重症脓毒症远期生活质量调查

目的 分析重症脓毒症患者出院2年到5年以后的生活质量,为脓毒症的治疗和康复提供参考.方法 采用前瞻性、观察性、双盲方法,随访2002年1月1日-2007年3月1日出院的重症脓毒症与非脓毒症外科危重病患者,根据纳入及排除标准,共362例进入随访计划,排除死亡、失访及拒绝的病例,最终51例纳入随访分析,采用SF-36量表对...     

经皮腰椎间盘切割术的远期疗效与生活质量分析

目的 分析经皮腰椎间盘切割术(PLD)治疗腰椎间盘突出症患者的远期疗效与生活质量,探讨影响PLD远期疗效的因素.方法 采用查阅原始病案、信函、电话与走访相结合的随访方式,对2000年1月-2002年3月在我院接受PLD治疗的129例患者进行远期随访研究.收集患者围手术期的临床资料,并对所有的患者通过Oswestry功能障碍指数(ODI)、JOA腰痛疗效评定标准以及SF-36量表进行问卷评分,对未回信者通过电话或走访进行问卷评分,使用Wilcoxon's rank sum test、Chi-square test等统计方法对随访数据进行统计学分析.结果 共随访到108例患者(随访率83.7%),有效问卷104份;平均随访期为(6.6±0.7)年,远期ODI均分为6.97分(总分45分),疗效优良率(ODI<20%)为71.2%;回信患者的JOA均分为(23.66±5.72)分(总分29分);所有患者的SF-36总均分为(75.88±25.57)分(总分100分),其中部分纬度的评分与ODI评分具有相关性;随访期内共有9例(8.3%)患者因疗效差而接受外科手术,未见与PLD相关的并发症;年龄、病程、出院时疗效等可能是影响远期疗效的因素.结论 PLD治疗腰椎间盘突出症具有创伤小、恢复快、疗效好且稳定的特点,远期疗效及生活质量受较多因素的影响.     

Global and region-specific patient-reported outcomes pre and post a division I football season

ObjectiveDetermine the change in global and region-specific PROMs among athletes from one NCAA Division I football team during one season.DesignProspective cross-sectional study.SettingAthletic training facility.Patients or other participantsFifty-three Division I collegiate football athletes (n = 54) were eligible (20.1 ± 1.4 years, 187.7 ± 8.3 cm, and 113.5 ± 25.6 kg) for analyses. Participants completed five PROMs (Disablement in the Physically Active Scale [DPA], Epworth Sleep Score [ESS], Headache Impact Test [Hit-6], Disabilities of the Arm, Shoulder, and Hand [DASH], and the Lower Extremity Functional Scale [LEFS]) before the season and the same five PROMs after the season.Main outcome measuresA multivariate repeated measure analysis of variance (ANOVA) was conducted for all dependent variables. Alpha level was set at ɑ = 0.05.ResultsThe overall multivariate repeated measures ANOVA was significant for time (p = 0.01). Follow up one-way ANOVA’s indicated the DPA (p < 0.01, mean decrease/worse of 6.6 points) and LEFS (p = 0.01, mean decrease/worse of 4.1 points) were statistically significant between time points.ConclusionDivision I football can be detrimental to the physical, mental, and emotional health of the athletes. From these data, global and one region-specific PROM decreased over one season in one NCAA Division I football team.     

创伤性颅脑损伤患者的长期预后研究

目的 探讨中重度创伤性颅脑损伤 （ traumatic brain injury, TBI）患者康复治疗出院后的长期预后，以及癫痫对长期预后的影响。方法 对102例康复治疗出院的中重度TBI患者进行随访研究。结果 死亡率为2．0％，不良预后发生率为16．7％，继发癫痫者占33．3％。功能独立性程度和就业状况比例失衡。继发癫痫组在GOS、残疾等级量表功能部分（DRS—F）、就业部分（DRS—E）等级和生存质量指数（QLI）评分上与无癫痫组比较，差异均有统计学意义（P〈0．05），继发癫痫者的长期预后相对更差。经Pearson相关性分析，GOS与DRS—F、DRS—E、QLI评分之间的相关性均达到显著性水平。结论　康复治疗后的中重度TBI患者远期死亡率为2．0％，再就业率低，癫痫对远期生活质量有显著影响。应规范TBI急性期和亚急性期的康复体系，为大样本长期预后研究打下基础。     

