健康教育路径对哮喘患者自我管理能力及症状控制的影响

目的探讨健康教育路径对哮喘患者自我管理能力和临床症状的影响。方法将80例哮喘患者随机分为观察组和对照组,对照组采用常规护理,观察组采用健康教育路径,比较2组患者的病情管理能力、症状控制、住院时间以及生活质量。结果观察组疾病认知、情绪管理、症状管理、用药依从性等症状管理能力高于对照组,差异有统计学意义(P0.05)。观察组哮喘积分低于对照组,住院时间少于对照组,生活质量各方面评分高于对照组,差异有统计学意义(P0.05)。结论健康教育路径使健康教育更加程序化、规范化,有利于提高哮喘患者的病情管理能力和症状控制程度。     

快速康复外科护理在结直肠癌手术病人中的应用效果研究

目的:探讨快速康复外科护理在结直肠癌手术病人中的应用效果。方法:将2013年1月~2014年3月在我院行结直肠癌手术病人116例随机等分成观察组与对照组,对照组给予常规护理,观察组实施快速康复外科护理,比较两组病人术后首次排气时间、开始进食时间、术后住院时间、住院总费用、术后并发症发生情况及对护理工作满意度。结果:观察组病人术后首次排气时间、开始进食时间、术后住院时间、住院总费用、术后并发症发生率明显低于对照组(P0.05);满意度明显高于对照(P0.05)。结论:快速康复外科护理有助于缩短住院时间,减少住院费用,提高病人满意度,值得临床推广应用。     

Dissociation as a Mediator of the Relationship Between Childhood Trauma and Nonsuicidal Self-Injury in Females: A Path Analytic Approach

New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.     

临床护理路径在急诊呼吸衰竭患者重症监测中的应用研究

目的:分析临床护理路径在急诊呼吸衰竭患者重症监测中的临床价值,为临床运用提供参考依据。方法:选择2013年4月至2014年6月期间收治的82例急诊呼吸衰竭患者,按照随机数字法分为实验组(n=42)和对照组(n=40)。实验组患者按照临床护理路径进行护理,对照组患者则采用常规护理。比较两组患者临床护理价值的差异性。结果:实验组患者的ICU住院时间、住院费用以及呼吸机使用时间均显著低于对照组患者,差异具有统计学意义(P<0.05);实验组患者发生自发性气胸、肺部感染、尿路感染、肾功能不全及应激性溃疡等并发症的发生率和总发生率均显著小于对照组患者,具有统计学意义(P<0.05);实验组患者对健康教育的总体掌握状况以及总体护理满意度均显著高于对照组患者,差异均具有统计学意义(P<0.05)。结论:临床护理路径在急诊呼吸衰竭患者重症监测中的使用,能够显著降低ICU住院时间、住院费用、呼吸机使用时间,并发症的发生率,且提供患者对健康教育的总体掌握状况以及总体护理满意度,值得在临床上推广使用。     

转化生长因子β1/细胞外信号调节激酶/基质金属蛋白酶通路对腺样囊性癌侵袭和迁移的影响

目的 探讨转化生长因子β1/细胞外信号调节激酶/基质金属蛋白酶2(TGF-β1/ERKl/2/MMP-2)通路在腺样囊性癌(ACC)侵袭和迁移过程中的作用及机制.方法 以腺样囊性癌ACC-2细胞株为研究对象.用转化生长因子β1(TGF-β1)以及ERK通路抑制剂UO126处理ACC-2细胞.MTT检测ACC-2细胞的增殖情况,Transwell实验检测细胞迁移、侵袭能力,Westem blot蛋白印迹检测ACC-2细胞中ERKI/2的活化及MMP-2的表达情况,实时荧光定量聚合酶链反应检测ACC-2细胞中MMP-2的mRNA的表达情况.结果 TGF-β1及UO126干预后,ACC-2细胞增殖能力无明显变化;TGF-β1刺激可增强ACC-2细胞迁移、侵袭能力,增加ACC-2细胞p-ERKI/2和MMP-2蛋白以及MMP-2 mRNA的表达.而UO126阻断ERK磷酸化后,抑制了TGF-β1刺激的增强作用,ACC-2细胞的迁移、侵袭能力降低,MMP-2蛋白和mRNA的表达均下降.结论 TGF-β1/ERKl/2/MMP-2通路参与了人唾液腺ACC侵袭和迁移能力的调节.TGF-β1可通过上调ERK1/2,继而上调MMP-2,促进人唾液腺ACC细胞的侵袭和迁移能力,ERKl/2可能成为人唾液腺ACC侵袭防治的新靶点.     

