Narrative literature review: sexual dysfunction in the patient on hemodialysis.

Sexual dysfunction is common in patients on hemodialysis. This narrative literature review utilized Roy's Adaptation Model to identify sexual dysfunction and its effect on adaptive modes in patients on hemodialysis. The majority of studies reviewed indicated a physiologic effect in men (78%). Fewer studies reported an effect on self-concept (66%), intimate relationship (21%), or family/social roles (less than 1%). Findings also revealed minimal patient expression of sexual dysfunction to health care providers.     

过渡期护理模式对慢性阻塞性肺疾病出院患者自护行为的干预效果

目的 探讨应用过渡期护理模式(Transitional Care Model,TCM)对慢性阻塞性肺疾病(COPD)出院患者自我护理行为的影响.方法 以T℃M为依据,对40例COPD出院患者进行4个月的护理干预.出院前3d及干预后4个月,采用COPD患者自我护理行为问卷评估患者的自我护理行为状况.结果干预后,COPD患者自我护理行为及各维度得分均高于干预前,差异具有统计学意义(P＜0.01).结论运用TCM为COPD出院患者提供过渡期护理,有利于提高患者的自我护理能力.     

待肾源移植透析者连续性肾脏替代治疗对顽固性高血压的影响

背景：维持性血液透析人群中有10%-49%的患者合并顽固性高血压,常规药物治疗效果差。连续性肾脏替代治疗可较好地清除患者血浆中的中、大分子毒素,理论上可通过降低相关毒素水平干预顽固性高血压形成机制。 目的：观察连续性肾脏替代治疗对维持性血液透析患者顽固性高血压的影响。 方法：45例维持性血液透析合并顽固性高血压患者,随机分为血液透析组22例与连续性血液净化组23例,血液透析组则行常规血液透析治疗,连续性肾脏替代治疗组在常规血液透析治疗基础上每周行连续性肾脏替代治疗1次。 结果与结论：治疗3个月后,连续性血液净化组肾素、内皮素、血管紧张素Ⅱ、C-反应蛋白、白细胞介素6、肿瘤坏死因子α水平均低于试验前水平,24 h平均血压下降,且差异均有显著性意义（P＜0.05）,血液透析组上述各指标较试验前无变化（P＞0.05）;试验后连续性血液净化组上述各指标均低于血液透析组,差异有显著性意义（P＜0.05）。结果显示在常规血液透析基础上行连续性肾脏替代治疗可明显降低合并顽固性高血压维持性血液透析患者的血压,其机制可能是降低了患者血浆中的中、大分子毒素以及炎症因子水平。     

糖尿病终末肾病维持性血液透析患者相关生物因子的探讨

目的 分析糖尿病终末肾病维持性血液透析患者相关生物因子的变化。方法 收集维持性血液透析患者共54例,分为耱尿病终末肾病（26例为A组）与非糖尿病终末肾病组（25例为B组）。测定血清甲状腺素、瘦素、脂联素、胰岛素等指标进行比较分析。结果 糖尿病终末肾病维持性血液透析患者与其他维持性血液透析患者血清瘦素、胰岛素、胰岛素抵抗指数、空腹血糖水平具有差异。而甲状腺素、脂联素、肌酐、尿素氮水平并无明显不同。结论 糖尿病终末肾病血液透析患者高瘦素、高胰岛素血症较其他维持性血液透析患者更为严重,且存在着胰岛素抵抗,临床中应根据维持性血液透析患者不同的病理生理特点做出针对性的治疗。     

病耻感对中青年维持性血液透析患者心理痛苦的影响

目的 探讨自尊在中青年维持性血液透析患者病耻感与心理痛苦之间的中介效应,以及家庭亲密度在其中的调节效应。方法 采用便利抽样法,利用病耻感量表、自尊量表、家庭亲密度量表及心理痛苦温度计于2021年6月—12月对福建省福州市、莆田市4所三级甲等医院382例中青年维持性血液透析患者进行调查,应用SPSS 26.0软件进行相关分析,运用PROCESS宏程序中的Model 4进行中介效应分析和Model 58进行调节效应分析。结果中青年维持性血液透析患者心理痛苦检出率为59.7%,病耻感、自尊、家庭亲密度、心理痛苦之间存在两两相关关系（均P<0.001）。自尊在病耻感与心理痛苦间起部分中介作用（β=-0.22,t=-3.85,P<0.001）,家庭亲密度调节了这一中介过程的前半路径（β=0.19,t=5.08,P<0.001）,高的家庭亲密度会减弱病耻感对自尊的影响,反之,则增强。结论 中青年维持性血液透析患者病耻感不仅能直接正向预测心理痛苦,还能通过自尊对其产生间接的影响,家庭亲密度调节了这一过程。可采取叙事家庭疗法降低患者病耻感,提高家庭亲密度,保护自尊,减轻心理痛苦。     

