护理干预对慢性阻塞性肺病患者影响的研究

目的 探讨护理干预对慢性阻塞性肺病(COPD)的影响.方法 将2008年10月到2010年8月于我院住院治疗的60例COPD患者随机分为对照组和干预组,对照组30例接受常规护理;干预组30例给予制定、实施系统的护理干预措施.观察两组患者动脉血气分析指标的变化、住院天数、住院费用、患者对COPD相关知识的掌握及对护理质量...     

Social and Self-Reflective Use of a Web-Based Personally Controlled Health Management System

Background

Personally controlled health management systems (PCHMSs) contain a bundle of features to help patients and consumers manage their health. However, it is unclear how consumers actually use a PCHMS in their everyday settings.

Objective

To conduct an empirical analysis of how consumers used the social (forum and poll) and self-reflective (diary and personal health record [PHR]) features of a Web-based PCHMS designed to support their physical and emotional well-being.

Methods

A single-group pre/post-test online prospective study was conducted to measure use of a Web-based PCHMS for physical and emotional well-being needs during a university academic semester. The PCHMS integrated an untethered PHR with social forums, polls, a diary, and online messaging links with a health service provider. Well-being journeys additionally provided information to encourage engagement with clinicians and health services. A total of 1985 students and staff aged 18 and above with access to the Internet were recruited online, of which 709 were eligible for analysis. Participants’ self-reported well-being, health status, health service utilization, and help-seeking behaviors were compared using chi-square, McNemar’s test, and Student’s t test. Social networks were constructed to examine the online forum communication patterns among consumers and clinicians.

Results

The two PCHMS features that were used most frequently and considered most useful and engaging were the social features (ie, the poll and forum). More than 30% (213/709) of participants who sought well-being assistance during the study indicated that other people had influenced their decision to seek help (54.4%, 386/709 sought assistance for physical well-being; 31.7%, 225/709 for emotional well-being). Although the prevalence of using a self-reflective feature (diary or PHR) was not as high (diary: 8.6%, 61/709; PHR: 15.0%, 106/709), the proportion of participants who visited a health care professional during the study was more than 20% greater in the group that did use a self-reflective feature (diary: P=.03; PHR: P<.001).

Conclusions

There was variation in the degree to which consumers used social and self-reflective PCHMS features but both were significantly associated with increased help-seeking behaviors and health service utilization. A PCHMS should combine both self-reflective as well as socially driven components to most effectively influence consumers’ help-seeking behaviors.     

A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study.

AIMS: Uncertainty exists as to which reperfusion strategy for ST-elevation myocardial infarction (MI) is optimal. We evaluated whether optimal pharmacologic therapy at the earliest point of care, emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Which Early ST-elevation myocardial infarction Therapy (WEST) was a four-city Canadian, open-label, randomized, feasibility study of 304 STEMI patients (> 4 mm ST-elevation/deviation) within 6 h of symptom onset, emphasizing pre-hospital ambulance treatment and participation of community and tertiary care centres. All received aspirin, subcutaneous enoxaparin (1 mg/kg), and were randomized to one of three groups: (A) tenecteplase (TNK) and usual care, (B) TNK and mandatory invasive study < or = 24 h, including rescue PCI for reperfusion failure, and (C) primary PCI with 300 mg loading dose of clopidogrel. Time from symptom onset to treatment was rapid (to TNK for A = 113 and B = 130 min and for PCI in C = 176 min). The primary outcome, a composite of 30-day death, re-infarction, refractory ischaemia, congestive heart failure, cardiogenic shock, and major ventricular arrhythmia, was 25% (Group A), 24% (Group B), and 23% (Group C), respectively. However, there was a higher frequency of the combination of death and recurrent MI in Group A vs. Group C (13.0 vs. 4.0%, respectively, P-logrank = 0.021), yet no difference between Group B (6.7%, P-logrank = 0.378) and C. CONCLUSION: These data suggest that a contemporary pharmacologic regimen rapidly delivered, coupled with a strategy of regimented rescue and routine coronary intervention within 24 h of initial treatment, may not be different from timely expert PCI.     

