肾移植受者应对方式对服药依从性及自我管理的影响

目的探讨肾移植受者疾病应对方式、服药依从性及其自我管理的特点,并分析应对方式对服药依从性和自我管理依从性的影响。 方法采用便利抽样选取2019年3月至5月广州医科大学附属第三医院器官移植随访门诊就诊的肾移植受者作为研究对象。采用一般情况调查表、医学应对问卷、免疫抑制剂依从性Basel评估量表(BAASIS)及肾移植受者自我管理调查量表作为调查工具。所有问卷调查均在肾移植受者门诊随访时进行。采用成组t检验比较肾移植组和慢病常模组面对、回避和屈服因子得分。应用分层回归方程分析肾移植受者应对方式对服药依从性和自我管理的影响。P<0.05为差异有统计学意义。 结果肾移植受者面对因子得分[(19.8±2.9)分]最高。肾移植组和慢病常模组回避因子得分分别为(15.1±2.7)和(14.4±3.0)分,差异有统计学意义(t＝-2.320,P<0.05)。肾移植受者BAASIS得分平均为(22.2±2.6)分,125例受者中53例(42.4%)受者服药依从性好。36例(28.8%)曾在过去1个月中至少漏服1次免疫抑制剂;19例(15.2%)在过去1个月中曾出现至少1次连续漏服状况;63例(50.4%)曾在过去1个月中提前或推迟2 h服药;9例(7.2%)曾不按医嘱剂量服药。肾移植受者自我管理总得分为(91±8)分,其中68例(54.4%)自我管理水平良好,57例(45.6%)自我管理处于中等水平。受者饮食、治疗、躯体活动和社会心理管理得分分别为(29.5±3.0)、(33.4±3.4)、(15.7±2.1)和(12.4±1.6)分。面对、回避和屈服3个变量分别解释服药依从性总变异的8.6%,治疗管理总变异的13.7%,躯体活动管理总变异的7.0%,社会心理管理总变异的25.0%,整体自我管理总变异的15.0%。服药依从性的预测因子为屈服(β＝-0.252,P<0.01),饮食管理的预测因子为面对(β＝0.212,P<0.05),治疗管理的预测因子为面对(β＝0.348,P<0.01),躯体活动管理的预测因子为面对(β＝0.255,P<0.01),社会心理管理的预测因子为面对和屈服(β＝0.394和-0.271,P均<0.01),整体自我管理的预测因子为面对(β＝0.365,P<0.01)。 结论肾移植受者应对方式是服药依从性和自我管理的重要影响因素,应重视其对待疾病的态度和方式,及时转换其消极的应对策略,以提高其服药依从性和自我管理水平。     

儿童肝移植受者术后五年生存和睡眠质量调查研究

目的探究长期存活(≥5年)的儿童肝移植受者生存和睡眠质量及其影响因素。 方法采用儿童生存质量量表3.0(PedsQL? 3.0)移植模块和儿童睡眠质量调查问卷调查2006年1月至2013年6月在上海交通大学医学院附属仁济医院肝脏外科接受肝移植术后存活5年以上的30例儿童受者生存和睡眠质量。采用电子邮件发送并回收调查问卷,调查问卷均由家长填写。调查问卷发放时间为2018年6月第1周,回收时间为6月第2周。采用成组t检验比较不同性别和供肝来源儿童受者生存质量得分,采用单因素方差分析比较不同血型儿童受者生存质量得分。采用Mann－Whitney U检验比较不同性别和供肝来源儿童受者睡眠质量得分,采用Kruskal－Wallis检验比较不同血型儿童受者睡眠质量得分。P<0.05为差异有统计学意义。 结果实际回收有效问卷27份,其中男性14例,女性13例,移植和调查时中位年龄分别为11个月(5～12个月)、80个月(66～180个月)。27例受者平均身高、体质量、体质指数分别为(127±13)cm、(25±6)kg、(15.7±1.9)kg/m²。27例受者生存质量总分为(73±14)分,其中药物依从性、药物不良反应、移植后社会关系、疼痛、对健康状况的担忧、对治疗的焦虑、对外貌的自我感觉和交流问题8个维度得分分别为(82±13)、(78±17)、(71±16)、(72±19)、(56±28)、(67±28)、(68±21)和(80±16)分。睡眠质量总分中位数为0.23分(0～0.63)分,其中打鼾、日间过度嗜睡、行为和睡眠相关性呼吸问题4个维度得分中位数分别为0.22分(0～0.78分)、0.14分(0～0.57分)、0.50分(0～1.00分)和0.25分(0～0.50分)。不同性别、血型和供肝来源儿童受者生存和睡眠质量得分差异均无统计学意义(P均>0.05)。 结论肝移植术后存活5年以上儿童受者生存和睡眠质量尚可,性别、血型和供肝来源均不是生存和睡眠质量的影响因素。     