Factors associated with changes in nurses' emotional distress during the COVID-19 pandemic

PurposeThe purpose of this study was twofold: to assess if nurses experienced changes in emotional distress (stress, depression, and anxiety) as the number of patients infected with coronavirus disease 2019 (COVID-19) increased and if there were any sociodemographic, psychosocial, and work environmental influence on the change.MethodsUsing a repeated cross-sectional study design, we collected survey data among 198 South Dakota (SD) nurses. Data were collected in two waves, during the first 12 months of the COVID-19 pandemic in the United States (July and December 2020). Participants completed two online surveys: (a) The Depression, Anxiety, and Stress Scale (DASS-21); and (b) Change Fatigue Scale. Predictive factors were divided into three groups: sociodemographic, psychosocial, and work environment variables. Multiple linear regression models were run to estimate the factors associated with the change in DASS-21 subscale score.ResultsTotal DASS-21 score and scores for all subscales significantly increased from Survey 1 to Survey 2. Significant positive associations were found between change fatigue and workplace barriers with change in depression, anxiety, and stress scores. A linear relationship was identified between self-worry about COVID-19 risk and depression and stress and being male and young were associated with changes in depression.ConclusionsIncrease in emotional distress of nurses as the pandemic progresses is consistent with other studies. It is vital for healthcare organizations to recognize the factors associated with the changes in emotional distress and their role in decreasing the stress levels of nurses.     

左卡尼汀改善非糖尿病维持性血液透析患者胰岛素抵抗

目的探讨左卡尼汀对非糖尿病维持性血液透析(HD)患者胰岛素抵抗的影响。方法41例非糖尿病HD患者为研究对象,20例应用左卡尼汀治疗,另21例作为对照组。治疗方法为静脉注射左卡尼汀(雷卡)1.0g、每次透析结束后静脉注射,观察时间6月。观察指标包括空腹血糖、胰岛素、胰岛素抵抗指数(HOMA-IR)和炎症标志物血C反应蛋白(CRP)。结果左卡尼汀治疗6月后,治疗组和对照组空腹血糖无变化,而在治疗组空腹胰岛素和HOMA-IR明显下降,下降差值分别为-10(-35,20)vs-1(-15,20),P=0.03;(-2.8±0.6)vs(-0.4±0.5),P0.01。血CRP在治疗组明显下降,下降差值为(-5.9±1.2)vs(-0.1±0.1)(对照组),P0.01。相关分析显示,血CRP与空腹胰岛素(r=0.56,P0.01)和HOMA-IR(r=0.46,P0.05)呈正相关。结论静脉注射左卡尼汀治疗有效改善非糖尿病HD患者胰岛素抵抗,改善的胰岛素抵抗与改善炎症状态有关,我们的结果对HD患者胰岛素抵抗的治疗提供新的治疗思路。     

Palliative care in Parkinson's disease: implications for neuroscience nursing.

Parkinson's disease (PD) is a chronic, progressive neurological disease affecting 1.5 million Americans. The modern success of pharmacology and deep-brain stimulation surgery to treat the motor symptoms of tremor, rigidity, and bradykinesia provide PD patients with longer lives and increased motor functioning. However, in the moderate and advanced stages of disease, the therapeutic benefits of pharmacology diminish and motor symptoms are more complicated to treat. The nonmotor symptoms of PD receive little attention in clinical settings, although they can lead to disability and caregiver burden. The Center to Advance Palliative Care advocates applying the principles of palliative care to chronic disease. Likewise, the World Health Organization has redefined palliative care to include life-threatening illness. The Parkinson's Disease Model of Care (PDMC) takes the precepts of palliative care and presents a model for the neuroscience nurse to use in individual care planning across the trajectory of disease. The PDMC guides the nurse in providing relief from suffering for PD patients and their families, from diagnosis through bereavement, with an emphasis on advance care planning.     

Screening for symptoms of depression by physical therapists managing low back pain

BACKGROUND AND PURPOSE: Depression is a condition that worsens the prognosis of low back pain (LBP) and is under-recognized and undertreated in primary care. The purpose of this study was to evaluate the accuracy with which physical therapists screen for depressive symptoms among their patients with LBP. SUBJECTS: Sixty-eight physical therapists and 232 patients with nonspecific LBP from 40 physical therapy clinics participated. METHODS: Patients completed the reference standard (Depression Anxiety Stress Scales [DASS]) and a 2-item screening test for depression taken from the Primary Care Evaluation of Mental Disorders Procedure (PRIME-MD). Treating physical therapists used a 0 to 10 scale to judge whether each patient was depressed. Based on the short-form Depression Anxiety Stress Scales (DASS-21) depression scale score, each patient was categorized as exhibiting normal, mild, moderate, severe, or extremely severe depression symptoms, and receiver operating characteristic (ROC) curves were generated to describe test accuracy. RESULTS: The 2-item screening test was more accurate in screening for depressive symptoms than the physical therapists' ratings were; for example, in detecting moderate depressive symptoms in the 2 areas under the ROC curve, values were 0.66 versus 0.79. DISCUSSION AND CONCLUSION: Because the therapists did not accurately identify symptoms of depression, even symptoms of severe depression, despite the common presentation in their clinics, we recommend that physical therapists managing patients with LBP use the 2-item depression screening test. Administration of this screening test would improve physical therapists' ability to screen for symptoms of depression and would enable referral for appropriate management.     

Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression,anxiety, and stress levels

AimThe aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic.MethodsAn anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21).ResultsOf the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001).ConclusionIn this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.     

Continuous spinal anesthesia in very elderly patients with high anesthesia risk in traumatologic-orthopedic and general surgery interventions

Continuous spinal anaesthesia (CSA) was carried out via a 28-gauge spinal catheter in 154 surgical patients at the Department of Anaesthesiology and Critical Care at Radeberg Asklepios-ASB Hospital between May 1992 and March 1999. The method was used preferably in patients aged over 70 (mean age 82.3 years) with high general risk during anaesthesia (ASA III-IV) who underwent orthopaedic or general surgery of the lower limb and hypogastrium. Remarkably, an anaesthetic level of between Th 8 and Th 10 was achieved with the low initial dose of 7.5 mg of 0.5% hyperbaric bupivacaine. Only minimal cardiovascular and respiratory side-effects were observed in comparison to single shot spinal and general anaesthesia. In the whole series, no anaesthesia-related complications were seen. Another benefit of CSA is the option of applying a second dose with longer duration of surgery to keep the optimal anaesthetic level. In addition, the method is suitable for postoperative analgesia over a period of 2 to 3 days.     

延续性优质护理干预对肾衰竭维持性血液透析患者自我管理能力和依从性的影响

目的 分析延续性优质护理干预对肾衰竭维持性血液透析患者自我管理能力和依从性的影响。方法 选取2018年4月至2020年8月我院进行维持性血液透析的100例肾衰竭患者作为研究对象,根据随机数字表法将其分为对照组与观察组,各50例。对照组给予常规护理干预,观察组给予延续性优质护理干预。比较两组患者的干预效果。结果护理后,两组的SAS、SDS评分、Scr、BUN水平均降低,GSES评分升高,且观察组优于对照组（P<0.05）。观察组的依从性、自我管理能力各项评分均高于对照组（P<0.05）。结论 延续性优质护理干预对肾衰竭维持性血液透析患者的护理效果显著,能有效改善患者的心理状态,降低Scr、BUN水平,提高其依从性和自我管理能力。     

The Role of Rehabilitation Professionals in Care Transitions for Older Adults: A Scoping Review

Abstract

Aim: To identify existing theories and conceptual models that inform care transition interventions and to explore whether the role of rehabilitation professionals is explicitly stated or implied in these theories and models.

Methods: We searched multiple databases and included articles published from 2000 to 2018, with distinct mention of care transitions of older adults (>65 years) from one care setting to another.

Result: Two theories (Middle Range Theory and System of Care Philosophy), and six conceptual models (Coleman’s Model, 4Cs of Transitional Model, Quality Cost Model of Advanced Practice Nurses Transitional Care, Health Belief Model, Care Transition Framework, Ideal Transition in Care) were identified in 13 of the 21 articles; however, only one conceptual model in an opinion paper illustrated the role of a physiotherapist in care transition.

Conclusion: Most of the models, frameworks and theories that inform care transition interventions did not explicitly consider the role of RPs.     

连续性血液净化治疗危重症46例临床分析

目的 :回顾性分析连续性血液净化治疗重症急性肾功能衰竭和多脏器功能衰竭的疗效和影响预后的因素。方法 :46例连续性血液净化治疗病例均来自我院加强治疗科 1995年以来接受连续性血液净化治疗的病人。应用连续性动 静脉血液滤过 2例 ,连续性静 静脉血液滤过 8例 ,连续性动 静脉血液透析滤过 2例 ,连续性静 静脉血液透析滤过 2 9例 ,连续性血浆滤过吸附 5例。结果 :46例经连续性血液净化治疗后尿素氮、肌酐和水、电解质、酸碱失衡均得到较好的控制 ,以存活组较满意 ;在治疗过程中 ,血流动力学稳定。 46例中死亡 2 7例 ,存活 19例 ,死亡原因与年龄、疾病严重程度等因素有关。结论 :连续性血液净化能有效地清除溶质和水分 ,且有十分稳定的血流动力学 ,是治疗重症急性肾功能衰竭和多脏器功能衰竭的有效方法     