心理干预对新兵适应障碍影响的Meta分析

目的:系统评价心理干预对新兵适应障碍的影响。方法:检索中国知网CNKI数据库,收集截止至2016年9月1日正式发表的关于心理干预对我国新兵适应障碍影响研究的文献,运用RevMan 5.2软件对符合纳入标准的文献进行Meta分析。结果:共纳入4篇文献、378名新兵。Meta分析显示,与心理干预前比较,干预后SCL-90总均分降低(SMD=-0.21,95%CI为-0.37~-0.05,P=0.009)。干预后部分因子分降低,如强迫、人际关系、抑郁、焦虑、敌对性和恐怖因子分差异有统计学意义(SMD=-0.29,-0.43,-0.22,-0.33,-0.23,-0.22;P0.01),躯体化、偏执和精神病性因子分及阳性项目数变化无统计学意义。结论:心理干预可以有效改善部分新兵适应障碍问题。     

Longitudinal analysis of discussion topics in an online breast cancer community using convolutional neural networks

Identifying topics of discussions in online health communities (OHC) is critical to various information extraction applications, but can be difficult because topics of OHC content are usually heterogeneous and domain-dependent. In this paper, we provide a multi-class schema, an annotated dataset, and supervised classifiers based on convolutional neural network (CNN) and other models for the task of classifying discussion topics. We apply the CNN classifier to the most popular breast cancer online community, and carry out cross-sectional and longitudinal analyses to show topic distributions and topic dynamics throughout members’ participation. Our experimental results suggest that CNN outperforms other classifiers in the task of topic classification and identify several patterns and trajectories. For example, although members discuss mainly disease-related topics, their interest may change through time and vary with their disease severities.     

重性精神疾病患者出院后参加社区管理治疗的现状及影响因素分析

目的了解重性精神疾病患者出院后同意参加社区管理治疗的现状及影响因素。方法对2011年出院的1 021例重性精神疾病患者所填写的社区管理治疗知情同意书进行回顾性分析。结果同意参加社区管理治疗患者为588例(57.59%),不同意参加患者为433例(42.41%);不同意参加社区管理治疗的患者与性别(男性)、年龄(25岁)、居住地(城市)等因素相关,经比较,P0.01。结论重性精神疾病患者出院后同意参加社区管理治疗比例较低,与性别、年龄、居住地有关。     

Prediction equations for handgrip strength in healthy Indian male and female subjects encompassing a wide age range

Primary objective : Handgrip strength is a simple index of skeletal muscle function and a functional index of nutritional status. A major lacuna in the use of handgrip strength is the limited availability of normative data. The main objective of this paper was to develop prediction equations for handgrip strength in Indians covering a wide age range. Methods : Handgrip strength and basic anthropometric parameters were measured in 1024 healthy Indian subjects of both genders (613 males, 411 females) between the ages of 5 and 67 years. The sample was randomly divided into two sets; one set ( n = 677) was used to develop the prediction equations for handgrip strength and the other ( n = 347) was used to validate the equations. Each data set was further divided into two subsets (adults > 18 years, sub-adults &#114 18 years), since separate equations were developed for adults and sub-adults. Simple models that included one of the following variables: height, forearm circumference and age as well as a full model that included all three variables were developed. Gender was included in all models. Results : In general, all simple models predicted handgrip strength better in sub-adults ( R 2 = 0.78-0.81) as compared to adults ( R 2 = 0.52-0.57). The best simple model in sub-adults was that which included age and gender ( R 2 = 0.81), while for adults it was that which included forearm circumference and gender ( R 2 = 0.57). The full model explained a further 3.4-6.5% of the variance in handgrip strength in sub-adults and a further 6.3-13.3% in adults. Conclusions : The simple and full model equations for handgrip strength had high predictive power in the sub-adults, while they were less predictive in adults. The equations will be of particular use in physiological studies assessing muscle strength and in clinical investigations of patients with malnutrition and neuromuscular disorders.     

