基于决策树的肿瘤患者难免性压疮风险预测模型研究

目的评价决策树预测肿瘤患者难免性压疮风险的准确性与合理性,为压疮预防提供依据。方法收集Braden评分高风险肿瘤患者611例的临床病例资料,采用CHAID算法构建肿瘤患者难免性压疮风险预测的决策树模型,并通过ROC曲线下面积、灵敏度和特异度指标比较其与Braden评分的预测效果。结果 46例发生难免性压疮,发生率为7.53%。决策树模型包含3层共11个节点,提取6条分类规则,筛选出4类高危人群,即Braden评分≤11分,翻身计划无法落实;Braden评分11分,皮肤有现存或潜在损伤;Braden评分≤11分,翻身计划可以落实,但存在增加压疮发生风险的特殊情况;Braden评分11分,皮肤没有现存或潜在损伤,但翻身计划无法落实。决策树模型ROC曲线下面积为0.840;决策树模型的灵敏度为0.848、特异度为0.774。结论决策树模型ROC曲线下面积、灵敏度及特异度均较好,可以用于肿瘤患者难免性压疮高危人群的筛选和管理。     

斜视儿童生存质量现况及其影响因素分析

目的 了解斜视儿童生存质量现状并分析其影响因素,为提供精准护理干预提供理论依据。方法 采用便利抽样法选取某三 级甲等医院眼科住院等待手术的8~17岁斜视儿童113例,应用一般资料调查表、斜视儿童生存质量量表、医院焦虑抑郁量表、简 易应对方式量表、社会支持评定量表和正性负性情绪量表进行问卷调查,采用多元逐步回归分析其影响因素。结果 斜视儿童生 存质量总分为(61.32±16.31)分,心理社会维度(62.69±18.17)分,视觉功能维度(58.57±19.26)分。多元逐步回归分析结果显 示,斜视类型、性别、焦虑、情绪是斜视儿童生存质量的主要影响因素(P<0.05,P<0.01)。结论 8~17岁斜视儿童整体生存质 量较低,医护人员需根据患儿的性别、斜视类型、心理健康状况等针对性进行精准护理干预,提高其生存质量。     

基于SEER数据库构建转移性乳腺癌患者的生存预测模型

目的 探讨影响初诊转移性乳腺癌患者预后的风险因素并构建生存预测模型.方法 通过SEER数据库收集2010-2013年期间的初诊转移性乳腺癌患者并采用R软件随机分为建模组与验模组.通过SPSS软件使用log-rank法比较建模组中不同转移部位的转移性乳腺癌患者的生存预后并制作Kaplan-Meier生存曲线.采用单因素分...     

晚期乳腺癌患者的ANZ生存预测模型的验证

目的验证晚期乳腺癌患者的生存预测ANZ模型。方法收集本中心104例辅助治疗后出现复发或转移、拟接受一线治疗的晚期乳腺癌患者的临床和病理学资料,利用ANZ模型预测该部分患者的生存时间,分析该模型对中国晚期乳腺癌患者的生存预测的鉴别能力和准确性。结果 ANZ模型对本中心104例晚期乳腺癌患者进行外验证的C-index为0.61(0.53,0.70),calibration plot提示模型预测生存时间与实际生存时间的拟合度稍差。结论 ANZ模型对本中心辅助治疗后出现复发或转移、拟接受一线治疗的晚期乳腺癌患者的生存预测效能欠佳,可能不是一个适合中国患者的生存预测模型,未来需要建立一个基于中国患者人群、具有更全面建模因素的晚期乳腺癌生存预测模型。     

成人斜视患者报告结局测评系统的构建及应用

目的基于计算机自适应测试技术构建成人斜视患者报告结局测评系统,并评价临床应用效果。方法以患者报告结局国际开发标准作为方法学指南,采用质性研究、德尔菲法、Rasch模型等方法形成测评条目,基于计算机自适应测试技术建立测试系统,包括测评系统、统计相关和系统管理3大核心模块。将该系统应用于101例成人斜视患者(系统测评组),并与采用纸质版测评的对照组(100例)进行效果比较。结果系统测评组测评时间显著短于对照组,患者测评满意率及依从率显著高于对照组(P0.05,P0.01)。结论基于计算机自适应测试技术开发的成人斜视患者报告结局测评系统,可缩短测评时间,提高患者测评满意度和依从性。     