伴传染性疾病的血液透析患者生活质量的调查与分析

目的调查伴有传染性疾病的血液透析患者的生活质量。方法选取在某院血液净化中心进行血液透析的患者94例,按是否伴有传染性疾病分为两组,其中伴有传染性疾病的血液透析患者47例(50%)、普通血液透析患者47例(50%)。采用问卷调查的方法调查两组患者的生活质量。结果伴有传染性疾病血液透析患者的生活质量评分为(113.43±21.09)分,普通血液透析患者评分为(150.22±20.14)分,两组比较,差异有统计学意义(t=8.55,P<0.01)。结论伴有传染性疾病血液透析患者的生活质量评分低于普通血液透析的患者,应引起医护人员的关注。     

Applying the Chronic Care Model in a Free Clinic

Uninsured patients with diabetes are less likely than insured patients to receive recommended care and access the appropriate chronic care management programs, resulting in poorer outcomes. A pilot program using the Chronic Care Model framework was implemented to determine its effectiveness in improving clinical and self-management outcomes of high-risk patients with diabetes attending a free clinic for the uninsured. A comparison of baseline and posttest findings showed a statistically significant reduction in hemoglobin A1c. Although not statistically significant, downward trends were observed in blood pressure, triglycerides, and low-density lipoprotein levels. All patients had documented self-management goals and reported high satisfaction with the program. These findings suggest that programs guided by the Chronic Care Model have the potential to improve clinical outcomes and self-management skills of uninsured patients with diabetes.     

Techniques of continuous arteriovenous hemofiltration and hemodialysis. Renal replacement in the ICU for hypervolemic, uremic patients

Continuous arteriovenous hemofiltration (CAVH) and continuous arteriovenous hemodialysis (CAVHD) are extracorporeal ultrafiltration techniques that permit ongoing removal of plasma water and uremic toxins. Both techniques are performed in the ICU with a minimum amount of equipment and achieve overall fluid balance more readily than intermittent hemodialysis. CAVH is used to manage hypervolemia, electrolyte imbalance, and/or mild uremia. CAVHD is used in hypercatabolic patients with acute renal failure who are hypervolemic and uremic; a dialysate fluid is used for more efficient solute removal. The most serious complications of CAVH and CAVHD relate to bleeding associated with cannulation or anticoagulation. Excess fluid and electrolyte losses may also occur.     

无肝素化持续血液滤过在妇产科危急重症中的应用研究

目的探讨无肝素化持续血液滤过在产后大出血、多脏器功能不全产妇中的应用效果。方法采用前后对照法,比较2010年采用肝素抗凝持续血液滤过治疗的产妇（对照组）与2013年采用无肝素化持续血液滤过治疗的产妇（观察组）伤口、阴道流血情况以及凝血功能检查情况。结果观察组产后大出血、多脏器功能不全产妇的伤口、阴道流血明显较对照组少,差异有显著意义（P〈0．001）;观察组产后大出血、多脏器功能不全产妇的活化部分凝血活酶时间测定明显降低（P〈0．001）。结论无肝素化持续血液滤过治疗能有效减少病人出血等并发症发生。     

The techniques used to sedate ventilated patients

A survey of sedation techniques for ventilated patients was performed by visiting 34 Intensive Care Units in Great Britain and Northern Ireland. The opiates in frequent use were phenoperidine (21 units-62% of units), papaveretum (11–32%) and morphine (9–26%). Many units used more than one opiate. Levorphanol, buprenorphine, pethidine, fentanyl and codeine were little used. Frequent use of diazepam was found in 22 units (64%), of lorazepam in 11 (32%) and of Althesin in four (12%). Other sedative drugs, droperidol, chlormethiazole, chlorpromazine and ketamine were used on an occasional basis. Continuous sedation using nitrous oxide was employed in nine (26%) of units — for more than 24 h in sex (18%). All units used pancuronium-31 (91%) used it frequently. Curare was in frequent use in five units (15%). There was wide variation in the way in which the drugs were used. A compromise between the ideal and the practicable method was common, depending more upon shortage of trained nursing staff than upon lack of funds for equipment or expensive drugs. The depth of sedation thought to be ideal depended on the state of the patient as well as the usual practice in the ICU — however a majority (23=67%) of units aimed to keep most patients well sedated and detached from the ICU environment. The use of very large doses of opiate to obtund the stress response was thought helpful in only six units (18%) and then in a minority of patients.This study was carried out on a Travelling Fellowship awarded by the Intensive Care Society and Janssen Pharmaceuticals Ltd. A shortened form wa spresented at the 18th meeting of the Intensive Care Society in November 1979. (Abstract in Intensive Care Med (1980) 6:137)