Personas in online health communities

Many researchers and practitioners use online health communities (OHCs) to influence health behavior and provide patients with social support. One of the biggest challenges in this approach, however, is the rate of attrition. OHCs face similar problems as other social media platforms where user migration happens unless tailored content and appropriate socialization is supported. To provide tailored support for each OHC user, we developed personas in OHCs illustrating users’ needs and requirements in OHC use. To develop OHC personas, we first interviewed 16 OHC users and administrators to qualitatively understand varying user needs in OHC. Based on their responses, we developed an online survey to systematically investigate OHC personas. We received 184 survey responses from OHC users, which informed their values and their OHC use patterns. We performed open coding analysis with the interview data and cluster analysis with the survey data and consolidated the analyses of the two datasets. Four personas emerged—Caretakers, Opportunists, Scientists, and Adventurers. The results inform users’ interaction behavior and attitude patterns with OHCs. We discuss implications for how these personas inform OHCs in delivering personalized informational and emotional support.     

Supporting children with burns: Developing a UK parent-focused peer-informed website to support families of burn-injured children

BackgroundChildren’s burn injuries can have a significant psychosocial impact on parents. However, the stress involved in caring for a child following a burn can often go unrecognized and does not necessarily prompt help seeking by parents.ObjectiveIt is common for adults to seek health-related support and information via the Internet. Many benefit from immediate and easy access to online psychological interventions. A prototype burn-specific, parent-focused, peer-informed, supportive website, designed to provide easy access to information and psychoeducation, was created and tested for acceptability.Patient involvementUsing a partnership-based method of website development, parents and professionals (clinical, academic and support organizations) were recruited and their particular expertise was acknowledged and valued. A participatory action approach was adopted to determine the acceptability of the website for parents/carers.Methods31 participants (9 parents, 22 professionals) tested a prototype version of the website. Data was collected using the eHealth Impact Questionnaire and the concurrent think-aloud protocol.ResultsParents and professionals had favorable opinions of the website. Parents’ ratings tended to be more favorable than professionals’, which was significant for the information and presentation. Participants’ thoughts were categorized into seven topics: need, structure/navigation, trust/relevance, language/comprehension, therapeutic content, mode of delivery, and suggested improvements.DiscussionMany practical and psychological barriers can prevent parents of burn-injured children accessing psychosocial support and contribute to a feeling of isolation. Participants felt that the website would be a valuable addition to UK pediatric burn care. The existence of an accessible resource could help to normalize parents’ experience of their child’s injury and reduce their perceived isolation, although peer interaction is not provided by the website.Practical valueThis online resource, hosting information and peers’ personal experiences, offers promising and exciting opportunities to empower parents whilst providing accessible supportive advice to encourage self-care and formal/informal support seeking when necessary.     

Structural and functional profiles of the gut microbial community in polycystic ovary syndrome with insulin resistance (IR-PCOS): a pilot study

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that affects 9–21% of reproductive-aged women. Affected women frequently display obesity, insulin resistance, and inflammation. Altered gut microbial community has been reported in PCOS and obese PCOS patients. However, the profile of the gut microbial community in insulin resistant PCOS (IR-PCOS) patients still remains unknown. In this study, next-generation sequencing based on the 16S rRNA gene was used to compare the gut microbial composition of women with IR-PCOS (n = 9, PCOS with insulin resistance), NIR-PCOS (n = 8, PCOS alone) and healthy controls (n = 8, HC). We assessed that the composition of the gut microbial communities in NIR-PCOS and IR-PCOS patients were significantly altered. The family Bacteroidaceae was prolific in the NIR-PCOS group and reached its highest level in the IR-PCOS group, while the Prevotellaceae dramatically decreased in PCOS patients, especially in the IR-PCOS group. Subsequent correlation analysis revealed that the increased clinical parameter levels, including insulin resistance, sex-hormones and inflammation, were positively associated with the abundance of Bacteroidaceae, but negatively associated with that of Prevotellaceae. In addition, IR-PCOS patients also displayed a significant difference in their amounts of Ruminococcaceae and Lachnospiraceae when compared to the NIR-PCOS group. Moreover, the functional prediction from PICRUSt revealed that 73 pathways are significantly changed in the gut microbial communities of PCOS patients. Specifically, 21 metabolism-associated pathways, including the steroid hormone biosynthesis and lipopolysaccharide biosynthesis pathways, are obviously changed in IR-PCOS when compared to NIR-PCOS and HC groups. Taking this into consideration, our present study suggests that the dysbiosis of gut microbial communities occurred most notably in IR-PCOS patients, and the difference in gut dysbiosis profile between the IR-PCOS and NIR-PCOS should be considered in clinical treatment for PCOS patients and future drugs development.