肺移植术后气道狭窄的最新研究进展

随着手术技术和术后管理方案的优化,肺移植数量大幅提升,已成为治疗终末期肺病患者的重要手段。但由于支气管缺血和免疫抑制等综合因素的影响,肺移植术后气道狭窄发生率较高,严重影响肺移植受者的术后生存及生活质量。近年来,随着围手术期管理、器官保存及手术技术等的改善,肺移植术后气道狭窄的发生率有所下降,但仍处于较高水平,早期诊断、及时干预对改善气道狭窄患者的预后至关重要。因此,本文就肺移植术后气道狭窄的一般情况、诊断、治疗及预防进行综述,旨在为肺移植术后气道狭窄的综合管理提供参考,以改善肺移植受者预后。     

肺移植术后气道吻合口狭窄的诊治进展

肺移植是治疗多数终末期肺病的唯一有效手段,而气道吻合口并发症是限制肺移植受者术后存活及生存质量的主要障碍.气道吻合口狭窄是肺移植术后最常见的气道吻合口并发症.近年来,受者选择、器官保存、外科技术、术后重症监护管理、免疫抑制、抗真菌及内镜治疗等方面的改进,降低了气道吻合口狭窄的发生率,改善了肺移植手术结果和受者生存情况....     

肝移植受者生存质量现状及影响因素分析

目的调查肝移植受者生存质量现状,并探讨其影响因素。 方法选取2017年12月在中山大学附属第一医院器官移植科复查的115例肝移植受者,使用一般资料问卷和简明健康调查(SF-36)量表进行调查。采用独立样本t检验比较肝移植组与常模对照组SF-36量表各维度得分,采用单因素方差分析比较不同学历等人口社会学及临床相关资料对生存质量的影响,组间两两比较采用LSD法。计数资料采用频数和构成比表示。P<0.05为差异有统计学差异。 结果共发放问卷115份,回收有效问卷108份,有效回收率93.9%。108例肝移植受者生存质量总分平均为(592±138)分,其中PCS得分平均为(286±71)分,MCS得分平均为(306±75)分;生理机能维度得分最高[(86±14)分],生理职能维度得分最低[(55±42)分]。肝移植受者生理机能、生理职能、躯体疼痛、社会功能和情感职能5个维度得分均低于常模,差异均有统计学意义(t＝3.78、6.05、5.54、1.61和0.36,P均<0.01)。以SF-36量表中PCS和MCS作为因变量,分析肝移植受者人口社会学及临床相关资料对生存质量的影响。结果显示,性别、文化程度、月收入、术后生存时间以及术后有无再就业是肝移植受者生存质量的影响因素(P均<0.05)。 结论肝移植受者生存质量还有待提高。医护人员应多关注女性、文化程度较低、月收入较低、术后生存时间<1年、术后未再就业的肝移植受者,提高其生存质量。     

卒中恢复期患者的自我管理干预

目的探讨卒中恢复期患者自我管理干预的效果。方法将福建省闽东、闽南、闽西、闽北、闽中6所三级甲等医院的160例卒中恢复期患者按照随机数字表法分为观察组和对照组各80例。对照组按照卒中恢复期中医护理方案进行常规护理,观察组在此基础上应用疾病自我管理模式进行干预。采用卒中自我管理行为评定量表、慢性病管理自我效能感量表和卒中患者生存质量量表,对两组患者干预前、干预3个月、干预6个月后自我管理行为和生活质量改善情况进行评定。结果干预后,观察组自我管理水平、自我效能感和生存质量评分显著优于对照组(均P 0. 01)。结论卒中恢复期自我管理模式的应用,可提高患者的自我效能,改善其生存质量。     

