农村社区护理中心模式构想

分析了农村开展社区护理的必要性与必然性 ,认为当前我国农村社区护理中心的模式应以乡村医生为主体 ,以镇村组织一体化为基础 ,以初级卫生保健为主要内容 ,以地方经济为后盾 ,并对这一模式的发展前景进行了展望。     

Development and psychometric evaluation of workplace psychologically violent behaviours instrument

Aim. To develop an instrument to determine nurses’ perceptions of psychologically violent behaviours that they are exposed to in the workplace. Background. According to Leymann, psychological terror or mobbing in work life involves hostile and unethical communication, which is directed in a systematic way towards one individual who, due to mobbing, is pushed into a helpless and defenceless position, and being held there by means of continuing mobbing activities. Design. Survey. Methods. Because nurses who work in hospitals are generally the principle victims of physical, emotional and verbal violence due to the nature of their work environment, the research sample comprised 476 hospital nurses. Data were collected via self‐administered questionnaires. Results. The instrument to determine the perception of workplace psychologically violent behaviours contains 33 items and four factors (individual’s isolation from work, attack on professional status, attack on personality and direct attack). All items have shown statistically significant correlation (p < 0·01); the instrument’s total Cronbach’s α internal consistency coefficient was found to be 0·93. Conclusions. The findings show that the instrument’s validity and reliability are within the limits of an acceptable level and that it is an instrument that will encourage more studies on this subject. Relevance to practice. Defining the psychological pressure that nurses are exposed to in the workplace and determining its negative effects on the victim of workplace psychological pressure and on the institution will make it possible to protect individuals and the institution from psychological violence with both individual and institutional practices.     

碘伏在儿科皮肤护理中的应用

不同浓度碘伏应用于小儿皮肤完整性受损的护理疗效显。笔着重讨论了作用原理，提出根据小儿年龄、创面部位、面积采用不同浓度的碘伏，才能取得满意的疗效。     

影响腹膜透析患者社会回归因素的分析

目的：通过分析影响腹透患者社会回归的因素，探求促进腹透患者社会回归的途径。方法：分析16l例透析时间超过3个月的腹透患者的社会回归现状，分析患者的个人情况、临床治疗情况、社会心理及经济情况，探讨影响社会回归的可能因素。结果：社会回归为1级的患者占总患者数的13％，2级2912％，3级47．8％，4级12.4％。影响社会回归的因素为Charlson并发症指数、Hamilton抑郁积分、Engle系数。结论：加强慢性肾脏病的一体化治疗、改善患者的心理社会及经济因素可能是改善腹透患者社会回归的有效途径。     

护理教育中的生死教育

回顾了生死教育的缘起和发展,讨论了生死教育实施的必要性和合理的内容结构及开展形式。提出生死教育能够赋予学生人文关怀的意愿和能力,最终提升医疗护理品质,理当作为医学教育的组成部分。     

刍议护理语言的应用及作用

从临床护理语言在疾病康复中的作用出发 ,探讨了护士的社会角色、融洽护患关系等问题。提出临床护理语言是一个广义的概念 ,护患沟通中语言交流与非语言交流同等重要 ,是影响病人身体康复的重要社会因素。     

Early replacement therapy in a first Japanese case with autosomal recessive guanosine triphosphate cyclohydrolase I deficiency with a novel point mutation

Autosomal recessive guanosine triphosphate cyclohydrolase I (GTPCH) deficiency is an inborn error of tetrahydrobiopterin (BH4) synthesis from GTP. GTPCH deficiency causes severe reduction of BH4, resulting in hyperphenylalaninemia (HPA) and decreased dopamine and serotonin synthesis. Without treatment, a patient with GTPCH deficiency develops complex neurological dysfunctions, including dystonia and developmental delays. The first Japanese patient with GTPCH deficiency was discovered by HPA during asymptomatic newborn screening. The phenylalanine level at the age of 5 days was 1273 μmol/L (cutoff value, 180.0 μmol/L). The high serum phenylalanine level was decreased to normal after adequate BH4 oral supplementation. Serum and urinary pteridine examination revealed very low levels of neopterin and biopterin. Sequence analysis of GCH1 revealed compound heterozygous point mutations, including a novel point mutation (p.R235W). Replacement therapy with BH4 and L-dopa/carbidopa were started at the age of 1 month, and 5-hydroxytryptophan (5-HTP) was started at the age of 5 months. At 10 months of age, the patient showed slight dystonia but no obvious developmental delay. Cerebrospinal fluid should be examined to determine the appropriate dosage of supplement drugs. In conclusion, it is important to control the serum phenylalanine level and perform early replacement of neurotransmitters to prevent neurological dysfunction.     

