上海地区儿童综合性医院心理门诊来访者的特征及演变

目的分析上海地区儿童综合性医院心理门诊首次来访者的人口学特征、疾病分布,为探索心理卫生服务模式的发展方向提供理论基础。方法回顾2010-2014年复旦大学附属儿科医院心理科门诊病例资料完整的首诊病例共8 916例,对人口学特征、诊断归类进行统计,分析疾病分布特征。结果儿童心理门诊首诊人次逐年增加,平均幅度18.17%,就诊人群0~18岁,平均年龄为(6.64±3.47)岁,以0~6岁年龄段人数最多,男童多于女童,男女比例为2.79∶1。因各类精神障碍就诊比例为70.1%,按比例前五位依次为注意缺陷多动障碍、精神发育迟缓、广泛性发育障碍、言语及语言障碍、躯体形式障碍五大类。6岁组主要精神障碍依次为:广泛性发育障碍、精神发育迟缓以及注意缺陷多动障碍,6~12岁组儿童精神障碍依次为注意缺陷多动障碍、精神发育迟缓以及情绪障碍。青春期常见精神障碍为注意缺陷多动障碍、精神发育迟缓、情绪障碍、躯体形式障碍。结论综合性儿童医院心理门诊来访者呈快速上升趋势,儿童心理行为问题在不同年龄段和不同性别中呈现特点不同。     

新入职护士心理护理临床实践体验的质性研究

【】目的 探讨新入职护士心理护理临床实践体验,为构建“新入职护士心理护理临床实践技能”培训提供实证参考。方法 采用目的抽样法,应用半结构访谈法,对上海三家三级甲等医院14名新入职临床护士进行深入访谈,采用主题分析法对访谈资料进行整理分析。 结果 基于访谈转录稿,提炼出3个主题:从自我需求中体验到心理护理的重要性、对患者心理护理实践能力的发展、对新入职护士心理护理临床实践培训的建议。结论 新入职护士基于自身体验能意识到心理护理,随着临床适应,能够将心理护理理念融入临床实践,但其自助与助人能力均有待提升。有必要对新入职护士开展心理护理实践技能培训,但培训目标应聚焦自助与助人双重能力培养;培训需植根于临床情境案例,促进心理护理实践技能的临床转化与迁移。     

三级综合医院新护士规范化培训的现状调查

目的调查全国三级综合医院落实《新入职护士培训大纲(试行)》的现状,以及新护士对培训的感受和意见,为进一步完善培训方案提供参考。方法采用方便抽样法,于2018年8月—9月抽取31个省、自治区、直辖市的1 421所三级综合医院以及62 031名新护士为调查对象。采用自行设计的调查问卷,以问卷星的形式进行调查。结果 91.6%的医院开展了新护士规范化培训项目。基础培训时长为4.0(2.0,6.0)周,专业培训时长为11.0(3.0,23.8)个月。基本理论知识培训落实率为88.8%～98.6%,常见临床护理操作技术培训落实率为81.6%～97.7%;临床科室轮转落实情况为内科(91.0%)、外科(91.8%)、重症监护病房(85.8%)、急诊(85.1%)、妇产科(72.7%)、手术室(71.3%)、儿科(70.6%)。培训方法主要为操作示教(96.8%)、课堂讲授(95.5%)、临床查房(91.5%)及个案护理(82.0%);临床实践能力考核方式为标准化病人(76.7%)、高仿真情景模拟(63.4%)。78.0%的新护士认为培训内容符合大纲要求,55.8%的新护士认为规范化培训的时长合适,...     

细胞形态学检查在初诊急性白血病中的应用价值

目的探究细胞形态学检查在初诊急性白血病中的应用价值。方法将2018年1月至2020年1月收治的90例急性白血病患者作为试验组,另选取同期90例健康体检者作为对照组,两组研究对象均接受细胞形态学检查,并对检查结果进行分析。结果试验组的细胞核偏移、白细胞减少、红细胞异常的检出率均明显高于对照组,差异有统计学意义(P<0.05)。细胞形态学诊断急性白血病的灵敏度为87.78%,特异度为91.11%,准确度为89.44%。结论细胞形态学检查在急性白血病诊断中有着较高的应用价值,可更好地指导疾病的诊断和治疗干预,促进急性白血病患者预后的改善。     

乳腺癌患者确诊期症状群特征的潜在剖面分析

目的 调查我国首次确诊乳腺癌患者术前症状群的内部特征,并分析不同类别间人口学变量的分布差异。 方法 2021年6－12月,采用便利抽样方法选取上海市某三甲医院收治的首次确诊为乳腺癌患者198例作为研究对象。采用一般人口学问卷、疼痛数字评分表、状态-特质焦虑量表、匹兹堡睡眠质量指数量表、FACIT疲劳量表进行调查,对该症状群的结果进行潜在剖面分析,检验不同类别间的人口学变量分布差异。 结果 乳腺癌患者术前疼痛-焦虑-疲乏-睡眠障碍症状群可分为高症状组、中症状组和低症状组3个类别。3组患者分别有80例（40.40%）、91例（45.96%）、27例（13.64%）。相比于低症状组,高症状组、中症状组患者生活质量得分较低,但差异无统计学意义（P＞0.05）。不同类别的乳腺癌患者术前症状群在年龄（F=3.310,P=0.039）、职业分布上（χ2=15.041,P=0.020）存在差异（P＜0.05）。结论 首次确诊乳腺癌患者术前症状群存在异质性,年龄和职业是影响首次确诊乳腺癌术前症状群潜类别的重要影响因素。医护人员应关注年轻在职的首次确诊的乳腺癌患者,提供个性化的护理措施,从而提高患者的生活质量。     

