社区护理干预对老年高血压患者生活质量影响研究

目的：探讨社区护理干预对老年高血压患者生活质量影响。方法：将167例老年高血压患者按照护理方法分为对照组（n=83）与观察组（n=84）,分别采用常规护理与社区护理干预。比较两组患者护理前后生活质量。结果：观察组患者护理后SF-36生活量表中PF、BP、GH、SF、RE及MH评分均显著高于护理前（P＜0.05）,但对照组患者护理前后SF-36生活量表各维度评分差异均无统计学意义（P＞0.05）。结论：社区护理干预能够有效改善老年高血压患者的生活质量,应加以推广、应用。     

护理程序在改善社区糖尿病患者血糖代谢、生活质量及满意度中的作用

目的：探讨护理程序在改善社区糖尿病患者血糖代谢、生活质量及满意度中的作用。方法：运用随机整群抽样的方法选取社区2013年1月-2014年9月收治的80例糖尿病患者,依据随机数字表法将这些患者分为研究组和对照组两组,各40例。给予对照组患者常规健康教育管理,给予研究组患者常规健康教育管理基础上的护理程序管理,然后对两组患者的血糖代谢、生活质量及满意度进行统计分析。结果：入组时两组患者的各代谢指标、DSQL量表评分和SF-36量表评分、满意度之间的差异均无统计学意义（P〉0.05）;管理1年、2年时研究组患者的体质指数、空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、总胆固醇水平、DSQL量表评分均显著低于对照组,差异有统计学意义（P〈0.05）;SF-36量表评分、满意度均显著高于对照组,差异有统计学意义（P〈0.05）。结论：护理程序能够有效改善社区糖尿病患者血糖代谢指标,提高患者的生活质量及满意度,值得在临床推广。     

医院-家庭协同无缝隙延续护理对老年冠心病PCI患者心理状态、自我管理水平及生活质量的影响

探讨医院-家庭协同无缝隙延续护理对老年冠心病经皮冠状动脉介入治疗（PCI）患者心理状态、自我管理水平及生活质量的影响。方法 选取2018年10月—2020年2月在南阳市某三甲医院接受PCI治疗的148例老年冠心病患者为研究对象，采用随机数字表法将患者分为对照组（n=74例）和观察组（n=74例）。对照组患者给予常规护理，观察组患者在对照组护理基础上给予医院 家庭协同无缝隙延续护理。比较2组患者术中不良反应发生情况；比较2组患者入院、出院及出院3个月时的心理状态[汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）]、生活质量[明尼苏达心力衰竭生活质量量表（MLHFQ）]及自我管理水平[自我管理行为量表(CSMS)]。结果 对照组患者术中发生不良反应41例，不良反应发生率为55.41%。观察组患者术中发生不良反应14例，不良反应发生率为18.92%。观察组患者术中不良反应发生率低于对照组，差异有统计学意义（P＜0.05）。入院时，2组患者HAMA、HAMD、MLHFQ、CSMS评分比较，差异均无统计学意义（P＞0.05）。出院及出院3个月时，观察组患者HAMA、HAMD、MLHFQ评分均明显低于对照组，差异有统计学意义（P＜0.05）。出院及出院3个月时，观察组患者CSMS评分均明显高于对照组，差异有统计学意义（P＜0.05）。结论 医院-家庭协同无缝隙延续护理可有效改善老年冠心病PCI患者负性情绪，降低术中不良反应发生率，提升患者生活质量及自我管理水平。     

经皮冠状动脉介入治疗对冠心病患者生活质量的影响

目的应用普适性量表-医学结局研究简短量表（SF-8）和冠心病专用量表-西雅图心绞痛调查问卷（SAQ）评价经皮冠状动脉介入治疗（PCI）对冠心病患者生活质量的影响。方法以PCI治疗成功病例171例和同期接受单纯药物治疗的冠心病患者198例为对象，采用回顾性问卷调查的方式调查患者在入院前1天、出院后第1天以及患者出院后第6个月的生活质量。结果PCI治疗组患者的生活质量为出院后6个月〉出院前〉入院前（P〈0.05）；药物治疗组患者的生活质量为出院后6个月〉出院前〉入院前（P〈0.05）；PCI治疗组患者生活质量变化幅度高于药物治疗组患者的生活质量变化幅度。结论PCI手术可以显著提高冠心病患者的住院期间和出院后近期的生活质量。     

