PRECEDE-PROCEED模式在护理评估中的应用

PRECEDE-PROCEED模式在指导健康促进的临床、教育及科研工作中起着至关重要的作用。以“提高社区老龄糖尿病人群的生活质量”为例,从该模式的产生、模式评估步骤分析及模式的应用方面,详细分析了PRECEDE-PROCEED模式的结构及其在护理评估中的应用,为护理同行了解PRECEDE-PROCEED模式提供帮助。     

PRECEDE-PROCEED模式健康教育对养老护理员关于老年期痴呆患者护理知信行的干预效果分析

目的 分析PRECEDE-PROCEED模式健康教育对养老护理员关于老年期痴呆(痴呆)患者护理知识、信念、行为的影响.方法 随机抽取某养老机构的104位护理员作为实验组,另抽取其他养老机构的101位护理员作为对照组,分别给予PRECEDE-PROCEED模式和普通模式健康教育干预,并于干预前后对他们进行痴呆护理的知信行调查评估.结果 实验组经过PRECEDE-PROCEED模式干预后,护理员的痴呆护理知识、信念、行为方面均较干预前具有显著改变和提高,与对照组比较,行为方面得分差异有统计学意义(P＜0.05).结论 PRECEDE-PROCEED模式的护理健康教育,能有效提高养老护理员的护理水平,有助于进一步提高老年痴呆患者的生活质量.     

“格林模式”在产后女性盆底肌修复健康教育中的应用效果

目的探讨"格林模式"(PRECEDE-PROCEED模式)在产后女性盆底肌修复的健康教育中的应用效果。方法选取2020年1—12月产后修复中心进行盆底肌恢复患者40例,按组间基本特征匹配原则分为对照组和观察组,每组20例。对照组采用常规健康教育方法;观察组在对照组的基础上采用PRECEDEPROCEED模式改善健康教育方法。初次检查后,对两组产后女性均定期(每个月)采用问卷调查(微信追踪)的形式回访,以两组产妇干预后4个月肌力恢复情况作为评价指标。结果采用PRECEDE-PROCEED模式后,观察组产后女性盆底肌修复影响因素评估得分高于对照组,差异有统计学意义(P<0.05)。实施健康教育前,两组盆底肌肌力比较,差异无统计学意义(P>0.05);采用PRECEDE-PROCEED模式4个月后,两组盆底肌肌力均明显恢复,但观察组肌力评级优于对照组,差异有统计学意义(P<0.05)。结论与常规护理健康教育方法相比,应用PRECEDE-PROCEED模式对产后女性进行健康教育,能够显著提高其对疾病的认知及盆底肌修复效果,具有较大的临床应用推广意义。     

基于PRECEDE－PROCEED模式的健康宣教对肾结石患者术后健康行为及疾病知识掌握度的影响

目的探讨基于格林(PRECEDE-PROCEED)模式的健康宣教对肾结石患者术后健康行为及疾病知识掌握度的影响。方法收集2019年10月至2020年9月厦门大学附属第一医院160例肾结石患者术后临床资料进行回顾性分析, 开展病例对照研究, 根据建档顺序分为对照组(n=80)和研究组(n=80)。对照组予以常规护理, 研究组在常规护理基础上予以基于PRECEDE-PROCEED模式的健康宣教, 统计比较两组干预前后健康行为、自我护理能力及疾病知识掌握度、护理满意度。结果研究组肾结石病因、肾结石预防、肾结石术后饮食、肾结石术后活动评分较对照组高, 差异有统计学意义(P<0.05);干预后研究组健康责任、体育运动、营养评分较对照组高, 差异有统计学意义(P<0.05);干预后研究组自我护理能力量表各维度评分较对照组高(P<0.05);研究组服务质量量表各维度评分较对照组高, 差异有统计学意义(P<0.05)。结论基于PRECEDE-PROCEED模式的健康宣教可提高肾结石患者疾病认知及自我护理能力, 有助于患者保持健康行为, 对护理满意度较高。     

PRECEDE-PROCEED模式的健康教育对直肠癌术后永久性结肠造口患者自护能力及生活质量的影响

目的:探究PRECEDE-PROCEED模式(格林模式)的健康教育对直肠癌术后永久性结肠造口患者自护能力及生活质量的影响。方法:选取我院2016年10月～2018年1月直肠癌术后永久性结肠造口患者74例,随机数字表法分为对照组(n=37)与观察组(n=37)。均行腹会阴切除、永久性乙状结肠末端造口术,对照组给予常规健康教育;观察组给予PRECEDE-PROCEED模式的健康教育。对比两组护理前后ESCA(自护能力测定量表)评分、SF-36(生活质量调查表)评分。结果:护理后观察组ESCA各维度(自我概念、健康知识水平、自我责任感、自我护理技巧)评分高于对照组(P0.05);护理后观察组SF-36评分与对照组相比,明显升高(P0.05)。结论:PRECEDE-PROCEED模式的健康教育应用于直肠癌术后永久性结肠造口患者,可提高其自护能力与生活质量。     

