Younger Nursing Home Residents: A Scoping Review of Their Lived Experiences,Needs, and Quality of Life

ObjectivesThe percentage of younger nursing home (NH) residents (ages 18–64 years) in some countries such as the United States and Canada has been increasing over the years. In fact, it is generally held that younger NH residents are considerably different from the older residents (age ≥65 years). There is a need to understand who they are, why they resided in NHs, and their quality of life (QoL). The aims of the study were to describe the experiences, needs, and QoL among younger residents living in NHs.DesignScoping review.Settings and Participants(Younger) Residents of NHs.MethodsFive databases (PubMed, CINAHL, PsycINFO, Web of Science, and Scopus) and Google Scholar were used to search for relevant studies. PRISMA diagram was used to guide this scoping review.ResultsThe key findings of the study cover 5 themes: (1) Confinement, (2) Lack of socialization, (3) Lack of privacy, (4) Lack of appropriate settings, and (5) Loss of identity, as well as results of QoL were generated.Conclusions and ImplicationsThis scoping review provides a deeper understanding of the lived experiences, needs, and QoL among younger NH residents. The results provide suggestions for future studies regarding new interventions to optimize the QoL of NH residents.     

Parental experiences of adopting healthy lifestyles for children with disabilities living with overweight and obesity

BackgroundChildren with disabilities present with high obesity rates.ObjectiveThis study explored the parental experience of adopting healthy lifestyle choices, for children with disabilities, who received dietetic weight management advice.MethodsSemi-structured qualitative interviews were carried out with eight parents/carers in their own homes or healthcare setting in an inner London locality, or by telephone. Data was analyzed using an interpretative phenomenological analysis (IPA) approach.ResultsFive superordinate themes emerged: 1. Strategies to promote healthy lifestyles: encouraging physical activity, limiting access to food and taking a gradual approach to making lifestyle changes. 2. Challenges to adopting healthy lifestyles: selective eating patterns, the high cost of healthy foods and parental/carer lack of time. 3. The role of healthcare professionals (HCPs): revealed that not all parents/carers received advice or support, prior to dietetic referral, when managing their child's weight. Feeling reassured by HCPs was valued. Parents/carers reported a positive experience of seeing the dietitian, as they appreciated receiving practical and individualized advice. 4. Support needs: family support and support from families with children with disabilities was explored. 5. Parent/carer wellbeing: such as stress was found to have a detrimental impact on parents making healthy lifestyle changes.ConclusionsAdopting a healthy lifestyle involved a variety of strategies and challenges, some of which are specific to this population group and should be considered by HCPs, when having weight-related discussions and offering advice. Parental/carer support needs and wellbeing should also be taken into consideration when planning weight management services for this population group.     

金子久学术思想探析

探讨了金氏医案中所体现的学术思想,论述了金氏临旆重视阴阳五行、挈中气机要领、把握升降关键、擅调先天后天的治疗特点,阐述了其临床重视四诊合参、炮制遗药注重实效的治学精神和求实作用。     

Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty?

BackgroundMultiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data.MethodsThe records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment.ResultsOf the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments.ConclusionThe present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.     

数据挖掘在名老中医经验传承的应用现状与智能化趋势

现在,数据挖掘技术正朝着智能化的趋势快速发展,人工智能（AI）在西医学的广泛应用,尤其是AI分析方法在疾病早期诊断与评估、疾病的治疗策略与医疗资源管理这几个方面突出的使用效果,为AI与中医药的结合提供了有价值的参考,尤其在名老中医经验的学习与传承方面。近十余年来,名老中医经验学习与传承领域数据挖掘技术的研究成果颇多,在梳理常用数据挖掘工具与分析方法的基础上,结合AI分析方法在西医学的应用,可以对中医药领域数据挖掘的智能化学习发展方向进行预测与展望,为继承与发展名老中医经验提供更高效的途径,加快中医现代化研究。     