乳腺癌患者术后社区康复状况调查与需求分析

目的了解乳腺癌患者术后什区康复状况及影响因素，探索社区卫生服务对乳腺癌患者术后社区康复的干预方法。方法选择老西门街道189名乳腺癌术后患者作为对象。分别从日常生活能力（ADL）、生存质量测评（WHOQOL-BREF）、症状自评（SCL-90）、肢体测量4个方面开展调查评估。结果社区乳腺癌患者术后肢体康复情况好，生活功能无影响．但心理康复不理想。结论社区卫生服务应注重生理-社会-心理的医学模式，重视并提供乳腺癌术后患者神区心理康复的十预、支持作用．以利患者真正尽早回归神会，提高生存、生活质量。     

社区护理对长期卧床患者压疮的疗效观察

目的探讨社区护理对长期卧床患者压疮的疗效观察。方法选取2013年4月-2015年2月广州市某社区卫生服务中心的长期卧床患者100例,随机分为观察组和对照组,每组50例。对照组患者给予常规的出院健康教育指导,观察组患者在对照组基础上给予社区护理。比较2组患者的压疮发生情况、护理满意度及生活质量。结果护理干预后,观察组患者压疮发生率为6.0%,明显低于对照组的20.0%,差异有统计学意义(χ2=4.33,P0.05);观察组患者的护理满意度评分为98.36±2.53,明显高于对照组的93.41±2.14,差异有统计学意义(t=5.24,P0.05);2组患者SF-36量表各维度得分均高于护理前,且观察组患者SF-36量表各维度得分均高于对照组,差异有统计学意义(P0.05)。结论社区护理干预能有效降低社区长期卧床患者的压疮发生率,提高患者的生活质量。     

医疗联合体荔湾模式探索与研究

目的探索医疗联合体的建立及运行模式。方法自2013年广州市荔湾区社区卫生服务机构与附近二、三级医院建立医疗联合体,比较医联体实施前后的社区卫生服务中心门诊人次、培训次数和社区居民的满意度。结果实行医联体后,社区卫生服务中心门诊人次、培训次数和社区居民的满意度明显提高。结论通过建立医联体可以有效提高社区卫生服务中心服务能力水平,确保医疗工作的质量,提高社区居民的满意度。     

支持疗法对社区老年抑郁患者生活质量的影响

目的 探讨支持疗法对社区老年抑郁患者生活质量的长期影响。方法 对用老年抑郁量表（GDS）筛选出的社区老年抑郁患者进行为期6个月的支持疗法，治疗结束后，用健康调查问卷（SF-36）调查患者生活质量。结果 研究组患者生活质量的情感职能（RE）、活力（VT）、心理功能（MH）、社会功能（SF）维度分数显著高于对照组患者。结论 支持疗法针对性强，形式合理，适用于社区的老年心理卫生保健。     

冠脉狭窄PCI术后应用延续性护理的效果

目的 分析接受经皮冠状动脉介入术（PCI）的冠脉狭窄患者进行延续性护理的效果，为临床提供参考借鉴。方法将2017年1月—2018年1月天津市蓟州区人民医院收治的120例接受PCI的患者作为研究对象，按照随机数字表法将其分为对照组和观察组，每组各60例。对照组采用常规护理，观察组在对照组的基础上采用延续性护理。观察两组患者在出院后生活质量评分以及冠脉狭窄自我管理行为量表评分（CSMS）。结果 观察组患者躯体活动受限程度、心绞痛稳定程度、心绞痛发作情况、治疗满意度、疾病认知程度评分优于对照组，差异均有统计学意义（P<0.05）。两组患者出院时CSMC评分，差异无统计学意义（P>0.05）。观察组患者出院后6个月、出院后1年的CSMS评分为（75.14±15.56）分和（96.45±38.55）分，优于对照组的（65.91±18.23）分和（71.06±29.75）分，差异均有统计学意义（P<0.05）。结论冠脉狭窄患者在PCI治疗后给予延续性护理，可提高对疾病的认知功能，增强其自我管理能力，以获得良好的预后，值得临床应用推广。     