PRECEDE-PROCEED模式健康教育在高热惊厥患儿家属中的应用

目的探讨PRECEDE-PROCEED模式健康教育在高热惊厥患儿家属中的应用效果.方法将86例高热惊厥患儿及86名家属按照患儿入院顺序分为观察组与对照组,每组患儿43例,家属43名.对照组家属实施常规健康教育,在此基础上观察组家属施以PRECEDE-PROCEED模式健康教育,出院后随访1个月.采用疾病知识评价问卷评定患儿家属健康知识掌握情况,焦虑自评量表、抑郁自评量表评定患儿家属焦虑、抑郁情绪,由责任护士对患儿治疗期间家属配合情况进行评估,随时记录患儿退热时间、止惊时间及随访期间惊厥复发次数,采用满意度评价问卷评定患儿家属护理满意度.结果干预后观察组患儿家属疼病知识评价问卷各维度评分均显著高于对照组(P<0.01);焦虑自评量表、抑郁自评量表评分均显著低于对照组(P<0.05或0.01);患儿家属配合度(93.0%)、护理满意度(95.3%)显著高于对照组(76.7%、74.4%)(P<0.05或0.01);两组患儿退热、止惊时间比较差异无统计学意义(P>0.05),但观察组患儿复发次数显著少于对照组(P<0.01).结论对高热惊厥患儿家属进行PRECEDE-PROCEED模式健康教育,能有效缓解其焦虑抑郁情绪,提高对相关健康知识的掌握程度、临床工作配合度、护理满意度,有利于降低患儿惊厥复发率.     

我国城市空巢老人安全现状评估及对策

利用PRECEDE-PROCEED模式对我国城市空巢老人的安全状况从社会学、流行病学、行为环境、教育组织和管理政策五个方面进行了评估,并针对空巢老人目前存在的安全问题提出了相应的对策。     

我国城市空巢老人安全现状评估及对策

利用PRECEDE-PROCEED模式对我国城市空巢老人的安全状况从社会学、流行病学、行为环境、教育组织和管理政策五个方面进行了评估,并针对空巢老人目前存在的安全问题提出了相应的对策。     

PRECEDE-PROCEED模式对全髋关节置换患者生活行为的效果

目的 探讨PRECEDE-PROCEED模式对全髋关节置换患者健康行为和生活质量的干预效果。 方法 选择2018年2月至9月行初次人工全髋关节置换术的103例患者,分为对照组(n = 51)和干预组(n = 52)。对照组进行常规围手术期指导,干预组在此基础上实施PRECEDE-PROCEED模式,按照模式9个环节,以倾向因素、促成因素和强化因素为核心,围绕健康行为6个方面多维度制定干预措施。出院后随访6个月,分别在第1、3、6个月时采用健康促进生活方式量表Ⅱ(HPLP II)和健康调查简表(SF-36)进行评估。 结果 两组出院时HPLP II和SF-36评分均无显著性差异(P > 0.05)。术后1、3和6个月,干预组HPLP II和SF-36评分均高于对照组( t > 2.307, P< 0.05)。 结论 PRECEDE-PROCEED模式可改变全髋关节置换患者术后不良的生活行为,提高健康行为水平和生活质量。     

PRECEDE-PROCEED健康教育模式在慢性心力衰竭患者中的应用

目的 探讨PRECEDE-PROCEED健康教育模式在慢性心力衰竭患者中的应用效果。方法 选取2021年1月—2022年1月医院收治的慢性心力衰竭患者80例为研究对象,按组间基本特征具有可比性的原则分为对照组和观察组,每组40例。对照组患者采取常规健康教育护理干预,观察组患者实施PRECEDE-PROCEED模式健康教育护理干预,出院后进行为期24周的随访观察。比较两组患者干预前后心功能[美国纽约心脏病协会（NYHA）分级标准分为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级]、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）评分、6 min步行距离（6MWT）、心力衰竭自我护理指数量表（SCHFI）及明尼苏达心力衰竭生活质量量表（MLHFQ）评分。结果 健康教育前,两组慢性心力衰竭患者心功能、SAS与SDS评分、6 min步行距离、自我护理能力与生活质量量表评分的比较,差异无统计学意义（P>0.05）。健康教育后,观察组患者心功能改善情况优于对照组,SAS、SDS评分低于对照组,6MWT长于对照组,SCHFI评分高于对照组,MLHFQ评分低于对照组,组间比较差异均有统计学意义（P<0.05...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.