量表)对102名手术后患者的家属进行调查.结果 18例(17.64%)患者家庭出现轻度或重度的家庭功能障碍,APGAR总分(8.49±1.92)分,其中亲密度得分最高[(1.81±0.44)分]、合作度得分最低[(1.61±0.57)分];手术患者FBS总分(1.20±0.63)分,得分最高的是家庭经济负担[(1.72±0.96)分]、最低的是家庭成员躯体健康[(0.63±0.83)分];不同手术类型、手术时间和付费方式家庭FBS得分比较,差异有显著性意义(P＜0.05,P＜0.01);家庭功能总分与家庭负担及家庭关系、家庭成员躯体健康、家庭成员心理健康呈显著负相关(P＜0.05,P＜0.01).结论 手术不仅对患者本人的生理、心理产生很大影响,对其家庭功能也会产生多方面的影响,导致家庭负担的增加.护理人员在照顾手术患者时,要进一步强化整体护理的理念,为患者及其家属提供全面的整体护理,促进患者及其家庭功能健康发展,减轻患者家庭负担.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。