多种膳食纤维配伍改善便秘的效果

目的 探讨多种膳食纤维配伍改善功能性便秘的效果.方法 对30例功能性便秘患者采用自身对照试验方法,每天早晚冲服10 g多种膳食纤维组成的固体饮料,连续15 d.通过观察患者排便困难程度、粪便性状、排便不尽感、排便频率、腹胀改善情况和生活质量量表评分,了解膳食纤维改善便秘的效果.结果 服用8 d后,排便频率、粪便性状、排便不尽感、排便困难差异有统计学意义.服用15 d后,显效者占90%,有效率达96.67%,但随访1个月后,有效率下降为16.67%.结论 多种膳食纤维配伍的固体饮料改善功能性便秘作用确切,服用方便,依从性良好.     

Dose-response relationship of active commuting to work: Results of the GISMO study

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT —the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or “Delta” Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.     

骨质疏松症的生命质量研究现状

生命质量是近年来发展起来的一种全新的医学概念,正逐渐替代疾病的传统评价指标.随着人口的老龄化进程加快,骨质疏松症性椎体压缩骨折的发病率也在逐年升高,椎体成形术是其主要治疗手段.生活质量的评价已成为椎体成形术治疗骨质疏松性椎体压缩骨折的主要热点.本文介绍了生命质量的概况,着重阐述了其在骨质疏松症领域及在椎体成形治疗方面的研究方法和现状.     

早期低剂量腹膜透析对改善尿毒症患者生活质量的价值

目的探讨早期低剂量腹膜透析治疗尿毒症患者的疗效。方法选择2007年3月-2010年2月慢性肾功能不全患者38例,分为两组:腹透组(n=19):接受常规药物治疗,并予间歇性腹膜透析,每日4000～6000ml,每周4～5d;对照组(n=19):接受常规药物治疗。随访24周。所有患者在治疗前、后采用症状频率和严重指数、SF-36生活质量量表对临床症状、生活质量进行评价,并监测血常规、肝肾功能、血糖、电解质及尿量。结果腹透组血红蛋白、血肌酐均较对照组明显改善。腹透组患者临床症状评分治疗前为11.80±5.41,治疗后第8周和第12周时分别降低至7.15±3.15(P<0.05)和5.94±3.70(P<0.01),对照组在治疗前、治疗后第8周和第12周时评分分别为11.23±5.35、9.80±4.02和10.11±4.48。两组间的差异持续至随访期结束。腹透组患者生活质量明显改善。结论早期低剂量腹膜透析可有效改善尿毒症患者临床症状和生活质量。     

血运重建对非ST段抬高急性冠脉综合征患者生活质量的影响

目的探讨血运重建对非ST段抬高急性冠脉综合征(NSTE-ACS)患者生活质量的影响。方法将559例NSTE-ACS患者分为完全血运重建组(完全介入治疗组、冠脉搭桥手术组)、不完全血运重建组(不完全介入治疗组)、单纯药物治疗组,通过SF-36生活质量量表随访2年患者的生活质量变化。结果 (1)经过2年的随访调查,发生重大心血管事件的有111例。(2)在SF-36量表中的各个维度改善情况显示,单纯药物治疗组对各个维度的改善率普遍偏低,且与其他三组相比,差异有统计学意义(P<0.01或P<0.05);而在躯体疼痛、社会功能、情感职能、精神健康、健康变化5个维度中,完全介入治疗组改善率优于冠脉搭桥手术组(P<0.05)。结论完全冠状动脉血运重建可显著改善NSTE-ACS患者远期的生活质量,完全介入治疗对躯体疼痛的改善率最高;冠状动脉搭桥对生理职能改善率最高。     