远程监控对居家自动化腹膜透析患者容量管理的影响

目的 探讨远程监控对居家自动化腹膜透析患者容量管理的影响。方法 将74例居家自动化腹膜透析患者随机分为对照组和观察组各37例。对照组实施常规随访管理干预,观察组实施远程监控干预,均干预6个月。比较两组患者容量管理相关知识、容量自我管理行为、体内水剩余和血压。结果 观察组和对照组干预后容量管理相关知识得分、容量自我管理行为得分较干预前提高(P<0.05,P<0.01),体内水剩余值、血压较干预前显著降低(均P<0.01);观察组干预后各项指标显著优于对照组(P<0.05,P<0.01)。结论 远程监控能提高居家自动化腹膜透析患者容量相关知识和容量自我管理行为水平,改善其容量负荷。     

等待肺移植患者生存质量及其影响因素研究

目的了解等待肺移植患者的生存质量及其影响因素。方法采用简明健康问卷(SF-36)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和领悟社会支持量表(PSSS)对55例等待肺移植患者进行调查。结果等待肺移植患者SF-36各维度得分23.18~74.57,显著低于常模(均P<0.01);SAS、SDS得分分别为48.09±9.06、52.18±9.98,显著高于常模(均P<0.01);PSSS社会总支持因子得分为5.56±1.04,其中家庭内支持因子得分显著高于家庭外支持因子(P<0.05)。多因素分析结果显示生存质量的影响因素为呼吸困难和抑郁(P<0.05,P<0.01)。结论等待肺移植患者的生存质量较低,其生存质量受呼吸困难和抑郁的影响。医务人员应从患者生理及心理方面进行有效干预,以提高其生存质量。     

肺移植患者居家监测管理App的设计与应用

目的探讨App用于肺移植患者居家监测管理的效果,为肺移植居家管理提供有效方法。方法将80例肺移植患者采用随机数字表法分为对照组和干预组各40例。对照组接受常规随访干预,干预组应用自行设计的App进行居家监测管理。出院前及出院后1个月、3个月比较两组BODE指数、生活质量、焦虑抑郁,并统计出院后3个月内再入院次数。结果干预组出院后3个月BODE指数与对照组比较P=0.05,生活质量评分显著高于对照组,焦虑评分显著低于对照组(P0.05,P0.01);干预组出院后3个月内再入院次数显著少于对照组(P0.05)。结论对肺移植患者应用App实施居家监测管理可改善患者的生活质量和焦虑情绪,但对BODE指数的改善效果还需进一步观察。     

肺移植术后发生恶性肿瘤的研究进展

肺移植已经成为终末期肺病的最有效治疗手段.随着肺移植技术以及围手术期管理的不断优化,移植术后早期疗效已有明显改善,但远期预后仍不乐观.威胁受者远期生存的因素除了常见的慢性移植肺功能障碍,还包括术后恶性肿瘤.肺移植术后常见的恶性肿瘤包括非黑色素瘤皮肤癌、移植后淋巴组织增生性疾病和肺癌.实体器官移植术后绝大部分受者需要接受...     

脑卒中恢复期患者自我管理项目的构建与评价

目的构建一套适用于脑卒中恢复期患者的自我管理项目。方法在文献回顾和大样本调查的基础上,根据脑卒中恢复期患者的特点,以自我管理理论为基础,自我效能为调节因子,构建具有中医特色的脑卒中恢复期患者自我管理项目。抽取180例患者进行临床随机对照试验验证项目的有效性。结果形成了以健康教育为主、辅以自我效能训练的自我管理模式,包括疾病相关知识健康教育、安全用药指导、康复锻炼管理、中医特色康复、自我监测、情志调护、饮食管理、日常生活起居管理、社会支持管理9项。干预4个月后,观察组患者自我管理能力和生活质量显著高于对照组(均P0.01)。结论应用具有中医特色的脑卒中恢复期患者自我管理项目,能有效改善患者健康行为,提高患者生活质量。     

