基于扎根理论的急性脑卒中患者延迟就诊应对模型的构建

目的探讨急性脑卒中患者延迟就诊的应对过程,构建应对模型。方法运用格拉泽传统扎根理论研究方法,对12例延迟就诊的急性脑卒中患者进行半结构式深度访谈,提取主题。结果析出核心主题"急性脑卒中患者就诊应对方式",基于Lazarus压力应对模式构建急性脑卒中患者延迟就诊应对模型,包括感知阶段、犹豫阶段、决策阶段3个应对阶段,认知因素、经济因素、社会支持、促进因素和阻碍因素5个原因要素。结论急性脑卒中患者延迟就诊受多种因素影响,应对模型的初步构建可为进一步探索急性脑卒中患者院前延迟就诊的干预策略提供依据。     

心力衰竭患者就医延迟的研究进展

介绍心力衰竭患者就医延迟的定义和现状,从患者因素和社会因素两方面分析心力衰竭患者就医延迟的主要影响因素,并从患者自身应对及外部干预方法综述缩短心力衰竭患者就医延迟的措施,旨在为国内相关研究及针对性干预提供参考.     

乳癌患者就医延迟及其疾病认知现状调查

目的了解乳癌患者就医延迟和对乳癌疾病认知的现状,为促进乳癌的早期防治干预提供参考。方法自行设计就医情况调查表和乳癌相关知识问卷对92例乳癌住院患者进行调查。结果乳癌患者就医延迟发生率为31.5%,平均就医延迟时间为(155.7±75.2)d;在疾病认知方面,仅6.5%患者对乳癌知识掌握度高,68.5%患者对乳癌知识掌握度低。结论乳癌患者就医延迟现象严重,乳腺疾病相关知识掌握度低,乳房自检意识缺乏,有必要对妇女进行乳癌相关知识健康教育和自检技能的培训,提高妇女对于乳癌知识的认知率,降低就医延迟率。     

糖尿病足患者就医延迟的研究进展

介绍糖尿病足患者就医延迟的概念、分析糖尿病足患者就医延迟影响因素(包括个人因素、疾病因素、社会因素),并提出加强基层糖尿病防治团队专业能力建设、开展远程医疗、推进科普宣传、完善社会和医疗保障制度管理策略,旨在为开展健康教育及构建干预方案提供参考,促进患者积极就医。     

护理风险管理能力概念框架的构建

目的 初步构建护理风险管理能力的概念框架,为相关领域的评价或培训提供依据.方法 根据文献查阅法、小组讨论法和预咨询法拟定护理风险管理能力概念框架,列举护理风险管理能力的构成因素.运用Delphi法对国内的50名护理专家进行问卷函询.根据专家的评定结果和修改意见确定最终的护理风险管理能力概念框架,并确定各项构成因素的权重.结果 进行两轮函询,专家问卷回收率分别为94.00％和93.62％,函询专家的权威系数为0.828,专家意见的协调系数为0.320.护理风险管理能力概念框架由3项一级因素和10项二级因素组成,一级因素包括护理风险管理知识、护理风险管理技能和护理风险管理态度,其权重依次为0.20、0.39和0.41.结论 构建的护理风险管理能力概念框架结果可信,可为护理管理者客观评价并培训护理人员护理风险管理能力提供理论框架.     

宫颈癌患者就医延迟与家庭动力的相关性研究

目的了解宫颈癌患者就医延迟与家庭动力的现状,分析两者的相关性,为宫颈癌患者就医延迟的健康干预提供参考。方法采用宫颈癌患者就医情况调查问卷和家庭动力评定量表(FAD)对72例宫颈癌患者进行调查。结果宫颈癌患者就医延迟发生率为37.50%;时间最短3d,最长1 440d,中位数47.25d;就医延迟组在沟通、情感反应、情感介入和总的功能得分与未延迟组比较,差异有统计学意义(均P<0.05);情感介入、总的功能、沟通、问题解决和情感反应维度得分与患者就医延迟时间呈正相关(均P<0.05)。结论宫颈癌患者就医延迟的现象普遍,情感介入、总的功能、沟通、问题解决和情感反应是影响宫颈癌患者就医延迟的因素。     