Condition-specific health-related quality of life amongst amateur athletes six months and one-year following sport-related concussion: A prospective,follow-up

ObjectiveTo prospectively investigate the condition-specific health-related quality of life (HRQoL) of athletes six months and one-year following sport-related concussion.DesignProspective, longitudinal study.SettingClinical research centre at university school of public health.ParticipantsAmateur athletes who were diagnosed with sport-related concussion within one-week after presenting to a hospital emergency department were recruited along with sex-, age-, and activity-matched, non-concussed, control athletes. Concussion and control participants were assessed six months and one-year following sport-related concussion and study enrolment, respectively.Main outcome measuresParticipants completed the Post-Concussion Symptom Scale and five condition-specific HRQoL patient-reported outcome measures – Headache Impact Test-6, Fatigue Severity Scale, Neck Disability Index, Generalised Anxiety Disorder-7, and Dizziness Handicap Inventory. We performed Frequentist and Bayesian mixed-design analyses of variance to compare the concussion group and control group at both assessments and quantify whether there was greater evidence in favour of the null hypothesis compared with the alternative hypothesis.ResultsAt six-month and one-year assessments, the concussion group (n = 47; male = 72%; mean (SD) age = 22.68 (5.07)) and the control group (n = 47; male = 72%; mean (SD) age = 23.81 (4.60)) reported similar clinical symptom severity scores and condition-specific HRQoL. The proportion of athletes in the concussion group with clinically-impaired scores was similar to the proportion of non-concussed athletes with clinically-impaired scores. At six-month and one-year assessments, there was moderate-to-very strong evidence that there was no difference between concussion and control participants’ perceptions of the effects of headache, fatigue, neck pain, anxiety, and dizziness on HRQoL.ConclusionThere was moderate-to-very strong evidence in favour of no difference between the concussion and control groups on symptom severity scores and condition-specific HRQoL patient-reported outcome measures at six-month and one-year assessments. These results suggest that condition-specific HRQoL returns to the levels of non-concussed individuals within six months following sport-related concussion.     

4502名军队离退休老干部健康状况及不良生活方式调查分析

目的分析军队离退休老干部的健康状况及影响健康的主要不良生活方式。方法纳入2008年6-12月上海、南京、青岛、杭州等4个城市的60岁以上离退休干部,采取横断面现场调查方法,指导研究对象填写老年人生活质量调查表5000份,对其生活质量进行调查与分析。结果回收有效问卷4502份,有效率90.03%;离退休老干部所患主要慢性病按检出率排列,位于前10位的分别是冠心病、高血压病、2型糖尿病、前列腺增生、慢性胃炎、脑血管意外、慢性支气管炎、肿瘤、高脂血症和白内障,其中除慢性胃炎外,其他9种疾病的患病检出率均与年龄有一定的相关性;吸烟、不坚持体育锻炼和少食水果是军队离退休老干部的主要不良生活方式。结论获得了军队部分离退休老干部健康状况的基本资料,总结出常见的10种慢性病及不良生活方式,可为进一步研究军队离退休老干部健康状况和相应的保健措施提供参考。     

恶心呕吐对妊娠妇女生活质量的影响

目的对有恶心呕吐症状的妊娠妇女生活质量进行横断面调查,分析影响生活质量的社会及躯体因素。方法 195例有恶心呕吐症状的妊娠妇女,孕6～14周,采用妊娠专用恶心呕吐量化表(PUQE)对患者症状进行量化,运用医疗结局研究量表简表SF-36及妊娠恶心呕吐生活质量量表(NVPQOL)对患者的生活质量进行评测。记录患者的人口学特征,运用多元回归分析筛选影响生活质量的社会及躯体因素。结果妊娠呕吐患者最常见的症状依次为恶心(96.4%),干呕(91.3%),呕吐(63.1%);年长及较高收入患者的症状相对比较轻。两种量表均显示,PUQE评分是影响妊娠妇女生活质量的主要因素。回归分析表明,就患者的躯体症状而言NVPQOL比SF-36更为敏感(OR分别为2.463及1.588)。结论恶心呕吐症状是引起妊娠妇女生活质量下降的主要原因,特异性量表NVPQOL用于妊娠呕吐患者生命质量的测试优于普适性量表SF-36。     