血液恶性肿瘤患者生存质量研究

目的：通过分析１２８例血兴恶性肿瘤患者生存质量（ＱＯＬ），探讨ＱＯＬ的影响因素，方法：自诊断存活２年以上的１２８例血液恶性肿瘤患者，其中１６例接受骨髓移植植或外周血干细胞移植，采用填表或信函问询，结果：随存活时间延长，Ｋarnofsky计分逐步上升，依次为淋巴瘤＞ＣＭＬ＞ＡＬ＞ＭＭ，骨髓或外周血干细胞移植后１年者＞化疗后缓解期超过２．５年者＞移植后１年以内者＞缓解期少于２．５年者，对中药或气功的总的肯定率达５７．４％，结论：骨髓或外周血干细胞移植后１年以化疗达缓解超过２．５年者生理机能明显改善，但普遍存在心理，社会问题，ＭＭ患者ＱＯＬ较差，医疗费用是主要的忧虑根源，有关干细胞移植的疑虑值得引起关注，应加强中医在肿瘤治疗后期的调理作用。     

乳腺癌患者生存质量研究现状

目的 了解乳腺癌患者生存质量的研究现状、相关影响因素及干预措施.方法 检索有关乳腺癌患者生存质量研究的最新文献并进行综述.结果 尽管乳腺癌的治愈率和生存率已有改善,但乳腺癌作为重大应激事件,疾病本身及治疗相关不良反应常会让患者产生疲乏感、活动能力下降、焦虑、抑郁等负面情绪,严重影响患者的生存质量乃至生存预后.患者年龄、...     

冠心病患者介入治疗后远期生存质量研究

目的了解冠心病患者介入治疗后远期生存质量,为制订针对性干预对策提供依据。方法采用西雅图心绞痛生存质量测量量表（SAQ）对接受冠状动脉介入治疗的64例患者分别于治疗前24h、治疗后3个月、2年进行问卷调查。结果介入治疗前24h、治疗后3个月、2年SAQ总分主要分布为20～59分、60～100分和40～79分。介入治疗后3个月、2年患者SAQ总分及各因子分较治疗前24h显著提高（均P〈0．01）;介入治疗后2年SAQ总分及4个因子（除外疾病主观感受程度）得分显著低于治疗后3个月（均P〈0．01）。结论冠状动脉介入治疗能有效改善冠心病患者的生存质量;随着出院时间的延长,生存质量有下降趋势。完善医院随访制度,建立医院-社区联合健康教育网络,可望提高患者遵医行为,从而提高生存质量。     

冠心病患者介入治疗后远期生存质量研究

目的 了解冠心病患者介入治疗后远期生存质量,为制订针对性干预对策提供依据.方法 采用西雅图心绞痛生存质量测量量表(SAQ)对接受冠状动脉介入治疗的64例患者分别于治疗前24 h、治疗后3个月、2年进行问卷调查.结果 介入治疗前24 h、治疗后3个月、2年SAQ总分主要分布为20～59分、60～100分和40～79分.介入治疗后3个月、2年患者SAQ总分及各因子分较治疗前24 h显著提高(均P＜0.01);介入治疗后2年SAQ总分及4个因子(除外疾病主观感受程度)得分显著低于治疗后3个月(均P＜0.01).结论 冠状动脉介入治疗能有效改善冠心病患者的生存质量;随着出院时间的延长,生存质量有下降趋势.完善医院随访制度,建立医院一社区联合健康教育网络,可望提高患者遵医行为,从而提高生存质量.     

中文版斜弱视患者生存质量量表的信度和效度检测

目的检测中文版斜弱视患者生存质量量表(Amblyopia and Strabismus Questionnaire,ASQE)的信度和效度。方法通过系统的前译-回译形成中文版ASQE,并对119例斜弱视患者进行测定,对结果进行信度和效度分析。结果中文版ASQE共5个维度26个条目,总量表的Cronbach′sα系数为0.906,重测信度为0.725～1.000,折半信度为0.893。各维度得分和量表总分相关(r=0.576～0.857,均P<0.01),因子分析提取了6个特征根大于1的因子,各条目载荷0.387～0.889,6个因子累积解释了66.697%的变异。结论中文版ASQE具有良好的信度和效度,适合中国斜弱视患者生存质量的测量。     

成人头颈部白癜风患者生活质量调查

目的：探讨影响成人头颈部白癜风患者生活质量的相关因素并进行量化分析,为临床选择合理的治疗方案提供线索。方法：以头面部脂溢性皮炎患者作为对照组,采用简体中文版皮肤病生活质量指数（dermatology life quality index,DLQI）和流调中心抑郁量表（center for epidemiologic studies depression scale,CES-D）,对确诊为头颈部白癜风和头面部脂溢性皮炎的患者进行面对面调查评估。结果：成人头颈部白癜风患者DLQI和CES-D分值显著高于对照组（P〈0.05）,且DLQI分值与CES-D之间存在正相关（r=0.48,P〈0.05）。结论：头颈部白癜风可以严重影响患者的生活质量,应及早进行治疗和心理疏导。     

Predicting factor of quality of life in long-term jaundice-free survivors after the Kasai operation

Background/Purpose

The aim of this study was to determine simple predictors for quality of life (QOL) in long-term jaundice-free survivors after the Kasai operation.

