乳腺癌患者照顾者照护体验质性研究的Meta整合

目的系统评价乳腺癌患者照顾者的照护体验,为指导医院、社区及居家的延续性护理提供参考。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、Medline、CNKI、CBM、Wanfang Data、VIP数据库,检索关于乳腺癌患者照顾者照护体验的质性研究,检索时限均从建库至2018年3月。采用NoteExpress软件筛选和分析文献、澳大利亚JBI卫生保健中心质性研究质量评价标准(2017)评价文献及Meta整合方法对结果进行整合。结果共纳入9篇文献,提炼50个结果,归纳组合为9个新类别,整合成4个结果:照顾者渴望疾病和治疗信息,但医务人员提供的信息不能满足其需求;照顾者尽力帮助患者,二者关系增强;照顾者身心负担重,渴望得到家庭及外界支持;照顾者的生活方式改变,但逐渐面对现实,主动增强自身照护能力,承担家庭重任,胜任力建立。结论照顾者照护体验到照顾负担、信息和支持需求,且在照顾过程中照护能力提升。政府、医疗机构、社区应重视乳腺癌对照顾者的影响,了解并尊重其需求,为照顾者提供照护指导,给予物质和精神支持,提高照护能力,促进乳腺癌患者及照顾者的身心健康。     

Long-term Complications After Liver Transplantation

Background

Along with an increased number of cases of liver transplantation (LT), perioperative mortality has decreased and short-term survival has improved. However, long-term complications have not been fully elucidated today.

Purpose

Chronic complications were analyzed individually to find risk factors and to improve long-term outcomes after LT.

Subjects

There were 63 cases of LT from our outpatient clinic that were included in this study. Among them, 58 were performed using living donor LT and 5 were performed using deceased donor LT. Original diseases mainly consisted of hepatitis C virus (HCV; 45.9%) and hepatitis B virus (23.0%).

Findings

The median follow-up was 5.4 ± 3.3 years (range, 0.1∼17 years). Overall survival at 2, 3, 5, and 10 years was 89.3%, 83.4%, 81.3%, and 81.3%, respectively. Long-term complications mainly consisted of renal dysfunction (62.7%), dyslipidemia (29.4%), diabetes mellitus (21.6%), and arterial hypertension (21.6%). In univariate analysis, HCV (P = .03) and elapsed years after LT (P = .02) were identified as predictive factors for arterial hypertension and recipient age >50 (P = .03), and elapsed years after LT for renal dysfunction (P = .03), respectively. In multivariate Cox regression analysis, HCV (odds ratio [OR] 5.25, 95% confidence interval [CI] 1.05–34.06, P = .04) was identified as a predictive factor for arterial hypertension, and recipient age older than 50 years for renal dysfunction (OR 5.67, 95% CI 1.34–28.88, P = .02). The number of elapsed years after transplantation was also identified as a predictive factor for arterial hypertension/dyslipidemia/renal dysfunction (OR 13.88/14.15/4.10, 95% CI 1.91–298.26/2.18–290.78/1.09–18.03, P = .01/.003/.04). Fifty percent of the recipients developed renal dysfunction within 8 years after LT, and fluctuation of estimated glomerular filtration rate (eGFR) within 3 months after LT was successfully associated with an annual decrease of eGFR (r² value = 0.574, P < .0001).

Conclusion

Renal dysfunction is the most frequent chronic complication after LT. As chronic individual eGFR can be now accurately predicted with deterioration speed, recipient strata for renal protection strategies should be precisely targeted.     

电子病案在病案管理职能转变中的作用

目的探讨电子病案的广泛应用促进病案管理的职能改变。方法通过电子病案与纸质病案在组织结构、工作流程、工作方式等方面存在的差异进行比较。结果电子病案以其信息采集速度快,信息存储容量大,占用存储空间小,检索使用方便、快捷,并能实现广域网信息数据交流与共享等优势,将成为全面实现以＂病人为中心＂的人性化管理模式的转变的催化剂。结论必须加快推广、规范电子病案的临床应用,全面提高病案管理人员以及全体医护人员的业务素质与技能,才能实现病案管理职能全方位的转变。     

