基于跨理论模型动机访谈改善老年高血压患者自我效能及疗效的研究*

目的探讨基于跨理论模型(TTM)动机访谈(MI)改善老年高血压患者自我效能及疗效。方法将286例60～75岁社区老年高血压患者随机分为对照组和观察组,每组各143例,对照组给予社区分层分级管理干预,观察组在社区分层分级管理的基础上开展基于跨理论模型动机访谈干预,两组干预时间均为18个月。干预前后分别测评自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量,采用t检验和χ2检验比较两组自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量。结果干预前,两组自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量之间差异均无统计学意义(P0.05);干预18个月后,观察组自我效能、自我管理、高密度脂蛋白、血压治疗及控制情况和生存质量较对照组均有显著改善(P0.05)。结论基于TTM的动机访谈是有效的认知、行为改变技术,有助于提高患者自我效能和自我管理水平,改善高密度脂蛋白、血压治疗及控制情况和生存质量,值得在社区推广应用。     

Standards for Instrument Migration When Implementing Paper Patient-Reported Outcome Instruments Electronically: Recommendations from a Qualitative Synthesis of Cognitive Interview and Usability Studies

Objectives

To synthesize the findings of cognitive interview and usability studies performed to assess the measurement equivalence of patient-reported outcome (PRO) instruments migrated from paper to electronic formats (ePRO), and make recommendations regarding future migration validation requirements and ePRO design best practice.

Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care

The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient׳s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice.     

The multiple mini‐interview: how long is long enough?

Objectives  The multiple mini-interview (MMI) overcomes the limitations of the traditional panel interview by multiple sampling to provide improved objectivity and reliability. Reliability of the MMI is affected by number of stations; however, there are few data reporting the influence of interview duration on MMI outcome and reliability. We aimed to determine whether MMI stations can be shortened without affecting applicant rankings or compromising test reliability.
Methods  A total of 175 applicants were interviewed and assessed at 10 8-minute stations. Applicants were scored once after 8 minutes at five control stations and twice after 5 minutes and 8 minutes at five experimental stations. Scores at 5 and 8 minutes were compared using t -tests and correlation coefficients. Rankings of applicants based on 5- and 8-minute scores were compared using Spearman's rank order coefficient. The reliability of the MMI was examined for 5- and 8-minute scores using generalisability theory.
Results  Mean scores at 5 minutes were lower than mean scores at 8 minutes. Cumulative scores at 5 minutes were also lower. There were highly significant correlations between 5- and 8-minute scores at all experimental stations (0.82–0.91; P  < 0.01) and between the cumulative scores at 5 and 8 minutes (0.92; P  < 0.01). There was a strong correlation between applicant rankings based on cumulative 5- and 8-minute scores (Spearman's rank order coefficient 0.92). Reliability was not affected.
Conclusions  Reducing the duration of MMI stations from 8 to 5 minutes conserves resources with minimal effect on applicant ranking and test reliability.     

Geriatric Rehabilitation: Elderly Clients' Experiences of a Pre-discharge Occupational Therapy Group Programme

This study describes how elderly people, temporarily living in a pre-discharge community rehabilitation centre, may experience participation in an in-patient occupational therapy programme built around group activities. The group activity programme was comprised of five sessions, each focusing on a theme chosen to encourage reflection and mutual sharing of experiences and support. Data were collected through interviews with each of the three participants immediately after each of the five group sessions. The resultant 15 interviews were analysed by adopting a Grounded Theory approach. The results show that the ways in which the participants experienced participating in the group activity programme can be described from two distinct core categories: experiences of activation and experiences of transformation . The category of activation emerged from their experiences of a creative force whilst engaged in performing the activities and from their discovery that the group was a good place for learning . Engagement in the group activities also seemed to bring about a transformation in the participants in that their experiences triggered reflection and adaptation , which contributed to a change in attitude and a personal synthesis where their new discoveries were internalized. The study shows the potential a group activity programme in occupational therapy has in triggering an adaptational and reflective process within elderly people facing discharge from hospital. Hence, group activity interventions in occupational therapy are suggested as one possible way to support the elderly person in the discharge process from hospital to the home.     