张声生教授运用风药治疗脾胃病经验

风药者,取象春季生发之气也,兼轻巧活泼、芳香辛散、轻扬升浮、通达宣散之性,此药可调肝宣肺运脾、斡旋气机升降,辅有承转机体脏腑气机以交通各脏之功,配伍风药医脾胃之疾,每获良效。张声生教授巧用风药于脾胃之疾,配伍敛阴、补气、活血、降气之药以取风药之长兼制风药之弊,其虽属佐使之品,然组方配伍之术于诊疗临床脾胃之疾常为点睛之笔,甚有裨益。     

Is romantic partner betrayal a form of traumatic experience? A qualitative study

According to a growing body of research, betrayal by a romantic partner is increasingly considered as a form of interpersonal trauma. Between 30% and 60% of betrayed individuals experience symptoms of post-traumatic stress disorder (PTSD), depression and anxiety to clinically meaningful levels. From a clinical perspective, this constellation of symptoms can be conceptualized as a stressor-related adjustment disorder. Yet, no qualitative research has examined the association between romantic betrayal and traumatic stress from the perspective of betrayed individuals. Face-to-face semi-structured interviews were conducted with 13 participants who had completed a clinical trial for a new treatment for adjustment disorder stemming from betrayal. Data were analysed using thematic content analysis. Although betrayal was experienced as a shocking and destabilizing event, and participants used trauma or ‘feeling traumatized’ as a metaphor to describe their experience, few had constructed their reaction as traumatic stress. In fact, participants reported experiencing difficulties understanding the intensity of their experience. However, when exposed to external sources (e.g., books and interviews by psychologists and researchers) that used a trauma and PTSD framework to explain the effects of betrayal, participants reported feeling clarity, validation and relief. Findings are discussed in the light of theoretical and clinical implications.     

Self-care experiences of Pakistani patients with COPD and the role of family in self-care: A phenomenological inquiry

Self-care enables patients in improving quality of life and reducing hospital admissions. Research explored the experiences of patients about breathlessness, sleep problems and complication management in chronic obstructive pulmonary disease (COPD). However, the self-care experiences and the role of the family in self-care are underexplored. This study aimed to understand the self-care experiences of patients with COPD and explore the role of the family in self-care. An interpretive phenomenological inquiry was used, and 13 patients were interviewed in 2019 from two hospitals in Pakistan. The inclusion criteria were patients above 30 years of age at any stage of COPD, who received a confirmed diagnosis of COPD and were receiving the treatment, and engaged in self-care at their homes or communities. The interviews lasted for 35–60 min. Ricoeur's interpretation theory was used for data analysis comprising steps explanation, naive understanding and in-depth understanding. Self-care emerged as a complex individual and familial endeavour affected by personal, social and economic factors. Poverty was one of the core determinants of self-care. Patients emphasised the spiritual, cultural and traditional approaches to self-care. Future research is warranted to develop better understanding of spiritual and cultural self-care and how these dimensions of self-care affect patients’ self-care behaviours.     

我国医疗联合体建设现状与发展思考

医疗联合体是我国建设整合型医疗卫生服务体系的具体表现形式之一,具有优化资源配置、提高资源利用率、改善不合理就医秩序、促进医疗机构同质化发展的重要作用。通过梳理医疗联合体构建背景、发展历程、国内外典型经验,结合党的十九届五中全会精神,为完善我国医疗卫生服务体系,提出要构建科学、有效、统一的医疗联合体绩效考核评价体系,充分发挥绩效评估的激励引导作用,开展医疗联合体评估工作,推动医疗联合体高质量发展。     

颌骨骨折465例治疗体会

目的总结五年颌骨骨折治疗体会,探讨有关问题.方法选用1995年3月至2000年3月治疗的颌骨骨折465例,男348例、女117例.根据就诊时间早晚、致伤原因、骨折部位及分类,治疗方法选择进行总结.结果治疗有效率98.92%,行紧急气管切开术45例,抗体克12例,手术切开复位骨间固定284例,手法或牵引复位外固定181例,术后感染骨延迟愈合8例(1.7%)合并颅脑损伤死亡5例(1.08%).结论①排除颅脑及内脏损伤,保证无窒息、休克发生,通过临床表现确诊骨折类型.②要使骨折片尽早复位,应用坚固内固定技术保证骨块不再移位,恢复伤前咬合关系,软组织要严密缝合.③正确地运用正颌外科技术,使陈旧性骨折达到三维立体方向复位.