优质护理在慢性乙型病毒性肝炎患者中的临床效果观察

目的研究优质护理策略在慢性乙型病毒性肝炎治疗中的临床效果。方法对入住该院治疗的慢性乙型病毒性肝炎患者106例进行研究,随机分为二组,在常规药物治疗的基础上,对照组给予基础护理,观察组患者给予优质护理策略,包括:宣讲教育、心理护理、饮食护理以及医护人员的管理等。结果观察组患者18个月的HBeAg转阴率、HBV DNA转阴率以及HBeAg/抗-HBe血清转化率均明显高于对照组,二组比较差异有统计学意义(P<0.05);观察组患者生活、饮食、用药等综合生活质量评分均明显高于对照组,差异有统计学意义(P<0.05);观察组临床总有效率为90.6%,明显高于对照组71.7%,二组比较差异有统计学意义(P<0.05)。结论优质护理在慢性乙型病毒性肝炎患者的治疗中具有重要的作用,改善患者疾病状态更明显,可以显著提高生存质量,临床总有效率更高,值得在临床治疗中予以关注。     

培哚普利对COPD大鼠肺功能及IL-8、TNF-α含量的影响

目的观察培哚普利对慢性阻塞性肺疾病(COPD)大鼠肺功能和肺组织及血清中炎性因子的影响。方法将30只雄性SD大鼠随机分为3组,A组(正常对照组)、B组(LPS组)、C组(ACEI+LPS组),每组10只。采用2次气管滴注脂多糖(LPS)加烟熏的方法建立COPD大鼠模型,通过检测大鼠肺功能和血清及肺组织匀浆中IL-8、TNF-α含量,观察培哚普利对大鼠肺功能和体内炎性因子的影响。结果(1)大鼠呼吸功能测定:A组、B组与C组的VE值(ml/min)分别为180.50±23.58、108.50±33.53与140.90±33.10;PEP值(ml/s)分别为30.20±1.67、20.30±2.78与25.77±3.45;FEV_(0.3)值(ml)分别为4.91±0.30、4.01±0.30与4.55±0.18;与A组相比,B组、C组VE值分别下降40%、22%,PEP值分别下降33%、15%,FEV_(0.3)值分别下降18%、7%。3组间两两比较,差异均有统计学意义(P<0.05)。(2)大鼠血清中IL-8含量(ng/L),A、B、C组分别为21 1.69±13.40、386.10±26.52、324.58±25.49;肺组织匀浆中A、B、C组分别为348.96±4.78、439.28±15.15、394.00±9.78,3组间两两比较,差异均有统计学意义(P<0.05)。大鼠血清中TNF-α含量,A、B、C组分别为42.28±2.55、102.86±5.99、68.90±3.20;肺组织匀浆中A、B、C组分别为131.44±7.90、201.21±4.98、154.34±4.73,3组间两两比较,差异均有统计学意义(P<0.05)。结论培哚普利能明显改善COPD大鼠肺功能,其机制可能是通过下调COPD大鼠血清和肺组织匀浆中IL-8、TNF-α含量而实现。     

Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: an exploratory analysis

Objective: There is a need to identify safe and effective opioid-sparing multimodal alternative treatment strategies and approaches, including topical analgesics, for opioid-experienced chronic pain patients to mitigate the risk of addiction, misuse, and abuse of opioids.

Methods: This subset analysis from a prospective, observational study evaluated changes in opioid use, other concurrent medication use, and pain severity and interference in opioid-experienced patients (OEP) treated with topical analgesics for chronic pain with measures obtained at baseline and 3- and 6- month follow-up.

Results: The 3-month opioid-experienced patient (3-month OEP) group included 121 patients who completed baseline and 3-month follow-up assessments; 27 opioid-experienced patients completed baseline and 6-month follow-up assessments (6-month OEP). Demographic characteristics, and mean pain severity and interference scores were similar between groups at baseline. After treatment with topical analgesics, 49% of patients in the 3-month and 56% of patients in the 6-month group reported they had completely discontinued use of opioids. In addition, 31% of patients at the 3-month assessment and 30% at the 6-month assessment reported that they were no longer taking any pain medication. Other concurrent medications decreased by 65% after 3 months, and 74% after 6 months. There were statistically significant decreases from baseline in pain severity and interference scores within the 3- (CI:0.7–1.4, 1.4–2.2) and 6-month (CI:0.7–2.4 (severity); CI:1.2–3.5 (interference)) OEP groups.

Conclusions: Opioid use and other concurrent medications decreased among opioid-experienced chronic pain patients after 3- and 6- months of treatment with topical analgesics. Pain severity and interference scores also decreased. The topical analgesics were reported to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.     

Effectiveness of Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease With Different Degrees of Static Lung Hyperinflation

Objective

To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).

Nursing clinical practice changes to improve self‐management in chronic obstructive pulmonary disease

Aim

To propose nursing clinical practice changes to improve the development of patient self‐management.

Background

Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates.

Introduction

Control of the disease's progression, the preservation of autonomy in self‐care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self‐management.

Methods

A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis.

Results

The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision‐making process. The specific guidelines, the provision of material to support decision‐making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self‐management skills related to the awareness of the need for ‘change’, hope, involvement, knowledge and abilities.

Discussion

The implemented changes have improved health‐related behaviours and clinical outcomes.

Conclusion

To support self‐management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours.

Implications for nursing and/or health policy

The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes.     

某高校教师慢性病状况分析

目的：评估高校教师的慢性病患病状况,发现危险人群,分析危险因素,为高校有针对性地做好预防保健工作提供科学依据。方法采用描述性流行病学方法,对某高校2007年1787例和2013年1652例教师健康体检结果中患病率居前四位的高甘油三酯、脂肪肝、高血压、糖尿病四种慢性病患病情况进行分析。结果2013年教师健康体检结果中高甘油三酯、脂肪肝、高血压的总患病率分别为31.0%,30.0%,23.3%,均明显高于2007年的22.7%,19.2%,12.6%,差异有统计学意义（P<0.01）,且男性患病率均明显高于女性,差异有统计学意义（P<0.01）,40岁~60岁是高发年龄段。结论上述慢性病在教师人群中患病率较高,与教师工作压力大、自身锻炼较少以及不良的生活习惯有关。因此,加强健康教育,普及预防保健知识,不断增强教师的自我保健意识,提高预防保健能力非常必要。     

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants

Objective

The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP).

慢性肾衰竭患者甲状旁腺激素水平的变化及其意义

目的:探讨血清甲状旁腺激素(PTH)在诊治慢性肾衰竭中的临床意义。方法:将40例慢性肾衰竭患者设为观察组,40例健康体检者设为对照组。测定两组研究对象的血清PTH、尿素氮(BUN)、血肌酐(Scr)、血钙、血磷水平,并进行相关性分析。结果:与对照组比较,观察组患者的血清PTH、尿素氮、血肌酐、血磷水平显著增加,血钙显著减少,差异有统计学意义(P<0.05)。观察组患者的血清PTH水平与尿素氮、肌酐、血磷水平呈正相关(r=0.55-0.68,P<0.05),而与血钙水平呈负相关(r=-0.38,P<0.05)。结论:血清PTH水平可以作为诊疗慢性肾衰竭的重要参考指标,对临床预防和早期处理钙磷代谢紊乱具有重要价值。