血液科医护人员经历患者自杀事件心理体验的研究

目的探讨血液科医护人员经历患者自杀事件后的心理体验,为减轻医护人员心理负担、完善患者自杀管理机制提供参考。方法运用现象学研究方法,对经历患者自杀的13名血液科医生和护士进行半结构化深度访谈,用Colaizzi 7步分析法分析资料。结果血液科医护人员经历患者自杀事件后的心理体验主要分为情绪体验和认知体验。情绪体验包括害怕与惊慌、沮丧与内疚、焦虑与压力感;认知体验可归纳为患者自杀征兆、患者自杀原因、医护对自身职业角色的认知、对自杀管理的思考4个主题。结论患者自杀事件给医生和护士带来不同程度的负性影响,但其也积极寻找原因、寻求解决方案来避免患者自杀事件的发生。管理者要关注经历患者自杀事件的医护人员的支持需求,避免产生职业疲溃和倦怠,确保医疗安全和质量。     

危重患者决策代理人心理体验及干预的研究进展

综述国内外危重患者决策代理人心理体验及干预的研究进展,危重患者决策代理人主要的心理体验包括角色认知、复杂的决策历程、对决策相关信息的反应及对信息提供者的反应;影响决策代理人心理体验的主要因素包括外部因素(如患者预后的不确定性、与临床医生沟通不畅或冲突、ICU环境因素)和内部因素(如性别、与患者的关系、压力应对方式);跨学科家庭会议、以家庭为中心的查房、预立医疗照护计划等干预方式可切实改善决策代理人的不良心理体验。     

肾移植受者心理体验的研究进展

综述国内外肾移植受者心理体验的研究进展,肾移植受者主要的心理体验包括对新器官的心理认知、复杂的情感历程及对供者的反应;影响患者心理体验的主要因素包括患者因素、供者因素、术后并发症、社会支持。目前肾移植受者心理干预模型主要有安全感为主的心理社会需求模型及压力适应与应对模型。开展正念减压、社会支持、多元化随访提高自我管理能力等综合干预,可切实提高肾移植受者术后短期和长期生存率,改善术后生活质量,促进肾移植受者术后身心健康。     

住院艾滋病患者主要照顾者负性心理的质性研究

目的了解住院艾滋病亲属照顾者在看护期间内的主要压力源及负性心理体验。方法采用个人深度访谈法,收集8名照顾者的资料,用主题分析法进行分析,归纳住院艾滋病患者主要照顾者的压力源种类及其负性心理体验。结果照顾者压力源主要来源包括与艾滋病相关的压力源、与经济相关的压力源及与社会文化相关的压力源;照顾者的负性心理体验主要有怀疑、否认,恐惧、害怕,痛苦、矛盾,愤怒,迷茫无助及社交减少。结论住院艾滋病患者照顾者的压力源来源于多个方面,其负性心理体验复杂,研究者应重视主要照顾者的压力,为其提供有效的干预措施,加强支持系统。     

1型糖尿病大学生患者在校期间生活体验的质性研究

目的了解1型糖尿病大学生患者在校期间的生活体验,探寻大学生患者的心理变化及需求,旨在帮助其正确处理疾病管理与学业、生活之间的关系。方法采用质性研究中的现象学研究方法,深度访谈10例1型糖尿病大学生患者在校期间的生活体验,对访谈资料进行整理分析。结果 1型糖尿病大学生患者在校期间的生活体验主要包括自我调适、压力感受、社会支持和情感体验。结论 1型糖尿病大学生患者正处于成人初显期这一特殊时期,需要面对学业与疾病自我管理的双重压力。医护工作者应关注其情绪与压力,鼓励其积极寻求社会支持,促进其对疾病的自我管理。     

短肠综合征患者饮食行为特征及管理的质性研究

目的 深入了解短肠综合征患者饮食行为特征及自我饮食管理方面的体验,以进一步指导和干预患者饮食管理,提高饮食管理依从性.方法 运用质性研究中的现象学方法 ,对15例短肠综合征患者进行面对面、半结构式访谈,采用Colaizzi现象学资料分析法分析访谈资料.结果 短肠综合征患者的饮食行为特征及管理中主要存在4个方面的体验:日...     