医护一体化护理在冠心病PCI术后护理中的应用

探讨医护一体化护理在冠心病经皮冠状动脉介入手术（PCI）术后护理中的应用效果。方法 选取2018年6月-2019年6月辽宁省某医院收治的90例行PCI治疗的冠心病患者,采用随机数字表法分为一体化组与对照组,每组45例。对照组患者术后采用常规护理,一体化组患者术后采用医护一体化护理,术后随访1年。比较2组患者护理干预前后自我管理能力,血压、血糖及血脂水平,生活质量,术后1年药物服药达标率,支架狭窄及主要不良心脏事件发生情况。 结果 一体化组患者护理干预后冠心病自我管理行为量表（CSMS）各维度得分及总分高于护理干预前且高于对照组,差异均有统计学意义（P<0.05）。一体化组患者术后1年降糖药物服药达标率高于对照组,差异有统计学意义（P<0.05）。一体化组患者护理干预后收缩压、舒张压及总胆固醇水平均低于干预前且低于对照组,差异均有统计学意义（P<0.05）。一体化组患者护理干预后生存质量简表（SF 36）中生理机能、生理职能、活力、社会功能、情感职能、精神健康及一般健康状况维度得分高于护理干预前且高于对照组,差异均有统计学意义（P<0.05）;2组患者护理干预后SF 36量表中躯体疼痛维度得分低于护理干预前且一体化组低于对照组,差异均有统计学意义（P<0.05）。对照组患者术后1年心绞痛复发率高于一体化组,差异有统计学意义（P<0.05）。结论 医护一体化护理能有效建立冠心病患者PCI术后的自我护理意识,提高其疾病自我管理能力,有助于减少术后不良心血管事件发生风险。     

老年冠心病PCI术后患者心理弹性与自我管理行为相关性研究

目的 研究老年冠心病PCI(percutaneous transluminal coronary intervention)术后患者心理弹性与自我管理行为的相关性,为提升患者自我管理行为干预措施的制订提供参考。方法 采用分层随机方法抽取在本院接受PCI手术的老年冠心病患者185例,采用一般资料调查表、心理弹性量表(CD-RISC)、冠心病自我管理行为量表(CSMS)对研究对象进行问卷调查,评价其心理弹性水平和冠心病自我管理行为,并分析两者相关性。结果 185例冠心病PCI术后老年患者CD-RISC总分为(69.24±10.35)分,其中自强维度条目均分最高(2.91±0.48)分,其次为坚韧与控制(2.74±0.39)分、乐观(2.58±0.37)分;CSMS量表总分为(71.57±11.74)分,其中日常生活管理行为维度条目均分最高(2.79±0.36)分,其次为疾病医学管理行为(2.71±0.35)分、情绪管理行为(2.31±0.29)分。Pearson相关性分析显示,老年冠心病PCI术后患者心理弹性与自我管理行为呈正相关(r=0.792,P＜0.001)。结论 老年冠心病PCI术后患者心理弹性及自我管理行为能力较差,心理弹性与自我管理行为呈正相关关系,临床应重视该类患者心理干预,提升其自我管理行为。     

电话加短信随访对冠心病患者生活质量的影响

目的 探讨电话加短信随访对冠心病患者生活质量的影响。 方法 选择某医院心内科2012年4月1日-12月31日住院冠心病患者160例,随机分入干预组和对照组,每组80例。所有患者住院期间按冠心病诊疗常规进行治疗护理,出院后对照组门诊随诊,干预组定期电话加短信随访,干预2年。观察患者病情控制效果,用西雅图心绞痛量表(SAQ)评定患者生活质量。 结果 在出院后1年、2年末,干预组SAQ各项目评分均显著高于对照组(P<0.001);出院后2年内,干预组再入院率、病死率和心脏事件发生率均显著低于对照组(P<0.05)。 结论 电话加短信随访有助于提高冠心病患者生活质量,有利于病情控制。     

团体活动式延续护理干预对冠心病介入治疗患者自我管理能力及生活质量的影响

目的研究团体活动式延续护理干预对冠心病介入治疗患者自我管理能力及生活质量的影响。方法98例冠心病介入治疗患者随机分为两组各49例,对照组行常规护理干预,观察组在对照组基础上实施团体活动式延续护理干预,比较两组干预前后的自我管理能力和生活质量。结果干预前,两组的CSMS评分及WHOQOL-BREF量表中各维度评分比较无统计学差异(P>0.05);干预12周后,观察组的CSMS评分及WHOQOL-BREF量表中各维度评分均显著高于对照组(P<0.05)。结论团体活动式延续护理干预可有效提高冠心病介入治疗患者的自我管理能力和生活质量。     

Is quality of life measurement likely to be a proxy for health needs assessment in patients with coronary artery disease?