动机性访谈护理对糖尿病患者自我管理和血糖控制的作用

目的:分析动机性访谈护理对糖尿病患者自我管理和血糖控制的作用与意义。方法:于2015年2月至2016年10月选取102例糖尿病患者作为研究对象,随机分为观察组和对照组,每组51例。对照组给予基础药物治疗、常规护理和健康教育,观察组在此基础上实施动机性访谈干预,对比两组护理效果。结果:经动机性访谈护理后,观察组生理功能、社会功能、情感职能和总体健康提高程度显著高于对照组(均P <0. 05);两组糖化血红蛋白、空腹血糖显著下降,且观察组下降程度显著高于对照组(均P <0. 05);观察组饮食自我管理、心理自我管理、治疗自我管理及自我管理总分显著高于对照组(均P <0. 05);观察组患者对护理非常满意率92. 16%,显著高于对照组的74. 51%(P <0. 05)。结论:动机性访谈护理可显著提高糖尿病患者的生活质量和自我管理水平,降低血糖水平,值得临床采用和推广。     

Trends in U.S. adult chronic disability rates over time

BackgroundTrends in the patterns and prevalence of chronic disability among U.S. residents carry important implications for public health and public policies across multiple societal sectors.ObjectivesTo examine trends in U.S. adult population rates of chronic disability from 1998 to 2011 using 7 different disability measures and examining the implications of trends in population age, race and ethnicity, and body mass index (BMI).MethodsWe used National Health Interview Survey data on civilian, non-institutionalized U.S. residents ages ≥18 from selected years between 1998 and 2011. We used self-reported information on functional impairments, activity/participation limitations, and expected duration to create 7 chronic disability measures. We used direct standardization to account for changes in age, race/ethnicity, and BMI distributions over time. Multivariable logistic regression models identified associations of disability with sociodemographic characteristics.ResultsWithout adjustment, population rates of all 7 disabilities increased significantly (p < 0.0001) from 1998 to 2011. The absolute percentage change was greatest for movement difficulties: 19.3% in 1998 and 23.3% in 2011. After separate adjustments for trends in age, race/ethnicity, and BMI distributions, 6 disability types continued to show increased rates over time (p < 0.01), except for sensory disabilities. Over time, poor education, poverty, and unemployment remained significantly associated with disability.ConclusionsIf these trends continue, the numbers and proportions of U.S. residents with various disabilities will continue rising in coming years. In particular, the prevalence of movement difficulties and work limitations will increase. Furthermore, disability will remain strongly associated with low levels of education, employment, and income.     

A qualitative exploration of staff views towards the uptake of NHS Direct

ObjectivesTo explore the views of staff to examine the underlying factors that may contribute to the variation of uptake to NHS Direct.MethodsAdopting a qualitative approach two focus groups were carried out with staff (n=13); which included registered nurse advisors and health advisors at two NHS Direct sites: Bristol and Manchester in England. Findings were analysed using framework analysis [1].ResultsStaff views for explaining reasons why people do and do not engage with NHS Direct focused on themes centred on ‘knowledge of NHS Direct’, ‘attitudes towards NHS Direct’, ‘the cost of using NHS Direct’, ‘time/speed of using NHS Direct’ and finally ‘satisfaction with the service’.ConclusionThis research has explored staff views of the barriers and facilitators that may impact on the uptake NHS Direct, which can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.     

Parent versus child report of young children’s parasocial relationships in the United States

This study examines parent perceptions of their young children’s one-sided, emotionally tinged relationships with media characters, also known as parasocial relationships (PSR). Prior research has collected data on young children’s PSR by surveying parents, while other studies have relied directly on child interview. The current study is the first to compare children’s answers to those of their parents. Factor analyses revealed that parents and children both reported three components of children’s PSR: social realism, attachment and character personification (parents) or attachment and friendship (for their children), and humanlike needs. Both parent and child reports accounted for approximately 60% of the variance in children’s PSR. Nonetheless, only approximately one-third of parents and children reported on the same favorite character. The implications for research on children’s PSR using both parent and child reports are discussed.     

电话随访对留置双J管患者遵医依从性的影响

目的 探讨采用电话随访方式对留置双J管患者进行出院后健康教育的效果.方法 将留置双J管的患者按出院先后顺序1～462号按奇偶号分为对照组和观察组,各231例.两组住院期间及出院前均进行常规健康教育,观察组在出院时建立电话随访登记本,出院后由专人对患者的饮食、服药、休息、活动等内容进行电话随访.随访1个月后,观察、比较两组的留置管并发症、自我护理情况、相关知识掌握情况.结果 观察组电话随访率100.0％,对相关知识掌握率96.4％,自我护理能力95.1％;对照组对相关知识的掌握率61.1％、自我护理能力67.9％;两组比较,差异有统计学意义(P＜0.01).观察组留置管并发症明显少于对照组.结论 电话随访方式健康教育将医院健康教育工作延伸到留置双J管患者家中,减少了各种并发症的发生,取得了较好的社会效果,得到了患者及其家属的好评.