胸外科重症患者100例术后呼吸功能恢复方法指导

目的:探讨胸外科重症患者术后呼吸功能恢复的方法及效果.方法:对100例胸外科重症患者进行术后呼吸功能训练指导及精心护理,观察记录呼吸功能恢复情况.结果:100例患者术后呼吸功能均得到及时有效的恢复,无死亡病例,无并发症发生,呼吸功能恢复效果良好.结论:术后呼吸功能训练及精心护理对胸外科重症患者术后肺功能的恢复有积极作用.     

危重患者家属疾病不确定感与生活质量及不良情绪的相关性分析

目的：对危重患者家属疾病不确定感与生活质量的关系进行研究,为提高患者日常生活质量提供可参考依据。方法选取85例危重患者家属作为研究对象,采用疾病不确定感量表（ MUIS）、中文版健康调查简表（ SF-36）对其疾病不确定感及生活质量进行评估,采用SDS和SAS量表进行不良情绪的评价,分析不确定感与生活质量及不良情绪的相关性。结果患者家属MUIS量表总分、不明确性、复杂性、信息缺乏和不可预测性各维度得分分别为（113．65±11．64）,（41．34±4．56）,（23．65±3．46）,（19．64±2．65）,（15．34±2．56）分。 SF-36量表情感职能和活力维度得分最低,分别为（57．65±8．46）,（53．64±8．65）分;SDS与SAS量表得分分别为（57．65±5．46）,（56．64±5．65）分。 MUIS总分、不明确性、复杂性、信息缺乏维度与生活质量各维度呈负相关（r＝-0．532～-0．324,P＜0．05）,与SDS、SAS呈正相关（r＝0．376～0．574,P＜0．05）;不可预测性与总体健康、情感职能、活力、精神健康呈正相关（r＝0．354～0．441,P＜0．05）,与SDS、SAS呈负相关（r分别为-0．476,-0．489;P＜0．05）。结论危重患者的家属有明显的疾病不确定感及不良情绪,生活质量显著降低,在临床工作中护士要积极与其进行沟通,并给予相应支持,以增强患者家属信心。     

骨科医师面临的医疗风险(二)

希波克拉底誓言要求医生全心全意为患者提供最佳的帮助，一个训练有素的医生如果自始至终遵从这一准则，就会将目前的医疗风险降到最低，而良好的医患关系也有助于消除医疗纠纷。导致医疗纠纷的最主要原因是医生未能正确认识到医疗本身是一门艺术而并非是医生学科水平的不足。急诊室是医疗纠纷高发之地，而纠纷的发生率与患者的受伤程度并不成正比，实际上．往往是较轻程度的损伤更易导致医患矛盾。     

药学干预对农村慢、性病患者用药依从性的影响

目的：探讨药学干预对提高农村慢性病患者用药依从性的效果,提高其治疗效果,降低严重并发症的发生。方法：随机抽取4个行政村的慢性病患者分为试验组和对照组,对对照组患者仅根据慢性病管理要求进行监控;对试验组患者及家属进行强化教育、针对性的用药指导等药学干预措施,在首次干预后1个季度及1年进行用药依从性调查。结果：通过药学干预,试验组患者的用药依从性显著提高,疾病控制效果也明显提高。结论：药学干预能明显提高农村慢性病患者的用药依从性、疾病控制效果,能显著提高慢性病管理的效果,药学干预与慢性病管理相结合是提高公共卫生工作质量的新思路。     

Head and neck cancer patients’ recollection of their clinical characteristics

Patient-reported outcomes (PRO) are an important component of treatment evaluation. Typically they are completed by patients on paper, but through advances in technology such as mobile phone apps and websites, there is a great opportunity for electronic completion. It can be challenging, particularly at a regional or national level, to maintain accurate core clinical records on head and neck cancer (HNC) (baseline, recurrence, second primary, and further treatment), and these will influence PROs and the reporting of outcomes. In addition, with data security and confidentiality there is merit in undertaking anonymous surveys, but in this approach, there is a reliance on patients’ recall. The aim of this study therefore was to compare updated hospital records with details completed by patients. In January 2019, 395 HNC patients who had been treated in 2015 and 2016 were sent a survey. They were asked to recall the clinical variables of gender, age at diagnosis, tumour site, tumour stage, and primary treatment, and these were analysed for agreement with the hospital records. The kappa statistic (KP) was used to measure the strength of agreement for categorical variables. There were 146 responders and one patient correctly stated that they did not have cancer. Five indicated further disease rather than primary cancer. Agreement between the hospital record and patients’ recall was excellent for gender (KP=0.97) and age group (KP=0.92), very good for treatment (KP=0.79), and good for site of cancer (KP=0.61), but poor for stage of cancer (KP=0.18). In general, patients gave accurate accounts of these details apart from tumour stage.     