Background

The identification of patients' health needs is pivotal in optimising the quality of health care, increasing patient satisfaction and directing resource allocation. Health needs are complex and not so easily evaluated as health-related quality of life (HRQL), which is becoming increasingly accepted as a means of providing a more global, patient-orientated assessment of the outcome of health care interventions than the simple medical model. The potential of HRQL as a surrogate measure of healthcare needs has not been evaluated.

Objectives and method

A generic (Short Form-12; SF-12) and a disease-specific questionnaire (Seattle Angina Questionnaire; SAQ) were tested for their potential to predict health needs in patients with acute coronary disease. A wide range of healthcare needs were determined using a questionnaire specifically developed for this purpose.

Results

With the exception of information needs, healthcare needs were highly correlated with health-related quality of life. Patients with limited enjoyment of personal interests, weak financial situation, greater dependency on others to access health services, and dissatisfaction with accommodation reported poorer HRQL (SF-12: p < 0.001; SAQ: p < 0.01). Difficulties with mobility, aids to daily living and activities requiring assistance from someone else were strongly associated with both generic and disease-specific questionnaires (SF-12: r = 0.46-0.55, p < 0.01; SAQ: r = 0.53-0.65, p < 0.001). Variables relating to quality of care and health services were more highly correlated with SAQ components (r = 0.33-0.59) than with SF-12 (r = 0.07-0.33). Overall, the disease-specific Seattle Angina Questionnaire was superior to the generic Short Form-12 in detecting healthcare needs in patients with coronary disease. Receiver-operator curves supported the sensitivity of HRQL tools in detecting health needs.

Conclusion

Healthcare needs are complex and developing suitable questionnaires to measure these is difficult and time-consuming. Without a satisfactory means of measuring these needs, the extent to which disease impacts on health will continue to be underestimated. Further investigation on larger populations is warranted but HRQL tools appear to be a reasonable proxy for healthcare needs, as they identify the majority of needs in patients with coronary disease, an observation not previously reported in this patient group.

     

Responsiveness of the coronary revascularisation outcome questionnaire compared with the SF-36 and Seattle Angina Questionnaire

We describe a comparison of the responsiveness of three validated instruments when used with patients undergoing coronary bypass surgery (CABG) and angioplasty (PTCA). Patients were randomly selected to receive the Coronary Revascularisation Outcome Questionnaire (CROQ), and either the Seattle Angina Questionnaire (SAQ), or the SF-36 before and 3 months after coronary revascularisation. At total of 199 patients (127 CABG, 72 PTCA) completed the CROQ; 55/72 CABG and 34/38 PTCA patients also completed the SAQ or SF-36, respectively. Effect sizes and standardised response means were calculated as change over the 3-month period for scales measuring similar constructs on each instrument. We used bootstrap estimation to derive 95% confidence intervals for differences in the responsiveness indices. For CABG, the CROQ demonstrated significantly greater change in psychosocial functioning than the SF-36, but less than the SAQ. For PTCA, the CROQ showed greater change for symptoms than the SAQ, but the SAQ was more responsive in terms of physical functioning; and the CROQ showed significantly greater change than the SF-36 for psychosocial functioning. There were no other significant differences between similar scales on the three instruments. In conclusion, the CROQ was as responsive as the disease-specific SAQ and more responsive than the generic SF-36.     

Health-related quality of life in patients with coronary artery disease treated for angina: Validity and reliability of German translations of two specific questionnaires

The German versions of two patient-perceived heart disease specific health-related quality of life (HRQL) questionnaires, the Seattle Angina Questionnaire (SAQ) and the MacNew Heart Disease questionnaire, were examined for their psychometric properties in patients with angiographically documented coronary artery disease and angina who were treated either medically or invasively and followed up for 1 year. Both HRQL questionnaires and the modified Canadian Cardiovascular Society (CCS) angina-associated disability scale were completed by 158 patients at baseline and 12 months later when they also completed a generic health status questionnaire, the SF-36. Both specific HRQL questionnaires were acceptable to patients. Three of the four MacNew scales, but none of the SAQ scales, discriminated between patients by baseline CCS disability levels I and IV. Internal consistency ranged from 0.75 to 0.94 for the SAQ and from 0.86 to 0.97 for the MacNew scales. Test–retest reliability over a 4-week period of time ranged from 0.45 to 0.81 for the SAQ scales and 0.61 to 0.68 for the MacNew scales. Over 12 months, HRQL improved (p > 0.001) on three of the five SAQ and on all four of the MacNew scales with the responsiveness statistic ranging from 0.59 to 1.55 for the SAQ and 0.86 to 1.12 for the MacNew. The 12 month scores on all SAQ and MacNew scales were significantly higher in patients who improved than those who deteriorated on the SF-36 reported health transition question. We conclude that the SAQ and the MacNew are both valid, reliable, and responsive in German, that the MacNew discriminates better between angina grades at baseline, that HRQL improves over 12 months with both measures, that the SAQ angina frequency and disease perception scales have the largest effect sizes, and that the 12-month change in HRQL with both instruments was associated with change in SF-36 reported health transition status.     