护士主导的电话随访对阴道炎患者自我效能与疾病复发的影响

目的探讨护士主导的电话随访对阴道炎患者自我效能与疾病复发的影响。 方法选择2014年1月至12月于本院治疗的阴道炎患者50例为观察组,实施护士主导的电话随访护理方案进行护理;选择2013年1月至12月于本院治疗的阴道炎患者48例为对照组,给予常规护理;比较护理干预后两组患者的自我效能、复发情况及生活质量。 结果护理干预后观察组在按医嘱服药、监测症状、调节心理、角色功能、情绪控制以及与医生的沟通管理上的评分分别为（9.32±0.25）、（8.26±0.58）、（8.63±0.62）、（9.11±0.35）、（9.41±0.32）和（8.55±0.75）分,均高于对照组,差异均具有统计学意义（P均<0.05）。观察组患者中,复发5例;对照组患者中,复发12例,差异具有统计学意义（t = 4.695,P < 0.05）。观察组患者护理后在生理维度、心理维度、治疗维度、社会维度上的得分均显著低于对照组,差异均具有统计学意义（P均<0.01）。 结论护士主导的电话随访护理可显著提高患者的自我效能及生活质量,能明显降低复发率。     

Quality of life after lung transplantation: a cross-sectional study.

BACKGROUND: The increase in life expectancy has raised the importance of quality of life after lung transplantation, although this issue has not yet been systematically investigated. The aim of this cross-sectional study was to provide an overview of quality of life in lung transplant patients. METHODS: Between April and July 2001, a set of 4 questionnaires were given to all adult, German-speaking lung transplant recipients (n = 108; response rate 87% [n = 94]): St. George's Respiratory Questionnaire (SGRQ), a lung-specific health status instrument; the Short Form-36 (SF-36), a general quality of life measure; the Hospital Anxiety and Depression Scale (HADS-D) and a self-reported questionnaire concerning sexual functioning, physical symptoms, adverse effects of immunosuppression and satisfaction with outcome. RESULTS: With regard to the SGRQ, all lung transplant recipients had significantly better scores, which reflected an enhanced quality of life compared with the reference value for patients with obstructive pulmonary disease (SGRQ: p < 0.001 in all sub-scales). The Hospital Anxiety and Depression Scale and the Mental Component Summary Scale of the SF-36 did not differ significantly compared with published normative data in the healthy population. However, the side effects of immunosuppression proved to be a major factor influencing the quality of life of lung transplant recipients (11% influenced strongly and 24% moderately). Seventy-six percent of lung transplant patients were highly satisfied with the transplant outcome and 92% would opt for the procedure again. Among all lung transplant recipients, those with cystic fibrosis were most satisfied (significantly) with their quality of life. CONCLUSIONS: Although lung transplant patients must cope with the side effects of immunosuppression, they report a highly satisfying quality of life with regard to physical and emotional well-being and social and sexual function.     

Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients

Russell C, Conn V, Ashbaugh C, Madsen R, Wakefield M, Webb A, Coffey D, Peace L. Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients.
Clin Transplant 2011: 25: 864–870. © 2010 John Wiley & Sons A/S. Abstract: Background: Immunosuppressive medication non‐adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area. Methods: Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non‐adherence using electronic monitoring. Fifteen non‐adherent participants were randomized to receive either a continuous self‐improvement intervention or attention control management. The six‐month continuous self‐improvement intervention involved the participant and clinical nurse specialist collaboratively identifying the person’s life routines, important people, and possible solutions to enhance medication taking. The participant then received individual monthly medication taking feedback delivered via a graphic printout of daily medication taking generated from electronic monitoring. Results: The mean medication adherence score for the continuous self‐improvement intervention group (n = 8) was statistically significantly higher than the attention control group’s (n = 5) mean medication adherence score (p = 0.03). The continuous self‐improvement intervention effect size (Cohen’s d) was large at 1.4. Participants’ perceptions of the intervention were highly favorable. Conclusions: The continuous self‐improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients. A fully‐powered study with a diverse sample is needed to confirm these preliminary findings.     

