高血压并发脑梗死患者血压控制与自我管理行为、生活方式的相关性及护理对策

目的 探讨高血压并发脑梗死患者自我管理行为和生活方式与血压控制的相关性,并讨论相关的护理对策.方法 分层抽样选取高血压并发脑梗死患者268例,设计调查表调查所有患者自我管理行为和生活方式,分析其对血压控制的影响,分析其护理对策.结果 年轻、文化程度高、生活水平高、自我管理能力强、蔬菜摄人量充足、食盐和烟酒摄入量少以及适度进行体育锻炼的受调查者血压控制情况更好.年长、自我管理能力差、盐摄入量高均不利于血压的控制.结论 有效的自我管理和良好的生活方式可以很好地控制高血压并发脑梗死患者的血压,改善患者预后和生活质量.     

Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes

Aim: To examine the effects of life review on daily activities, social participation, outlook on life, and perceptions of living in a nursing home measured by life satisfaction and quality of life in older adults. Method: The study design was a two-phase quasi-experimental pre-post-tests including development and testing of a life review protocol. Nine residents, age ≥65, participated in a life review group once weekly for 6 weeks. Outcomes were analyzed using the Life Satisfaction Index-Z (LSI-Z) and pre-post surveys. Results: LSI-Z scores improved post-intervention and survey outcomes indicated participation in activities of daily living (ADLs), socialization, outlook on life, and living in a nursing home perceptions improved for all participants. Conclusion: The study demonstrates the effectiveness of a life review protocol to improve ADLs, social participation, and enhancing perceptions of outlook on life and living in a nursing home enhancing QOL and life satisfaction for older adult nursing home residents.     

Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital

Context

Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.

Dispositional hope and life satisfaction among older adults attending lifelong learning programs

BackgroundThe aim of this study is to explore the indirect effects of dispositional hope in the life satisfaction of older adults attending a lifelong learning program at the University of Valencia, Spain. We examine the mediating impact of dispositional hope regarding its ability to impact life satisfaction while considering affective and confidant social support, perceived health and leisure activities, consciousness and spirituality as predictors.MethodsAnalysis were based on survey data (response rate 77.4%) provided by 737 adults 55 years old or more (Mean age = 65.41, SD = 6.60; 69% woman). A structural model with latent variables was specified and estimated in Mplus.ResultsThe results show the ability of just a few variables to sum up a reasonable model to apply to successful aging population. All these variables are correlated and significantly predict hope with the exception of health. The model additionally includes significant positive indirect effects from spirituality, affective support and consciousness on satisfaction. The model has a good fit in terms of both the measurement and structural model. Regarding predictive power, these comprehensive four main areas of successful aging account for 42% of hope and finally for one third of the life satisfaction variance.ConclusionsResults support the mediating role of dispositional hope on the life satisfaction among older adults attending lifelong learning programs. These findings also support the MacArthur model of successful aging adapted to older adults with high levels of functional, social and cognitive ability. Dispositional hope, perceived health, and social support were the strongest predictors of satisfaction with life.     

Use of [177Lu]Lu-DOTA-TATE in the treatment of gastroenteropancreatic neuroendocrine tumours: Results of a UK cost-effectiveness modelling study

AimTo evaluate the cost-effectiveness of [¹⁷⁷Lu]Lu-DOTA-TATE versus relevant comparators for the treatment of neuroendocrine tumours located in the gastrointestinal tract (GI-NETs) and the pancreas (P-NETs).Materials and methodsA three-state partitioned survival model was developed to perform a cost-utility analysis of [¹⁷⁷Lu]Lu-DOTA-TATE versus standard of care (high dose Octreotide LAR), everolimus and sunitinib. Effectiveness data for SoC, everolimus and sunitinib were obtained from published Kaplan–Meier survival curves. Given a lack of head-to-head effectiveness data, matching adjusted indirect comparisons (MAICs) were performed to population-adjust [¹⁷⁷Lu]Lu-DOTA-TATE survival data based on prognostic factors and derive estimates of relative effectiveness. Health state utilities were estimated from real-world evidence. Drug acquisition costs were taken from nationally published sources (BNF, NICE), and administration costs were based on treatment protocols in [¹⁷⁷Lu]Lu-DOTA-TATE studies, combined with nationally published unit costs (PSSRU, DoH reference costs). Incidence of adverse events were estimated using published sources. A discount rate of 3.5% was applied to both utilities and costs, and deterministic and probabilistic sensitivity analyses were performed. Costs were included from an NHS perspective and presented in 2017/18 GBP (and PPP Euros for base case).ResultsIn GI-NETs, the incremental cost-effectiveness ratio (ICER) of [¹⁷⁷Lu]Lu-DOTA-TATE compared to SoC and everolimus was £26,528 (€27,672) and £24,145 (€25,186) per QALY, respectively. In P-NETs, the ICER of [¹⁷⁷Lu]Lu-DOTA-TATE compared to SoC was £22,146 (€23,101) or £28,038 (€29,251) dependent on matched population, and £21,827 (€22,766) and £15,768 (€16,445) compared to everolimus and sunitinib, respectively.ConclusionsAt a willingness to pay threshold of £30,000, [¹⁷⁷Lu]Lu-DOTA-TATE is likely to be a cost-effective treatment option for GI-NET and P-NET patients versus relevant treatment comparators (NHS perspective).