老年人衰弱预防与延迟或逆转干预的证据总结

目的 总结并评价老年人衰弱预防、延迟或逆转干预的相关证据,为临床实践提供循证依据.方法 根据"6S"证据模型,自上而下检索国内外相关数据库中有关老年人衰弱预防、延迟或逆转干预的相关证据,包括指南、专家共识、证据总结和系统评价.并由2名研究者对所纳文献进行质量评价、证据提取及汇总.结果 共纳入16篇文献,包括4篇指南,1篇专家共识,2篇证据汇总和9篇系统评价.从运动干预、营养干预、多因素干预、用药管理、老年评估及健康教育等6个方面共总结30条证据.结论 证据使用者应结合机构环境和患者意愿,合理选择证据进行转化及应用,为衰弱老年人提供个性化的干预方案.     

脑卒中高危人群院前延迟行为意向的潜在剖面分析

目的 探索脑卒中高危人群院前延迟行为意向的潜在剖面分型,并分析其影响因素,为制定针对性干预措施提供参考。方法 采用一般资料调查表、脑卒中院前延迟行为意向量表、慢性病病人健康素养量表对213例脑卒中高危人群进行调查。对脑卒中高危人群院前延迟行为意向进行潜在剖面分析,并通过单因素分析和logistic回归分析识别其潜在剖面的影响因素。结果 脑卒中高危人群院前延迟行为意向分为3个类别：高延迟-高合理化组(12.7%)、中等延迟组(66.7%)和低延迟-低警觉组(20.6%)。logistic回归分析结果显示,常居地、吸烟情况、性格分型、健康素养是脑卒中高危人群院前延迟行为意向潜在剖面的影响因素(均P<0.05)。结论 脑卒中高危人群院前延迟行为意向存在异质性,医护人员可依据院前延迟行为意向特征及影响因素开展针对性干预,改善其院前延迟现状。     

脑卒中高危人群院前延迟行为意向的潜在剖面分析

目的 探索脑卒中高危人群院前延迟行为意向的潜在剖面分型,并分析其影响因素,为制定针对性干预措施提供参考。 方法 采用一般资料调查表、脑卒中院前延迟行为意向量表、慢性病病人健康素养量表对213例脑卒中高危人群进行调查。对脑卒中高危人群院前延迟行为意向进行潜在剖面分析，并通过单因素分析和logistic回归分析识别其潜在剖面的影响因素。结果 脑卒中高危人群院前延迟行为意向分为3个类别：高延迟-高合理化组（12.7%）、中等延迟组（66.7%）和低延迟-低警觉组（20.6%）。logistic回归分析结果显示,常居地、吸烟情况、性格分型、健康素养是脑卒中高危人群院前延迟行为意向潜在剖面的影响因素（均P<0.05）。结论 脑卒中高危人群院前延迟行为意向存在异质性，医护人员可依据院前延迟行为意向特征及影响因素开展针对性干预，改善其院前延迟现状。     

消化内镜微创治疗患者的护理风险管理

目的 探讨消化内镜微创治疗患者的护理风险管理效果。 方法 选取护理风险管理实施前后不同阶段的消化内镜微创治疗患者分别作为对照组和干预组。对照组960例实施常规护理;干预组2 040例实施护理风险管理,包括护理风险识别、评估、处理和评价4个阶段的管理。比较两组患者不良事件及隐患事件发生率、住院患者及医生对护理工作满意度。 结果 风险管理实施后护理不良事件及隐患事件显著少于实施前,患者的护理满意率显著提高（均P＜0.01）。 结论 对消化内镜微创治疗患者实施护理风险管理,能够有效预防和减少风险事件发生,提高护理质量和患者满意度。     

Diagnostic delays in laryngeal carcinoma: professional diagnostic delay is a strong independent predictor of survival