The Bridge: A mobile application for burn patients

Global use of the internet has become commonplace, and smart phones have paved the way for technological mobility. Incorporation of smart phone technology has the potential to positively affect health outcomes through use of health-directed applications (apps), particularly for those patients living in medically underserved areas. The Bridge Mobile App for Burn Patients (fka: HealthySteps), is a pilot project that was developed to address the unique recovery needs of patients with major burn injuries who are being discharged from a regional burn center. App content was developed from three focus groups to explore and elucidate on stakeholders’ understandings of the bio-psycho-social education and messages that they believed would improve short-term outcomes for newly discharged burn patients. The app will provide burn patients with accessible support 24 h a day, seven days a week. Original recovery-stage appropriate bio-psycho-social content, instructional videos and links to burn-supportive web sites are delivered directly to patients’ smart phones for the first 90 days following discharge. The primary goal for the Bridge App is to decrease unplanned hospital re-admissions, while supporting increased quality of life and resilience in short-term recovery. In addition, the Bridge Mobile App is designed to collect patient data reflecting pain, anxiety, mood, itching, medication compliance, social participation, self-efficacy and return to work on a password protected, HIPPA compliant, encrypted mainframe.     

Self-efficacy and self-management behaviors in patients with chronic kidney disease

Although past research has examined self-management among patients with end-stage renal disease (ESRD), little is known about self-management in patients with chronic kidney disease (CKD). In this cross-sectional survey (no intervention), 174 patients with CKD (serum creatinine > or =1.7 mg/dL) completed self-reported measures of self-efficacy, physical and mental functioning, and self-management. The purpose of the study was to explore the association between patients' perceived self-efficacy and their self-management behaviors. Five types of self-management behaviors were measured: communication with caregivers, partnership in care, self-care, self-advocacy, and medication adherence. Controlling for other relevant variables including age, education, diabetic status, hypertension, serum creatinine, physical functioning, and mental health functioning, higher perceived self-efficacy scores were associated with increased communication, partnership, self-care, and medication-adherence behaviors. In this study, patients' perceived self-efficacy was a more consistent correlate of self-management behavior than were demographic or health characteristics. Because self-management has been associated with positive patient outcomes, fostering self-management by supporting patient self-efficacy may have long-term benefits.     

Transplant Outcomes and Economic Costs Associated with Patient Noncompliance to Immunosuppression

We describe factors associated with immunosuppression compliance after kidney transplantation and examine relationships between compliance with allograft outcomes and costs. Medicare claims for immunosuppression in 15 525 renal transplant recipients with at least 1 year of graft function were used to calculate compliance as medication possession ratio. Compliance was categorized by quartiles as poor, fair, good and excellent. We modeled adjusted associations of clinical factors with the likelihood of persistent compliance by multiple logistic regressions (aOR), and estimated associations of compliance with subsequent graft and patient survival with Cox proportional hazards (aHR). Adolescent recipients aged 19–24 years were more likely to be persistently noncompliant compared to patients aged 24–44 years (aOR 1.49 [1.06–2.10]). Poor (aHR 1.80 [1.52–2.13]) and fair (aHR 1.63[1.37–1.93]) compliant recipients were associated with increased risks of allograft loss compared to the excellent compliant recipients. Persistent low compliance was associated with a $12 840 increase in individual 3-year medical costs. Immunosuppression medication possession ratios indicative of less than the highest quartile of compliance predicted increased risk of graft loss and elevated costs. These findings suggest that interventions to improve medication compliance among kidney transplant recipients should emphasize the benefits of maximal compliance, rather than discourage low compliance.     

全病程管理对听神经瘤术后吞咽障碍患者康复的影响

目的 探讨全病程管理促进听神经瘤术后吞咽障碍患者康复的效果。方法组建全病程管理小组,选取56例听神经瘤术后吞咽障碍患者为研究对象,按照住院时间分为对照组28例,实施常规护理;干预组28例,实施个案管理师主导的全病程管理。结果干预1年后,两组服药依从性、康复依从性及吞咽功能的时间效应、交互效应和组间效应差异有统计学意义（均P＜0.05）;两组生存质量的时间效应及组间效应差异有统计学意义（均P<0.05）。结论全病程管理能有效提高听神经瘤术后患者的服药及康复依从性,促进吞咽功能恢复,提高生活质量。