阶段性改变模式在促进高血压患者规律运动的效果研究

目的探讨阶段性改变模式在促进高血压患者运动的效果。方法选择119例高血压患者为研究对象,随机分为干预组和对照组。干预组接受阶段性改变模式的运动干预措施,对照组接受常规运动健康教育。结果干预后干预组患者行为改变阶段较高（P〈0．01）,运动频率及运动持续时间亦较对照组高（P〈0．01）。干预后干预组患者血压下降较对照组患者明显（P〈0．05）。结论阶段性改变模式对促进高血压患者运动有效,运动干预后血压下降明显。     

健康信念模式对高血压患者行为改变的影响

目的探讨健康信念模式在帮助高血压患者建立健康行为中的作用。方法将120例高血压患者随机分为干预组和对照组各60例,对照组接受常规的健康教育,干预组接受以健康信念模式为理论基础的护理干预,比较两组干预效果。结果干预前两组患者收缩压和舒张压比较差异无统计学意义（P〉0．05）;干预后干预组收缩压、舒张压分为（102．73±10．87）,（62．00±5．53）mmHg,低于对照组（128．13±13．29）,（68．52±10．04）mmHg,差异有统计学意义（t=11．50,4．41,P〈0．01）;两组干预前后行为改变评分比较差异均有统计学意义（19〈0．01）;两组干预后除“按时服药”、“定期测量血压”两项比较差异无统计学意义（P〉0．05）外,其余3项和总均分差异均有统计学意义（P〈0．05）。结论健康信念模式对帮助高血压患者建立良好的健康行为有促进作用,良好的健康行为对有效控制患者血压水平具有重要意义。     

社区护理干预对高血压病患者的影响

目的探讨护理干预对高血压病患者的影响。方法对己在社区卫生服务站建立健康档案的67例高血压病患者进行高血压相关知识的健康教育,并对其服药、饮食、运动和心理等进行干预,进行健康生活方式的指导。结果实施护理干预后,患者的血压平均值明显下降（P〈0．01）;服药的依从性明显提高（P〈0．01）;不良生活方式（包括饮食习惯、适量运动及控制体重）也得到改变。结论对社区高血压病患者的护理干预是控制和防治高血压的有效措施。     

高血压病患者不良生活方式的护理干预及效果评价

目的通过护理干预改变高血压患者的不良生活方式,以达到更好地预防和治疗高血压病。方法通过入院评估,制定护理干预措施;培训病人和医务人员;采用护理干预措施包括疾病相关知识宣教、心理指导、用药指导、饮食指导和运动指导;跟踪随访3个月。结果8项干预指标中,除体重干预前后差异不明显（P〈0．05）,其余7项干预指标均有显著效果（P〈0．01）。结论高血压与肥胖、精神压力、饮食、运动、吸烟饮酒、遵医行为等因素有关。护理干预提高了高血压病人对不良生活方式的认知,可改变高血压患者的不良生活方式,从而提高其治疗依从性。     

护理干预对原发性高血压病患者遵医行为的影响

目的探讨护理干预对原发性高血压病患者遵医行为的影响。方法将80例原发性高血压患者分为两组,对照组40例给予一般性治疗与护理,干预组40例在此基础上给予饮食、运动、药物治疗、心理因素等方面进行护理干预。结果干预组血压控制情况与护理前差异有统计学意义（P〈0．01）,遵医行为与对照组比较差异有统计学意义（P〈0．01）。结论护理干预能明显提高原发性高血压病患者的遵医行为,血压控制良好,提高了患者的生活质量。     

聚焦解决模式在社区高血压患者自我管理中的应用

目的探讨聚焦解决模式应用于健康教育在社区开展对高血压患者自我管理的影响。方法选取社区高血压患者100例随机分为对照组和实验组各50例。对照组给予常规高血压健康教育指导,实验组应用聚焦解决模式进行高血压自我管理健康教育,干预前及干预后6个月,比较两组血压情况、高血压知识掌握情况及自我管理行为。结果干预前后两组患者血压值比较,差异无统计学意义（P〉0．05）,干预后实验组患者血压值收缩压和舒张压分别为（132．48±7．13）,（87．55±4．25）mmHg,明显低于对照组的（141．60±5．57）,（93．23±2．61）mmHg,差异均有统计学意义（￡分别为7．482,8．779;P〈0．01）;干预后实验组患者高血压家庭血压监测、诊断标准、危险因素、相关疾病方面知识掌握情况均明显优于对照组,差异均有统计学意义（x。分别为44．000,29．265,22．236,11．408;P〈0．01）;自我管理行为中整体健康自评、疲劳状态、情绪低落、每周锻炼时间及6个月内看门诊次数实验组明显优于对照组,差异均有统计学意义（P〈0．05）。结论聚焦解决模式应用于健康教育有利于社区高血压患者获得解决问题的知识和技能,能有效提高社区高血压患者自我管理效能。     