医患纠纷的经济学分析及对策

医患纠纷是由于患者在医院就医期间发生的许多问题导致的一种不和谐人际关系的外在表现。近年来,呈现不断上升的趋势。本文用经济学原理,通过经济模型,分析医患纠纷的经济学内涵,以此为基础提出医患纠纷的解决方案,以维护医疗环境及社会的和谐稳定,为我国经济建设做出医疗行业的贡献。     

癌症患者心理韧性质性研究的系统评价

目的 系统评价有关癌症患者心理韧性发展的真实体验,为更好地制定心理韧性干预方案提供理论依据。方法 计算机检索Cochrane Library、Medline、CINAHL、Embase、PubMed、Web of Science、Psyc INFO以及中国生物医学文献数据库、中国知网、维普、万方数据库从建库至2019年6月相关的质性研究。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准（2016）对文献进行评价,采用汇集性整合方法进行结果整合。结果 共纳入10篇文献,提炼42个明确的结果,形成8个类别,汇总成3个整合结果。①心理韧性发展是动态循环的过程：危机负性期,调节成长期,积极转化期,循环强化期;②心理韧性的阻碍因素：个体（消极应对,错误认知,症状和体象困扰）,环境（传统社会文化,医疗环境,家庭负担）;③心理韧性的保护因素：个体（积极心理与应对方式,复原经历,宗教信仰,自我表露,利他主义与行为）,环境（家庭因素,医疗照护,人际支持）。结论 心理韧性的发展是动态循环过程,受个体和环境因素影响,医护人员应根据不同阶段的影响因素给予针对性护理措施,促进患者心理韧性的形成和发展,提高患者的生活质量。     

Potential role of the compound Eucommia bone tonic granules in patients with osteoarthritis and osteonecrosis: A retrospective study

BACKGROUND Osteoarthritis is a major source of pain,disability,and socioeconomic cost worldwide.Osteonecrosis is a disabling disorder that frequently occurs in the younger population aged from 20-50 years.The compound Eucommia bone tonic granules,a traditional Chinese medicine,can alleviate the damage of osteoarthritis and osteonecrosis.AIM To investigate the potential role of the compound Eucommia bone tonic granules(Eucommia)in the treatment of patients with osteoarthritis and osteonecrosis.METHODS One-hundred forty osteoarthritis and osteonecrosis cases admitted to our hospital from January 2013 to December 2017 were selected.Patients were divided into two groups:Eucommia-meloxicam group and meloxicam group.Clinical efficacy and the Western Ontario and McMaster Universities Arthritis Index(WOMAC)score were evaluated according to the evaluation criteria of orthopedic diseases.The levels of bone-GLA protein,interleukin-17,recombinant human S100 calcium binding protein A12,sphingosine 1-phosphate,cystatin C,creatinine,and hemoglobin in peripheral blood were determined.RESULTS The total effective rate in the two osteoarthritis groups was not different,but the total effective rate in the two osteonecrosis groups was significantly different.The overall efficacy of Eucommia-meloxicam group was superior to that of the meloxicam group.WOMAC showed that pain,stiffness,and dysfunction in the two groups of osteoarthritis and osteonecrosis before and after treatment were significantly different.The concentration of recombinant human S100 calcium binding protein A12,sphingosine 1-phosphate,cystatin C,creatinine,and hemoglobin before and after treatment in the Eucommia-meloxicam group and meloxicam group of osteoarthritis and osteonecrosis were significantly different,and the two treatment groups were significantly different from each other for osteoarthritis.CONCLUSION Our findings indicate that Eucommia can effectively enhance the curative effect of meloxicam,and the combination of Eucommia and meloxicam is superior to meloxicam alone.     

128例老年胃癌患者围手术期临床特点分析及护理对策

目的：提高对老年胃癌患者围术期护理的认识。方法：对128例≥65岁胃癌患者与同期〈65岁212例胃癌患者围术期各方面资料进行对比分析。结果：≥65岁组术前合并症多，全胃及联合脏器切除比例高、创伤大，术后非手术相关并发症多，患者文化水平较低，社会支持水平低。结论：对老年胃癌患者应重视术前的全面评估和充分准备，争取和利用患者的社会支持系统，采取灵活多样的形式进行健康教育，术后重视呼吸系统、心血管系统并发症及手术相关并发症（吻合口瘙、胃排空障碍、胰腺炎、胸腔积液或腹腔积液等）的预防和护理。