Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.     

Influence of plasma drug level and the presence of conduction disease on the electrophysiologic effects of procainamide.

Electrophysiologic measurements were made in 16 patients before and after the intravenous administration of procainamide. The drug was administered at two different dose levels. The lower plasma procainamide level (6 to 7 μg/ml) caused small decreases in cycle length (848 ± 13 versus 799 ± 42 msec), sinus nodal recovery time (1,166 ± 81 versus 1,024 ± 90 msec at a paced rate of 120 beats/min) and sinoatrial conduction time (105 ± 11 to 90 ± 9 msec). Sinus or atrial echo zones, whether or not they caused supraventricular tachyarrhythmia, were abolished by procainamide in 11 of 13 instances. The higher plasma level of procainamide (10 to 11 μg/ml) generally caused greater changes in electrophysiologic measurements. Atrial refractory periods tended to increase but changed significantly only at higher plasma levels. The latter effect was blunted in patients with a prolonged sinoatrial conduction time. The A-H interval and atrioventricular nodal functional refractory period tended to decrease at higher plasma levels, but not significantly. The H-V interval increased slightly from 48 ± 2 to 52 ± 2 msec; this effect was blunted in patients with bundle branch block.It is concluded that procainamide could be useful in managing supraventricular tachyarrhythmia because it abolishes atrial and sinus echo zones that trigger supraventricular tachyarrhythmia and because its widespread effects make it capable of blocking reentry at several sites. The electrophysiologic effects or procainamide are less predictable in patients with conduction disease, and some effects occur only at high plasma levels.     

基于案例的Teach-back在肿瘤患者预防跌倒 健康教育中的应用

目的 探讨基于案例的Teach-back法在肿瘤患者预防跌倒健康教育中的应用效果。方法 选取我科2016年6-12月120例肿瘤患者作为对照组,2017年1-6月140例肿瘤患者作为观察组。对照组实施传统预防跌倒健康教育,观察组采用基于案例的Teach-back法实施预防跌倒的健康教育。比较2组患者跌倒防范措施依从率、跌倒发生率的差异。结果 观察组患者跌倒防范措施依从率为97.63%,明显高于对照组的85.18%(χ²=2 774.640,P<0.001),患者跌倒发生率低于对照组(χ²=5.119,P=0.024)。结论 在肿瘤跌倒高风险患者中运用基于案例的Teach-back对患者进行健康教育,能有效提高患者跌倒防范措施的依从率,降低患者跌倒发生率,值得临床推广。     

采用PRECEDE模式探讨影响初产妇 母乳喂养率的因素

目的 采用PRECEDE (predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation)模式分析影响初产妇母乳喂养率的相关因素。方法 选取产科2013年1月-2015年12月收治的260例住院分娩初产妇为研究对象,根据PRECEDE模式设计量表对所有产妇进行评估。记录产妇的PRECEDE评分与产后6个月内纯母乳喂养率,对影响母乳喂养的因素进行单因素分析,并进行logistic回归分析。结果 260例初产妇出院时及产后1~6个月母乳喂养率分别为80.76%、77.31%、72.69%、63.84%、56.15%、49.62%、36.92%。倾向因素中母乳喂养知识、母乳喂养态度、理想喂养方式,强化因素中社会环境认同、家庭成员支持是影响纯母乳喂养的因素。结论 医护人员应加强初产妇产后喂养知识和技能的培训,鼓励产妇进行纯母乳喂养,以提高初产妇母乳喂养率。     

Describing Self‐Care Self‐Efficacy: Definition,Measurement, Outcomes,and Implications

PURPOSE

The pragmatic utility method of concept analysis was used to explore the usefulness of the concept self‐care self‐efficacy.

DATA SOURCES

Empirical studies across disciplines published between 1996 and 2015 were used as data.

DATA SYNTHESIS

A data matrix was developed. Analytical questions and responses were derived from the data to understand patterns, develop new knowledge and achieve synthesis.

CONCLUSION

Usefulness of the concept is contingent on how it is defined and measured. Self‐care self‐efficacy is associated with performance of self‐care activities and positive health outcomes in diverse populations.

IMPLICATIONS

Research can guide development of targeted interventions to increase patients' self‐care self‐efficacy, thus reducing costs, and assisting people to achieve optimal health.     

Behavioral intention to prevent cervical cancer and related factors among female high school students in Japan

Aim

This study aimed to examine female high school students’ behavioral intention to prevent cervical cancer and related factors.

Methods

The participants were 2158 female high school students at 16 high schools in A prefecture in the Tohoku region in Japan. A self‐administered questionnaire was carried out that was developed based on a conceptual framework comprising the Health Belief Model and Theory of Reasoned Action.

Results

The responses were obtained from 2072 students (96.0%). Of these, the answers of 2028 respondents were analyzed after excluding those participants who did not complete the behavioral intention item (effective response rate: 97.0%). A factor analysis and covariance structure analysis yielded a model with strong goodness‐of‐fit that explained the behavioral intentions based on an “Awareness of the importance and effectiveness of cervical cancer screening,” “Obstacles to cervical cancer prevention behavior,” “Subjective norms for adopting cervical cancer prevention behavior,” and “The behavior of someone close that encourages cervical cancer prevention behavior.”

Conclusion

The statistical analysis yielded a model with strong goodness‐of‐fit that explained female high school students’ behavioral intentions, which were related to four factors, including “the awareness of the importance and effectiveness of cervical cancer screening.”