采用知信行模式进行健康教育对原发性高血压病患者不良生活方式的干预效果

目的观察知信行健康教育模式对原发性高血压病患者不良生活方式的干预效果。方法将符合标准的200例原发性高血压病患者按照治疗的先后顺序，分为试验组和对照组各100例。在患者来院就诊或住院治疗时，责任护士在给予基本检查治疗，并对患者健康行为以及主要危险因素和对疾病认知程度进行评估的基础上，试验组采用知信行健康教育模式，对照组采用传统的健康教育模式，分别对两组患者进行为期60d的健康教育。健康教育结束后再次评估两组患者的健康行为的变化情况。结果试验组健康教育后患者健康行为优于健康教育前（P〈0．01）；对照组除“戒烟限酒”外，健康教育后患者健康行为优于健康教育前（P〈0．01）；健康教育后试验组患者健康行为优于对照组（P〈0．01）。结论知信行模式可以更有效地促进原发性高血压病患者健康行为的建立，改善对疾病的不良认知，减少影响疾病转归和康复的危险因素。     

“知-信-行”模式在高血压患者健康教育中的应用

目的探讨“知一信一行”模式在高血压患者健康教育中的应用和效果。方法将100例高血压住院患者随机分为对照组和干预组各50例。对照组接受传统的健康教育,干预组应用“知一信一行”模式进行健康教育指导。采用调查问卷,分别于入院24h内和出院后6个月对两组患者进行调查,比较两组患者对疾病知识的掌握、遵医行为及血压控制达标情况。结果两组患者干预前对疾病相关知识的认知得分比较,差异无统计学意义（P〉0．05）,干预后干预组患者对疾病相关知识的认知得分为（67．4±4．3）分高于对照组的（51．2±3．8）分,差异有统计学意义（t=19．90,P〈0．01）;干预前两组患者遵医行为比较,差异无统计学意义（P〉0．05）,干预后干预组患者戒烟限酒、规律作息、适当运动、情绪控制、合理饮食、遵医用药、定期复查的遵医行为情况均优于对照组患者,差异均有统计学意义（x。分别为5．828,5．482,7．294,4．320,6．139,6．775,24．731;P〈0．05）;干预前两组患者血压控制达标率比较,差异无统计学意义（P〉0．05）,干预后干预组达标率为92．0％,高于对照组的64．0％,差异有统计学意义（x2=11．422,P=0．001）。结论对高血压患者采用“知一信—行”模式进行健康教育可提高患者对疾病的认知程度和遵医行为,从而改善临床治疗效果,提高患者的生活质量。     

高血压病的社区护理干预

目的：探讨社区护理干预对高血压患者的效果。方法：对社区120例实行全国高血压社区规范化管理的患者进行随访,普及高血压相关知识,实施健康教育、营养干预、运动锻炼等社区护理干预,比较干预前后患者对高血压知识认知状况、血压控制的效果。结果：120例患者干预后对高血压知识的知晓状况明显高于干预前（P〈0．01）,干预后患者血压控制效果明显优于干预前（P〈0．01）。结论：建档后定期对社区高血压患者实施社区护理干预,对高血压病患者的治疗有连续性、系统性,随访方便,是降低患者血压、保证患者生活质量、预防高血压并发症的有效措施。     

高血压人群的社区健康干预效果评价

目的探讨社区健康干预对改变高血压患者的不良生活行为、提高患者治疗效果，降低高血压病治疗费用的效果。方法对2个社区45岁以上中老年人进行健康普查，检出的287名高血压病人作为研究对象。在其中一个社区有组织、有计划地进行健康教育和干预。结果经过社区医疗干预，2年内患者血压控制率显著升高（p〈0．01），心脑血管意外事件发生率降低（p〈0.05），患者用于高血压病药物治疗的年平均费用降低（p〈0.01）。结论社区健康干预能提高高血压的治疗效果，降低医药费用。     

The Take Control of Your Blood pressure (TCYB) study: study design and methodology

