湖南省护理管理者对开业护士的态度调查

目的 了解湖南省护理管理者对开业护士的态度和意愿,为我国开业护士的探索提供参考。 方法 利用自行设计的问卷对湖南省14个市州的护理管理者进行横断面调查。 结果 4 998名调查对象中,有34.91%和59.84%护理管理者认为非常有必要或有必要开展开业护士项目,且79.49%护理管理者认为开业护士就业前景广阔。回归分析显示,对开业护士的态度及意愿得分主要受职称、学历、是否出诊专科护理门诊和是否接触过开业护士实践或研究的影响（均P＜0.05）。护理管理者认为当前发展开业护士的首要影响因素为国家政策导向（45.10%）,主要担忧患者的理解和接受度不高（60.20%）。 结论 湖南省护理管理者对开业护士普遍持积极态度,且发展意愿强烈,但仍存顾虑。可立足国情,积极探索开业护士参与卫生保健服务,提升全民健康水平。     

湖南省护理管理者对开业护士培养与执业期望调查

目的 了解湖南省护理管理者对国内开业护士培养及执业期望,为我国开业护士培养实践提供参考。方法 采用自行设计问卷对湖南省1 996名护理管理者进行网络横断面调查。结果 护理管理者认为开业护士应具备的最重要的前3项核心能力依次为独立实践能力（95.34%）、临床质控能力（78.21%）和临床研究能力（68.84%）。申请者的准入标准,以本科学历（74.90%）、主管护师职称（67.18%）、成为注册护士并积累5～10年全科护理经验（78.96%）和5～10年专科护理经验（76.40%）的选择率最高。1 321名（66.18%）护理管理者期望研究生学位教育与专项教育项目均作为我国开业护士的教育途径。44.94%期望由国家级卫生行政部门进行资格认证,87.88%期望定期延续认证。开业护士8大执业内容的选择率均超过53.00%。结论 护理管理者立足国情和人们健康需求,提出了我国 开业护士培养、认证及执业期望,有助于我国开业护士工作的开展和稳健发展。     

糖尿病足患者三级甲等医院专业诊疗中心就诊前的诊治状况及影响因素分析

背景与目的:糖尿病足(DF)是糖尿病患者致残、致死的主要原因之一,而早期诊断和规范治疗不仅可提高疗效、促进溃疡愈合,也是保肢和节省医疗费用的有效途径。本研究探讨DF患者在具有专业DF多学科诊疗团队的三级甲等医院就诊前的诊治现状及相关因素,为DF的规范化诊疗提供相关依据。方法:于2017年10月-11月期间,采用随机整群抽样法,抽取湖南、浙江、上海、四川、广东、河北、黑龙江、澳门的13家具有专业DF诊疗中心的三级甲等医院共326例Wagner 1~5级DF患者行问卷调查与足部检查,以患者就诊于三级甲等医院前伤口清洗液的选择和伤口用药情况为指标评估治疗的规范性,分析可能影响其治疗规范性的因素。结果:在326例DF患者中,误诊率为25.8%,治疗不规范率为72.7%。单因素分析结果显示,患者治疗的规范性与清创人、就诊医院级别、敷料应用人、院前诊治地点、并发症个数和清创地点有关(均P<0.05);Logistic多元回归分析结果表明,医院分级和敷料应用人是DF治疗规范率的独立影响因素(均P<0.05),其中三级医院DF治疗规范率是一级医院的6.707倍,且明显优于二级医院,敷料应用人为伤口/造口治疗师的DF治疗规范率是敷料应用人为患者本人的24.117倍,且明显优于敷料应用人为医生和护士。结论:DF患者在进入具有专业DF多学科诊疗团队的三级甲等医院前存在较多的误诊和治疗不规范的现象。因此,需进一步加强对基层医院医务人员DF多学科规范化诊治的培训,尤其应重视伤口/造口治疗师的培养;完善基层医疗机构和三级医院DF患者双向转诊的标准;鼓励患者主动就医,以减少误诊和不规范诊治现象的发生。     

Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: a cross-sectional study in Changsha,China

Background

Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes.

Methods

The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver’s depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers’ burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans’ functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers.

Discussion

This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke.

Trial registration

ClinicalTrials.gov: NCT03142841— Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022.

     

糖尿病患者足部风险筛查现状及影响因素研究

目的 调查糖尿病患者足部风险筛查现状,分析患者定期足部风险筛查的影响因素,为开展针对性干预以促进糖尿病足风险筛查提供参考.方法 采用便利抽样方法抽取湖南省32所综合医院内分泌科住院糖尿病患者1 027例,使用自制问卷调查患者足部风险筛查情况.结果 糖尿病足高危人群占57.1％,仅15.7％的患者能做到定期筛查.未定期筛查的主要原因是患者个人觉得没有必要、不方便去医院检查、医护人员未告知等.Logistic回归分析显示性别、家庭人均月收入、糖尿病足高危人群、筛查必要性认知是影响糖尿病患者定期足部风险筛查的主要因素(P＜0.05,P＜0.01).结论 糖尿病患者定期足部风险筛查率偏低,需重点关注女性、家庭人均月收入低、非糖尿病足高危人群、对筛查认知不足的糖尿病患者,并从患者认知、心理建设、筛查工具选择等方面进行针对性干预,从而提高患者定期足部风险筛查依从性.     