BACKGROUND: Clinical stage at the time of diagnosis is the most important determinant of prognosis in cancers of the head and neck. Accordingly, delay in diagnosis could worsen survival in laryngeal cancer, although this hypothesis has not been verified in previous studies. METHODS: To determine the effects of patient and professional diagnostic delays on survival in patients with laryngeal squamous cell carcinoma (LSCC), a population-based sample of 66 patients with LSCC in Northern Finland between 1990 and 1995 was investigated. In addition to clinical data from tertiary care units and mortality data from the national death register, we collected data about the first medical visit in primary care that resulted, subsequently, in the diagnosis of malignancy. RESULTS: Long professional delay in diagnosis (>or=12 months) was an independent and statistically significant determinant of worsened prognosis (adjusted relative hazard of death 4.74, p =.05). There was no correlation between patient delay and prognosis. Another significant factor related to impaired prognosis was advanced stage (IV vs I-III, adjusted relative hazard of death 5.18, p =.02). Long professional delay was not significantly related to any of the demographic or clinical characteristics. CONCLUSIONS: A long professional delay is a marked and independent determinant of impaired survival in laryngeal carcinoma and equals the effect of advanced stage. However, unlike in most other cancers, early symptoms and slow tumor growth give the physician a fairly long time to reach the correct diagnosis before the delay turns out to be fatal.     

General anesthesia for cesarean delivery and childhood neurodevelopmental and perinatal outcomes: a secondary analysis of a randomized controlled trial

BackgroundIn 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment may be negatively affected by anesthesia or sedation exposure in pregnancy or before three years of age. We examined the association between general anesthesia at the time of cesarean delivery and early childhood neurodevelopment.MethodsA secondary analysis of a multicenter randomized controlled trial assessing magnesium for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure was general compared to neuraxial anesthesia. The primary outcome was motor or mental delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII). Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable logistic regression models were performed to control for confounders.ResultsOf 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia. There were no differences in the primary composite outcome of developmental delay (aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe mental delay, or mild or moderate motor delay. Severe motor delay was more common among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days, P=0.010).ConclusionsGeneral anesthesia for cesarean delivery was not associated with overall neurodevelopmental delay at two years of age, except for greater odds of severe motor delay. Future studies should evaluate this finding, as well as the impact on neurodevelopment of longer or multiple anesthetic exposures across all gestational ages.     

Delay in Diagnosis and Its Effect on Clinical Outcome in High‐grade Sarcoma of Bone: A Referral Oncological Centre Study

Objective

To investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high‐grade sarcoma of bone in a single‐referral oncological center.

Methods

Fifty‐four patients with osteosarcoma, 29 with Ewing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient‐ or doctor‐related. Short total delays were defined as <4 months; prolonged delays >4 months were assumed to have prognostic relevance.

Results

Total delay in diagnosis was 688.0 days in patients with chondrosarcoma, which is significantly longer than the 163.3 days for osteosarcoma (P < 0.01) and 160.2 days for Ewing sarcoma (P < 0.01). Most doctor‐related delays were at the pre‐hospital stage, occurring at the general practitioner (GP)'s office. However, prolonged total delays (≥4 months) did not result in lower survival rates. Five‐year‐overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma.

Conclusion

Prolonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP‐related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre‐hospital stage.

     

Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY study

PurposeBreast cancer (BC) patients’ (pts) management was affected by a global reorganization after Coronavirus disease 2019 (COVID-19). Our multicenter study aimed to assess the impact of COVID-19 on access to diagnosis, staging and treatment for BC pts compared to pre-pandemic.MethodsMedical records of all consecutive newly diagnosed BC pts referred to 6 Italian Institutions between March and December 2020 were assessed. Monthly access rate and temporal intervals between date of symptoms onset, radiological, cytohistological diagnosis and treatment start were analyzed and compared with 2019.ResultsA reduction (25%) in newly diagnosed BC was observed compared to 2019 (666 vs 890). New BC pts in 2020 were less likely to be diagnosed with early stage BC (77% vs 83%, p < 0.01), had a worse performance status according to the Eastern Cooperative Oncology Group (ECOG PS) (19.8% had PS > 0 in 2020 vs 16.5% in 2019, p < 0.01) and fewer pts were asymptomatic at diagnosis in 2020 (54% vs 71%,p < 0.01). COVID-19 did not negatively impact in terms of access to diagnosis, staging and treatment. Time intervals between symptom onset and radiological diagnosis, symptom onset and cytohistological diagnosis, cytohistological diagnosis and treatment start were maintained or improved. However, less cases were discussed in multidisciplinary tumor meetings during 2020 (60% vs 73%, p < 0.01).ConclusionsOur data proved an alarming reduction of early stage BC associated with the COVID-19 crisis in 2020. Despite the upheaval generated by the pandemic, our study shed light on the effective performance delivered by Italian Oncology Departments to guarantee diagnostic-therapeutic pathways.     