Methods

Kasai’s original portoenterostomy was performed on 55 patients with biliary atresia. Among them, records were reviewed retrospectively of 35 long-term (at least 5 years) and jaundice-free (clearance in bilirubin level less than 1.0 mg/dL after Kasai operation) survivors. The patients were divided into 2 groups based on QOL, and the differences in clinical and laboratory data were analyzed statistically.

Results

The ages at Kasai operation, histologic, fibrosis grade of liver biopsy specimen at operation, the first onset and frequency of postoperative cholangitis, and postoperative clearance speed of jaundice after Kasai operation were not significantly different between the 2 groups. The aspartate aminotransferase (AST) level at 1 year was significantly correlated with the serum concentration of hyaluronic acid and an independent predictor for QOL in long-term jaundice-free survivors of the Kasai operation.

Conclusions

The serum AST level at 1 year was a simple, strong predicting factor of QOL and liver dysfunction in long-term jaundice-free survivors after Kasai operation and may prove useful in planning liver transplantation.     

Long-term disease-specific quality of life in adult anorectal malformation patients

Background

Fecal and urinary incontinence may differently influence various aspects of quality of life (QOL). The main aim of the present study is to determine whether fecal and urinary incontinence measured at time 1 of the study will predict QOL at time 2 (after 4 years), above and beyond the prediction already explained by fecal and urinary incontinence at time 2.

Methods

Thirty-six adult patients from the Italian Parents' and Patients' Association for Anorectal Malformations answered items about urinary and fecal incontinence at time 1 of the study and completed the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire after 4 years from the first questionnaire. Two sets of hierarchical regression analyses were conducted with fecal and urinary incontinence serving as predictors of QOL and the different areas of QOL from the Hirschsprung Disease/Anorectal Malformation Quality of Life serving as outcome variables.

Results

The principal findings indicated that fecal continence is a strong predictor of QOL in the areas of social functioning, emotional functioning, and body image and that urinary incontinence predicted sexual functioning.

Conclusions

It seems that one's past experience with fecal incontinence is extremely relevant to current QOL, especially for body image. Urinary incontinence contributed less in explaining QOL in our patients, but because it is very relevant for sexual functioning, it should not be disregarded.     

Social quality of life for adult patients with anorectal malformations

Background/Purpose

Pediatric surgeons who performed the initial surgery on anorectal malformations (ARM) lose contact with the patients as they become adults. In the present study, we examined 20- to 40-year-old adult patients with a history of surgery for ARM and analyzed them from the points of social quality of life.

Patients and Methods

Twenty-nine patients with ARM, aged 20 to 40, were surveyed by questionnaire or personal interview. Thirteen with high-type and 9 with intermediate-type anomalies underwent abdominoperineal rectoplasty, and 7 with low-type anomalies underwent perineoplasty between 1965 and 1985. Responses were analyzed from the perspectives of bowel, urinary, and sexual functions and social activity.

Results

One third of patients with high- or intermediate-type anomalies occasionally complained of fecal soiling. However, the other patients gained good bowel function and enjoyed occupational or student life without problems. Fecal soiling was the key factor disturbing occupational life, although the problem remained within a socially manageable level. All of the patients with ARM had normal urinary function. Three of the 18 male patients had sexual problems such as erectile or ejaculatory dysfunction because of associated genitourinary anomalies. Nine of the 11 female patients had regular menstruation and the other 2 had irregular menstrual periods. Five female patients were married and 4 of the 5 had children (1-5 children). Modes of delivery were normal vaginal delivery in 8 and cesarean section in 1. Only one of the 5 had a slight sacral anomaly. However, she had no apparent abnormality of bladder function and got through pregnancy and delivery without difficulty.

Conclusion

One third of adult patients with high- or intermediate-type anomalies after abdominoperineal rectoplasty had some problems in bowel function. Fecal soiling was the key factor that disturbed their occupational life. Most of the patients had normal urinary and sexual functions if they did not have associated genitourinary anomalies and enjoyed social activities.     