Reliability and validity of the Norwegian translation of the Seattle Angina Questionnaire following myocardial infarction

The aim of this study was to validate the Norwegian version of the Seattle Angina Questionnaire (SAQ), a self-administered 19-item questionnaire designed to assess health-related quality of life in patients with chest pain or coronary artery disease. In 885 patients with prior myocardial infarction (MI), we abstracted clinical data from the patients medical records. Two to three years after the MI, we mailed a self-administered questionnaire including the SAQ, the Short Form 36 (SF-36), and questions about current medication, to the 548 patients still alive. The response rate was 74%. Internal consistency reliability of the SAQ, assessed with Cronbachs , ranged 0.75–0.92. Test–retest reliability, tested with an intraclass correlation coefficient, ranged 0.29–0.84. The pattern of association between similar and dissimilar scales of the SAQ and SF-36 mainly supported the construct validity of the SAQ. Four of the five SAQ scales discriminated between patients with different medication regimens as a proxy for severity of angina pectoris. We conclude that the Norwegian version of the SAQ showed acceptable reliability and cross-sectional validity following MI, with properties in line with the original US version.     

Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program

Objective  The aim of this study was to evaluate the impact of a home based intervention program (HBIP) on health related quality of life (HRQoL) after coronary artery bypass grafting (CABG). To strengthen the clinical interpretation, HRQoL data were compared to the general population. Methods  In a randomised controlled trial (RCT), a total of 185 CABG patients (93 vs 92) completed the study. The intervention group received a HBIP 2 and 4 weeks after surgery. HRQoL was measured by the Seattle Angina Questionnaire (SAQ) and the Short Form 36 (SF-36) in both patient groups before surgery, at 6 weeks and 6 months after surgery. Results  Significant improvements were found in both groups for the majority of subscales of HRQoL at 6-week and 6-month follow-up. However, these improvements did not differ significantly between the groups. Compared to the general population, significant differences (P < 0.05) were found for the SF-36 subscales: role physical, role emotional and bodily pain. Conclusions  HRQoL after CABG improved markedly over time, but no significant or clinically important differences were found when compared with controls. Thus, work to further develop and test the effect of a HBIP on HRQoL in patients undergoing rehabilitation following CABG is warranted.     

介入治疗对老年冠状动脉粥样硬化性心脏病的疗效

目的分析经皮冠状动脉介入治疗对老年冠状动脉粥样硬化性心脏病的效果。方法入组本院2018年1月-2019年1月收治的老年冠状动脉粥样硬化性心脏病患者共70例,随机分组,对照组的患者采用药物治疗,观察组则在对照组的基础上增加经皮冠状动脉介入治疗。比较两组纽约心功能分级降低两级时间、治疗后患者心功能左心室射血分数、左心室短轴缩短水平、室壁运动积分、左室舒张收缩末期最大内径;比较治疗后患者的西雅图心绞痛量表(Seattle angina questionnaire,SAQ)各项生存质量评分;比较治疗后的血清学炎症因子C反应蛋白以及白细胞介素-2;治疗总有效率。结果观察组纽约心功能分级降低两级时间、治疗后患者心功能左心室射血分数、左心室短轴缩短水平、室壁运动积分、左室舒张收缩末期最大内径、西雅图心绞痛量表(SAQ)各项生存质量评分、血清学炎症因子C反应蛋白以及白细胞介素-2、治疗总有效率均优于对照组,P<0.05。结论经皮冠状动脉介入治疗对于老年冠状动脉粥样硬化性心脏病的治疗效果确切,可有效改善血清学指标和改善患者心功能,促进患者生存质量提高。