Start-up delays of infusion syringe pumps

BACKGROUND: We performed a bench experiment to investigate the extent of start-up delays in fluid delivery for four different syringe pumps after initially placing the infusion syringe in the syringe pump. METHODS: Pump performance was determined at an infusion rate of 1 ml.h-1 with and without a fluid bolus delivered by the infusion pump prior to connecting the infusion line to the simulated patient. RESULTS: The time (mean +/- SD) from starting the pump up to first fluid delivery (t1) differed considerably between pumps (from 6.75 +/- 4.4 to 57.2 +/- 28.6 min) as did the time to steady state fluid delivery (t2) (from 19.6 +/- 9.3 to 76.3 +/- 29.0 min). Applying an initial bolus of 2 ml before connecting the line to the simulated patient practically eliminated the delay in fluid delivery (t1 ranging from 0.3 +/- 0.1 to 1.1 +/- 0.8 min). This manoeuvre also reduced the time to steady flow delivery (t2 from 6.0 +/- 3.1 to 11.1 +/- 4.3 min, P<0.001) and minimized the differences between syringe pumps. CONCLUSIONS: Syringe pump design affects start-up delay times because of free play of the syringe. These delays can be eliminated by a start-up bolus of 2 ml prior to connecting the infusion line to the patient.     

The effect of patient's delay and doctor's delay in patients with malignant germ cell tumours

In 103 patients with malignant germ cell tumours the initial clinical diagnosis was incorrect in 45 (44%). The correct diagnosis was established within 2 months in only 31% of the patients, and delayed by more than 6 months in 27%.
Stage, distribution and survival were correlated with the histology, but not with the duration of symptoms or the patient's/doctor's delay.
Rapidly growing tumours often belonged to the non-seminornaious group where advanced tumour stages and low survival rates were more common than in the seminoma group.
The overall prognosis of patients with malignant germ cell tumours may be increased by an early diagnosis of testicular tumours in non-symptomatic patients, especially in men with possible risk factors (cryptorchidism, atrophic testis, antecedent contralateral testicular cancer).     

大时滞温度控制系统

本文介绍了温度控制试验系统的结构、控制方案、闭环阶跃响应曲线和主要技术数据。     

Quantized filter design of interconnected continuous‐time delay systems

A generalized approach to the problem of quantized filtering is investigated by designing a set of decentralized filters for a class of linear interconnected continuous‐time systems with unknown‐but‐bounded couplings and interval delays and where the quantizer has arbitrary form. An LMI‐based method using a decentralized quantized filter is designed at the subsystem level to render the global filtered system delay‐dependent asymptotically stable with guaranteed γ ? level. It is established that this setting encompasses several special cases of interest including interconnected delay‐free systems, single time‐delay systems and single systems. We illustrate the theoretical developments by numerical simulations. Copyright © 2012 John Wiley & Sons, Ltd.     

虫草制剂对延缓慢性肾衰竭进展的实验研究

目的：为观察中药治疗慢性肾衰竭(CRF)的疗效。方法：采用5／6肾切除大鼠CRF模型，对肾衰大鼠用中药治疗后的肾功能等血液生化指标及残余肾组织病理情况进行了检查。结果：发现中药可降低CRF大鼠的死亡率，降低血Scr和BUN水平，具有明显的延缓CRF进展的作用。在肾组织病理学改变上，中药能延缓肾小球硬化的进展。结论：中药能有效控制慢性肾衰竭的进展。