阅读疗法对抑郁症患者生活质量的影响

目的探讨阅读疗法对抑郁症患者生活质量的影响。方法将92例抑郁症患者随机分为观察组和对照组各46例,两组均给予抗抑郁药物治疗和一般康复治疗,观察组在此基础上联合阅读疗法,疗程3个月。干预前后采用汉密顿抑郁量表(HRSD)、生存质量测定量表(QOL-100)对两组患者进行评定。结果两组HRSD评分干预后较干预前均有下降,观察组下降值显著大于对照组(均P<0.01);干预后观察组QOL-100总评及各因子(除精神信仰外)评分较干预前显著提高(均P<0.01)。结论阅读疗法对抑郁症患者的康复治疗有较好的辅助作用,能显著改善其抑郁症状和生活质量。     

69例腹膜透析患者生活质量分析

目的探讨本中心腹膜透析（PeritonealDialysis,PD）对慢性肾衰竭患者生活质量的影响,并初步分析影响PD患者生活质量的因素。方法肾内科腹膜透析患者69例,运用KDQOL-SFTMl．3（包括健康调查简表MedicalOutcomesStudyHealthStatusShortForm,SF-36和Kidneydiseasetargetarea,KDTA）生活质量量表调查,根据Hays方法进行评分。结果（1）男性PD患者与女性PD患者在KDTA和SF-36总分方面有显著性差异。（2）每天透析剂量6000ml以上PD患者与每天透析剂量在6000ml以下的PD患者在KDTA和SF-36总分方面有显著性差异。（3）PD患者的生活质量与透析时间的长短明显相关。（4）40岁以下患者在KDTA和SF-36的总分方面与4（J岁以上患者无明显差异（P〉0．05）。（5）透析费用支付方式对PD患者的生活质量影响明显,医疗保险的PD患者的生活质量评分在KDTA及SF-36总分方面明显高于新农合的PD患者。结论影响PD患者生活质量的因素除医学因素外,非医学因素亦占重要地位。     

Health-related quality of life in adult patients with esophageal atresia--a questionnaire study

Background/Purpose

Long-term sequelae caused by associated anomalies or respiratory and gastrointestinal disorders are common after the repair of esophageal atresia (EA). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of patients with EA.

Methods

A questionnaire including a 36-item Gastrointestinal Quality of Life Index, a 15-item Respiratory Symptoms-Related Quality of Life Index, and a 36-item psychosocial survey and a symptoms query was sent to 159 patients with EA with or without tracheoesophageal fistula (TEF), who were operated on between 1949 and 1979, and to 400 healthy control subjects. A 36-item Health Survey Form was sent to patients with EA only and the results were compared with values of the general Finnish population.

Results

A total of 128 patients with EA (80%) and 162 control subjects (41%) returned the questionnaire. Median age [patients with EA, 38 (range, 24-54) years; control subjects, 36 (20-56) years] and sex distribution (M/F of patients with EA, 57:70; control subjects, 63:99) were comparable. Of the 128 patients, 115 (91%) had EA with a distal TEF, 8 (6%) had EA without TEF, 3 (2%) had EA with proximal and distal TEF, and 2 (1%) had TEF without EA. The types of esophageal repair were distributed as follows: primary end-to-end anastomosis (n = 112), colon interposition (n = 10), gastric tube (n = 3), thoracic skin tube (n = 1), and fistula closure only (n = 2). Thirty-eight patients had significant associated anomalies. Gastrointestinal Quality of Life Index scores did not differ statistically between patients with EA and control subjects. However, the incidence of regurgitation (17% vs 10%) and dysphagia (10% vs 2%) was significantly higher in patients with EA (P < .5). Low Respiratory Symptoms-Related Quality of Life Index was found in 10 of 128 patients with EA and in 3 of 163 control subjects (P < .05). Psychosocial survey scores and the incidence of acquired diseases did not differ between the groups (P = NS). The 36-item Health Survey Form indicated low HRQoL in 19 (15%) of patients with EA (expected value, 16%). Of the 19 patients with EA with low HRQoL, 8 (42%) had significant congenital or EA-associated diseases and 11 (58%) had acquired diseases. The type of EA or esophageal conduit was not related to HRQoL.

Conclusions

Most adult survivors of EA or TEF repair have a normal quality of life. Morbidity from esophageal functional disorders and respiratory disorders with or without acquired diseases impairs HRQoL in 15% of patients with EA.