外科手术病人术后下肢深静脉血栓形成风险评估表的研制

[目的]制订全面的外科手术病人术后下肢深静脉血栓形成(DVT)风险评估表,更加准确地预测术后DVT高危风险病人,及早做好预防。[方法]参考目前正在使用的评估表并结合国内外文献编制,经专家评议、论证形成最终评估表。[结果]术前对手术病人进行静脉血栓风险评估,根据评估结果采取相应预防措施。[结论]深静脉血栓形成风险评估表科学、全面、可操作性强。     

The Association of Social Factors and Health Insurance Coverage with COVID-19 Vaccinations and Hesitancy,July 2021

BackgroundThere are racial differences in COVID-19 vaccination rates, but social factors, such as lack of health insurance or food insecurity, may explain some of the racial disparities.ObjectiveTo assess social factors, including insurance coverage, that may affect COVID-19 vaccination as of June–July 2021 and vaccine hesitancy among those not yet vaccinated, and how these may affect racial equity in vaccinations.DesignCross-sectional analysis of nationally representative survey data.ParticipantsAdults 18 to 64 participating in the Census Bureau’s Household Pulse Survey for June 23 to July 5, 2021.Main MeasuresVaccination: receipt of at least one dose of a COVID-19 vaccine. Vaccine hesitancy: among those not yet vaccinated, intent to definitely or probably not get vaccinated.Key ResultsIn unadjusted analyses, black adults were less likely to be vaccinated than other respondents, but, after social factors were included, including health insurance status, food sufficiency, income and education, and state-level political preferences, differences between black and white adults were no longer significant and Hispanics were more likely to be vaccinated (OR = 1.87, p < .001). Among those not yet vaccinated, black and Hispanic adults were vaccine hesitant than white adults (ORs = .37 and .45, respectively, both p < .001) and insurance status and food insufficiency were not significantly associated with vaccine hesitancy. The percent of state voters for former President Trump in 2020 was significantly associated with lower vaccination rates and with increased vaccine hesitancy.DiscussionThe results indicate that much of the gap in COVID vaccination rates for minority adults are due to social barriers, rather than differences in racial attitudes. Unvaccinated minority adults expressed less vaccine hesitancy than white adults. Social barriers like food insecurity and insurance coverage could have deterred prompt COVID-19 vaccinations. Reducing these problems might help increase vaccination rates.     

Clinical relevance of internal mammary node mapping as a guide to radiation therapy.

BACKGROUND: The surgical management of breast cancer has changed markedly with the development of lymphatic mapping and sentinel lymph node (SLN) biopsy. Lymphatic mapping technique varies with respect to injection method, mapping agent, and surgical technique. The decision to pursue the internal mammary nodes (IMN) is another source of controversy. METHODS: From April 1998 to November 2000, 1,470 patients underwent lymphatic mapping for breast cancer and were prospectively entered into the breast database. The combined technique method was used, consisting of both isosulfan blue dye and technetium-99 labeled sulfur colloid. Patients with inner quadrant lesions and suspicion for internal mammary metastasis had preoperative lymphoscintigraphy. Those with internal mammary radioactivity noted by either lymphoscintigraphy or gamma probe underwent removal of the internal mammary sentinel nodes. RESULTS: Thirty-six of the 1,470 (2.4%) patients mapped had at least 1 internal mammary lymph node removed. Inner quadrant lesions were present in 24 of the 36 (67%) IMN mapped patients. Of the 36 patients mapping to the IM area, 5 (14%) had at least 1 IM node positive. Two of the 5 (40%) had only IM metastasis, with 1 of these patients having 5 of 5 IMN positive and no disease detected in her axilla. A total of 2 of the 5 (40%) IM positive patients had more than 1 IMN positive. Twenty-eight of the 36 (78%) IM node harvested patients had preoperative lymphoscintigraphy, with 18 (64%) IMN appearing on imaging. Complications occurred in 3 of the 36 (8%) IMN mapped patients, without clinical significance. CONCLUSIONS: Mapping to the IMN basin with the finding of metastasis results in N3 disease by the current staging system. The consequence for these patients is radiation therapy to the IMN basin. It is significant to note that 14% (5 of 36) were upstaged as result of IMN detection and 40% (2 of 5) had multiple positive IMNs. Substantial disease was detected in these 5 patients necessitating additional radiation therapy while avoiding IM radiation and its attendant complications in 86% of patients mapping to the IM basin.