Developing a Patient-Centered Radiology Process Model

PurposeThere has been increasing interest in the process of care that patients experience. To keep step with the rest of medicine, our specialty should be designing metrics that assess the overall experience of patients seeking care in radiology departments. A recent memo from the ACR chair calls for more work in this area. The aim of this study was to develop a patient-centered model for the experience of radiologic care, which may be helpful in addressing this need.MethodsUsing principles of multiattribute utility theory and psychometric theory as well as recent literature, a model was developed for a patient-centered index that could be used in radiology facilities.ResultsA model was developed that concisely incorporates patient-centeredness of both radiologists and staff members (communication with patient and referrers, competence, and pain control) as well as patient- and process-related issues such as costs, procedural morbidity, access to care, appointment duration, waiting, timing of appointments, cleanliness of facility, and coordination with clinical services. The overall radiology process model was constructed as a set of nested models, which allow more integrated detail within the domains of patient experience.ConclusionsThis model and others like it may help the ACR develop quality metrics to reasonably quantify the patient experience.     

护理干预对血液透析病人生活质量的影响

目的：探讨护理干预对血液透析病人生活质量的影响。方法：比较护理干预前后病人营养及透析并发症的情况。结果：护理干预后38例病人的营养状况有显著改善（P〈0．05）,并发症的发生率明显下降（P〈0．05）。结论：护理干预提高了血液透析病人的生活质量。     

综合康复治疗对直肠癌Miles术后恢复期患者生存质量的影响

目的探讨综合康复治疗对直肠癌Miles术后恢复期患者生存质量的影响。方法54例直肠癌Miles术后患者,其中32例（治疗组）于术后2周始给予人工肛门综合护理、性生活指导及心理干预等康复治疗。22例（对照组）只给予人工肛门一般性护理指导。利用症状自评量表（SCL-90）、Olson婚姻质量问卷（ENRICH）分别于术后2周及6个月对二组患者生存质量进行评估。结果综合康复治疗组人际关系敏感因子分、抑郁因子分较治疗前均明显降低（P〈0.05）,性生活因子分明显升高（P〈0.05）。对照组差异无显著性（P〉0.05）。结论综合康复治疗能改善Miles术后患者的生存质量。     

系统护理干预对妇科癌症患者化疗期生活质量的影响

目的探讨系统护理干预对妇科癌症患者化疗期生活质量的影响。方法将初次接受化疗的妇科癌症患者80例随机分为干预组和对照组各40人。对照组仅采用常规护理方法，干预组在常规护理的基础上进行支持性心理治疗、健康教育放松训练、有效应对方式、家庭及社会支持等系统护理干预。结果12周后干预组生活质量综合评分显著高于对照组（P〈0.01）。焦虑抑郁评分明显低于对照组（P〈0．01）。结论系统护理干预显著提高妇科癌症患者化疗期生活质量，缓解病人焦虚抑郁水平。     

Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy

ObjectiveTo cross-culturally adapt and validate the Victorian Institute of Sports Assessment – Hamstrings (VISA-H) scale into Spanish.DesignClinical measurement study (psychometric analysis).SettingSports clubs and physiotherapy clinics.ParticipantsThe Spanish version of the VISA-H (VISA-H-Sp) scale was administered to 101 subjects: 50 healthy runners and 51 patients with a clinical diagnosis of PHT.Main measuresThe Victorian Institute of Sports Assessment – Hamstrings.ResultsCronbach's alpha for the VISA-H-Sp was >0.8. The ICC _2,1 was 0.993 (95%CI 0.991–0.995). In the exploratory factor analysis, a one-factor solution explained 72.1% of the total variance. Athletes with PHT scored significantly lower in the VISA-H-Sp than healthy subjects (P < 0.001). The VISA-H-Sp score results in the PHT group showed significant correlations with SF-36 physical components (Spearman r’>0.6; P < 0.001), and low or non-significant association with psychological dimensions. The standard error of measurement was 1.45 whereas the minimal detectable change was 4.02 points. The responsiveness indicators included an effect size of 2.75, and a standardised response mean of 3.1 at discharge.ConclusionThe VISA-H-Sp shows adequate psychometric properties for assessing the severity of symptoms in Spanish-speaking athletes who suffer from PHT.     

Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S)

ObjectiveTo cross-culturally adapt and evaluate the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S) in Chilean runners with a running-related injury.DesignCross-cultural adaptation and validation study, following the Consensus-based Standards for selecting health Measurement Instruments (COSMIN) recommendations.SettingOutpatient sports medicine clinic and running clubs.ParticipantsUWRI was forward and backward translated, and culturally adapted. Thirty-one runners participated in the content validity of the UWRI-S; and fifty-seven in the assessment of psychometric properties.Main outcome measuresRunners seeking care from a physiotherapist completed the UWRI-S (baseline and after 48–72 h for reliability), Lower Extremity Functional Scale (LEFS), Patient Specific Functional Scale (PSFS), Global Rating of Change scale (GROC), and Numeric Pain Rating Scale (NPRS).ResultsSuggestions about accuracy of wording and understanding of items were incorporated. UWRI-S showed a positive moderate correlation with LEFS (r = 0.6; p < 0.05), positive fair with GROC (r = 0.5, p < 0.05), negative fair with NPRS (r = −0.4; p < 0.05) and no correlation with PSFS (r = 0.3; p = 0.1). UWRI-S demonstrated acceptable internal consistency (α = 0.87) and test-retest reliability (ICC = 0.87).ConclusionUWRI-S is a valid and reliable measure to evaluate running ability of Chilean runners during recovery from a running-related injury.     

HDR brachytherapy boost using MR-only workflow for intermediate- and high-risk prostate cancer: 8-year results of a pilot study

PurposeTo report 8-year clinical outcome with high-dose-rate brachytherapy (HDRBT) boost using MRI-only workflow for intermediate (IR) and high-risk (HR) prostate cancer (PC) patients.Methods and MaterialsFifty-two patients were treated with 46–60 Gy of 3D conformal radiotherapy preceded and/or followed by a single dose of 8–10 Gy MRI-guided HDRBT. Interventions were performed in a 0.35 T MRI scanner. Trajectory planning, navigation, contouring, catheter reconstruction, and dose calculation were exclusively based on MRI images. Biochemical relapse-free- (BRFS), local relapse-free- (LRFS), distant metastasis-free- (DMFS), cancer-specific-(CCS) and overall survival (OS) were analyzed. Late morbidity was scored using the Common Terminology Criteria for Adverse Events (CTCAE 4.0) combined with RTOG (Radiation Therapy Oncology Group) scale for urinary toxicity and rectal urgency (RU) determined by Yeoh.ResultsMedian follow-up time was 107 (range: 19–143) months. The 8-year actuarial rates of BRFS, LRFS, DMFS, CSS and OS were 85.7%, 97%, 97.6%, and 77.6%, respectively. There were no Gr.3 GI side effects. The 8-year actuarial rate of Gr.2 proctitis was 4%. The 8-year cumulative incidence of Gr.3 GU side effects was 8%, including two urinary stenoses (5%) and one cystitis (3%). EPIC urinary and bowel scores did not change significantly over time.ConclusionsMRI-only HDR-BT boost with moderate dose escalation provides excellent 8-year disease control with a favorable toxicity profile for IRPC and HRPC patients. Our results support the clinical importance of MRI across the BT workflow.