Augmentation of spelling therapy with transcranial direct current stimulation in primary progressive aphasia: Preliminary results and challenges

Background: Primary progressive aphasia (PPA) is a neurodegenerative disease that primarily affects language functions and often begins in the fifth or sixth decade of life. The devastating effects on work and family life call for the investigation of treatment alternatives. In this article, we present new data indicating that neuromodulatory treatment, using transcranial direct current stimulation (tDCS) combined with a spelling intervention, shows some promise for maintaining or even improving language, at least temporarily, in PPA.

Aims: The main aim of the present article is to determine whether tDCS plus spelling intervention is more effective than spelling intervention alone in treating written language in PPA. We also asked whether the effects of tDCS are sustained longer than the effects of spelling intervention alone.

Methods & Procedures: We present data from six PPA participants who underwent anodal tDCS or sham plus spelling intervention in a within-subject crossover design. Each stimulation condition lasted 3 weeks or a total of 15 sessions with a 2-month interval in between. Participants were evaluated on treatment tasks as well as on other language and cognitive tasks at 2-week and 2-month follow-up intervals after each stimulation condition.

Outcomes & Results: All participants showed improvement in spelling (with sham or tDCS). There was no difference in the treated items between the two conditions. There was, however, consistent and significant improvement for untrained items only in the tDCS plus spelling intervention condition. Furthermore, the improvement lasted longer in the tDCS plus spelling intervention condition compared to sham plus spelling intervention condition.

Conclusions: Neuromodulation with tDCS offers promise as a means of augmenting language therapy to improve written language function at least temporarily in PPA. The consistent finding of generalisation of treatment benefits to untreated items and the superior sustainability of treatment effects with tDCS justifies further investigations. However, the small sample size still requires caution in interpretation. Present interventions need to be optimised, and particular challenges, such as ways to account for the variable effect of degeneration in each individual, are discussed.     

Riding the Rapids: Living with autism or disability—An evaluation of a parenting support intervention for parents of disabled children

Evidence on the effectiveness of interventions to support parents of disabled children to manage their child's behaviour problems is limited. The aim of this study was to evaluate a group-delivered intervention (Riding the Rapids) which was specifically developed for parents of a child with a disability or autistic spectrum condition. This programme has been routinely delivered by a community-based mental health team across an urban, multi-ethnic locality for a number of years. A non-randomised controlled study design comprising an intervention group (n = 48) and comparator (no intervention) group (n = 28) was used to evaluate the effects of the intervention on child behaviour (Eyberg Child Behaviour Inventory; parent-set goals) and parenting efficacy and satisfaction (Parents Sense of Competence Scale) at post-intervention and six-month follow-up. Data on costs to the service provider of delivering the intervention were also collected. Receipt of the intervention was associated with significant reductions in parent-reported behaviour problems and significant improvements in parenting efficacy and satisfaction. At six-month follow-up, progress towards achieving parent-set child behaviour goals and parenting satisfaction had been maintained. Post hoc analysis suggests parents who do not have English as a first language may not benefit as much as other parents from this intervention. Findings suggest this is a promising intervention for parents of a child with a disability that is likely to be less resource intensive to service providers than individually delivered interventions. Limitations and implications for future research are discussed.     

Development and preliminary validation of the First Episode Social Functioning Scale for early psychosis

The current study aimed at developing and conducting a preliminary validation a novel social functioning measure for people with early psychosis. The First Episode Social Functioning Scale (FESFS) was developed to cover many domains specific to this population in their contemporary reality. The self-report version of the FESFS was administered to 203 individuals receiving services in first episode clinics. Scores of the GAF, SOFAS, Social Functioning Scale and BPRS were also obtained for parts of the sample to calculate convergent and discriminant validity. A subgroup also answered the FESFS at several time points during treatment in order to determine sensibility to change. Principal component factor analyses and internal consistency analyses revealed the following nine factors with alphas ranging from 0.63 to 0.80: Friendships and social activities, Independent living skills, Interacting with people, Family, Intimacy, Relationships and social activities at work, Work abilities, Relationships and social activities at school, Educational abilities. Convergent and discriminant validity were demonstrated, as well as sensitivity to change. Clinical and research utility of the FESFS are discussed.