A Path Analysis of the Variables Related to the Quality of Life of Mothers with Disabled Children in Korea

This study examines how different variables affect the quality of life of mothers of children with disabilities. We attempted to identify the relationship between child variables (age and whether the child has single or multiple disabilities), economic variables (monthly income and average monthly treatment cost), mother‐related variables (parenting stress) and social variables (social support) as predictors of the quality of life of mothers of children with disabilities, and the path along which these variables affect their quality of life. The dataset comprised 160 mothers of children with disabilities, who resided in Seoul city and Gyeonggi province. The participants answered questions related to their general information, quality of life, social support and parenting stress. The data were analysed using SPSS 17.0 and AMOS 16.0. We found that social support not only influences the quality of life through parenting stress but also is a direct factor. We also found that both whether a child had single or multiple disabilities and the average monthly treatment cost were significant factors that influenced the parent's quality of life indirectly through parenting stress. Moreover, we concluded that whereas the age of children with disabilities is only a direct impact on the mother's quality of life, monthly income has a direct influence on both parenting stress and quality of life separately, but it does not directly influence quality of life through parenting stress. In our opinion, this is the first study that has conducted a holistic analysis of the quality of life of Korean mothers of children with disabilities by considering a range of variables. Copyright © 2012 John Wiley & Sons, Ltd.     

Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement

Abstract

Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A large dataset from primary care psychotherapy was used to study relationships between alliance and outcome using piecewise multilevel path analysis. Results: Initial symptom level and symptom change up to session three predicted the alliance at session three. Working alliance significantly predicted symptom change rate from session three to termination, even while controlling for several possible confounds. Conclusions: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.     

兼顾效率与公平的中国卫生资源配置:问题发现及政策路径

目的:探讨卫生资源公平且有效率的配置方式,促进居民公平有效分享公共卫生资源。方法:基于我国31个省级区域2010~2014年的数据,通过超效率DEA模型测算各地区卫生资源配置效率,以各地医疗卫生机构获得的人均财政补贴收入来考察卫生资源配置的公平情况,对卫生公平和效率进行静态差异分析和动态固化分析。结果:无论是地区之间还是内部,我国卫生资源公平的差异程度以及固化程度都比效率大,卫生资源存在不公平和不合理两大问题。结论:中央政府应加大卫生资源调节力度,精准扶持那些"低公平、高效率"的地区,并形成稳定的激励机制。     

万古霉素个体化给药流程的建立及案例分析

目的：建立万古霉素个体化给药流程,并将其应用于临床实践。方法：临床药师依据万古霉素血药浓度监测结果和患者情况,应用建立的流程协助临床制定万古霉素初始给药方案,运用JPKD-vancomycin下的万古霉素群体药动学模型,结合贝叶斯反馈程序解读血药浓度监测结果、推算患者个体化给药剂量、预测调整后给药方案的血药浓度结果,有助于万古霉素个体化给药。结果：万古霉素个体化给药流程应用于万古霉素血药浓度的解读,为临床制定万古霉素个体化给药方案提供依据。结论：建立了万古霉素个体化给药流程,有助于协助临床合理用药,可提高万古霉素临床疗效和减少相关不良反应发生。