案例与情景模拟整合教学法在儿科新入职护士技能培训中的应用

目的：探讨案例与情景模拟整合教学法在新入职儿科护士技能培训中的应用效果。方法：2016年7月至12月,对湖北省2家三级甲等医院的104名新入职儿科护士分组进行技能培训。对照组按照传统演示教学方法,观察组在传统教学基础上增加案例教学和情景模拟整合教学法。通过技能考核和问卷调查,评价实施效果。结果: 观察组学员技能操作考核成绩、对技能培训模式的认同均高于对照组（P＜0.05）。结论：案例与情景模拟整合的教学方法能显著提高新入职儿科护士技能操作水平、激发学习兴趣、提高技能培训效果。     

Transition of newly graduated nurses in China: An evaluation study

The work adaptation of newly graduated nurses exerts a vital impact on their career developments. It is of great significance to guide newly graduated nurses to get acclimatized to the student-to-nurse transition. This study aimed to investigate the work adaptability disorder from the perspective of the organizational socialization and explore the potential factors of work adaptability disorder of newly graduated nurses. A cross-sectional study was performed. Convenience sampling was adopted to recruit 206 newly graduated nurses at four tertiary hospitals in China. The Work Adaptability Disorder Scale, the Transition Shock of Newly Graduated Nurses Scale, and the Organizational Socialization Questionnaire were utilized to measure the work adaptability disorder. The results showed the level of work adaptability disorder was mediocre among newly graduated nurses in China. The variables of gender, education, only child, family residence, transition shock, and organizational socialization could serve as predictors of work adaptability. Our research showed countermeasure of improving organizational socialization and relieving transition shock should be added to the training program of newly graduated nurses with purpose of promoting their adaptation.     

Bevacizumab in high-grade gliomas: past,present, and future

The survival of patients with high-grade gliomas (anaplastic gliomas and glioblastoma) remains poor despite current treatment modalities. However, an enhanced understanding of gliomagenesis is supporting the development of targeted molecular therapies with the potential for improving clinical outcomes. Glioblastoma (GBM) is characterized by extensive microvascular proliferation and the production of large amounts of VEGF. Bevacizumab is a humanized IgG1 monoclonal antibody that selectively binds with high affinity to human VEGF and neutralizes VEGF’s biologic activity. Preclinical data indicate that angiogenesis is essential for the proliferation and survival of GBM cells. A number of studies have evaluated the outcomes of both newly diagnosed and recurrent GBM patients with bevacizumab in a prospective manner. Here, we discuss the role of bevacizumab in the treatment of anaplastic gliomas and GBM in the recurrent and upfront setting.     

Minimal Residual Disease Negativity Does Not Overcome Poor Prognosis in High-Risk Multiple Myeloma: A Single-Center Retrospective Study

BackgroundMinimal residual disease (MRD) is a standard measurement for response assessment in multiple myeloma (MM). Despite new treatments, high-risk MM patients continue to have poor prognosis. We evaluated the effect of MRD negativity in high-risk versus standard-risk patients.Patients and MethodsWe retrospectively evaluated all consecutive MM patients who underwent routine MRD testing by 1-tube 8-color advanced flow cytometry with 2,000,000 events and sensitivity level 10⁻⁵ at our center from 2015 to 2018 after initial therapy. Kaplan-Meier and log-rank test were used to assess survival estimates and differences between study groups.ResultsOne hundred thirty-six patients with MRD testing after initial therapy or autologous stem-cell transplantation were identified. At a median follow-up of 14 months (range, 1-36 months), progression-free survival and overall survival were significantly worse in high-risk versus standard-risk patients. During the study period, 50% of high-risk group had experienced disease progression (relapse and/or death) versus 20% in the standard-risk group (P = .0006). No patients with standard-risk died, but 4 (14%) in the high-risk group did (P = .0007). Regardless of MRD status, high-risk patients had statistically significant worse progression-free survival than standard-risk patients. At median follow-up, those with disease 10% standard-risk/MRD negative; 20% standard-risk/MRD positive; 40% high-risk/MRD negative; and 45% high-risk/MRD positive had either experienced relapse or died (P = .0041). MRD status did not significantly affect overall survival in either group (P = .0914); however, longer follow-up is needed to assess survival.ConclusionGenetic abnormalities remain a powerful prognostic indicator for MM, regardless of MRD status. For newly diagnosed MM patients treated with novel triple-drug initial therapy and frontline autologous stem-cell transplantation, MRD-negative status did not mitigate the poor-prognosis outcomes of high-risk MM patients.