基于Wagner分级的糖尿病足溃疡智能分级系统的构建及验证

目的 基于Wagner分级构建糖尿病足溃疡智能分级评估系统，并验证其与伤口治疗师对同一足溃疡图片评估结果的同质性。方法 根据人工标注后的1 042张足溃疡图像，利用深度学习方法识别足溃疡图像各区域并进行分割，构建智能分级评估系统实现对足溃疡的自动分级。选取就诊的68例糖尿病足患者的150张足溃疡图片作为验证组，评价智能分级系统和国际伤口治疗师对150张足溃疡图片Wagner分级结果的一致性。结果 糖尿病足智能分级评估系统与伤口治疗师对足溃疡分级的加权Kappa值为0.643(P<0.01)。结论 基于Wagner分级的糖尿病足溃疡智能分级评估系统可实现临床同质化评价，辅助临床医护人员对足溃疡进行分级评估，根据分级结果实施针对性的治疗及护理措施，从而提高护理质量与效果。     

Statin-Induced Geranylgeranyl Pyrophosphate Depletion Promotes Ferroptosis-Related Senescence in Adipose Tissue

Statin treatment is accepted to prevent adverse cardiovascular events. However, atorvastatin, an HMG-CoA reductase inhibitor, has been reported to exhibit distinct effects on senescent phenotypes. Whether atorvastatin can induce adipose tissue senescence and the mechanisms involved are unknown. The effects of atorvastatin-induced senescence were examined in mouse adipose tissue explants. Here, we showed that statin initiated higher levels of mRNA related to cellular senescence markers and senescence-associated secretory phenotype (SASP), as well as increased accumulation of the senescence-associated β-galactosidase (SA-β-gal) stain in adipose tissues. Furthermore, we found that the levels of reactive oxygen species (ROS), malondialdehyde (MDA), and Fe²⁺ were elevated in adipose tissues treated with atorvastatin, accompanied by a decrease in the expression of glutathione (GSH), and glutathione peroxidase 4 (GPX4), indicating an iron-dependent ferroptosis. Atorvastatin-induced was prevented by a selective ferroptosis inhibitor (Fer-1). Moreover, supplementation with geranylgeranyl pyrophosphate (GGPP), a metabolic intermediate, reversed atorvastatin-induced senescence, SASP, and lipid peroxidation in adipose tissue explants. Atorvastatin depleted GGPP production, but not Fer-1. Atorvastatin was able to induce ferroptosis in adipose tissue, which was due to increased ROS and an increase in cellular senescence. Moreover, this effect could be reversed by the supplement of GGPP. Taken together, our results suggest that the induction of ferroptosis contributed to statin-induced cell senescence in adipose tissue.     

GSTM1、GSTT1基因多态性与抗结核药物致肝损害的相关性研究

目的 探讨GSTM1、GSTT1 基因多态性与抗结核药物致肝损害(ATDH)易感性之间的关系.方法该研究采用前瞻性设计,纳入2012年10月至2014年12月四川大学华西医院的结核病患者,并规律抗结核治疗至少3个月,分别于服药2、4周和2、3月时随访肝功能,以此评估患者肝功能情况.当发生肝功能损害时,即被纳入病例组,相反,则被纳入对照组.采用聚合酶链反应及琼脂糖凝胶电泳方法,检测GSTM1、GSTT1基因是否缺失并分析基因多态性.结果 该研究共纳入247例新发结核病患者,随访3个月后,病例组24例,对照组223例.两组中GSTM1 基因缺失的频率分别为 58.33%和 52.47%,差异无统计学意义(P= 0.668);两组中 GSTT1 基因缺失的频率分别为 45.83%和 51.12%,差异无统计学意义(P= 0.674).结论 在中国结核人群中,GSTM1、GSTT1 基因多态性与 ATDH 易感性可能无关,即该基因的缺失可能不会增加 ATDH 的风险.     

灾害护理学的发展现状和展望

介绍了灾害及其灾害护理学的基本概念,阐述了发展灾害护理学的必要性、灾害护理的工作内容以及灾害护理学的发展现状,并提出了现存问题和展望.     

Integrating genome‐wide association study summaries and element‐gene interaction datasets identified multiple associations between elements and complex diseases

Chemical elements are closely related to human health. Extensive genomic profile data of complex diseases offer us a good opportunity to systemically investigate the relationships between elements and complex diseases/traits. In this study, we applied gene set enrichment analysis (GSEA) approach to detect the associations between elements and complex diseases/traits though integrating element‐gene interaction datasets and genome‐wide association study (GWAS) data of complex diseases/traits. To illustrate the performance of GSEA, the element‐gene interaction datasets of 24 elements were extracted from the comparative toxicogenomics database (CTD). GWAS summary datasets of 24 complex diseases or traits were downloaded from the dbGaP or GEFOS websites. We observed significant associations between 7 elements and 13 complex diseases or traits (all false discovery rate (FDR) < 0.05), including reported relationships such as aluminum vs. Alzheimer's disease (FDR = 0.042), calcium vs. bone mineral density (FDR = 0.031), magnesium vs. systemic lupus erythematosus (FDR = 0.012) as well as novel associations, such as nickel vs. hypertriglyceridemia (FDR = 0.002) and bipolar disorder (FDR = 0.027). Our study results are consistent with previous biological studies, supporting the good performance of GSEA. Our analyzing results based on GSEA framework provide novel clues for discovering causal relationships between elements and complex diseases.