住院艾滋病患者主要照顾者负性心理的质性研究

目的了解住院艾滋病亲属照顾者在看护期间内的主要压力源及负性心理体验。方法采用个人深度访谈法,收集8名照顾者的资料,用主题分析法进行分析,归纳住院艾滋病患者主要照顾者的压力源种类及其负性心理体验。结果照顾者压力源主要来源包括与艾滋病相关的压力源、与经济相关的压力源及与社会文化相关的压力源;照顾者的负性心理体验主要有怀疑、否认,恐惧、害怕,痛苦、矛盾,愤怒,迷茫无助及社交减少。结论住院艾滋病患者照顾者的压力源来源于多个方面,其负性心理体验复杂,研究者应重视主要照顾者的压力,为其提供有效的干预措施,加强支持系统。     

年轻宫颈癌患者治疗后性生活体验的质性研究

目的探讨年轻宫颈癌患者治疗后性生活的体验,为医务人员有针对性地实施干预提供依据。方法采用质性研究中的现象学研究方法,采用目的抽样法选取宫颈癌治疗后年轻患者12例,用深入访谈法收集资料,分析资料并形成主题。结果年轻宫颈癌患者治疗后性生活体验的生理感受主要有:性交痛、性交次数和持续时间减少以及性交困难;心理感受主要有担心、自卑和自责;对家庭关系的影响主要有:夫妻之间交流匮乏、妻子受歧视和丈夫更加体贴关心妻子。结论导致年轻宫颈癌患者性生活变化最常见原因是患者知识缺乏和没有得到正确适度的指导。医护人员应主动对年轻宫颈癌患者的性生活进行干预,指导其采取有效措施应对不良反应以达到性生活的和谐。     

异种角膜移植患者围手术期心理体验的质性研究

目的了解异种角膜移植患者围手术期的真实心理感受,为实施有针对性护理提供依据。方法采用目的抽样法选取10例异种角膜移植的角膜盲患者为研究对象,进行半结构式访谈,收集资料,采用Colaizzi分析方法对资料进行分析、整理、提炼主题。结果异种角膜移植患者术前心理体验主要有怀疑、纠结、自罪感、自卑和期望过高;术后心理体验主要有紧张、排斥、失望、人际关系敏感和无价值感。结论异种角膜移植患者围手术期有很多负性心理,需要医务人员提供更广泛细致的人文关怀和心理支持。     

ICU机械通气患者重症监护体验定量分析及定性研究

目的研究ICU机械通气患者在重症监护过程中的自身体验感受,为护理措施的制定提供依据。方法通过《机械通气患者重症监护体验量表》和开放式问题,调查50例机械通气患者在ICU内的体验和感受,用定量和定性相结合的方式进行分析。结果 78%患者有中度不良体验,10%患者有重度不良体验。不同的年龄组在"认知与感觉改变"维度、不同受教育程度组在"环境感受"维度、不同机械通气时间组在"环境感受"、"治疗与病情信息"维度的差异有统计学意义(均P0.05)。除疾病外让患者感觉最痛苦的是吸痰、气管插管和口渴。结论机械通气患者在ICU内均感受到了较强的不良体验,不同年龄、受教育程度、机械通气时间对患者的自身体验起着影响作用。将患者个性化需要和感受融入护理措施,是有效减少不良感受的刺激,提升护理质量的可行途径。     

Capecitabine plus oxaliplatin vs fluorouracil plus oxaliplatin as first line treatment for metastatic colorectal caner – meta-analysis of six randomized trials

Objective  This meta-analysis was performed to evaluate the efficacy and safety of capecitabine plus oxaliplatin vs fluorouracil (FU) plus oxaliplatin as first line treatment for metastatic or advanced colorectal cancer.
Method  A total of 2196 patients from six randomized controlled trials were available for analysis, which included 1105 patients in capecitabine plus oxaliplatin group and 1091 patients in FU plus oxaliplatin group. The efficacy data included overall survival (OS), progression-free survival (PFS), time to treatment failure (TTF), overall response rate (ORR), and the safety data contained specific grade 3 and 4 toxicity such as anaemia, thrombocytopenia, neutropenia, diarrhoea, nausea, asthenia, vomiting, abdominal pain, hand foot syndrome, neuropathy and stomatitis were evaluated.
Results  Pooled analysis of OS (hazards ratio HR = 1.04, 95%CI: 0.95–1.14), PFS (1.08, 0.98–1.18), ORR (odds ratio OR = 0.87, 0.73–1.03) in the capecitabine plus oxaliplatin group shows no statistical significance when compared with those in the FU plus oxaliplatin group. The statistically significant differences in pooled estimates suggest a higher incidence of grade 3/4 thrombocytopenia (OR = 1.87, 1.24–2.81), grade 3/4 hand-foot syndrome (3.90, 2.13–7.12) in the capecitabine plus oxaliplatin group and grade 3/4 neutropenia (0.20, 0.07–0.53) in the FU plus oxaliplatin group. No statistically significant difference was noted in the incidence of grade 3/4 anaemia, asthenia, diarrhoea, nausea, vomiting, abdominal pain, neuropathy and stomatitis.
Conclusion  The effect of capecitabine plus oxaliplatin regimen is similar to FU plus oxaliplatin regimen as first line treatment for metastatic colorectal cancer, but it offers advantages of simplicity and convenience to administer.     

Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged

Postoperative pain can have a significant effect on patient recovery. An understanding of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care. To assess patients' postoperative pain experience and the status of acute pain management, we conducted a national study by using telephone questionnaires. A random sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion. Patients were asked about the severity of postsurgical pain, treatment, satisfaction with pain medication, patient education, and perceptions about postoperative pain and pain medications. Approximately 80% of patients experienced acute pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain, with more patients experiencing pain after discharge than before discharge. Experiencing postoperative pain was the most common concern (59%) of patients. Almost 25% of patients who received pain medications experienced adverse effects; however, almost 90% of them were satisfied with their pain medications. Approximately two thirds of patients reported that a health care professional talked with them about their pain. Despite an increased focus on pain management programs and the development of new standards for pain management, many patients continue to experience intense pain after surgery. Additional efforts are required to improve patients' postoperative pain experience. IMPLICATIONS: A survey of 250 US adults who had undergone a recent surgical procedure asked about their postoperative pain experience. Approximately 80% of patients experienced pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain. Additional efforts are required to improve patients' postoperative pain experience.     

A comparison of hematologic toxicity profiles after heated intraperitoneal chemotherapy with oxaliplatin and mitomycin C

BackgroundAlthough peritoneal carcinomatosis (PC) from colorectal and appendiceal tumors is consistent with metastatic disease, complete cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) using mitomycin C (MMC) can improve survival. A recent phase I study by our group using hyperthermic intraperitoneal oxaliplatin has demonstrated its safety and appropriate dose. Our goal in this study is to present a single institution’s experience with the hematologic toxicities of the two agents.MethodsWe performed a retrospective review of 187 patients with PC of colorectal or appendiceal origin who underwent HIPEC with MMC or oxaliplatin between October 2006 and September 2009. Hematologic toxicities were graded according to the NCI Common Terminology Criteria for Adverse Events Version 4.0.ResultsOf the 187 patients, 55 had oxaliplatin-based HIPEC while 132 patients received MMC. Splenectomy was performed in 95 patients (50.8%) due to disease involvement. When comparing hematologic toxicity for MMC and oxaliplatin among the cohort of patients who underwent splenectomy, a statistically significant difference was noted in the incidence of platelet (P = .02) and neutrophil (P = .05) toxicity, with oxaliplatin having a higher incidence of grade 3 and grade 4 platelet and neutrophil toxicity respectively. However, no statistically significant difference in hematologic toxicity was noted between the two agents in patients who did not undergo splenectomy during cytoreductive surgery.ConclusionsOxaliplatin-based HIPEC for PC of colorectal and appendiceal origin is associated with similar white blood cell toxicity and higher platelet and neutrophil toxicity compared to MMC-based HIPEC.     

Hepatic Arterial Infusion of Oxaliplatin and Intravenous LV5FU2 in Unresectable Liver Metastases from Colorectal Cancer after Systemic Chemotherapy Failure

Background We have previously shown promising activity of hepatic arterial infusion (HAI) oxaliplatin combined with intravenous (IV) 5-fluorouracil (5-FU) and leucovorin (LV) as first-line chemotherapy in patients with colorectal liver metastases (CRLM) (intent-to-treat [ITT] objective response rate [ORR], 64%; secondary resection rate, 18%; overall survival [OS], 27 months). Whether this regimen could be beneficial after systemic chemotherapy failure is unknown. Methods Patients with unresectable CRLM and history of systemic chemotherapy failure were treated bimonthly with HAI oxaliplatin (100 mg/m² 2 hours) combined with IV LV and IV bolus and infusional 5FU (modified LV5FU2 regimen). Results Forty-four consecutive patients (median age 56 years; median number of prior systemic chemotherapy regimens, 2 range 1–5) were included, of whom 43 (98%) had previously received oxaliplatin (n = 34), irinotecan (n = 37), or both (n = 28). Patients received a median of nine cycles of HAI oxaliplatin and IV modified LV5FU2 (range 0–25). Toxicity included grade 3–4 neutropenia (43%), grade 2–3 neuropathy (43%), and grade 3–4 abdominal pain (14%). We observed 24 partial ORs (62%) among the 39 assessable patients (ITT ORR, 55%; 95% CI, 40–69%), including 17, 12, and 12 patients who had failed to respond to prior systemic chemotherapy with FOLFIRI, FOLFOX, or both, respectively. Tumor response allowed further R0 surgical resection (n = 7) or radiofrequency ablation (n = 1) of initially unresectable CRLM in eight patients (18%). Median progression-free survival and OS were 7 and 16 months, respectively. Conclusions HAI oxaliplatin and IV LV5FU2 is feasible, safe, and shows promising activity after systemic chemotherapy failure, allowing surgical resection of initially unresectable CRLM in 18% of patients.     