BACKGROUND: Among the 65 million Americans with hypertension, only approximately 31% have their blood pressure under control (<140/90 mm/Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for blood pressure, interventions to improve blood pressure control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a two by two design is being conducted to improve blood pressure control. This five-year trial evaluates two patient-directed interventions designed to improve blood pressure control among patients diagnosed with hypertension in a community-based primary care setting. METHODS: Patients are randomized to one of four groups: usual care, home blood pressure monitoring, tailored behavioral self-management intervention that is administered via telephone by a nurse, or a combination of the home blood pressure monitoring and tailored behavioral intervention. Patients receiving the home blood pressure monitoring are trained in the use of an electronic blood pressure measurement device, are asked to measure their blood pressure 3 times/week, and send in two-month blood pressure recordings throughout the 24-month study duration. The behavioral intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. A nurse delivers all behavioral self-management modules over the telephone bi-monthly for 24 months. The primary outcome is the proportion of patients who achieve control of their blood pressure based on evidence-based guidelines (for patients without diabetes <140/90 mm/Hg, for patients with diabetes <130/80 mm/Hg) evaluated at six-month intervals over 24 months (five measurements) using a random-zero sphygmomanometer. CONCLUSION: Despite the known risk of poor blood pressure control, and the wide availability of effective treatment strategies, a majority of adults still do not have their blood pressure controlled. This study will be an important step in defining two explicit interventions to improve blood pressure control. To our knowledge, this study is the first to combine both a tailored behavioral self-management intervention and self-monitoring home blood pressure intervention to improve blood pressure control among patients in a primary care setting.     

The veterans' study to improve the control of hypertension (V-STITCH): design and methodology

BACKGROUND: Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (<140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, interventions to improve BP control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a split-plot design is being conducted to improve BP control. This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans. METHODS: In a cluster-randomization, 30 primary care providers in the Durham VAMC Primary Care Clinic were randomly assigned to receive the provider intervention or control. The provider intervention is a patient-specific electronically generated hypertension decision support system (DSS) delivering guideline-based recommendations to the provider at each patient's visit, designed to improve guideline-concordant therapy. For these providers, a sample of their hypertensive patients (n=588) was randomly assigned to receive a telephone-administered patient intervention or usual care. The patient intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. All modules are delivered over the telephone bi-monthly for 24 months. In this trial, the primary outcome is the proportion of patients who achieve a BP < or =140/90 mm Hg at each outpatient clinic visit over 24 months. CONCLUSION: Despite the known risk of poor BP control, a majority of adults still do not have their BP controlled. This study is an important step in testing the effectiveness of a patient and provider intervention to improve BP control among veterans in the primary care setting.     

Implementing a palm pilot intervention for primary care providers: Lessons learned

The Personal Digital Assistance for Guideline Adherence (GLAD Heart) study was designed to test a strategy to improve quality of care through increased adherence to ATPIII cholesterol guidelines. This paper describes the overall study design including the multi-faceted intervention and outcome measures. Sixty-one primary care practices in NC were recruited and randomized to either a personal digital assistant-based cholesterol management intervention or an intervention similar in intensity and frequency of contact but focused on a hypertension clinical practice guideline. Installation and implementation of the technology intervention was challenging. Over the course of the study, there were 74 technical issues requiring assistance for the palm pilot from 23 participating practices. The GLAD Heart project was completed successfully with some impact on cholesterol management. Technology has the potential to improve the quality of care provided in the healthcare setting. However, potentially expensive interventions such as that conducted in GLAD Heart should undergo rigorous testing to assure their efficacy before widespread adoption.     

Rationale and study protocol for a two-part intervention: Safety planning and structured follow-up among veterans at risk for suicide and discharged from the emergency department

There are no evidence-based, brief interventions to reduce suicide risk in Veterans. Death by suicide is a major public health problem. This article describes a protocol, Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment [SAFE VET], developed for testing the effectiveness of a brief intervention combining a Safety Planning Intervention with structured follow-up (SPI–SFU) to reduce near-term suicide risk and increase outpatient behavioral health treatment engagement among Veterans seeking treatment at Veteran Affairs Medical Center (VAMC) emergency departments (EDs) who are at risk for suicide. In addition to describing study procedures, outcome measures, primary and secondary hypotheses, and human subjects' protection issues, the rationale for the selection of SPI–SFU as the intervention is detailed, as are safety considerations for the unique study setting and sample.     

Strategies for maintaining integrity of a behavioral intervention

The purpose of this article is to address issues in maintaining the integrity of a behavioral intervention. Examples are provided from a recently completed study on how to train research staff and monitor the integrity of the intervention. In this exemplar, the integrity of the behavioral intervention was addressed by the design of the study and research staff training. Throughout the study, the integrity of the behavioral intervention was monitored by delineating a checklist of topics that must be addressed, critiquing audiotapes of the intervention, and discussing incomplete or missing elements with the research staff.     

心理行为干预对难治性高血压患者的影响

目的观察心理行为干预对难治性高血压患者的影响。方法按人院先后顺序将91例难治性高血压患者随机分为对照组（45例）和观察组（46例）,对照组给予常规一般健康教育,观察组给予针对性的心理行为干预,在出院后第6个月、12个月通过随访了解两组患者血压、服药依从性、心理状态等情况,并作比较。结果干预后6个月和12个月时,观察组患者血压明显低于对照组（均P〈0．05）,观察组患者服药依从性、良好生活方式及心理状态改善情况明显优于对照组（均P〈0．05）。结论心理行为干预能有效减轻患者焦虑抑郁状态、提高患者服药依从性、建立良好生活方式。从而达到有效控制血压的目的。     

Responses of Female Fire‐Setters with Mild and Borderline Intellectual Disabilities to a Group Intervention

Background This report describes a cognitive behavioural group intervention for women with mild and borderline intellectual disabilities detained in a secure hospital setting because of their fire‐setting behaviour. The study aimed to examine participants’ motivations for setting fires, their responses to an intervention designed specifically for this group and to monitor their progress over an extended follow‐up period. Methods A number of fire‐specific and clinical assessments were administered before the intervention started and immediately after it concluded to examine trends in the group data. Detailed case study material was collected in order to describe participants’ engagement in and reactions to the treatment process, and their status at 2‐year follow‐up. Results The intervention successfully engaged participants in the therapy process, all of whom completed the programme. Scores on measures related to fire‐related treatment targets and clinical measures pertinent to motivations for fire‐setting generally improved following the intervention. There were no reports of participants setting any fires 2 years after the intervention programme was completed. Conclusions The group intervention appeared to be acceptable and beneficial to study participants. This pilot study needs to be extended into a more robust evaluation of this approach with this group.     

Module-based comprehensive approach for addressing heterogeneous mental health sequelae of violent loss survivors

ABSTRACT

Significant strides have been made in the trauma and grief fields to address the unique needs of those who have lost a loved one to violent death. Several treatment techniques have been found to be effective for symptoms of trauma and grief that are prevalent among violent loss survivors including restorative retelling and cognitive behavioral strategies. Current interventions either are tailored for a specific mental health problem or are more universal in nature for grief related to violent loss. This paper presents an evidence-based and guided modular approach for responding to the myriad potential mental health needs of violent loss survivors. A comprehensive module-based structured intervention for violent loss survivors, which specifically targets several common mental health difficulties following traumatic loss, may offer clinicians a thorough and flexible approach guided by clinical assessment to address the distinctive and common issues violent loss survivors often face.     

Impact of new clinical trials on recent guidelines on hypertension management

Abstract

Guidelines on hypertension diagnosis and treatment have been issued in 2007. Since then, a number of major intervention clinical trials have been designed, carried out, and completed with the aim of investigating unsolved issues related to the impact of the blood pressure-lowering intervention on cardiovascular risk and events. These include, among others, the nephroprotective properties of antihypertensive drugs, the blood pressure targets to be achieved during treatment in uncomplicated and more so in complicated hypertensive patients, the advantages of one drug combination versus another, and the benefits of antihypertensive drugs in the very elderly. All these questions have received a clear-cut answer by the results of recently performed clinical trials, which have been included in the 2009 update document of the European guidelines. This paper will be focused on the 2007 guidelines document and the 2009 update paper, highlighting the new concepts and recommendations provided by the most recent intervention trials.     

Impact of new clinical trials on recent guidelines on hypertension management

Guidelines on hypertension diagnosis and treatment have been issued in 2007. Since then, a number of major intervention clinical trials have been designed, carried out, and completed with the aim of investigating unsolved issues related to the impact of the blood pressure-lowering intervention on cardiovascular risk and events. These include, among others, the nephroprotective properties of antihypertensive drugs, the blood pressure targets to be achieved during treatment in uncomplicated and more so in complicated hypertensive patients, the advantages of one drug combination versus another, and the benefits of antihypertensive drugs in the very elderly. All these questions have received a clear-cut answer by the results of recently performed clinical trials, which have been included in the 2009 update document of the European guidelines. This paper will be focused on the 2007 guidelines document and the 2009 update paper, highlighting the new concepts and recommendations provided by the most recent intervention trials.