Low-back pain. Perception and tolerance

The relationship between pain modifying factors, pain duration, and the role of anxiety in low-back pain experience were studied. Three groups of patients with low-back pain were examined using the Tourniquet Pain Test, McGill Pain Questionnaire, Rating Scale of Pain Intensity, State-Trait Anxiety Inventory, and Psychological Discomfort Questionnaire. Significant differences in all measured features emerged between acute and chronic pain groups. Groups of acute and subchronic pain and groups of subchronic and chronic pain differed only in several parameters, suggesting an intermittent phase in acute pain transition into chronicity. While pain prolonged, pain experience gradually but irregularly changed, exaggerating pain perception. The changes concerned mainly emotional factors and were related to the chronicity itself. Anxiety also played a significant role.     

A Phase I Trial of Oxaliplatin for Intraperitoneal Hyperthermic Chemoperfusion for the Treatment of Peritoneal Surface Dissemination from Colorectal and Appendiceal Cancers

Background  Cytoreductive surgery with intraperitoneal hyperthermic chemoperfusion (IPHC) has evolved into a promising approach for peritoneal surface malignancy. A large body of literature suggests that oxaliplatin has excellent cytotoxicity against colorectal cancer. Therefore, we undertook a phase I evaluation of IPHC with oxaliplatin for peritoneal dissemination from colorectal and appendiceal cancers to establish the dose-limiting toxicity (DLT) and the maximum tolerated dose (MTD). Methods  Cohorts of three patients underwent cytoreductive surgery followed by a 2-h IPHC with escalating doses of oxaliplatin at a target outflow temperature of 40°C. The initial peritoneal oxaliplatin dose was 200 mg/M² with increases planned in 50 mg/M² increments. Plasma and perfusate samples were collected during the IPHC and evaluated using emission spectrometry techniques. Normal tissue and tumor samples were collected before and after the IPHC for analysis. DLT was defined as a grade 3 toxicity lasting 5 days. Results  Fifteen patients were enrolled at two dose levels. Peritoneal fluid areas under the curve (AUCs) were above those of plasma. Additionally, intratumoral oxaliplatin was similar to that of surrounding normal tissue. Dose-limiting toxicities at 250 mg/M² were observed in two of three patients enrolled in this study. Conclusion  We found that IPHC with 200 mg/M² of oxaliplatin is well tolerated and is the MTD for a 2-h chemoperfusion. Higher doses are not feasible with this perfusion protocol given the significant toxicities associated with 250 mg/M² oxaliplatin. Based on the data from this phase I study, we propose to conduct further studies with oxaliplatin delivered at 200 mg/M².     

脑卒中患者偏瘫肩痛的症状体验及影响因素研究

目的探讨脑卒中患者偏瘫肩痛的症状体验及其强度的影响因素,为临床症状管理提供参考。方法采用一般资料调查表、脑卒中后偏瘫肩痛症状评估问卷、简易疲乏量表、医院焦虑抑郁量表对153例脑卒中后偏瘫肩痛患者进行调查。结果脑卒中患者偏瘫肩痛症状强度得分为(5.99±2.04)分,为中等疼痛;症状困扰总分为(11.98±5.20)分,属于中等困扰;肩痛症状强度的影响因素包括脑卒中疾病分期、肩痛频度和疲乏水平(均P0.05)。结论脑卒中患者的偏瘫肩痛症状体验呈多样性,临床护理人员应对不同肩痛频度、疾病分期、疲乏水平的患者给予针对性的症状管理干预措施,促进其康复。     

Intraabdominal pressure rise during weight lifting as an objective measure of low-back pain

Twenty-three male patients who had chronic nonspecific low-back pain were asked to record the amount of pain they felt on an arbitrary scale while lifting light weights in different directions. During the lifts their intraabdominal pressures were recorded with an intragastric transducer. The patients who experienced extra pain during the lift had higher rises of pressure than both normal controls and those patients who did not experience extra pain. The available evidence suggests that this pressure rise may be a response to low-back pain and may be used as a method of objectively measuring that pain.